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Infertility Therapy


Since the recent publication of my book When You're Not Expecting, many people have approached me to ask about the counseling experience: How to know when counseling is a good "next step," how to access a counselor experienced with infertility issues, what costs may be involved, and what to expect of the counseling experience. The common thread that seems to be present in these conversations is " Since I feel like I'm going crazy, is counseling likely to be of any help?" These are very importan.....   Read More

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Since the recent publication of my book When You're Not Expecting, many people have approached me to ask about the counseling experience: How to know when counseling is a good "next step," how to access a counselor experienced with infertility issues, what costs may be involved, and what to expect of the counseling experience. The common thread that seems to be present in these conversations is " Since I feel like I'm going crazy, is counseling likely to be of any help?"

These are very important questions. Since I have provided counseling to hundreds of couples and individuals grappling with infertility, I know all too well the kinds of barriers that can prevent people from seeking help for the emotional fallout of infertility. In the coming weeks I will devote several blog posts to various dimensions of infertility counseling. Today we'll begin with how to get started in this process.

First, I think readers would agree with me that the infertility experience is filled with stress. Who to tell, how much to tell, how to cope with the fertile world, how to communicate with loved ones and health care providers, how to juggle treatment and personal life and, above all, how to bear the interminable waiting. This list could be much more extensive, but you get the idea: it doesn't take long for infertility to become a ruling force in your life. And this is an experience for which you probably have had no preparation. This also is an experience for which you lack a road map, so looming out there in the future is the fear of the unknown and whether you'll have the emotional strength to emerge from the infertility journey unscathed.

Fertility drugs

Clomiphene and gonadotropins, the most commonly used fertility drugs, regulate your reproductive hormones and trigger the release of one or more eggs in each ovulation cycle. Most women use them for three to six months before conceiving or trying a different kind of treatment.

Side effects and drawbacks

These fertility drugs increase your odds of having twins or more.

Clomiphene can cause hot flashes, mood swings, pelvic pain, breast tenderness, ovarian cysts, nausea, thick and dry cervical mucus, headaches, mild depression, and visual symptoms.

Gonadotropins can cause rash or swelling at the injection site, mood swings, breast tenderness, abdominal bloating, and headaches. About 10 to 20 percent of women who take gonadotropins develop a mild form of OHSS (ovarian hyperstimulation syndrome), which causes enlarged ovaries and fluid build-up in the abdomen.

You may feel discomfort in your back or shoulders after a laparoscopy. It stems from the carbon dioxide gas used during surgery to inflate your abdomen for easier viewing of your organs.

If you had general anesthesia, the breathing tube used during surgery may give you a sore throat for a few days.

If you had general anesthesia, you'll feel sleepy for a few hours and may have some nausea.

The incisions in your abdominal area may feel sore for a few days.

Success rates

About 80 percent of women who take clomiphene ovulate in the first three months of treatment. Of them, 30 to 40 percent conceive by their third treatment cycle.

The pregnancy rate for gonadotropins with timed intercourse is 15 percent per cycle.

Reduce Animal Proteins and Increase Whole Foods in Your Diet

"One of the easiest ways to improve your fertility is to improve the quality of the fuel you put into your body," Karchmer tells me. "Women who are struggling to get pregnant often feel powerless, but even something as simple as increasing the amount of vegetables you eat can dramatically improve your overall health and fertility. Remember, what you eat forms the building blocks for a healthy uterine lining and optimal egg development; both are essential for conception and a healthy pregnancy."

In a large-scale study of women who had difficulty conceiving, scientists found that increasing the intake of animal protein, even by as little as one serving a day, resulted in a 32 percent higher likelihood of ovulatory infertility. Furthermore, researchers found that women who consumed plant proteins for as little as 5 percent of their total daily calories had a 50 percent decrease in their risk of ovulatory infertility.

Whole foods also play an important role. A low glycemic load, such as that created by low-carbohydrate and whole grain diets, appears to protect fertility. Women with high glycemic loads, the result of a diet high in processed and refined foods, were demonstrated to have nearly twice the risk of ovulatory infertility as women with low glycemic loads.

The RIGHT fats are key too. In a recent study, every 2 percent increase in calories consumed via unhealthy trans-fats increased the risk of ovulatory infertility by more than 70 percent. This was especially true when these trans-fats replaced fertility-friendly monounsaturated fats.

Drink, Drink, Drink... Water

Just as important as the foods you eat are the drinks you drink. Not drinking enough water -- or drinking too many unhealthy beverages like sodas, coffee or alcohol -- can lead to dehydration and negative effects upon your fertility.

"The more hydrated your cervical mucus is, the easier sperm can travel through it. Studies have found that sperm had the highest difficulty traveling through thick cervical mucus with low water content. So to give yourself the best chances of conception, we recommend decreasing your intake of dehydrating sodas and coffees and exchange hydrating smoothies, teas and most importantly, water," Karchmer explains.

If you're not a big water drinker, here's a suggestion that I found helpful when we were trying to get pregnant. Fill up a big cup of water every morning. Then set an alarm on your phone to go off every two hours during the day. When it beeps or buzzes, or sings (whatever you have your alarm ringtone set to), that means it's time to refill your water glass. Still full from the last time you filled it? Drink up!

Sleep Well

Are you getting enough sleep? "Sleep is essential for hormone regulation, which is a cornerstone of a healthy reproductive cycle," Kirsten explains. "Sleeping less than seven to eight hours per night has been associated with depressed leptin levels throughout the following day. Leptin is important because it controls a whole cascade of hormones -- GnRH, FSH, LH -- that regulate your menstrual cycle." Disturbances in leptin concentrations have also been linked with poor egg quality.

A lack of sleep also affects our stress levels. People with acute or prolonged sleep deprivation experience higher levels of stress and associated stress hormones, like cortisol, the following day. Higher cortisol levels are linked to more negative feelings of stress throughout the day and can reduce the chances of successful embryo implantation. Elevated cortisol has also been associated with higher levels of very early pregnancy loss. In a 2009 published by the National Academy of Sciences, pregnancies exposed to higher levels of cortisol were found to be 2.7 times more likely to end in miscarriage.

Infertility Therapy

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