Understanding Infertility

By Dr. Anitha Nair, Reproductive EndocrinologistShady Grove Fertility Centers, Washington, DC

Eighty five percent of all couples trying to conceive will become pregnant within one year. Approximately 7 million, or 1 in 6 couples, will have difficulty conceiving and may need medical help to identify and treat the possible causes of infertility. The good news is that there are treatments now to help almost everyone.

Infertility is a disease of the reproductive system that inhibits a couple's ability to have a baby. Infertility affects men and women equally without discrimination and for this reason both partners should actively participate in the diagnosis and treatment process .  Infertility is not uncommon and you are not alone. 

Forty percent of all infertility cases may be attributed to the woman, 40% to the man, in 10% of cases both partners contribute to the problem, and 10% of the time the cause can not be identified and it is unexplained. 

Defining Infertility The standard definition of infertility is the inability to achieve a pregnancy after one year of unprotected intercourse in couples where the woman is under age 35. Because a woman's fertility declines naturally as she gets older, couples should consider seeking medical help after 6 months of trying when the female partner is over age 35.

The Importance of a Woman's Age A woman's fertility peaks in her mid-20s, begins to decline around 27 and drops off more steeply after age 35. A woman's fertility is measured by her ability to achieve a pregnancy on a given month. For women, the ability to conceive is tied to the quality of her eggs. As women age, hormonal changes begin to take place. There is a lot going on but of particular interest are the 2 main hormones controlling the development and release of the egg each month. These are FSH (follicle stimulating hormone) LH (lutenizing hormone).

A rising FSH level is linked to a decreasing egg quality. Decreased egg quality means it becomes more difficult for the sperm to fertilize the egg naturally. There may even be chromosomal abnormalities occurring within the egg itself, which is why amniocentesis is recommended for pregnant women over 35.

To illustrate this point, the natural pregnancy rate for women under 30 is 20-30% per month, but by age 40 the likelihood of conception occurring drops to less than 5% per month.

If You Suspect Infertility If you are over 35 or if you suspect that past medical history may be impacting your fertility, run don't walk to the nearest fertility center. If you are under 35, a good first step is to consult with your primary care doctor or OB/GYN who can do the basic testing and determine a diagnosis. Don't let cost get in the way of scheduling that first appointment because most insurance plans will cover an initial consultation, and what you learn will be invaluable and may even put you on the road to parenthood.

Dr. Oz's resource for everything you need to know about your pregnancy.

