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Plenty. In fact, heart health and fertility go hand in hand.

Men undergoing fertility treatment are often at greater risk of heart disease. It’s difficult to parse out just how fertility and heart disease are interrelated, but it could be that the same behavioral and environmental factors that impact fertility in men also impact heart health. Entering fertility treatment may offer a secondary benefit to men by uncovering heart issues early on and offering the opportunity to address them before they become more serious.

The story is the same for women who struggle with infertility, particularly for women with Polycystic Ovarian Syndrome (PCOS). Many women with PCOS have elevated levels of insulin, which may lead to elevated triglycerides, low levels of high-density lipoprotein (HDL), high cholesterol, blood pressure, and atherosclerosis, all of which also lead to increased risk for a heart attack or stroke.

But there’s a silver lining: according to a recent study, women who become pregnant with reproductive assistance therapies experience lower rates of future heart-related issues. The lower risk later on may be attributable to healthier lifestyle changes women often make in an effort to become pregnant, such as quitting smoking and losing weight.

What can you do to take care of your heart here and now, and in the long term? Here are some tips:

Check in with your doctor. Get a read on key indicators for heart health, like blood pressure and cholesterol levels.
Discuss results with your doctor and make a plan to address any numbers that seem troubling.
Quit smoking and avoid second-hand smoke. Your doctor can recommend smoking cessation programs and treatment.
Eat a heart-healthy diet. Fill your place with fruit, vegetables and whole grains, and cut back on salt, sugars and saturated or trans fats. Get your protein from beans, low- or fat-free dairy products, lean meats and fish.
Enjoy regular exercise that gets your heart pumping. Even just 30 minutes a day of moderate exercise like walking can help. Find activities you enjoy and make moving part of your daily routine.
Reduce stress. All the good work you do can be undone by stress. Stress may send you right back to smoking, indulging in unhealthy food, and other negative behaviors. Learn to reduce and manage stress in ways that are healthy for you, like meditation or exercise.
Get some sleep. Aim for a good seven to nine hours of sleep each night. If you struggle to wake up in the morning or feel sleepy throughout the day, check in with your doctor.

Fertility testings can provide valuable information about their general health of many infertile men and women.

Schedule an appointment with one of our specialists today by calling us at +52 329 688 0059 ext 606 or whatsapp us +1 310 994 7830

pmhfertility@puntamitahospital.com

Diminished Ovarian Reserve (DOR) is a decrease in the number and quality of the remaining eggs in the ovaries, or a poor response to ovarian stimulation. DOR is one of the major conditions leading to infertility in women. Ovarian aging occurs naturally as women get older, making it more challenging to get pregnant and stay pregnant. However, DOR is not a condition exclusive to women over 40. It can affect younger women as well.

Approximately 10 percent of women begin this usually age-related decline of ovarian function much earlier in life, meaning that when their ovarian reserve is evaluated, it is found to be lower than what is expected for their age. This may mean that their chance for conception is reduced as compared to other age- matched women. However, a slightly suboptimal ovarian reserve screen (blood or ultrasound results; AMH and antral follicle counts are most common) in a woman who has not yet attempted conception does not always imply that she cannot get pregnant and consultation with a reproductive specialist is critical in these cases.

It is important to remember that many women with even very low ovarian reserve can conceive with their own eggs. Some may require individualized treatment that is tailored for their ovarian reserve status.

SYMPTOMS

In most cases, there are no specific symptoms or signs. Some women may notice slight changes in their menstrual cycles, such as shorter or longer cycles or spotting before full menstrual flow.

CAUSES

Known causes of diminished ovarian reserve include smoking, endometriosis, previous ovarian surgery, exposure to toxic chemicals, chemotherapy or radiation. In many cases, the cause is unknown and most likely reflects a combination of environmental and genetic causes.

TESTING & DIAGNOSIS

The diagnosis of diminished ovarian reserve relies on both laboratory and ultrasound findings: high FSH (follicle stimulation hormone) or estradiol (estrogen) level in early follicular phase of the menstrual cycle, few recruitable, antral follicles on pelvic ultrasound, or low AMH (anti-mullerian hormone).

As a woman ages, her FSH and estradiol levels on her menstrual cycle day 2, 3, or 4 increases, and her antral follicle count decreases, which represents fewer numbers of eggs and follicles ready to respond to hormonal stimulation that month. Similarly, AMH is a marker of early follicles that decreases with worsening ovarian reserve.

EGG SUPPLY | DIMINISHED OVARIAN RESERVE

While men can produce millions new sperm each day throughout most of their life, females are born with their lifetime egg supply. This supply continually decreases with age, trauma (ex: ovarian surgeries or radiation) and through monthly ovulation. During a woman’s reproductive life she will ovulate approximately 300-400 eggs.

How is IVF Done—Step by Step?

In vitro fertilization (IVF) is the most effective, commonly performed and final infertility treatment in the world. Still, unless you have actually gone through it, most people don’t actually know what’s involved with the steps involved with this assisted reproductive technology (ART). You can consider this your introductory guide.

