Category: Fertility and Getting Pregnant

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Male infertility is more common than you may think.

— Here are five ways to protect your sperm

By Karin Hammarberg

Infertility is often thought of as a female problem, but one in three IVF cycles in Australia involve male infertility.

We recently published a review of the literature on whether men diagnosed with male factor infertility experience greater psychological distress than fertile men or men with an infertile partner. We found irrespective of the cause of infertility, men in couples with infertility have more symptoms of depression, anxiety and general psychological distress, worse quality of some aspects of life, and lower self-esteem than fertile men.

Research also shows sperm counts are declining worldwide, and that lifestyle and environmental factors can reduce male fertility.

While most male causes of infertility aren’t preventable, it’s important to know how to keep your sperm as healthy as possible. Here are five things men can do to boost their fertility.

1. Try to be in the healthy weight range

Obesity causes hormonal changes that have negative effects on semen, including the total number of sperm, the ability of the sperm to move, the number of live sperm, and the number of sperm with a normal shape.

These reduce the chance of both spontaneous and IVF conception.

The good news is the adverse effects on fertility caused by excess weight in men are reversible. Regular exercise and a healthy diet can help reduce weight and improve sperm quality.

There’s strong evidence a healthy diet rich in fruits, vegetables, whole grains, nuts, low-fat dairy, and seafood, and low in red and processed meats, sweets, and sweetened beverages is linked to better sperm quality.

2. Avoid recreational drugs

Recreational drug use is associated with poorer reproductive health. Psychoactive drugs such as cocaine, benzodiazepines, heroin, methamphetamine, oxycodone and ecstasy negatively affect male reproductive functions, including sexual urge, testosterone production, sperm production, and sperm quality.

While research on the link between marijuana use and sperm quality is inconclusive, some evidence suggests frequent marijuana use can reduce sperm quality and is a risk factor for testicular cancer.

3. Stay clear of anabolic steroids

Some men use anabolic steroids to enhance their physical performance and appearance. Globally, it’s estimated about one in 16 men (6.4%) use anabolic steroids sometime during their life. Male weightlifters aged 20-39 years, competitive fighters, and security personnel are among the most common users of anabolic steroids.

Anabolic steroids contribute to muscle growth and fat loss, but they also affect sexual function, including by reducing the size of testicles, reducing or stopping sperm production, and causing impotence and infertility.

Studies show most men start producing sperm again within a year of stopping anabolic steroids. But a recent study of men who became infertile as a result of anabolic steroids found that for some there is long-term damage to sperm production.

In this study of men who had stopped using anabolic steroids and had a six-month course of hormone treatment to improve sperm production, more than half still produced no sperm at all or very few sperm after six months.

4. Quit smoking and vaping

We all know tobacco smoking is terrible for our general health, but there’s now evidence it’s also bad for male fertility and reproductive outcomes.

In the past decade, vaping has become increasingly popular, especially among young adults. More than 500 e-cigarette brands and 8000 flavours have been commercialised. There’s now growing evidence from animal studies that vaping can harm male reproductive health, and experts recommend avoiding vaping when trying to conceive.

5. Reduce exposure to environmental chemicals

In our everyday lives we’re exposed to many different environmental chemicals – through the products we use, the food we eat, and the air we breathe. So-called endocrine-disrupting chemicals can reduce the quality of sperm and cause problems with fertility because they can mimic or block male sex hormones.

It’s impossible to avoid these chemicals completely, because they’re all around us. But you can take some simple steps to reduce your exposure, including:

  • washing fruit and vegetables
  • eating fewer processed, canned or pre-packaged foods
  • drinking from glass or hard plastic bottles, rather than soft plastic bottles
  • heating food in a china or glass bowl covered with paper towel or a plate rather than using plastic takeaway containers or those covered with cling wrap.

To inform men about how to look after their sperm, Your Fertility, a fertility health promotion program delivered by the Victorian Assisted Reproductive Treatment Authority, teamed up with Melbourne comedian Michael Shafar to create some helpful educational videos.

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How First US Over-the-Counter Birth Control Pill Could Revolutionize Reproductive Health

— “After a year during which there has been very little good news about people’s reproductive health, this is the first solid win in a long time,” says BU gynecologist

The FDA’s approval of Opill for over-the-counter use makes it the first hormonal contraceptive available without a prescription in the United States.

By Molly Callahan

The FDA’s approval of the first over-the-counter birth control pill in the United States could be a revolutionary change in birth control and reproductive health, says Katharine O’Connell White, an associate professor of obstetrics and gynecology at the Boston University Chobanian & Avedisian School of Medicine.

White, who is also vice chair of academics and associate director of the complex family planning fellowship at Boston Medical Center, says she felt “jubilation and glee” at hearing news of the Food and Drug Administration’s approval of Opill, a hormonal birth control pill, on Thursday.

“After a year during which there has been very little good news about people’s reproductive health, this is the first solid win in a long time,” she says. “And it finally puts the United States on par with most other countries in the world, where people have always had access to pills without a prescription.”

The news was received with support from almost every major reproductive health organization in the country, including the American Medical Association, the American College of Obstetricians and Gynecologists, the North American Society of Pediatric and Adolescent Gynecology, and the American Academy of Family Physicians.

The FDA’s approval comes amid myriad legal battles over reproductive rights—and almost exactly a year after the Supreme Court overturned Roe v. Wade, rescinding the right to abortion nationally.

