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Fertility 360

Understanding your cycle to optimize your fertility

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Optimize your fertility

Do you have a regular menstrual cycle? Do you know when you ovulate? Do you have a healthy period?

These are all questions you need to be able to answer to optimize your chances of having a healthy baby.

Let’s start with your cycle length. A healthy menstrual cycle will last somewhere between 26-32 days. There are 3 phases of the menstrual cycle.

The first phase starts on the first day of your period and is known as the follicular phase. This is when your eggs begin to develop and reach maturity. This phase on average lasts between 12-18 days. If it is shorter then this, it can mean your body doesn’t have long enough for your eggs to properly mature. A hormone called FSH (follicle stimulating hormone) is released from your pituitary gland and signals to your ovary to begin the process of maturing follicles. Often as we age the follicular phase will become shorter. This doesn’t mean it isn’t possible to get pregnant with a shorter follicular phase as I have had patients report having a healthy pregnancy with ovulating as early as day 9 but if we have to opportunity to develop the eggs a little longer they are generally more likely to be viable.

Your period can also tell you a significant amount about your menstrual health. Your period will ideally begin with menstrual flow that is bright red. If it begins with a lot of brownish discharge this indicates blood that is older and more stagnant. Flow should last between 4-7 days. Ideally you shouldn’t need to change your pad or tampon more then every 2-3 hours for 2-3 days of your period then the remaining days should be lighter. If your flow is lighter, then this it can mean you aren’t developing a robust enough lining for an embryo to implant. If your flow is heavier then this, it may indicate that you have an excess of estrogen compared to progesterone or that you have fibroids. These are both reason to follow up with your health professional.

Mid cycle is known as the ovulatory phase and lasts a few days. During this phase you should see changes in your vaginal secretions. Secretions become thinner and stretchy and will have an egg white like consistency. This mucus is designed to assist sperm and provide easier passage to the ovulated egg. Some women will have a regular menstrual cycle but will not ovulate regularly, while others will have an irregular cycle without regular ovulation.

There are several potential contributors to anovulatory cycles including:

  • Having an endocrine disorder such as PCOS
  • Having low body weight or body fat percentage
  • Poor blood sugar regulation
  • Endometriosis
  • Premature ovarian failure

There are multiple ways to test if you are ovulating or not. At home you can do a combination of monitoring your basal body temperature as well checking your cervical mucous. To test your basal body temperature – measure your oral temperature first thing in the morning before getting out of bed for one full cycle. During the first half or follicular phase your temperatures should average 36-37 degrees Celsius. When you ovulate, your temperature should raise by around 0.4 degrees Celsius. This increase should correspond with the change in cervical mucous to thinner egg white like secretions.

You can also test for ovulation using urine-based test strips that test for metabolites of a hormone called luteinizing hormone (LH). LH will surge right before you ovulate, so this can be a great indicator that your ovary is going to release an egg.

At a fertility clinic health professionals can assess if you are ovulating using a combination of regular blood work and transvaginal ultrasounds. With this option you are able to monitor the number of follicles developing and if they reach a size that is viable for a pregnancy.

If it is determined that you are not ovulating regularly it is very important to try to discern the underlying cause.

If you have been diagnosed with polycystic ovarian syndrome (PCOS) you may have irregular menstrual cycles and only ovulate during some cycles. PCOS is an endocrine disorder which means it has an impact on your body’s ability to regulate its hormonal cycle. Often women will have a challenging time regulating blood sugars, which can lead to inflammation in the body and disruption in healthy hormonal regulation. If this is your situation one of the most important things to do is to begin a regular exercise program. Exercise helps sensitize your hormonal receptors and helps regulate blood sugars as well as other hormones. If you aren’t currently exercising aim to start with regular daily walking for at least 20 minutes. If you are exercising already try to switch up between higher intensity training, cardio and weight training. It is ideal to do something active daily.