First, IVF is a sequence of procedures that involves fertilization of an egg outside a woman’s body in a specialized lab. It is often performed after other methods of trying to get pregnant have failed.

Here’s how IVF works, step-by-step:

Preparation for an IVF Cycle – Testing and Ovarian Stimulation

Before IVF, you’ll have an evaluation of your uterus and fallopian tubes to make sure there are no issues that require surgical repair. Pre-cycle testing includes hormonal evaluation to assess thyroid function and ovarian reserve, screening both partners for sexually transmitted infection, and a semen analysis of the male partner.

Most women will take fertility drugs for ovarian stimulation for 8-14 days; the average is 10-11 days. Ovarian stimulation is used to mature multiple eggs for egg retrieval. Even if ovulation is normal, fertility drugs are used to produce more than a single egg because pregnancy rates are higher with more eggs. An average of 10 – 20 eggs are usually retrieved for IVF. However, not all of them are viable to use as on average only about two-thirds have the appropriate maturity.

Your physician will carefully design a protocol to try to obtain the maximum number of eggs while protecting against development of ovarian hyper-stimulation syndrome (OHSS). Fertility drugs for IVF are usually injected, and you’ll be frequently monitored using hormonal testing and vaginal ultrasounds for the best result. Once an ultrasound determines you have a sufficient number of large enough follicles and your estrogen level is at the right level, you’ll receive a trigger shot of hCG or other medication. This replaces the natural luteinizing hormone surge a woman has that spurs the final stage of egg maturation, so eggs are capable of being fertilized.

Egg Retrieval

Thirty-four to thirty-six hours after receiving the trigger shot – before the eggs ovulate – you’ll have a surgical procedure to remove the eggs from follicles in your ovaries. For this egg retrieval procedure, an ultrasound is used to visually guide a small needle through the top of the vagina into one ovary and then the other. You shouldn’t experience any pain or discomfort during the process as you’ll be under sedation through an IV while closely monitored by an anesthesiologist.

Follicles are entered with the needle and the follicular fluid contents are removed using gentle suction that brings the egg along in the fluid; the entire process usually takes less than 30 minutes. You may feel some minor cramping the day of the procedure which is usually gone the next day. There may be a feeling of fullness and/or pressure due to expanded ovaries from the ovarian stimulation. This may last for a few weeks.

The fluid from the follicles – that contains the egg – is suctioned by the IVF physician through small tubing and into a test tube. The test tube is then handed to an embryologist who uses a microscope to find the egg in each test tube of follicular fluid. All the details of the eggs are carefully recorded. The number of eggs produced and removed are influenced by a patient’s age, ovarian reserve, response to ovarian stimulation and, occasionally, the ability to access the ovaries with the needle.

Fertilization

Once eggs reach the lab, experts examine them to determine maturity and quality. Mature eggs are transferred into a special culture medium, placed in an incubator and within a few hours of egg retrieval are fertilized with sperm. There are two ways to fertilize an egg: conventional insemination or intra-cytoplasmic injection (ICSI). Which process is used will be determined by your IVF team (physicians and embryologists) and depends on multiple factors related to the couple going through IVF. Both methods have approximately the same success rate. ICSI is used approximately 70% of the time when factors make fertilization less likely due to poor semen quality or previous IVF failure.

For the conventional method, sperm is placed in the culture medium in a small petri dish containing an egg; the sperm and eggs are incubated together in the dish in the lab, allowing the sperm to enter the egg on its own. For ICSI, one sperm is injected into the cytoplasm of the egg using a needle and a sophisticated operative microscope. No matter which process is used, fertilization is checked the next morning.

Embryo Transfer

Following fertilization, the IVF team and the couple determine exactly when embryo transfer will take place – anywhere between 1 and 6 days but usually 3-5 days after egg retrieval. However, if the decision is made to do genetic testing, first a biopsy is taken from the embryo, almost always on culture day 5 or 6. Usually 3 to 8 cells are sent for testing performed at an outside lab, while the embryos are frozen and remain in the IVF laboratory. After receiving the genetic test results, the selected embryo is chosen, thawed and transferred into the uterus, usually within 1 to 2 months after the egg retrieval.

The number of embryos produced depends on several factors including the age of the couple. In the past, multiple embryos were transferred in the hope of maximizing success but this often resulted in twins or rarely triplets, both of which are associated with pre-term birth and other serious complications to both babies and mother.

The safest approach is to limit transfer to a single embryo. To maximize the chance for success, the healthiest embryo is selected by the embryologist based on a grading system used to evaluate each embryo.

A soft, flexible, and thin catheter is used to transfer the embryo into the uterus. An abdominal ultrasound is used to make sure that the tip of the catheter places the embryo at the best location for the embryo to implant. Pain and discomfort are rare, and the experience has been compared to how it feels to get a pap smear. Good embryos not used for transfer are usually frozen in case the cycle is not successful or a couple wants more children following a successful first cycle.