Perrigo Company, which manufactures the pill, says it will likely be available in stores and from online retailers in the United States in early 2024.

BU Today spoke with White about the safety and effectiveness of Opill, as well as questions that still remain about its rollout and accessibility.

Q&A

with Katharine O’Connell White

BU Today: Based on what you’ve seen or read about Opill, how effective is it compared to other, prescription or nonprescription, birth control options?

White: The pill that got approved for over-the-counter use is a progestin-only pill. There are two types of birth control pills: the vast majority of pills—the ones you think about when you hear “The pill”—have estrogen and progesterone in them. But a few varieties are progestin only, for people who can’t or don’t want to take estrogen. So, this pill looks to be like other progestin pills. And all pills have roughly the same effectiveness rate—that they’re about 97 percent effective when taken perfectly, and about 93 percent effective when taken like a typical human being.

So, it’s a very effective method of contraception. And it’s now the most effective birth control that you can buy at the drugstore without a prescription. When you compare it to condoms and spermicides, or Plan B and other emergency contraception, all of those are effective, but they’re not as effective as a daily birth control pill.

BU Today: It sounds like in terms of effectiveness, it’s not necessarily better to get a prescription birth control pill vs this over-the-counter version. Is that correct?

White: So much of it is about access, which sounds like an advocacy talking point. But access has a real impact on people’s lives.

From the medical perspective, there’s no difference between a pill you take by prescription or a pill that you would then get over the counter. But the best birth control method for any given person is the one they’re most likely to take. And to take consistently. And now, we have a method that is not behind the walls of a doctor’s office. You don’t have to go in for a visit or a pap smear or even just get through on a telephone line in order to access this birth control. You can just walk into a place and get it and take it. That, for a lot of people, is going to be the key to feeling in control of their birth control.

BU Today: Do you see this as a step toward equalizing access to birth control or reproductive healthcare?

White: Hopefully—although I’m hesitant.

What’s really great about this is that it’s finally a highly effective method—a hormonal method—of birth control for which you don’t need medical insurance and you don’t need access to a doctor. This is great news for people who work weekdays and can’t get to a doctor’s office because they can’t take the time off of work. It’s great news for people who don’t have health insurance, or who are underinsured, meaning their insurance doesn’t cover a lot, or any, contraceptive methods. If you are new to this country and don’t have health insurance or if you are in a new job and in a new state and don’t yet have access to your insurance, this is going to help.

I’ll also add that this is birth control that you do not need to persuade [a healthcare provider] that you should take or want to take. It is a completely independent decision that you get to make, and that’s important.

The reason I’m hopeful that this will equalize access, but not certain, is because we don’t know how much it’s going to cost. And so it’s only an equity issue if everyone can actually access it. The company says that it’s committed to widespread access for the pill and that it’s going to have some kind of voucher or savings program for people who don’t have insurance coverage. Along with advocacy groups, it is going to push for coverage by insurance companies so that even though it’s over-the-counter, you can still use your insurance card, like you can in many places for emergency contraception, or until recently, COVID tests. But we need to see what the sticker price is.

BU Today: Besides the price, are there other things that you, or your colleagues in the medical community, are waiting to learn?

White: The implementation of something is always important. For example, when emergency contraception first went over-the-counter, it was actually, in a lot of cases, behind-the-counter. You had to ask a pharmacist for it, which meant that not only did you have to have a conversation, and possibly justify why you wanted something, there was a chance they would say no.

I want to see this product on the shelf, next to Plan B, next to KY jelly. I want it to be as easy as just taking it off the shelf, putting it in your cart, and checking out.

I also wonder: is it going to be behind in a clamshell? Are you going to have to get an employee to unlock it for you? Are you still going to have to deal with people’s judgment? Will mom-and-pop pharmacies refuse to stock it? Will Amazon stock it? Will national pharmacy chains make it available online? Because in that case, I can get it with my ibuprofen when I do an Amazon run. All of this remains to be seen. But I’m hopeful.

BU Today: Are there certain populations who might find an over-the-counter hormonal birth control option especially helpful?

White: Adolescents—you might not want to ask your pediatrician, who’s been seeing you since you were a baby, about the fact that maybe you need birth control. Adolescents are also people who maybe haven’t yet figured out how to get to the doctor on their own. Maybe they don’t have a car or don’t have access or even know how to navigate the system to try to get their own gynecologist. Now, they can just take matters into their own hands and get it.

I also think anyone who is on someone else’s insurance, where an explanation of benefits goes home whenever you have a visit with a provider or get a prescription filled. An over-the-counter option leaves less of a record. So if you are in a situation where you are not wanting your parents to know or not wanting your partner to know, this provides another layer of protection.

For people who have medical problems, whose doctors just tell them not to have sex so you don’t get pregnant—which is actually a thing—and don’t know who to turn to for advice, they can now do their own reading, decide this might be right for them, and then access it on their own. People who just changed jobs and whose new insurance hasn’t kicked in, or who have not yet found a new doctor. People who’ve just moved to a new state.

There are also all these situations during which there can be gaps in birth-control use. Let’s say you are a prescription-pill user or a patch or a ring user, but you find yourself in this position where you’re between insurance providers, between doctors, between homes, you then can just go get a pack [of birth control pills] to bridge that gap.

Or people who travel and forget their pack. You’re crazily packing for the airport, and you realize you’ve forgotten your pills. No worries, you can just go get a pack and take those pills for a week and then resume your birth control back at home.