Top 10 Fertility Tips

1. The woman's age is a key indicator for future success. 
   This point cannot be repeated enough. The single most common misperception among women is that they can achieve a pregnancy at any age. It is not true. A woman's fertility naturally decreases with age and fertility treatment results follow the same lines, down over time, beginning in the early 20s and dropping more rapidly after 35. Even with IVF, the big gun of fertility treatment, pregnancies over the age of 42 are uncommon. But what about those Hollywood stars who are having babies at 45, 48 and even 52? These women are most likely using donor eggs. 
2. Know when to seek help. 
   For women under 35, infertility is defined as 12 months of unprotected intercourse without conception. For women over 35, it is defined as 6 months of unprotected intercourse without conception.  If you stopped taking birth control a few years ago but haven't been actively "trying," you should also consider speaking to your doctor just to be sure everything is ok.
3. Know where to seek medical help. 
   Seventy-five percent of women begin at their OB/GYN and 15% of women go directly to a reproductive endocrinologist or fertility center. Both doctors will begin the same way, an infertility work-up of the male and female to uncover any potential causes of infertility. The OB/GYN may do surgery to improve physical conditions or possibly prescribe clomiphene citrate treatment to induce ovulation or to overcome a very mild male factor. For anything more advanced, most will refer out to the specialist. These days, particularly in metropolitan areas, more and more OB's are referring patients out to a specialist when the patient first suspects infertility, citing the advantages of patients going to a specialist whose entire practice is staffed and resourced to provide focused care for infertility.
4. Infertility doesn't discriminate. 
   Infertility is a disease of the reproductive system and it affects both men and women equally. For this reason, during the inital infertility work-up it is imperative that the male partner's fertility is tested as well as the females. Testing for male fertility is simple and non-invasive; a semen sample is taken to a laboratory and the sperm are observed under microscope. This test is called a semen analysis. Because 40% of fertility problems are attributed to the male, no treatment should be initiated before knowing the results of this test.
5. Understand you are not alone. 
   It seems that everyone knows someone who has had trouble conceiving. The fact is that 7 million couples, on average, 1 in 6 couples of reproductive years, will be infertile. The good news is that if they seek treatment and have the emotional and financial wherewithal, even couples with the most complicated cases can be successful in having a baby. Patient advocacy groups and online patient networks are great resources for information. You are not alone.
6. More of the same treatment is not always better. 
   When you are going through any fertility treatment it is important to understand that your chances for pregnancy are most likely going to be optimized by 3-6 treatment cycles. If pregnancy isn't happening and if no new information has been found to help improve the current treatment plan, then it is time to move on to the next option. If you have been taking clomiphene citrate for 6 months or more, it may be time to consider your next steps, especially if you are over the age the age of 35.
7. In Vitro Fertilization (IVF) is not usually your first option. 
   Many patients will begin with "low tech" treatment, achieve a pregnancy and never have a need for IVF. Others because of their diagnosis, blocked fallopian tubes or advanced age, will have to go straight to IVF or donor eggs to help them conceive. Patients who go to a fertility center are not typically pushed into IVF. Most specialists will take a stepped care approach to balancing your chances for success and the simplicity of the procedure. IVF offers outstanding success rates, no question, but it is also expensive, complex and time consuming, and, fortunately, it may not be necessary.
8. IVF is not experimental and the incidence of high-order multiple births are decreasing. 
   Over the past 25 years, IVF technology and our knowledge about the reproductive processes have improved remarkably affording many more couples the ability to conceive. Let's consider the fact that nearly 150,000 babies have been born since Louis Brown appeared on the scene back in 1970. Pregnancy rates have nearly doubled, Intracytoplasmic Sperm Injection (ICSI) has almost eliminated the need for donor sperm, and high-order multiple births have nearly been eliminated in center's like Shady Grove Fertility who are leading the charge in putting back only one embryo whenever possible.
9. Do your homework first, especially if you know you need a fertility specialist. 
   Infertility impacts couples medically, emotionally, and financially. You want to be sure that you are going to the best place for you and your partner. From a medical perspective, evaluate your doctor's training, the clinic's track record of success, and their treatment volume. From the emotional perspective, what kind of resources for support do they offer and is it integrated into the practice or part of an outside service? Are you comfortable with interactions you've had with staff? Cost is a big issue - do you get the sense they are on your team when it comes to insurance and payment options? Most importantly, seek the recommendation from people you trust, your doctor or friends who have gone to the center.
10. Insurance does cover fertility treatment. 
    Most infertile couples, if they have insurance, will have some coverage for testing, treatment or medications and many fertility centers across the United States offer innovative financial alternatives for couples without insurance benefits or limited resources. The alternatives include treatment discount options, 100% refund options, and even the option to finance treatment over time. Additionally, many pharmaceutical companies offer cost saving programs for the fertility medications and there are even organizations such as The Cade Foundation that offers grants for adoption or fertility treatment. Don't let money stop you from seeking treatment until you know more about the treatment you will need and have exhausted all possible avenues of support.

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Are These Natural Pain Relievers Right For You?

If you're living with chronic pain, you may have already tried the usual treatments. Natural relievers could be your key to success, but which one is right for your pain?

1.TENS: TENS, or transcutaneous electrical nerve stimulation, is an alternative pain relief therapy that uses a low-voltage electrical current to stimulate nerve fibers. It is especially used to treat musculoskeletal pain, such as muscle and joint pain.

Who should not use it? Children, pregnant women or anyone with an implanted electronic or metallic device should not use TENS. To use the TENS machine, proper training is required. Always consult your doctor before trying an alternative therapy.

2. Ginger: Ginger is a great natural pain reliever and may help with muscle and joint pain. It contains natural compounds that help your body fight inflammation. To try this remedy, add half a teaspoon of powdered ginger to hot water and drink it twice a day.

Who should avoid it? Avoid ginger if you have an allergy to ginger or a related plant, if you have a bleeding disorder or are using anticoagulant or antiplatelet medication, and prior to surgery. People with inflammatory bowel disease should avoid large quantities of fresh-cut ginger. The safety of ginger for children has not been well studied. Use ginger cautiously if you are diabetic, as it may contribute to low blood sugar, if you are pregnant or if you suffer from stomach or intestinal ulcers. 

