Wednesday, March 24, 2010
A lot of patients ask for information on fertility and I recommend a number of books. One that is very interesting is Taking Charge of Your Fertility, by Toni Weschler, MPH. It is subtitled "The definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health." It is an easy-to-read overview of natural approaches to enhancing fertility, as well as a discussion of the medical options for fertility and for birth control.
The center piece of her discussion is what she calls the Fertility Awareness Method. Basically, this a method to become aware of the signs of fertility, primarily temperature changes and changes in cervical mucous. I find this method of particular interest because it allows a woman to determine her specific fertility cycle and best days for getting pregnant, as opposed to taking the standard 28-day cycle, ovulation on day 14 as a guide. Ovulation can occur as early as day 8 for some, and very late for others, day 22 or beyond. For couples who are timing their sexual intercourse to coincide with fertile days, using the statistical generalization of 'day 14' may mean missing the actual days when fertility can occur, and missing their goal of pregnancy. Acupuncture and herbs are very good at regulating the menstrual cycle -- and helping a patient get to the ideal of a 28-day cycle, but it is always better to know the exact period of fertility for a particular patient, especially for those who have a long history of birth control use (the Pill) and irregular cycles.
Here are a few of my tips for fertility, some of which are also discussed in Ms. Wechsler's book.
1. Avoid the use of lubricants. Most are harmful to sperm, including saliva and glycerin (which is found in most lubricants). Changes in pH and osmolality both affect sperm motility and life span. Wechsler notes that canola oil and baby oil have shown minimal negative impact of sperm activity, and that egg white is considered by some to be the best option for those needing natural help, with some concern for the fact that egg white is not determined to be bacteria free. Pre-Seed Lubricant is a commercial option that has been created to avoid negative effects on fertility.
2. Related to the first item, douches, vaginal sprays and tampons are not recommended. Anything which alters the pH of the vagina or affects cervical mucous can negatively impact sperm motility and one's chances of getting pregnant.
3. Excessive exercise and low body fat can reduce fertility. This is something I discuss with patients regularly. For achieving pregnancy, and regulating the menstrual cycle, adequate intake of healthy fats and oils is very important. Reducing stress on the body is also important, and that includes avoiding over-exercising. Moderation is very important, as well as getting adequate rest and sleep.
4. Caffeine, nicotine, marijuana, alcohol and other recreational drugs should be eliminated or reduced. This seems obvious to most people, but it is worth mentioning. With my patients, I evaluate the stress-impact of these changes. Recreational drugs have to be eliminated, but for those who can't function without coffee or tea, it is sometimes better to reduce than to eliminate. The stress of going completely without may have a more negative short-term impact than the caffeine. For those with fertility challenges that persist for 4 months or more, it becomes more important to eliminate any factor which impacts fertility.
5. Anti-histamines -- this is an interesting one for those with allergies, and it is worth considering alternatives to their use if you are experiencing challenges in getting pregnant. Antihistamines can alter the cervical mucous -- which is usually not a good thing. Expectorants can be used to thin cervical mucous. This is an effect which is rarely discussed. For men, steroids, antimalarial drugs and ulcer medications can suppress sperm production.
6. Hot tubs, saunas, jacuzzis -- anything that increases the temperature of the testicles can reduce male fertility, or cause sterility in some. Avoid overheating -- it takes at least 6-weeks to recover, and may take up to 3 months. For men whose sperm is very sensitive to heat, wearing boxers and loose pants becomes important, as well as to avoid sitting with legs crossed for long periods. Bike riding can also have a negative impact for some, even long hot baths.