Hopefully, the development of the embryo continues in the uterus and the embryo hatches and implants in the uterine lining within 1-2 days following embryo transfer.

Assisted Hatching

Sometimes an additional process is used to provide further help for older women, for couples who have previously been unsuccessful with IVF or with frozen/thawed embryos. Assisted hatching is a micromanipulation procedure where a hole is made in the flexible shell that surrounds the cells of the early embryo. Normally, this membrane dissolves on its own since this is necessary for embryo implantation. This extra process has not been demonstrated definitively to improve live birth rates and there may be very minor risks involved. Also, there is no evidence that it improves pregnancy or live birth rates for other types of IVF patients. Assisted hatching, if performed, is done just prior to embryo transfer.

Pregnancy Test

About 12 days after an embryo transfer, you’ll have a blood pregnancy test. If a pregnancy is confirmed, you’ll be followed with blood tests and eventually, ultrasounds, to confirm viability and whether there’s a multiple pregnancy. If the pregnancy appears normal at 9-10 weeks, you’ll be referred back to your obstetrician!

Via The New York Times & The Broken Brown Egg

Even when it ends with a healthy baby, a long struggle to conceive may exact a brutal toll.

I recently came across a quotation by Vincent van Gogh, and it triggered something in me. “There may be a great fire in our soul, but no one ever comes to warm himself by it, all that passers-by can see is a little smoke,” van Gogh wrote, in an 1880 letter to his brother, Theo. The line haunted me for days; I was struck by this concept of the fire within. How many people do we pass every single day who are carrying around raging fires — who have a passion or a pain inside that is so great they can barely contain it?

For me, and for thousands of other people, infertility is that raging fire.

We kind of know that cousin or aunt who loves kids, and we kind of see the sadness in her eyes at baby showers, but we don’t really know the depth of her pain. We see how our co-worker lights up whenever other people talk about their children, but we don’t really know why he and his wife never had any. We read something once upon a time about recurrent miscarriage, and we felt sorry or sad, but we couldn’t picture anyone we knew who had lost multiple consecutive pregnancies.

Fire can leave serious damage behind. Because it can be hard to fully grasp what infertility involves unless you’ve dealt with it personally, many people believe that it’s all about the end game, a baby — that if you could just get to that prize, the pain of infertility would fade away. But infertility is bigger than babies. I say this often, because I want people to get it. It truly is. It can affect our physical and mental health in insidious — and sometimes enduring — ways.

I founded The Broken Brown Egg, an online community and awareness organization, in 2009, because I wanted to support women of color who are battling infertility. In the years since, hundreds of women have reached out to me to share their stories — about their struggles to conceive, and about the feelings of isolation and stress they often face, too. Research has shown that women dealing with infertility have depression and anxiety levels similar to those with cancer, H.I.V. and heart disease, and — through my advocacy work as well as my personal experiences — I have become intimately familiar with infertility’s psychological toll. Yet it took me a long time to acknowledge that infertility can be a form of trauma. It didn’t feel worthy of the term. I mean, infertility isn’t life-threatening, right?

Some researchers argue that the definition of trauma should be expanded to include the psychological and emotional response to not only physical threats, but threats to deeply held expectations of life. According to Allyson Bradow, a psychologist who wrote a paper on infertility, people affected by infertility must adjust to a major shift in life expectations while being exposed to constant reminders of their condition, through questions from family members, medical treatments or interactions with pregnant women.

“Psychologists must understand that infertility is a trauma, and often a complex trauma,” Bradow writes. “While anxiety, depression, and grief and loss are all a part of the psychological impact of infertility, there is much more to the experience which is defined by the individual.”

Infertility changes how you see yourself and the world. Somewhere along the journey, many of us stop feeling as though it is something that is happening to us, but instead begin to believe that it is a part of who we are. You become used to living in a constant state of fluctuating despair and hope. And this doesn’t turn off when and if you get pregnant. It doesn’t turn off when you hear or see the heartbeat. My son is 3. I’m still trying to turn it off.

Six months into motherhood, I felt as if I was in quicksand. I’d gotten through infertility, gotten past a failed adoption, braced my way through I.V.F. and a C-section. I should have felt invincible, but instead, I was numb. I felt as if the other shoe would drop at any moment. I had to pay for the victory that was my son, didn’t I? That was the routine of the roller coaster infertility had been for us. No success without swift defeat.

My therapist helped me to understand that I was dealing with postpartum depression, and explained that the stress of undergoing treatment for infertility has been shown to make some women more susceptible to postpartum depression. Some fertility clinics have even added counseling to their services, in the hopes of helping individuals and couples prepare for the mental effects of treatment.

Our public conversations surrounding infertility and mental health have separately been gaining traction in recent years and, thankfully, they are beginning to intersect. If you have struggled with both issues, as I have, know that you are not alone.

For more information about infertility contact us +5213296880059

pmhappointments@puntamitahospital.com