Trying to conceive can be a stressful process for many women, especially those who may be experiencing difficulty resulting from infertility. Patients who achieve pregnancy but then experience a pregnancy loss may feel even more frustrated. Recurrent pregnancy loss is defined as having two or more pregnancy losses following a documented gestational sac in the uterus.  Causes of recurrent loss can be related to uterine anomalies, immune issues, chromosomal imbalances in either the male or female partner, hormone issues, and most common, chromosomal imbalances in the embryo. 

Uterine Anomalies:

One of the most common uterine anomalies contributing to recurrent pregnancy loss is called a uterine septum.   A uterine septum results from failure of the uterus to develop normally in a female fetus in utero.  A septum acts like a dividing wall in the middle of the uterine cavity. . The septum itself is composed of fibrous tissue that does not have much blood supply on its own. Therefore, if a fertilized egg implants on the septum, it may not receive adequate nutrients during the pregnancy resulting in the possibility of loss. Most physicians agree that a uterine septum increases the risk of a pregnancy loss and should be removed if found. 

Fibroids, or benign fibrous tissue  of the uterus, are another anomaly responsible for some pregnancy loss or difficulty conceiving. There are different types of fibroids, depending on their location within the uterus. Fibroids located within the uterine cavity where the embryo implants and grows are linked to pregnancy loss.  There is also an increased risk for miscarriage in women with very large fibroids. 

Fortunately, treatment for both uterine septum and fibroids within the uterine cavity is available. Both can be removed surgically through minor, outpatient surgery in a minimally invasive procedure called Hysteroscopy.  Sometimes a larger procedure called a Myomectomy is needed for the removal of larger fibroids. 

Immune issues:  

Immune issues can involve either overactivity or low activity. With overactivity, the body responds by attacking and damaging its own tissues. In low activity cases, the body has difficulty fighting off infections and is, therefore, more vulnerable to disease. Two conditions seen in patients with recurrent pregnancy loss that fall under immune causes are Antiphospholipid syndrome and 

Antiphospholipid syndrome,  is an immune disorder where the body makes antibodies that attack phospholipids. Phospholipids are major components of plasma membranes and the structural component of cells. In antiphospholipid syndrome, blood clots can form within arteries, veins, and other organs. Recurrent pregnancy loss or stillbirth may be an effect of aPL as the clots may affect normal placental function. . 

This disorder is believed to be genetic and rare, found to be present in less than 200,000 cases each year. Medical professionals can prescribe blood-thinning medications to reduce the risk of blood clots.

Inherited thrombophilias is an inherited DNA mutation which results in the body producing too much or too little of a blood-clotting protein. The relationship between inherited thrombophilias and pregnancy loss remains controversial amongst doctors. They have reported evidence suggests treatment with an anticoagulant does not improve pregnancy outcomes. 

Hormone issues:

While there are several examples of hormone disruptions that could affect infertility and pregnancy loss, some examples are abnormal thyroid levels, elevated prolactin, and polycystic ovary syndrome (PCOS).

Abnormal thyroid function, both hyperthyroid and hypothyroid, appear to correlate to pregnancy loss. Hyperthyroidism produces too much thyroid hormone and can cause body processes to speed up, as in an elevated heart rate and metabolism.

On the other hand, hypothyroidism is the effect of too little or no thyroid hormone being produced. Most of the time thyroid conditions may be treated with medications. 

Prolactin is a hormone secreted after childbirth which aids in breastmilk production. In some cases, elevated prolactin in a woman before pregnancy may lead to infertility and or pregnancy loss as hormone production affects the estrogen and progesterone levels. However, high levels of prolactin may signal hypothyroidism or pituitary tumors and should be examined further. Sometimes there is no cause for the elevated levels of prolactin, and it may be treated with medication. 

Hypothyroidism is usually managed with medications, and tumors may be removed surgically. Other causes of elevated prolactin may be medications or stress. 

PCOS is common within the United States, with over 200,000 diagnosed cases each year. There is some evidence that women with PCOS have higher rates of pregnancy loss. This may be due to elevated male hormones, and elevated insulin levels. 

One resolution may be maintaining stable blood sugar levels. Some medical professionals might prescribe medications such as Metformin. Diet is another method that can manage PCOS symptoms and may help reduce pregnancy loss.