This means that birth control doesn’t have to be this precious, Hope Diamond–like resource. Now, your birth control pills can be available to you whenever you need them, wherever you are. That is revolutionary. No one should have to fight for birth control. And now you have an option where you can just go get it.

BU Today: What about from a safety viewpoint? Is it safe to take these over-the-counter pills?

White: I think there’s a natural hesitancy to embrace something as safe, especially when, for so long, people have been telling you that it’s not. There’s this idea that, ‘Well, we’ve had birth control pills for 50 years, why hasn’t it been available over the counter until now? Is it actually safe?’

It’s so important for people to know that we have reams of good evidence about how safe the pill is. There are very few people who cannot use this pill, and it is very well labeled for who shouldn’t use it.

There’s a very small group of people who can’t, and everybody else can use it safely. People who have breast cancer or certain kinds of liver disease or certain kinds of benign liver tumors, and some people with lupus, should not use this. But people who have the kinds of conditions on this list are people who are already plugged into a healthcare system where they can get access. The vast majority of healthy people who don’t need to see doctors can all take this.

BU Today: What should people who might use this as their first hormonal birth control know?

White: One of the common side effects of a progesterone-only pill is irregular bleeding. This might be occasional spotting, it might be bleeding more days than not, though not usually as heavy as a period. If people are not prepared for that, it can be very surprising. I’ve had more than one patient who stopped their birth control pills when they were spotting, because they thought that meant either it was making their body sick or that it wasn’t working. My message is that you may have weird bleeding for three months, possibly even a little longer. And that is normal. Weird is normal when it comes to bleeding on this pill. So don’t be alarmed.

Complete Article ↪HERE↩!

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Five important things you should have learned in sex ed

– But probably didn’t

It’s important to talk about sex with your partner.

By

If you grew up in the 90s and 00s, you may feel that sex education didn’t teach you much of practical value. Most sex education during this time followed a “prevention” approach, focusing on avoiding pregnancy and STIs, with most information largely targeted at heterosexual people.

While some schools are now making their sex education more “sex positive” and inclusive, that doesn’t change the fact that many in their 20s and 30s feel they’ve missed out on vital education that could have helped them better navigate the complex world of relationships and sexuality as adults.

But it’s never too late to learn. Here are five important lessons that sex ed should have taught you.

1. ‘Normal’ sex drive is a myth

Sex education never taught us that sex drive is highly variable and has no universal normal. While some may want sex several times a week, others may find once a month or less sufficient.

Regardless of how often you want or have sex, more important is understanding sex drive is affected by many factors, and may change throughout your lifetime. Many factors, such as hormone fluctuations, stress, certain medications (including antidepressants and hormonal contraceptives), as well lifestyle factors (such as smoking, drinking, exercise and diet) can all affect libido.

The most important thing is aspiring to understand your own sexual needs and desires and communicating these to your partner. This is important for personal wellbeing and healthy relationships.

Sex drive should only be considered problematic if you’re unhappy with it. If you’re concerned with it in any way, it’s worth checking with your GP.

2. Talking about sex is important

Many of us remember how sex ed tended to focus on discussing the harms that can come from sex. As such, some of us may now see the subject as taboo, and may shy away from talking about sex with our partner.

But research shows that sexual communication is associated with higher relationship and sexual satisfaction. When we openly communicate about sex, we’re revealing otherwise private aspects of ourselves (such as our desires or fantasies) to our partner. Doing so may, in turn, boost sexual satisfaction and feelings of intimacy, which may improve relationship satisfaction overall.

Thankfully, there’s ample advice online to help you learn how to start this conversation and know what sort of questions to ask your partner. Some relationship psychologists suggest starting these conversations as early as possible in relationships, to clarify needs and help ensure sexual compatibility.

They also suggest you continue sharing sexual fantasies as trust in the relationship grows, regularly asking your partner what they enjoy and sharing what you prefer as well.

3. Sexuality can be fluid

Most sex education in the 90s and 00s was largely skewed towards people who were heterosexual and cisgendered. This left those who identified as lesbian, gay, bisexual, non-binary or any other sexual or gender identity with little or no relevant information on how to negotiate sex and relationships.

This also means many people weren’t taught that sexuality can be multifaceted and fluid. Your sexuality is influenced by a combination of many biological, psychological and social factors, and may shift throughout your lifetime. So it’s perfectly normal for your sexual desire and who you’re attracted to change.

Two women hold hands while walking through a city.
It’s normal for sexuality to shift throughout your lifetime.

Research indicates that sexual fluidity may be more common among cisgender women and sexual minorities. It’s difficult to discern a clear reason for this, but one possibility is that men who identify as heterosexual may be less likely to act on same-sex attractions, perhaps for fear of negative reactions from those in their social circle.

There’s also evidence that same-sex attraction and sexual fluidity are influenced, in part, by genetics, showing us just how natural diversity in human sexuality is.

Understanding that sexuality can be fluid may help people to let go of potentially harmful misconceptions about themselves and others, and feel more open to express themselves and explore their sexual identity.

4. Sexually transmitted infections are very common

STIs are common, with one person being diagnosed every four minutes in the UK.

But most of us remember our sex ed classes focusing on prevention, resulting in stigmatised perceptions of STIs. This stigma can be harmful, and can impact a person’s mental and physical health, as well as their willingness to disclose their STI status to partners.