If you have an endocrine disorder, an autoimmune disorder (example Hashimoto’s thyroiditis or rheumatoid arthritis) or are low body weight making sure you are eating enough dietary fats can make a significant difference to help you ovulate regularly. Some of the foods to include more of include olive oil, coconut oil, avocado, nuts and seeds. It is also important to make sure you are getting enough carnitine in your diet. Carnitine is an amino acid that comes from animal protein. Carnitine works as a shunt to move fatty acids from the blood stream into mitochondria. Mitochondria are organelles that make energy in the form of ATP. If you don’t have enough carnitine the mitochondria can’t make enough fuel/energy. This can be a concern for cycle regulation as well as in conditions such as chronic fatigue syndrome, fibromyalgia, poor egg or sperm quality.

The third phase of the menstrual cycle is the luteal phase. This phase usually lasts between 12-15 days. During this phase the predominant hormone is progesterone. Progesterone encourages more blood flow into the uterus and is necessary for the fertilized egg to implant. If progesterone drops too early this results in a shortened menstrual cycle and often time can be the cause of early miscarriage if the newly formed embryo doesn’t have enough time to implant properly.

Low progesterone can result from chronic stress. When under stress your body makes more of a hormone called cortisol. Cortisol is made from progesterone, so if your body is making more cortisol than normal this can result in lower progesterone. This will not only impact progesterone during the luteal phase but can also lead to lower progesterone levels during the first half of the cycle. Low progesterone during the first half of the cycle can lead to a thinner uterine lining. If there is a lot of stress (which is commonplace during periods when fertility is an issue) then implementing stress management is critical. Exercise again will be important in this case but not excessive exercise. Aiming for between 30-60 minutes daily is great but going beyond 60 minutes daily can in some cases increase the depletion of progesterone. Eating a diet full of nourishing fruits and vegetables along with minimizing packaged and processed foods also takes stress off the body.

If progesterone is still low after implementing changes, there is an herb called chaste tree that can help support your body’s ability to make more progesterone. There is also the option of using either transdermal or oral progesterone medication. If this is a route you need to go it is important to continue your stress reduction as this extra progesterone can end up converting to cortisol as well.

We can also see a higher ratio of estrogen to progesterone which will give a similar result. If you have too much of either 16-OH estrone or 4-OH estrone this can impact your menstrual cycle as well as contribute to conditions such as endometriosis or fibrocystic breasts. You want to have most of your estrogen processed to end up as 2-OH estrone. A nutrient called indole-3-carbinol (I3C) which is found in brassica vegetables (kale, cabbage, broccoli and cauliflower) can assist your body encouraging estrogen to follow the pathway to end at 2-0h estrone or the “healthier estrogen”. This can then result in your body having a better ratio of estrogen to progesterone and resume regular ovulation.

An irregular menstrual cycle is a sign that hormones are not being effectively regulated in your body. Your body thrives on routine and wants to follow the natural rhythms of mother nature. An effective natural way to help regulate your menstrual cycle is with the use of traditional Chinese medicine and acupuncture or acupressure. Seeing a trained acupuncturist, you will have the opportunity to have imbalances acknowledged and improve the movement of energy or qi through the body. Another effective way to regulate your cycle is to look at the moon every night. Your monthly cycle will often then time with the planets natural moon cycles. Connecting with nature on a regular basis can also go a long way to helping your body’s natural rhythms. Many of us live in cities with very little exposure to the outdoors and nature. If you try to find a trail or to step in your backyard on the grass in your bare-feet these our great ways to connect yourself with the earth. This will not only help your menstrual cycles but your sleep cycle as well. Patients often will also note the more they connect with natural the less stressed or anxious they feel.

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Fertility 360

Study Points To Fertility As A Leading Economic Indicator

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Study Points To Fertility As A Leading Economic Indicator

Many research studies have shown that when the economy does well, people have more babies, and when the economy does poorly, they give birth less.

New research from the University of Notre Dame, however, discovers something unique — people appear to stop conceiving babies several months before recessions begin.