Hyperglycemia

Insulin resistance is similar to hormone issues listed above. When the body does not respond to insulin, glucose cannot be absorbed from the blood. The result can be prediabetes or diabetes.  There is currently evidence demonstrating that elevated blood glucose can be associated with increase first-trimester loss [R]. 

Within my clinic, I often screen patients with a fasting blood glucose test as well as screenings for insulin levels and HgbA1C. The results will provide a snapshot of what blood glucose has looked like over a 3-month period. 

Diet and lifestyle changes are usually recommended; however, medications such as Metformin may also be prescribed.

Chromosomal imbalances 

Balanced Translocation refers to a condition in which part of the chromosome has broken off and reattached to another location. Depending on the circumstances, a chromosomal translocation may be harmless, or it may cause serious health problems. 

In the case of balanced, or reciprocal, translocation many individuals are unaware they are affected until pregnancy. If an affected person’s cells attempt to divide to create egg or sperm cells, the irregular chromosome would contain extra or missing genetic material. It could lead to pregnancy loss, depending on the gene affected. 

The translocation can be diagnosed through a test called a karyotype; however, there is no treatment. 

Chromosomal abnormalities of the embryo account for the most common cause of first-trimester pregnancy loss. Unfortunately, there is no simple test, such as a blood draw, to determine the cause. Genetic testing after a pregnancy loss can be performed if pregnancy tissue can be collected and sent to the lab.  Pregnancy tissue can be collected in cases where a woman miscarries at home or if the patient has a procedure called a Dilatation and Curettage ( D&C ) .  If available the pregnancy can be tested genetically to confirm the presence of an abnormal number of chromosomes. 

If you’d like support with pregnancy loss, or you are experiencing difficulty conceiving , contact us and we can help you get tested and decide if treatment is right for you. 

When it comes to fertility, one of the most important stages of a woman’s cycle is the ovulation phase. Ovulation is when the mature egg is released from the ovary. Ovulation generally takes place approximately mid-cycle, but the days can vary. If a woman experiences irregular cycles, she will ovulate irregularly (ogliovulation). Some women may have irregular cycles and experience anovulation. 

The Importance of Ovulation

The mature egg must be released from the ovary in order for pregnancy to occur. The window of ovulation is a small 12-24 hours, so knowing when your body ovulates can increase your chances of getting pregnant. More importantly, learning your body’s ovulation cycle, or lack thereof, can be an early indicator of the need for medical assistance. 

Am I Ovulating?

If your periods are regular, it’s likely that you are ovulating. However, there are exceptions and although you wouldn’t have a real period without ovulation, the endometrium can still shed, leaving you to believe (understandably) that you’ve had a period.

There are many ways to detect ovulation, but few are a guarantee. If you’re having trouble pinpointing your ovulation, or suspect you may not be ovulating regularly, it is important to seek advice from a medical professional. 

If your cycles are regular, there are a few ways you can try to identify your ovulation at home. 

BBT Charting

BBT is an acronym for Basal Body Temperature, which is the temperature of your body upon waking. Your BBT can rise slightly after ovulation. This method can help you learn when or if you are ovulating. Charting your BBT does not tell you when you are ovulating while it’s happening – it can only confirm it after it’s happened. Therefore, if you want to use the charting method, you need to commit to it for a few months. You’re looking for a pattern, to predict when your future ovulations will occur. While this can help give you insight into your ovulation patterns, there is a great deal of room for error. If you are sick, stressed, taking your temperature at different times of the day, or have disrupted sleep, you can get an inaccurate reading. Should you decide to keep track of  your BBT, here are some tips to help you get the most accurate results:

• Take your temperature immediately upon waking. This means before you do anything. Even before you sit up! Since the temperature elevation is so small, even the smallest of actions can interfere. 
• Use basal body temperature digital thermometer for accurate results.
• Stay on a schedule and wake up at the same time each day. 

Urine Test Kits

LH (Luteininzing Hormone) is released from the body shortly before ovulation and that is what ovulation tests are detecting. Getting a positive result means you’ve had an LH surge, and ovulation will take place 12-36 hours later. It is recommended you begin testing on day 11 of your cycle and continue until you ovulate, or until day 20 (whichever comes first). The kits are similar to pregnancy tests, where you use a urine sample. The manual tests require you to compare a line to a control line and can be hard to read, leaving you more confused. Digital test kits are pricier but will give you a straightforward result. Be sure to follow the manufacturer’s instructions, as each brand and type of kit can vary. It’s important to note that these tests are not foolproof. It is possible to get a false positive. Additionally, if you have absent or irregular cycles, these tests will not be helpful and may prove to be nothing more than frustrating.