3. Arnica Gel: Arnica gel has been used for hundreds of years to soothe muscle aches and reduce inflammation.

How should you use it safely? Arnica gel is meant for external use only. Avoid contact with eyes, mucous membranes, broken skin or open wounds. When used long term it may cause skin irritation. If your pain continues longer than three days or worsens, consult your doctor. If it is swallowed, contact a poison control center immediately as it may cause illness or be fatal. Keep out of reach of children. 

Who should not use it? Anyone with an allergy to the arnica plant should avoid it. Women who are pregnant or breastfeeding and children should avoid it unless directed otherwise by a doctor.  

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The Big Deal About Marijuana Use

Paula Riggs, MD, explains how marijuana affects health and why users should think twice before they smoke.

Marijuana is the most commonly used illegal drug in the U.S. In the past five years, rising rates of adult and adolescent marijuana use in the U.S. has been linked to the broad perception that marijuana is a relatively low-risk "recreational" drug and does not lead to addiction. A recent 2013 national Gallup poll reported that 58% of Americans currently support legalization of marijuana. Colorado and Washington have recently passed such legislation, legalizing the sale of "recreational" marijuana and a number of other states are currently considering similar legislation. In light of this growing national momentum, it is important for the public to have access to accurate scientific information and be informed of current research findings regarding the health risks and benefits of marijuana and the public health implications of increasing access and use of marijuana.

Research shows that individuals who occasionally use marijuana may suffer fewer negative consequences and have a lower risk of becoming addicted in comparison to those who use regularly. Regular use over long periods can cause changes in the brain and behavior similar to other addictive drugs and can lead to addiction. Tetrahydrocannabinol (THC) in smoked marijuana enters the bloodstream and arrives at the brain almost immediately, causing the user to feel euphoric or "high" by activating the brain's reward or pleasure center to release dopamine in the same way that many other drugs do. Research shows that approximately 1 in 11 (9%) people who use marijuana will become dependent on it. The risk increases to 1 in 6 in those who start smoking marijuana as teenagers. Individuals who become addicted to marijuana have difficulty controlling their use, even when marijuana begins to interfere with and cause problems in their lives. Chronic, heavier marijuana users often experience symptoms of cannabis withdrawal such as increased irritability, craving, anxiety and sleep problems that can make it difficult to quit. Withdrawal and continued use despite negative personal, social, legal or medical consequences are hallmarks of addiction and dependence.

The acute effects or "high" from THC generally last 1 to 3 hours and cause impaired attention and decision-making and slowed reaction time, often accompanied by poorer coordination and balance. Studies have shown that marijuana use interferes with learning, information processing, and a person's ability to form new memories. Because of marijuana's negative effects on attention, memory and learning, individuals who smoke marijuana daily may function at a reduced intellectual level some or all of the time. Chronic, heavy, marijuana users also report problems with memory and learning that last much longer than the acute "high," and which may persist for several weeks after cessation.

Most of these deficits usually resolve with prolonged abstinence. However, in those who begin and continue to use marijuana regularly during their teenage years, memory and learning problems associated with marijuana use with may persist for years and may not be reversible even after stopping use. A recent longitudinal study showed that individuals who reported regular or heavy marijuana use as teenagers lost as much as eight points in IQ between ages 13 and age 38, even in those who stopped smoking marijuana as adults. The decline in IQ was not seen in individuals who started smoking marijuana as adults. Marijuana is thought to be "neurotoxic" to adolescent brain development because THC binds to cannabis (CB1) receptors and artificially disrupts the critical role that these receptors play in regulating the development of the pre-frontal cortex that occurs throughout adolescence into young adulthood. Other studies have shown that adolescent-onset marijuana use increases the risk of psychosis and may also increase the risk of becoming addicted to other drugs.

There is also evidence that prenatal marijuana exposure interferes with fetal brain development and is associated with lower birth weight. Approximately one third of the THC smoked by the mother during pregnancy crosses the placenta and affects the development of the endocannabinoid system, which is an important regulator of fetal brain development and the immune system. Prenatal marijuana exposure has been linked to inattention, hyperactivity, memory and learning problems in young children that persist at least into early adolescence. A longitudinal study reported that at age 14, the prenatally exposed youth continued to have learning and behavior problems and significantly lower academic achievement compared to those with no exposure or minimal prenatal exposure.