This prevention approach also meant we learned very little about how to recognise symptoms and treat STIs and fuelled the rise of myths surrounding STIs.

For example, one myth is that people with genital herpes can never have sex again without infecting their partner. Not only is this not true but also, as with all STIs, the earlier you’re diagnosed and treated, the easier it will be to avoid future complications such as infertility.

5. Navigating pregnancy and your fertility

Planning for pregnancy and parenthood is important for both women and men. But with sex ed’s focus so strongly placed on avoiding pregnancy, this means we missed out on important education relating to pregnancy and fertility. This means many women may not be properly educated about the many bodily changes that occur during pregnancy and afterwards.

Sex ed also failed to teach us that around 10%-15% of all pregnancies end in miscarriage. This can be a traumatic event, even in cases of early pregnancy loss. But knowing how common it is and having appropriate support could reassure many women that it isn’t their fault.

Many of us also won’t have learned about other aspects of fertility, such as how waiting to have children may affect your chances of getting pregnant. Nor will you have been taught about how lifestyle factors such as weight, diet, and exercise can also affect your chances of becoming pregnant. We also weren’t taught about how common problems with men’s fertility are, and how it can also decline with age.

Even if you did miss out on key sex ed in your earlier years, it’s never too late to begin exploring what healthy relationships and sexuality mean to you.

Complete Article ↪HERE↩!

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Keeping sex sexy when you’re trying to conceive

By a class=”byline-link byline-author-name” href=”https://www.insider.com/author/anna-medaris-miller” data-e2e-name=”byline-author-name”>Anna Medaris Miller

  • Sex with the sole goal of getting pregnant can take the fun and connection out of the experience.
  • Find ways to feel sexy without intercourse, sex therapist Ian Kerner said on the Pregnantish podcast. 
  • Seeking sexual moments between ovulation windows can also lead to more relationship fulfillment

Sex therapist Ian Kerner says there are three kinds of sex: recreational, relational, and procreative.

While the first can be fun and experimental and the second builds connection, the procreative type can be stressful, methodical, and often take the place of the other two.

“The move from relational sex to procreative sex can kind of strip out a lot of the other qualities that we’re used to having in sex and introduce a sort of … pressure and and a goal that creates all sorts of anxieties,” Kerner told Andrea Syrtash on her podcast Pregnantish. “And anxiety is the number one enemy of sexual health and sexual function and sexual arousal.”

But there are ways to integrate intimacy and eroticism into your sex life while you’re trying to conceive. Here’s what Kerner, author of “So Tell Me About the Last Time You Had Sex,” told Syrtash he recommends.

Keep having sex or sexual moments when you’re not ovulating

For heterosexual couples trying to conceive but not necessarily dealing with infertility,Syrtash, a sex and relationships writer who serves as editor-in-chief of the website Pregnantish, recommends maintaining intimacy even when the woman isn’t fertile.

That way, “you can keep the sexual connection outside of that ovulation conception window … so that it’s not all about the goal [of getting pregnant],'” she said.

Practically speaking, having sex outside of ovulation — a 24-hour window once a month — also means having it more regularly, and frequency matters, Kerner said. Studies have shown that couples who have sex once a week are most satisfied in their relationships. Any more doesn’t make a difference, but any less is linked with poorer relationship satisfaction.

“Really making that effort to hold on to sex is important,” he said.

Take ‘intercourse discourse’ off the table

Couples going through fertility treatments like IVF have different pressures when it comes to maintaining a satisfying sex life. They don’t have to have intercourse to procreate, and one partner may rarely feel in the mood, thanks to hormones that cause bloating, discomfort, and pain.

Add in the emotional toll of feeling like your body is betraying you, and getting busy in bed is an especially hard sell.

But Kerner says taking intercourse off the table and focusing on other ways to feel connected to and sexual with your partner. That can mean simply eyeing each other in the middle of the day and appreciating what makes the other one sexy, he said. 

“I think it’s absolutely OK to take sex off the table, but what I don’t necessarily think is OK is to lose all sense of sexiness or eroticism, or what I call the erotic thread, which is sort of the the space between sexual events,” Kerner said.

Look for, or plan, willingness windows

Lower the bar for how you think you’re supposed to feel before having sex. Rather than waiting until you’re both super horny, be open to moments when you’re simply willing to explore — again without intercourse necessarily being the end goal.

“You don’t always show up with desire for certain things, but if you recognize that something is important, like your own sexuality or your sexuality with your partner, then you can show up with willingness,” Kerner said. “Have the willingness to allow yourself to start to simmer and percolate some sexual cues.”

As Kerner told Insider’s senior sex and relationships reporter Julia Naftulin, this is what he calls a “willingness window,”

During that time you could read erotic books aloud, watch ethical porn, take a shower, enjoy a makeout session, or look back through photos of earlier in your relationship when you felt sexy. You can do anything that truly sounds fun and sexy to you both, Kerner suggested.

“Once couples or once an individual starts to engage with their sexuality and starts to sort of build up that arousal runway, then it really does lead to desire,” he said on the podcast.

Complete Article ↪HERE↩!

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Your Guide to Fertility and Getting Pregnant

Here’s a primer on how to conceive, whatever your sexual orientation, gender identity or relationship status.