Pay Attention to Your Body

While none of these symptoms are a guarantee of ovulation, there are signs your body can give you. Keeping track of these can help you detect ovulation. You may experience some, all, or none.  Here are a few things to look for:

• Ovulation pain: A sharp pain in your abdomen, approximately mid-cycle
• Increased sex drive
• Raw egg-like cervical mucus: Log the appearance of your cervical mucus throughout your cycle. When it becomes thicker and stickier, like a raw egg, you could be ovulating.
• Breast tenderness: This is usually noticed after ovulation

I Think I’m Ovulating! What now?

If any of the above methods have helped you detect your ovulation, you want to have sex regularly 5 days before and the day of ovulation. 

When to See a Doctor

If  your periods are irregular, abnormally long, or abnormally short, the above methods may be of little-to-no help. If any of the following apply to you, it is time to see your doctor:

• You are under 35 and you and your partner have had unprotected sex for 1 year
• You are over 35 and you and your partner have had unprotected sex for 6 months
• You have irregular cycles
• You are 40 or older

 Pacific Reproductive Center offers ovulation induction services for women experiencing ovulation irregularities. Contact our fertility clinic in California today for a consultation.

Endometriosis is said to affect 1 in 10 women during their reproductive years. Perhaps you are one of them. Effects of endometriosis can include painful periods, painful ovulation, pain during and after sexual intercourse, heavy menstrual bleeding, chronic pelvic pain, fatigue, and infertility. [R] This impacts your physical well-being and can impact your emotional health as well.  

What is Endometriosis

Endometriosis is a condition in which tissue similar to the lining inside the uterus (called “the endometrium”) is found outside the uterus. The condition induces a chronic inflammatory reaction that may result in scar tissue.  [R[ 

Symptoms

Endometriosis symptoms can include pain before and during periods, pain in between periods, pain during or after sex, pain when urinating or having a bowel movement (often during monthly periods), difficulty achieving pregnancy, and cysts of endometriosis on the ovaries called endometriomas, also sometimes called chocolate cysts.  [R] Other symptoms may include heavy bleeding during menstruation and fatigue. [R[  Some of the symptoms have been “normalized” to be associated with menstruation in general, and therefore, there seems to be an average delay of seven years between the onset of symptoms and a woman seeking treatment. [R] 

Cause

There is no known cause of endometriosis, but it appears to be related to complex interactions of immunologic, hormonal, environmental, and genetic factors. [R]  Women have a higher risk of developing endometriosis if their mother and/or sister(s) are also affected. Gynecological factors such as age when the menstrual period starts, prolonged menstrual flow, and short cycle interval may be possible risk factors. [R] There is some evidence environmental factors such as exposures to toxins such as dioxin (an environmental pollutant) and PCBs can correlate to endometriosis symptoms. [R]

Treatment

While there is currently no cure for endometriosis, there are treatments available. Pain medications may alleviate discomfort symptoms, although they do not address other symptoms such as heavy bleeding, fatigue, or infertility. Birth control pills may also be an option in reducing pain symptoms, though this is not an option for treatment if you are trying to conceive. Additionally, some women may not want to be on a hormone-based medication for an extended period of time. Doctors may also recommend surgery such as laparoscopy to remove endometriosis tissue or a hysterectomy depending on the severity of symptoms [R]

Treatment options are considered in relation to the patient’s age, desire for children, the severity of symptoms, and the endometriosis stage and should be discussed with your provider. 

How Does Endometriosis Affect Fertility

Having a diagnosis of endometriosis does not automatically mean a woman will experience infertility; some women can achieve pregnancy without difficulty. Women who have endometriosis may experience difficulty in achieving pregnancy.  Studies show endometriosis is the cause of up to 50% of infertility cases. [R] The excess tissue growth may cause adhesions, scarred fallopian tubes, or inflammation of the pelvic structures. 

