For Part 2 of 3 for the Wine & Gyn event with Dr. Zev Williams and Dr. Mary Rosser of New York Presbyterian, I'm going to highlight the topic of fertility. In a room full of young women, we definitely had plenty of questions about fertility. We probably could have kept those doctors going all night. Next week, I'll go into egg freezing, which was another topic of discussion that we were very curious about.
One of the main takeaways about fertility was that age is the number one factor, but we don't need to immediately start freaking out about that fact. There are also lifestyle choices with diet and our weight that factor in. Something that I found very interesting was that the woman, the man, and nature equally determine the likelihood of fertilization of an egg and a full-term pregnancy- ⅓ each. It does not all fall on the woman's ability to conceive, unlike popular belief. Also, once a man is over 40 years old, the quality of his sperm decreases, increasing the chance that their child will be born with Down Syndrome or a pre-disposition to Schizophrenia.
While there are many technical aspects when it comes to fertility, Dr. Rosser reminded us that having sex is a great first step in trying to get pregnant! :)
Questions and answers on fertility:
"Yes and no. Herbs and supplements might make blood levels appear better for fertility, but that could be false because it’s not actually reflecting the eggs specifically. Lifestyle factors like smoking, being too thin or overweight, in both men and women are factors. Insulin resistance and diabetes can affect it too. One of the misconceptions we hear is that the burden of infertility falls on women. "
"You can abort in two ways. A DNC where you go in and remove it or medication you can take at home if it is early enough. If you have one or two DNCs, and depending on who performs the DNC, you can risk scarring the uterine lining. In the U.S., that surgery is so much safer so the risk is much lower. They have a trial now that’s underway to remove the contents of the pregnancy with the camera so nothing else in the uterus is effected and only the embryo is removed."
"What they would like women to do is have regular visits with their OB because sometimes women don’t know when the right time to have a child. Looking at chronic medical conditions is important, based on medications they are on, referring them to specialists, and making sure that each individual knows all of her options before getting pregnant, in the safest way possible."
"There is definitely a component. Individual patients will determine that, there is no blanket statement. There are some conditions, like Turner’s Syndrome, where women are missing an X chromosome and go through menopause at 18 to 20, but their mother doesn’t have it. It varies so much, that it’s worth just being evaluated. Eggs produce a hormone called AMH and the more eggs you have, the higher the levels might be, but that can be misleading because it doesn’t determine your ability to conceive. There are so many components with fertility that we advise getting tested. IVF, while it is amazing, isn’t always the answer. Some women might be pushed to get it right off the bat and then after multiple unsuccessful rounds there might have been some other medical issue preventing fertility that gets overlooked. There was a patient who had gone through multiple rounds, came in to our office and we found a problem inside her uterus. We corrected it and she was able to conceive naturally."
"What happens during pregnancy is ovulation is shut down. Your hormones change because you aren’t producing an egg. This can actually lower your chances to have these cancers. Women who choose not to have children could have a higher chance because they continue to produce these hormones. Cancers might just be detected during pregnancy because women are under closer surveillance so there is a better chance of it being caught. They also make sure to check the breasts more during pregnancy because it can be overlooked."
"For Class B or C levels, you need to have that conversation with your doctor so they can speak with a specialist and come up with a regimen. You do need to plan ahead. The classes are going out of style, the categories are misleading. There aren’t enough studies showing anything for sure because they can’t do controlled studies on pregnant women. Category X though, for example, should be avoided at all costs. Something to keep in mind is that, over-the-counter medication is overlooked. A common lifestyle modification is going cold-turkey on coffee, 1-2 cups of coffee is safe, but when women go off completely they get headaches and start taking medications to get rid of that. Motrin, allergy medications, etc, are bad to have when you are in early pregnancy. For any medication at all, you must consult a doctor. Anything constricting small blood vessels should be avoided. The first trimesters is when the baby is going through organ development so less is more with any medication."
"A few years ago there were a few basic genetic diseases you can be tested for but now there are tests for over 300 genetic diseases. The cost is $250 for one partner to be screened and an additional $100 for the other partner to be tested. Historically, people had to wait until their child was born to know they were carriers, but now the carrier screening can be done sooner. You can even ask Alexa to send you the test from Amazon."
"Sperm banks. If you go online, the men are genetically tested, you can see if the man has fathered other children and if there were any issues, etc. You go to a fertility doctor and let them know you want to have a child on your own, then once you pick the donor, the sperm will come in a few days, then you get implanted via an intrauterine insemination (IUI) instead of IVF. You want to go somewhere that can give you peace of mind so you know you are being taken care of because they have done this with many patients. It’s like dating, you have to find the right doctor and doctor’s office where you feel welcome, comfortable, and where they answer your questions or bring up what you need to know that you wouldn’t know to ask about otherwise."
“Unfortunately not. There is something called secondary infertility where women will have a difficult time getting pregnant after they were able to get pregnant previously. It can definitely be devastating, because you didn’t have a problem the first time. There are different sets of causes that can lead to that. It could have something to do with the previous delivery or the uterus could have ben scarred, so there are a few things to look for. From the male side too, testicular cancer can come up. We look very closey at the semen analysis and if it has poor results we send it to a specialist. In some cases we do catch testicular cancer, but we catch it early enough that it can be cured.”
“We don’t know enough to be able to answer that definitively. There are some studies showing that a degree of morning sickness or any type of sickness when you are pregnant can lead to better outcomes with birth and the baby. We have had some women with no nausea at all who go on to have full-term, healthy deliveries. We also see the flip side of that too. In larger numbers, we’ve seen more nausea is a good sign, but the other is true too. Women’s experience from one pregnancy to the next can be very different also.”
Since writing this post, I have spoken with some friends about the topic of fertility and I’m already getting some more questions about it. I will be reaching out to the doctors with more questions for a future post so let me know if you have any questions I can help you get some answers to!
-Natalie