By Brooke Borel

The early scenes of “Private Life,” a 2018 Netflix film about a New York City couple who are trying to conceive, present an unsettling scenario for anyone pondering their biological clock: A 40-something woman wakes up after an infertility procedure to find that things can’t progress as planned. Her doctors successfully extracted her eggs — but they also realized that her partner can’t produce any sperm. There might be a fix, but there’s a catch: It’ll cost another $10,000. Oh, and the doctors need the check today.

The scene, of course, is fictional and is meant to draw laughs, but it’s also a good reminder of how unpredictable and costly infertility treatments can be. If you’re thinking about having kids, what’s the best way to achieve that goal without unexpected and costly medical intervention?

For most heterosexual couples, the first step is to try to conceive the traditional way, said Dr. Sherman Silber, M.D., director of the Infertility Center at St. Luke’s Hospital in St. Louis, Mo.: “I recommend, frankly, if they are young and fertile to make sure they have enough sex.”

But intercourse isn’t always a sure-fire route to pregnancy; many couples struggle with infertility because of age, illness or reasons that aren’t yet known to science, said the two fertility doctors and one researcher I spoke to for this guide. Around one in 15 married American couples are infertile, according to the most recent published data from the Centers for Disease Control and Prevention. And there are special considerations for people who are transgender, single or in same-sex relationships.

Then there’s the high cost, which “Private Life” got right: According to the Society for Assisted Reproductive Technology, as well as a fertility benefits expert I interviewed for this guide, treatments may run to thousands or tens of thousands of dollars and aren’t always covered by insurance.

For many, the first step is to time sex with ovulation.

First, some Sex Ed 101: In order to become pregnant, a sperm has to meet an egg at the right time. The ovaries typically release one egg once a month during ovulation. The egg travels through the fallopian tubes, where the sperm has to fertilize it. Next, the fertilized egg has to make its way to the uterus, develop a little more, and then implant in the uterine wall.

For heterosexual couples, it’s important to time unprotected sex with ovulation. (Women who have irregular periods and people who are single, transgender or in same-sex relationships are likely to skip this step and head straight to a fertility specialist.)

“We know that women ovulate about 12 to 14 days before their next menses,” said Dr. Esther Eisenberg, M.D., a medical officer in the Fertility and Infertility Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. “If you have regular periods, you can kind of figure it out.”

One option for tracking ovulation is to use a regular calendar and count back from the first day of your next projected period, although both free and paid smartphone apps will do the math for you. (If you’re using an app, read the fine print to make sure you’re comfortable with the data collection policies — some period trackers have come under scrutiny for sharing user health data with third parties.)

Another option, according to Dr. Eisenberg, is to use over-the-counter ovulation kits, which are a bit like at-home pregnancy tests. You pee on a stick, which measures luteinizing hormone. A surge in this hormone indicates ovulation, although it doesn’t prove it has happened (a woman can have the hormone surge but then fail to ovulate).

Doctors’ recommendations for how much sex you should have around ovulation vary, but it’s a good bet to try every other day or so in the days leading up to ovulation. Sperm can survive for several days in the female reproductive tract, but once you’ve ovulated, your egg has about a 12- to 24-hour window for fertilization. So, for the best chances of conception, have enough sex in the time leading up to that brief window.

Experts also recommend following basic health practices — such as sleeping on a regular schedule; avoiding alcohol and cigarettes; maintaining a healthy weight (being underweight or overweight can contribute to infertility) and following a balanced diet — to improve your odds of getting pregnant.

If you’re having trouble calculating your ovulation because of an irregular period, or if you’re not in a heterosexual partnership, it’s a good idea to seek the services of a fertility specialist at the beginning of your quest to conceive.

If you’re transgender, the American Society for Reproductive Medicine recommends that you discuss with a doctor how certain medical treatments — such as hormone injections or gender reassignment surgeries — may affect your fertility, as well as options for preserving eggs or sperm prior to transitioning.

For heterosexual couples, see a fertility specialist if you haven’t conceived after a year of regular, unprotected sex (if the woman in the partnership is under 35) or if you haven’t conceived after six months (if the woman in the partnership is 35 or older).

As with any medical treatment, your health insurance (if you have it) will largely determine which fertility doctors you can see without having to pay fully out of pocket. But it’s still a good idea to make sure you feel comfortable with whichever clinics are available to you, said Dr. Silber. Consider asking: What are the live-birth success rates? What sort of testing do they do? When doctors answer, Dr. Silber said, “see if they look you in the eye.”

Understand the basic fertility tests.

If you’re a woman in a heterosexual partnership and are struggling to conceive, you may assume that there is something wrong with you. But in many cases, the male partner is responsible as well, so both partners should get fertility testing from the start.

The type of testing you receive will depend on your sex and situation, said Dr. Janet Choi, M.D., medical director of CCRM New York, part of a nationwide network of fertility clinics.

For most women, Dr. Choi said, basic testing starts with blood work to check for certain infections and hormone levels — the latter of which is part of an ovarian reserve test to estimate how many eggs you have left. There may also be a blood test to check thyroid levels, since certain thyroid disorders can affect the menstrual cycle or increase the chances of miscarriage.

Next comes a transvaginal ultrasound, which is another part of an ovarian reserve test. A practitioner will insert a wand-like instrument into the vagina, allowing her to visualize the reproductive organs and to check the ovaries for cysts or other abnormalities, as well as to get an idea of how many eggs are left.