Because endometriosis may be caused by an excess of estrogen in the system, some women may also experience altered immune system functioning, changes in the eggs’ hormonal environment, impaired implantation of a pregnancy, and altered egg quality as a result of the hormonal imbalance. [R]

Endometriosis and IVF

Assisted reproductive technology is the first line of treatment in patients who experience infertility due to endometriosis. [R]  Studies seem to indicate that treatment’s success depends on individual patient factors play the most crucial role in the outcome. Treatment choice depends on the patient’s age, duration of infertility, disease level of progression, and childbearing wish. [R]
Integrative medicine may also provide support with pain management and stress during the IVF process for all patients, not just those with endometriosis. Yoga and acupuncture are two ways patients can manage pain and stress levels. A clean diet and lifestyle also promote healthier estrogen levels, which may support efforts in alleviating some symptoms of endometriosis. 

If have endometriosis and would like to explore treatment options, contact our clinic for an appointment. 

The experience of trying to conceive and the infertility journey can be emotional. Some emotions are positive as you look forward to adding to your family, yet feelings of stress and anxiety may surface as you wonder when it might happen for you, whether you are trying the right treatments, or worry about finances. Sadness or grief may arise if you have struggled with unsuccessful attempts. 

These thoughts can be hard on your body, with increased cortisol levels, depleted vitamin and mineral stores, and increased muscle tension.  Mindfulness meditation techniques address these issues. 

How Mindfulness Meditation Works

Mindfulness is defined as paying attention on purpose, in the present moment, without judging. This practice first asks you to quietly focus your mind on your inhale and exhale.  If you try this, you will notice that the mind wanders.  The mind does not want to stay put.  That is normal.  Mindfulness meditation practice simply involves this noticing:  You focus on the breath, you notice the mind wander, and you bring the mind back to the breath.  This noticing is the whole practice.  The moment you notice your mind has wandered, that’s mindfulness.  Noticing what your mind is up to and beginning to retrain it to rest in this moment, not the past or future, is the point.  ​This science-based healing approach has been widely studied and the benefits are well-documented.

Over time, practicing mindfulness meditation slows down the stress response.  We become calmer, able to see life through a mellower lens.  Anxiety is reduced, as is emotional reactivity.  We retrain the habitual pathways of the brain. Positive effects are seen in patients with depression and chronic pain, too.

​Mindfulness also works to reduce our judgments.   Our habit is to react to things as good or bad, often not noticing that most of our experience is neutral.  In practicing mindfulness, we note that things are as they are in this moment, noting that whatever it is, is already here.  We pause.  Instead of reacting, we respond. This simple difference, between reacting and responding, changes your experience of life (and the experience of those around you) significantly.  The pause offers the opportunity to choose what comes next… a space for wisdom to arise.  Moving forward with clarity becomes possible.

Benefits of Mindfulness-Based Stress Reduction During Fertility Treatments:

• Reduced stress and anxiety, which can be harmful physically and emotionally.
• Increased self-compassion. Treating yourself with the same care and kindness you would treat a friend becomes possible.
• Reduced self-induced pressure.  Choosing peace and calm allows for more grace in your fertility journey.  

Mindfulness-based stress reduction, once developed as a tool, will help you to live moment to moment without the burden of being judged.  This is called a practice because it takes practice to develop this skill.  We are humans with habits.  Emotional habits and thinking habits.  Mindfulness practice moves us out of habit and into present-moment awareness of our own life experience.

Resources

Incorporating a mindfulness-based stress reduction program into your daily routine may help with stress management, reducing anxiety, mitigating a pain response, increasing self-compassion, and overall wellness during your integrative fertility journey.  A list of resources for mindfulness meditations are included here on our site.​            

  If you are interested in a consultation to see if integrative techniques can further support your fertility journey, contact us today.

Exercise may already be a part of your everyday lifestyle. Most adults need both aerobic activity and strength training for overall health. The CDC recommends 150 minutes each week of cardiovascular exercise. That can be broken into smaller blocks of time, including anything from brisk walking to running and muscle-strengthening activities two or more times per week [R] But do the guidelines change if you are trying to conceive?  How does exercise impact your fertility?

Benefits of Exercise

There are many benefits of exercise, including weight management, blood sugar and insulin levels, improvement of mental health and mood, reduction of cancer risk, improved sleep, and improved sexual health, among others. [R] All of these facets can impact fertility in both men and women. 