Taken together, current research on the health risks associated with marijuana use warrant heightened public awareness, concern and action if we are to reduce the public health impact of current national trends toward further increasing access, availability, and use of marijuana, nationwide. Especially urgent is the need for effective public education, legislation and policies that limit or prevent prenatal exposure and reduce youth access to marijuana.

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Salt, Sugar and Fat: Could You Be Addicted?

What's the science behind our addiction to junk food? Could the food industry to blame? Journalist Michael Moss explains!

As a nation, Americans eat more than 33 pounds of cheese per year, which is three times more than Americans did in 1970. We also eat more than 70 pounds of sugar per year and up to six pounds of salt per year. Could our growing addiction to these unhealthy junk foods be causing our growing obesity crisis? And is the food industry to blame?

The majority of this food comes from processed sources – food that is “made in a plant rather than grown on a plant.” In fact, it’s harder to imagine someone binging on a whole bowl of apples or corn than someone gorging on a whole bag of chips or bag of cookies. New York Times investigative reporter Michael Moss suggests the addictive qualities of most junk foods could be boiled down to three additives: salt, sugar and fat.

According to Moss, salt is considered the “magical ingredient” because it provides a cheap burst of flavor. It not only makes sugar taste sweeter, it can even add crunch to crackers and chips. It also aids in prolonging shelf life. However, in excess, it can not only raise your blood pressure and damage your heart, it can also make you look puffy and retain more water weight. To make salt’s taste more powerful, companies use kosher salt instead of regular table salt. Why? Kosher salt is shaped differently and dissolves on your tongue faster and triggers a "flavor burst" all over your mouth.

Our bodies are hard-wired to crave foods with sugar. Food companies know this and take advantage of it, says Moss, by adding as much sugar as possible and using it to pull off a string of manufacturing miracles – from making donuts fry up bigger to giving cereal a toasty-brown look. In fact, there’s a crucial tipping point food companies look for when adding sugar to food, which Moss discovered, called the “bliss point.” This is the precise amount of sugar they will need to add that will send the consumer over moon without going overboard.

Fat is even more powerful than sugar. It comes in many forms and isn’t easily recognized on food labels. It provides twice the energy kick of sugar and gives food the capacity to sit on shelves for days and days. It can also give the food more bulk or texture. According to Moss, the more fat a food company adds to a particular product, the more attractive it was because of its altered “mouthfeel.” This describes the desirable texture of some foods, whether it be the gooey feeling of cheese, the creamy taste of alfredo sauce or the savory crunch of fried chicken.

What’s Going On Upstairs?

Research has shown that various forms of food stimuli (advertisements, smells, photographs of food) trigger the brain the same way that seeing white powder triggers cocaine addicts. Eating foods that are high in fat and sugar has been shown to surge the body’s release of its own opioids, which act like morphine in the body. Additionally, it has been shown that drugs that block the brain's addictive receptors for heroin and morphine also work at blocking a person’s cravings for sweet, high-fat foods.

One research project used a PET brain scan to compare the brain structures of a cocaine addict to that of a food addict. When cocaine addicts observed a video of someone snorting cocaine, their brains surged with dopamine, the brain’s feel-good chemical, in the dorsal striatum. However, when they exposed non-addicts to images of a delicious cheeseburger, they observed the same surges of dopamine in the same parts of the brain.

The King of Addictive Foods: The Potato Chip

Potato chips are the most weight-inducing food on the market, as they contain targeted amounts of salt, sugar and fat to ensure addiction, says Moss.

The factory process makes this food dangerously irresistible. After being cut into thin slices, the potatoes are fried to a crisp in fat, which gives the chip most of its calories. Then, they get covered in salt, which hits the tongue first and provides bursts of extra flavor. Then, the moment you eat them, the simple carbohydrates in the potatoes quickly break down into sugar, bringing you to the "bliss point" that makes the chip the most enjoyable. The sugar then quickly enters your bloodstream – causing your blood sugar to spike faster than it would had you consumed a similar amount of table sugar.

According to Moss, all three of the junk-food-addiction building blocks in the potato chip work together to make you crave more chips and gain more weight.

What Are Food Companies Doing About It?