Your doctor may also order an X-ray called a hysterosalpingogram (H.S.G.), which helps show whether anything in the reproductive tract is blocking sperm from reaching the egg. A practitioner will thread a tube through the cervix and inject an iodine dye into it, which fills the uterus and flows through the fallopian tubes; the X-ray picks up the dye to show whether the uterus is shaped normally and whether the fallopian tubes are blocked.

Comparatively speaking, most men have it easy when it comes to basic fertility testing: A doctor might order blood work to scan for certain infections or to check if hormone levels are normal. Men will also probably be asked to produce a sperm sample so that a practitioner can assess how much sperm is in the semen, how well they can move and how they are shaped. If the sperm fall short in any category, they may have a harder time reaching the egg — and the man may have to go through additional testing.

Know which treatments are available.

As with fertility testing, the type of infertility treatment you receive will depend on your unique health and medical history. If you’re a woman with a blocked fallopian tube, for instance, you may need surgery to remove the blockage or to repair damage before trying other fertility treatments. If you’re a man who isn’t producing sperm, it’s possible you have a blockage as well, and your doctor might recommend a procedure that retrieves viable sperm directly from the testes, or a surgery that removes the blockage.

If you’re a woman under 35, treatment will likely start conservatively, said Dr. Choi. For example, your doctor may prescribe oral drugs such as clomid or letrozole, which increase the odds of pregnancy by boosting the number of eggs you release during ovulation. This approach is also common for women with certain hormonal conditions such as polycystic ovary syndrome, in which ovulation doesn’t occur regularly.

Your doctor might instruct you to combine oral drugs with sex at home; or to time taking them with ovulation or with an in-office procedure called an intrauterine insemination (IUI), in which a clinician prepares a sperm sample then inserts it directly into the uterus to increase the odds of conception.

Women who are over 35 may also start conservatively with oral drugs or IUI, but if those measures don’t work after a couple of tries, or if it’s clear from your medical history that they aren’t likely to work, Dr. Choi typically recommends moving more quickly to more aggressive treatments, such as in vitro fertilization (I.V.F.). Here, the idea is to fertilize the egg outside of the body and then put the resulting embryo back in. (To read more about I.V.F., see our guide on it here.)

Fertility treatments will also vary for people who are single, in same-sex relationships or transgender. If you’re a woman who’s single or in a same-sex relationship, for example, you may try IUI or I.V.F. with sperm from a donor, depending on your age and your fertility status. Women in same-sex partnerships will also need to decide which partner should carry the baby, which will depend on preference, age and health. (It is also possible for one partner to harvest eggs and the other to carry the embryo, a process sometimes called reciprocal I.V.F., shared maternity or co-maternity.)

Men who are single or in same-sex partnerships will need a surrogate to carry the embryo, whether she uses IUI, I.V.F. or some other means of conception. Men in these circumstances may also need an egg donor.

If you’re transgender, your fertility treatment will depend on your individual history regarding sex reassignment surgeries, hormone treatments and so on. For example, if you’ve already had sex reassignment surgery, you may need donor sperm or eggs, unless you froze your own beforehand. If you only had hormone treatments, you may be able to reverse this process temporarily through new hormone treatments (under the guidance of a physician), in order to produce viable sperm or eggs.

Most insurance companies will cover fertility testing. But every expert I spoke to for this guide agreed that it’s a good idea to check with your provider before you start fertility treatment. There are no federal laws that require insurance to cover infertility diagnosis and treatment, and only 16 states require insurance companies to either cover or offer to cover it. “Under traditional coverage, if you have it, or if you don’t have coverage, you’re going to start acting a bit like an accountant and start adding up the dollars to figure out if you can afford it,” said David Schlanger, chief executive officer of Progyny, a fertility benefits management company.

Even in states that require coverage, details can vary. Some insurance plans cap the amount of money you can spend on fertility treatments. Say, for example, your plan allows up to $25,000, which sounds like a lot. But that could go quickly. According to the National Conference of State Legislatures, the average cost of one I.V.F. cycle is between $12,000 and $17,000 (without medication), and many people will need multiple cycles. Other insurance companies may require you to try IUI before I.V.F., even if your medical history suggests the latter is a better choice, which chips away at your allotted coverage. Still other plans don’t cover I.V.F. at all.

Even if your insurance covers a procedure, it may not cover other key factors. Prescriptions, for example, may not be included, and some fertility drugs can cost thousands of dollars. People who need sperm or eggs should check to see if donor tissues are covered. And laws regarding surrogates are “different all over the country,” Schlanger said. In New York, for instance, surrogacy isn’t even legal, although there have been proposals to lift the ban.

If your insurance doesn’t include fertility treatments, RESOLVE, an infertility advocacy nonprofit, recommends asking your employer if it’s possible to expand your plan.

Complete Article ↪HERE↩!

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Your Guide to Fertility and Getting Pregnant

Here’s a primer on how to conceive, whatever your sexual orientation, gender identity or relationship status.