Couples who are overweight may encounter more difficulties when trying to conceive. Women with a higher BMI may experience menstrual dysfunction and anovulation, placing them at risk for lowered conception rates or infertility.  [R] Increased weight in men has been associated with a lower testosterone level, poorer sperm quality, and reduced fertility as compared to men of average weight. [R] Exercise helps to increase metabolism, or how many calories you burn in a day. When combined with healthy eating, individuals may experience weight loss and lowered BMI, improving the chances of conception. 

Exercise can reduce the glucose in your blood and make you more sensitive to insulin. Insulin resistance affects ovulation, fertilization, and embryo implantation, causing first trimester miscarriages and infertility. [R] 

Stress hormones such as cortisol have been shown to play a role in the length of time needed for a couple to conceive successfully. [R] Cortisol also plays a role in your libido. It may sound like common sense, but having a low desire can affect your conception if you aren’t having sex within your ovulation window. Regular cardiovascular exercise was found to mitigate the health impact of psychological stress. [R] 

Exercise can help to mitigate the risk of certain cancers. This is particularly true of cancers which have increased risk related to BMI, insulin sensitivity, and increased estrogen levels. [R] According to the summary of the research cited, even recreational exercise levels showed benefits in reducing colorectal and breast cancer risks. 

Adequate sleep is necessary for maintaining optimal health. Irregular sleep patterns might adversely affect the hormone secretion impacting ovulatory cycles. The hormone disruption could additionally contribute to “insulin resistance and glucose intolerance potentially contributing to infertility and early pregnancy loss, particularly among women with PCOS.” [R] Exercise appears to have a positive correlation to sleep, especially in middle-aged and older adults. Regular exercise was found to have moderate and strong positive effects on overall sleep quality. In contrast, chronic exercise appeared to increase the total sleep time and sleep efficiency to some degree. [R] 

Finally, it appears exercise has a relationship to sexual health, including increased sexual drive, sexual activity, and sexual satisfaction. Obesity and inactivity have some relationship to sexual dysfunction, and in males, a high BMI can correlate to erectile dysfunction. [R] Among both men and women, moderate amounts of exercise appeared to stimulate sexual interest and behavior. [R] However, too much activity was associated with a decrease in testosterone, and other male hormones, which may decrease sexual desire [R]. Libido in men is dependent both on testosterone levels and on psychological factors

Exercise and Fertility

While it can be acknowledged that physical activity benefits overall health and well-being, does exercise specifically relate to fertility health? 

Lack of exercise or inadequate amounts of physical activity may result in health complications such as increased BMI, increased insulin resistance, and higher amounts of cortisol and estrogen in the bloodstream could affect poorer ovulation, fertilization rates, and embryo implantation. [R]  In males, lack of exercise and higher BMI has been linked to a lower testosterone level, poor sperm quality, and reduced fertility compared to men of normal weight. [R] 

When individuals begin exercising “too much,” it can also be counterproductive to fertility efforts as well. Studies done on both male and female athletes have shown that endurance training, such has long-distance running, has been linked to altering fertility. [R, R]  In some females vigorous exercise for extended periods can be linked with anovulation which can affect fertility. [R]. 

There appears to be an “upper limit” of exercise, especially when working with individuals who are elite athletes. In such cases, they may benefit from working closely with their medical professionals and trainers to develop a customized plan to ensure their well-being and fertility during conception efforts and pregnancy. [R[

The yoga asanas also help to strengthen the body and improve blood flow to the reproductive organs. Some research has shown improved blood flow and circulation as it relates to a higher abdominal temperature that may correlate to enhanced fertility. 

Physical activity such as yoga, pilates, and barre may be particularly helpful for fertility as the asanas, or physical poses, can bring a calming energy to the pelvis, stimulate the endocrine system and restore hormonal balance where needed. This applies to men as well as women.   [R]  Choosing yoga poses that target specific trigger points may help to regulate monthly cycles, improve libido, rebalance thyroid function, stabilize blood sugar, and support fertility health. To help support hormone balance, you might select poses such as fish pose, sun salutations, garland pose, mariachi’s pose, and the bound angle pose. Illustrations of these can be found here. 