The study, “Is Fertility a Leading Economic Indicator?” was published Feb. 26 in the National Bureau of Economic Research’s working paper series. It is coauthored by Notre Dame economics professors Kasey Buckles and Daniel Hungerman, and Steven Lugauer from the University of Kentucky.

The team compared conceptions to other well-known economic indicators — such as consumer confidence and durables purchases — over the past 30 years and found that conceptions fall at the same time or even before other indicators whenever a recession is about to start.

“We show that for the last three recessions, conceptions predicted the downturn just as well as traditional economic indicators did,” Buckles says.

The team examined data on more than 100 million births spanning decades in the United States. Unlike most studies that use data aggregated up to the year level, the NBER paper focuses on the timing of births within the year using monthly or quarterly data, which allowed the researchers to study changes occurring months before a recession — changes that papers using annual data would miss.

“Once you examine monthly or quarterly data, the pattern becomes obvious,” Hungerman says. “We show the existence and magnitude of this pattern before the Great Recession, and it’s striking since that recession was famously hard to predict. None of the experts saw it coming, and in its first few months, many business leaders were convinced the economy was doing OK — even as the number of conceptions plummeted and had been falling for a while.

“While the cyclicality of fertility has been studied before, the possibility that conceptions change months before recessions begin has not been shown before,” he says. “In fact, some well-known studies have even declared that the pattern we find shouldn’t exist.”

“One way to think about this,” Buckles says, “is that the decision to have a child often reflects one’s level of optimism about the future.”

The study also shows conceptions are slow to rebound when recessions end. The Great Recession famously had a “jobless recovery.” This study finds it also had a “babyless recovery.”

The paper is available online at http://www.nber.org/papers/w24355.


Also published on Medium.

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Fertility 360

Rainbow Babies: Tips To Move Through The Joys, Fears And Tears Of Pregnancy After Loss

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Rainbow Babies

Congratulations! You’re pregnant! Everyone around you is excited except, perhaps, for you. Last time this happened and/or the time before that and/or the time before that, the pregnancy didn’t continue. You may have had a miscarriage, a stillbirth or a neonatal loss. You may have felt isolation, grief, anger.

In fact, you may have thought this pregnancy would resolve these feelings when, in fact, you’ve been noticing lately that they’re all still lurking in the background. To make matters worse, you may now be feeling petrified you’ll lose this baby too. Worry, fear and uncertainty are very commonly felt by pregnant people who’ve experienced a loss.

Here are some suggestions to help you move through the challenges and enjoy pregnancy again.

1) It was not your fault
Whatever happened last time, it was not your fault. Not all pregnancies are perfect. Not all births end up in live babies. You did your best. Shitty things happen. It was not your fault.

2) Choose the right health care provider
It’s normal to be emotionally vulnerable. It’s normal to feel anxiety. It’s normal to want a million extra appointments but then simultaneously feel like that high after your fourth ultrasound was too short-lived. It’s also normal to be happy.

Research suggests that pregnant people following a loss do better with care providers that respect their unique experiences. Most often, this can be found in a care provider that provides strong continuity. For some this is someone they’ve worked with in a previous pregnancy. Others prefer to start afresh. Good, consistent professional support that honours your individual experiences is not only important for your personal wellbeing but it also improves pregnancy outcomes.

3) Ask for what you need
After a loss, many people find the need for more personalised care to support them through their pregnancy and birth. If you think you need a more frequent schedule of visits for your own wellbeing, ask. If you want to know how to get reassurance in the middle of the night, ask. If you need them to start the appointment with a fetal heart rate check, ask. If you want an additional ultrasound for reassurance, ask. Take an active role in planning your pregnancy and birth. If you’re not finding your care providers responsive, ask to change to someone else. Research suggests that feeling a sense of control in your journey can help you enjoy your pregnancy again.

4) Build your community
After experiencing loss, it’s not uncommon to delay emotional involvement in a subsequent pregnancy and that’s okay. This is your pregnancy and your baby. You get to decide when you announce your pregnancy to the world. You get to decide how you feel about your baby. However, sometimes this valuable protective mechanism also deprives us of seeking necessary support. Many woman do not get adequate emotional and psychological support to deal with their feelings.