By Brooke Borel

The Gist

  • Doctors define infertility as the inability to get pregnant after one year of regular, unprotected sex (if you’re a woman under 35) or after six months of trying (if you’re a woman 35 or older).
  • Age has a significant impact on fertility; especially for women, whose fertility tends to drop after age 35.
  • For women, other causes of infertility can include irregular periods, polycystic ovary syndrome, hormonal imbalances, being underweight or overweight, blocked fallopian tubes, an unusually shaped uterus or cancer treatments.
  • For men, age may still factor into infertility; those over 40 could see a fertility decline. Male fertility problems can also stem from irregularities in the amount, shape or movement of sperm; blockage or trauma in the testes; or cancer treatments.
  • It’s no magic pill, but most doctors recommend following basic health guidelines to improve your chances of conceiving: Get enough sleep, don’t smoke, curb use of alcohol, follow a nutritious and balanced diet and maintain a healthy weight.
  • See a fertility specialist if you’re a woman who meets the above definition of infertility; are single, in a same-sex relationship or are transgender; or if your doctor has told you that any existing illnesses, conditions or medical treatments may affect your fertility.

The early scenes of “Private Life,” a 2018 Netflix film about a New York City couple who are trying to conceive, present an unsettling scenario for anyone pondering their biological clock: A 40-something woman wakes up after an infertility procedure to find that things can’t progress as planned. Her doctors successfully extracted her eggs — but they also realized that her partner can’t produce any sperm. There might be a fix, but there’s a catch: It’ll cost another $10,000. Oh, and the doctors need the check today.

The scene, of course, is fictional and is meant to draw laughs, but it’s also a good reminder of how unpredictable and costly infertility treatments can be. If you’re thinking about having kids, what’s the best way to achieve that goal without unexpected and costly medical intervention?

For most heterosexual couples, the first step is to try to conceive the traditional way, said Dr. Sherman Silber, M.D., director of the Infertility Center at St. Luke’s Hospital in St. Louis, Mo.: “I recommend, frankly, if they are young and fertile to make sure they have enough sex.”

But intercourse isn’t always a sure-fire route to pregnancy; many couples struggle with infertility because of age, illness or reasons that aren’t yet known to science, said the two fertility doctors and one researcher I spoke to for this guide. Around one in 15 married American couples are infertile, according to the most recent published data from the Centers for Disease Control and Prevention. And there are special considerations for people who are transgender, single or in same-sex relationships.

Then there’s the high cost, which “Private Life” got right: According to the Society for Assisted Reproductive Technology, as well as a fertility benefits expert I interviewed for this guide, treatments may run to thousands or tens of thousands of dollars and aren’t always covered by insurance.

What To Do


First, some Sex Ed 101: In order to become pregnant, a sperm has to meet an egg at the right time. The ovaries typically release one egg once a month during ovulation. The egg travels through the fallopian tubes, where the sperm has to fertilize it. Next, the fertilized egg has to make its way to the uterus, develop a little more, and then implant in the uterine wall.

For heterosexual couples, it’s important to time unprotected sex with ovulation. (Women who have irregular periods and people who are single, transgender or in same-sex relationships are likely to skip this step and head straight to a fertility specialist.)

“We know that women ovulate about 12 to 14 days before their next menses,” said Dr. Esther Eisenberg, M.D., a medical officer in the Fertility and Infertility Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. “If you have regular periods, you can kind of figure it out.”

One option for tracking ovulation is to use a regular calendar and count back from the first day of your next projected period, although both free and paid smartphone apps will do the math for you. (If you’re using an app, read the fine print to make sure you’re comfortable with the data collection policies — some period trackers have come under scrutiny for sharing user health data with third parties.)

Another option, according to Dr. Eisenberg, is to use over-the-counter ovulation kits, which are a bit like at-home pregnancy tests. You pee on a stick, which measures luteinizing hormone. A surge in this hormone indicates ovulation, although it doesn’t prove it has happened (a woman can have the hormone surge but then fail to ovulate).

Doctors’ recommendations for how much sex you should have around ovulation vary, but it’s a good bet to try every other day or so in the days leading up to ovulation. Sperm can survive for several days in the female reproductive tract, but once you’ve ovulated, your egg has about a 12- to 24-hour window for fertilization. So, for the best chances of conception, have enough sex in the time leading up to that brief window.

Experts also recommend following basic health practices — such as sleeping on a regular schedule; avoiding alcohol and cigarettes; maintaining a healthy weight (being underweight or overweight can contribute to infertility) and following a balanced diet — to improve your odds of getting pregnant.

If you’re having trouble calculating your ovulation because of an irregular period, or if you’re not in a heterosexual partnership, it’s a good idea to seek the services of a fertility specialist at the beginning of your quest to conceive.

If you’re transgender, the American Society for Reproductive Medicine recommends that you discuss with a doctor how certain medical treatments — such as hormone injections or gender reassignment surgeries — may affect your fertility, as well as options for preserving eggs or sperm prior to transitioning.

For heterosexual couples, see a fertility specialist if you haven’t conceived after a year of regular, unprotected sex (if the woman in the partnership is under 35) or if you haven’t conceived after six months (if the woman in the partnership is 35 or older).

As with any medical treatment, your health insurance (if you have it) will largely determine which fertility doctors you can see without having to pay fully out of pocket. But it’s still a good idea to make sure you feel comfortable with whichever clinics are available to you, said Dr. Silber. Consider asking: What are the live-birth success rates? What sort of testing do they do? When doctors answer, Dr. Silber said, “see if they look you in the eye.”

If you’re a woman in a heterosexual partnership and are struggling to conceive, you may assume that there is something wrong with you. But in many cases, the male partner is responsible as well, so both partners should get fertility testing from the start.

The type of testing you receive will depend on your sex and situation, said Dr. Janet Choi, M.D., medical director of CCRM New York, part of a nationwide network of fertility clinics.