Women who exercise regularly prior to receiving IVF or ICSI treatment appear to benefit from physical activity and demonstrate higher success rates compared to women who are physically inactive. [R]  However, your doctor may recommend you decrease exercise, depending on your health history.

To schedule a consultation with one of our fertility experts, contact us today.

You may associate pregnancy with the idea of “eating for two” and craving unusual foods as the baby grows. This may be a popular adage, but keep in mind the best source of health for you and your developing baby is a nutrient-rich diet. While it’s possible to obtain adequate amounts of vitamins and minerals from eating a variety of fruits, vegetables, and lean proteins, many people do not. Legumes are rich in  protein, iron, folate, and calcium. Dark, leafy greens contain ample amounts of vitamin C, vitamin K, vitamin A, calcium, iron, folate, and potassium. Berries are high in antioxidants, while foods like salmon provide fatty acids for brain health.  If these foods aren’t staples in our diet, you may consider supplementation.

Taking prenatal vitamins in preparation of your pregnancy is like an insurance plan. The eggs that are ovulated start on their development journey about three months prior to the cycle. Before you begin trying to conceive, you may want to speak with your doctor about the best prenatal supplement for you.  Prenatal vitamins are recommended if you are not using birth control methods to prevent pregnancy, just in the event a pregnancy occurs you will want to ensure optimal nutrients are available for the fetus’s development. 

What to Look for In a Prenatal Vitamin

A good prenatal should have various vitamins and minerals to support the health of the mother and the baby. While supplements vary in their ingredients, key items to look for include 

• Vitamin A with the majority as beta carotene – extremely important for fetal vision development and immune function

• Vitamin B12 – important for maintaining the health of the nervous system

• Choline – supports the development of the baby’s brain and neural tube

• Iron – needed to make hemoglobin, a substance in red blood cells that transports oxygen throughout your body

• Methylfolate (instead of folic acid) – decreases the risk of preterm birth and congenital heart disease

• Calcium – necessary for skeletal formation and growth as well as muscle, heart, and nerve development
  •  
• Magnesium – enables the growth of strong bones and teeth in the baby and also supports the mother by reducing blood pressure levels and reducing the risk of premature contractions

• Selenium –  supports thyroid hormone metabolism, DNA synthesis and acts as an antioxidant protecting cells from damage and infection

• Zinc – needed for cell division and tissue growth during baby’s development

• Iodine – maintains normal thyroid function for both mother and baby

• Biotin – required for the metabolism of glucose and amino acids and is essential in liver, skin, and nervous system healthy

Your doctor will be able to assist you in choosing the right dosage for you, as they will take into account your health, current diet, and any concerns that may warrant additional supplementation. 

Many prenatal vitamins also contain Vitamin D and/or DHA. Sufficient levels of vitamin D help ensure proper calcium absorption. DHA, or Docosahexaenoic acid, is an omega-3 fatty acid essential for brain development during pregnancy.  While these two ingredients are beneficial, most supplements do not contain adequate amounts.  You will want to consult with your doctor to determine if you need an additional supplement. 

What to Avoid in Your Prenatal Vitamins

A good rule of thumb when choosing supplements is to look for those as natural as possible. Avoid those that have food colorings or dyes which are unnecessary and petrochemicals, hydrocarbon derivatives, and coal tar. These may act as endocrine disrupting chemicals and affect fertility along with having adverse effects on the immune system. 

Other ingredients in supplements you’ll want to avoid are hydrogenated oils like soybean, canola, and rapeseed.  These are sometimes added to supplements to preserve shelf life and save costs. The hydrogenated oils are considered trans fats and have been shown to cause health concerns such as heart disease, stroke, diabetes, and possibly infertility in both men and women. 

Folic acid is added to some brands of prenatal supplements. You may be aware folate is important for prenatal health and the baby’s growth and development, but folic acid is the synthetic form of folate. The body has a more difficult time breaking down the folic acid (the synthetic version of the vitamin), and unmetabolized folic acid (UMFA) can build up in the blood and cause health concerns. It’s recommended instead to seek out supplements which provide methylfolate as a source of folate.  

Your doctor will be able to recommend brands that are appropriate for you as they take into consideration your health history and nutritional needs. If you are local to the southern California area, I see patients in my offices in Los Angeles, Orange, and Riverside Counties where I offer comprehensive integrative fertility treatments. You can contact us for an appointment here.