While you may be turning to your partner, he or she may also be processing the pregnancy differently, particularly at triggering times, for they are on their own journey of isolation, grief, anger. Bring those into your community who will be there for you when things are tough. Ask your care provider to connect you with someone who’s experienced loss. Consider seeing if there are any support groups in your area for folks who’ve had similar experiences to your own. Research suggests group support helps diminish feelings of isolation and allows for stronger relationships between partners moving forward.

5) Prepare for your rainbow baby
The vast majority of people who’ve experienced losses do go on to have healthy babies. We call them rainbow babies. For, they are the beautiful babies we welcome into the world after the storm that is loss. Just think: you’re pregnant with your rainbow baby! Find ways for you and your support people to celebrate milestones, even when you’re feeling fears to the contrary. Find ways to do the things that normalise, even if a bit of adaptation is necessary.

If you think you’d feel isolated attending a regular childbirth education class, sign up for a private one instead. Read positive books about pregnancy, childbirth and parenting. Do the silly things you always imagined you’d do. Be determined to maintain hope: your rainbow baby is on the horizon!

If you want to find more support you can contact Rishma via her website www.rishmawalji.com

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Fertility 360

If You Wish To Get Pregnant Do Not Waste Time. Put Yourself In The Very Best Hands

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If You Wish To Get Pregnant Do Not Waste Time. Put Yourself In The Very Best Hands

Time-wasting is not an option when racing against the clock. When the aim of that race is to get pregnant, missed opportunities can never be recuperated. If a woman is of a certain age and not getting pregnant, there is only one sensible piece of advice: put yourself in the very best hands and do not leave what quality reproductive medicine can do for you to chance.

“The greater our ability to resolve issues, the more complicated the issues in the patients we treat become,” admits Instituto Bernabeu, a leading clinic for patients who, according to the statistics, have previously been unsuccessful an average of 2.5 times in courses of treatment performed by other clinics. These couples turn to Instituto Bernabeu looking for efficiency, effectiveness and quality. The clinic is convinced that personalisation and a comprehensive analysis of the patient are essential. Experience is also key. Each situation is studied in detail and the specialist then transmits the patient’s characteristics and needs to the medical committee and the case is studied and assessed. Gynaecologists, biologists, embryologists, geneticists, andrologists and pharmacists all play a role. This multi-disciplinary team helps the patient by pooling all its knowledge and using ground-breaking technology in order to achieve the desired pregnancy.

Understanding human reproduction requires sub-specialisation in each phase of the process so that personalised responses can be provided. Treatment cannot be generalised. Over a decade ago, Instituto Bernabeu was a pioneer in setting up different healthcare and research departments and these departments are continually updated and enriched with each new development. The clinic’s Implantation Failure and Recurrent Pregnancy Loss, Poor Ovarian Reserve units, the unit that deals with immunology issues and the specialists in the impact of genetics in gametes and embryos are clear examples of this. Each unit is managed by experts in the field. Each couple is a world in itself and needs cannot be met using standard courses of treatment.

In a society where globalisation is a trend, health issues must be given the importance they deserve. Medicine must search for solutions suited to each patient. Personalisation is key and, with this in mind, Instituto Bernabeu invests heavily in on-going training for its entire team; leading technology; and a specific infrastructure that, furthermore, adheres to strict quality standards and performs external audits in order to verify the efficiency of each phase of the process.

Healthcare goes hand in hand with constant research. “Each couple teaches us something new. Each course of treatment opens up a door to understanding human reproduction. The challenge we face is amazing because we have to design the specific solution that each patient needs,” explains Dr Rafael Bernabeu. In 2017 alone, Instituto Bernabeu delivered over 25 scientific research projects that were accepted for presentations at leading international human reproduction congresses. They were all borne of the search for an answer.

Personalisation and use of the very latest developments can turn into the difference between getting pregnant or performing unsuccessful treatment.

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