Instead of acknowledging claims that the food industry is deliberately making junk food more addictive, many food companies instead point fingers at the consumer for lack of self-control, says Moss. However, the larger picture is more complicated that. Many companies are merely trying to keep their brand in the mix in an atmosphere of stiff competition and limited profit margins. However, that’s no excuse for endangering the health of the public by developing new foods and drinks loaded with more sugar, more fat and more salt.

In order to protect yourself, become a food label vigilante. Actively look for foods that are lower in sodium, and have less sugar and lower fat. You can also seek out natural, plant-based snacks and food.

With enough consumer (and possibly government) coaxing, food companies will need to react and produce more of the healthy foods that the public desires.

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Are You a Carb Addict?

By Dr. Mike Dow Author of Diet Rehab: 28 Days to Finally Stop Craving the Foods That Make You Fat Ask yourself the 4 questions below to assess your carb addiction. Proceed to the Kick Your Carb Habit in 28 Days challenge.

Why do I reach for a big bowl of pasta at the end of a stressful day? And why do I need that bagel first thing in the morning to feel normal? Processed carbohydrates release serotonin in the brain – the feel-good chemical associated with happiness and peace.

There’s a difference between unhealthy carbs – like the heavily processed chips, white bread and pasta – and healthy ones – like quinoa, whole fruits and whole wheat bread. Unhealthy carbs release a rush of serotonin in the brain and have a low satiety value in the stomach – meaning they leave your stomach quickly. Healthy carbs provide a sustainable release of serotonin in the brain and have a high satiety value in the stomach – meaning they leave your stomach slowly and keep you fuller for a longer amount of time.

Of course, serotonin is also associated with how we think and feel. Low serotonin is associated with depression and anxiety. Certain thought patterns can keep you trapped in an addiction to unhealthy carbs.  For example, pessimistic thinking, where you always predict a catastrophic or negative result, and personalization, where you interpret all failures as a result of you not being good enough, are two of the most common. The more you avoid these thought patterns, the more you will boost your serotonin. And as you have learned, low serotonin can make you crave unhealthy carbs.

When people say they’re “self-medicating” with carbs, it’s not just an expression – it’s a potent and potentially addictive chemical response. 

Am I a Carbaholic?

Ask yourself these 4 questions to determine if you are indeed addicted to unhealthy carbs.

1. Do you need an eye-opener? If you need to have unhealthy carbs within an hour of waking up, you may be addicted. Needing an eye-opener is one of the ways we assess for all types of addiction. 

2. Have you been unable to cut down on the amount of unhealthy carbs you eat? Not being able to cut down means that you are powerless over unhealthy carbs. Admitting you are powerless is one of the key action steps in 12-step programs – whether that program is Alcoholics Anonymous or Overeaters Anonyous. 

3. Do you keep your unhealthy carb eating a secret? If there is a difference between your public eating and private eating, this means that you are ashamed to let people know just how many unhealthy carbs you eat. This is one of the warning signs of an eating disorder called binge eating disorder. Binge eaters sometimes will eat very healthily in front of family and friends but then later consume mass quantities of food in private.

4. Do you feel guilty after eating unhealthy carbs? Guilt is information that you know that what you’re doing is bad for you. You know that you have eaten based on above-the-neck emotional hunger rather than below-the-neck physical hunger. Physical hunger is easy to satisfy, but no amount of food will be enough to give you the happiness or peace you’re really longing for.

If you have answered yes to any of these questions, you may be addicted to unhealthy carbs.

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Addiction: Family Mapping

The first step to addiction recovery is asking the hard question: “How did we get here?” As interventionist Brad Lamm explains, there are usually signs and pieces to the family’s history that can help piece together where the addiction came from. Building a family map is a visual way to reveal the good, the bad and the ugly to help a family put together their story.

Brad Lamm challenges every family to build their story and map out their truth. Learn how to create this important resource. n example of Brad’s family map.

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A Food Addict’s Solution: The FLAB Card

If you’re a food addict, a slight moment of weakness can easily snowball into a binge. The next time you’re on the edge, reach for this card. It will remind you of the emotions that can trigger your addiction and help you to deal with them in a healthy way.

Before you reach for food, ask yourself: Am I feeling frustrated, lonely, anxious or bored? If those are the reasons you’re going for a snack, the food will not remedy the feeling you’re experiencing. Find a diversion that doesn’t involve eating.

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