For most women, Dr. Choi said, basic testing starts with blood work to check for certain infections and hormone levels — the latter of which is part of an ovarian reserve test to estimate how many eggs you have left. There may also be a blood test to check thyroid levels, since certain thyroid disorders can affect the menstrual cycle or increase the chances of miscarriage.

Next comes a transvaginal ultrasound, which is another part of an ovarian reserve test. A practitioner will insert a wand-like instrument into the vagina, allowing her to visualize the reproductive organs and to check the ovaries for cysts or other abnormalities, as well as to get an idea of how many eggs are left.

Your doctor may also order an X-ray called a hysterosalpingogram (H.S.G.), which helps show whether anything in the reproductive tract is blocking sperm from reaching the egg. A practitioner will thread a tube through the cervix and inject an iodine dye into it, which fills the uterus and flows through the fallopian tubes; the X-ray picks up the dye to show whether the uterus is shaped normally and whether the fallopian tubes are blocked.

Comparatively speaking, most men have it easy when it comes to basic fertility testing: A doctor might order blood work to scan for certain infections or to check if hormone levels are normal. Men will also probably be asked to produce a sperm sample so that a practitioner can assess how much sperm is in the semen, how well they can move and how they are shaped. If the sperm fall short in any category, they may have a harder time reaching the egg — and the man may have to go through additional testing.

As with fertility testing, the type of infertility treatment you receive will depend on your unique health and medical history. If you’re a woman with a blocked fallopian tube, for instance, you may need surgery to remove the blockage or to repair damage before trying other fertility treatments. If you’re a man who isn’t producing sperm, it’s possible you have a blockage as well, and your doctor might recommend a procedure that retrieves viable sperm directly from the testes, or a surgery that removes the blockage.

If you’re a woman under 35, treatment will likely start conservatively, said Dr. Choi. For example, your doctor may prescribe oral drugs such as clomid or letrozole, which increase the odds of pregnancy by boosting the number of eggs you release during ovulation. This approach is also common for women with certain hormonal conditions such as polycystic ovary syndrome, in which ovulation doesn’t occur regularly.

Your doctor might instruct you to combine oral drugs with sex at home; or to time taking them with ovulation or with an in-office procedure called an intrauterine insemination (IUI), in which a clinician prepares a sperm sample then inserts it directly into the uterus to increase the odds of conception.

[More on intrauterine insemination.]

Women who are over 35 may also start conservatively with oral drugs or IUI, but if those measures don’t work after a couple of tries, or if it’s clear from your medical history that they aren’t likely to work, Dr. Choi typically recommends moving more quickly to more aggressive treatments, such as in vitro fertilization (I.V.F.). Here, the idea is to fertilize the egg outside of the body and then put the resulting embryo back in. (To read more about I.V.F., see our guide on it here.)

Fertility treatments will also vary for people who are single, in same-sex relationships or transgender. If you’re a woman who’s single or in a same-sex relationship, for example, you may try IUI or I.V.F. with sperm from a donor, depending on your age and your fertility status. Women in same-sex partnerships will also need to decide which partner should carry the baby, which will depend on preference, age and health. (It is also possible for one partner to harvest eggs and the other to carry the embryo, a process sometimes called reciprocal I.V.F., shared maternity or co-maternity.)

Men who are single or in same-sex partnerships will need a surrogate to carry the embryo, whether she uses IUI, I.V.F. or some other means of conception. Men in these circumstances may also need an egg donor.

If you’re transgender, your fertility treatment will depend on your individual history regarding sex reassignment surgeries, hormone treatments and so on. For example, if you’ve already had sex reassignment surgery, you may need donor sperm or eggs, unless you froze your own beforehand. If you only had hormone treatments, you may be able to reverse this process temporarily through new hormone treatments (under the guidance of a physician), in order to produce viable sperm or eggs.

Most insurance companies will cover fertility testing. But every expert I spoke to for this guide agreed that it’s a good idea to check with your provider before you start fertility treatment. There are no federal laws that require insurance to cover infertility diagnosis and treatment, and only 16 states require insurance companies to either cover or offer to cover it. “Under traditional coverage, if you have it, or if you don’t have coverage, you’re going to start acting a bit like an accountant and start adding up the dollars to figure out if you can afford it,” said David Schlanger, chief executive officer of Progyny, a fertility benefits management company.

Even in states that require coverage, details can vary. Some insurance plans cap the amount of money you can spend on fertility treatments. Say, for example, your plan allows up to $25,000, which sounds like a lot. But that could go quickly. According to the National Conference of State Legislatures, the average cost of one I.V.F. cycle is between $12,000 and $17,000 (without medication), and many people will need multiple cycles. Other insurance companies may require you to try IUI before I.V.F., even if your medical history suggests the latter is a better choice, which chips away at your allotted coverage. Still other plans don’t cover I.V.F. at all.

Even if your insurance covers a procedure, it may not cover other key factors. Prescriptions, for example, may not be included, and some fertility drugs can cost thousands of dollars. People who need sperm or eggs should check to see if donor tissues are covered. And laws regarding surrogates are “different all over the country,” Schlanger said. In New York, for instance, surrogacy isn’t even legal, although there have been proposals to lift the ban.

If your insurance doesn’t include fertility treatments, RESOLVE, an infertility advocacy nonprofit, recommends asking your employer if it’s possible to expand your plan.

Complete Article ↪HERE↩!