Sarah Yang
With each passing year, semen quality in adult men declines, suggesting that age plays a greater role in male fertility rates than previously thought, according to a study by researchers at the University of California, Berkeley, and Lawrence Livermore National Laboratory.
Waning fertility
The study, published in the journal Human Reproduction, suggests that even healthy men may become progressively less fertile as time goes by.
"Prior studies on semen quality typically included men who came to fertility clinics," says Brenda Eskenazi, professor of epidemiology and maternal and child health at UC Berkeley's School of Public Health, and co-author of the study. "This is one of the first studies to focus on men with no known fertility concerns, giving us a better sense of whether age affects semen quality in a healthy population."
The researchers recruited 97 men between the ages of 22 and 80 who were employed or retired from Lawrence Livermore National Laboratory. Samples were brought to the onsite research laboratory within two hours after collection to accurately measure sperm motility -- its liveliness and direction of movement -- and other indicators of semen quality. The researchers gathered extensive medical, lifestyle and occupational exposure history from the men, and excluded those who had smoked in the prior six months or had other relevant health problems.
While age had an effect on semen volume, the more significant impact was on sperm motility, which researchers found decreased by 0.7 percent per year. That means the chance of sperm motility being clinically abnormal is 25 percent at age 22, 40 percent by age 30, 60 percent by age 40 and 85 percent by age 60.
"Simply put, sperm slow down with age," says study co-author Andrew Wyrobek, head of the Health Effects Genetics Division at Lawrence Livermore National Laboratory. "In addition, age impacts progressive motility, which is the ability of sperm to move forward with a clear goal in mind. Sperm that swim around in circles may get trapped in the female mucosa, while sperm that moves in a linear direction will have a greater chance of colliding with the egg."
Progressive motility also started to decrease in men in their 20s by 3.1 percent per year. By age 30, the probability of progressive motility being clinically abnormal is about 50 percent, gradually increasing to 82 percent by age 80.
Unlike the female biological clock -- which reflects a marked decline in fertility in a woman's mid-30s -- the male clock proceeds gradually, the researchers found.
The decreased fertility associated with maternal age has been well established, but understanding the effects of paternal age has become increasingly important. Over the decades, more and more men are having children at older ages. Since 1980, there has been a 24 percent increase in men aged 35 to 54 fathering children. But research has also indicated that older men take longer to conceive than their younger counterparts. One study of 8,515 planned pregnancies found that men older than 35 have half the chance of fathering a child within 12 months compared with men younger than 25, even when the age of the mother is considered.
The study by UC Berkeley and Lawrence Livermore helps shed light on why paternal age matters.
"Women tend to be the focus in fertility issues," says Eskenazi. "What we are saying is that men are not scot-free in this. Many of us have heard of men in their 70s and older who have kids, but the probability of that happening may be lower than we thought."
The authors said that changes in semen quality with age may be due to various physiological factors, including age-related narrowing and sclerosis of the testicular tube, degeneration of germ cells, and normal changes in the prostate, or to increased probability of exposure to disease or environmental agents.
"We considered time worked at Lawrence Livermore and occupational exposure in our study, and found no evidence that they affected semen quality," says Eskenazi.
The authors note that semen quality is considered a proxy for fertility, indicating that men who wait until they are older to have children are risking difficulties conceiving.
"Of course, age is just one of many factors to consider when having a child," said Wyrobek. "We want couples to be informed when making their decision."
Tampilkan postingan dengan label male fertility. Tampilkan semua postingan
Tampilkan postingan dengan label male fertility. Tampilkan semua postingan
Rabu, 10 Maret 2010
The male factor: The low down on fertility sperm testing
About 30 to 40% of all infertility cases have a male factor as the main cause and 40-50% as a contributing cause. Bearing these statistics in mind, it is somewhat puzzling that women seem to be the first to "blame" when infertility becomes an issue. The bottom line is that just because sperm move do not mean they are capable of initiating making a baby. Thousands of would-be parents can now be saved from costly infertility treatments through a new sperm test called Sperm Chromatin Structure Assay (SCSA) . Reproductive experts used to think that in this era of in-vitro fertilization (IVF) all that were needed were several live sperm to make a baby. Experts now know that this is not entirely the case.
Looking deeper
Dr Ken Gelman is a Cooper City, Florida-based endocrinologist and fertility expert, and one who is frustrated with the medical community that he says often negates the male role in infertility. As Dr Gelman explains, what matters is not only the sperm count, percentage of sperm that swim, how they appear and whether the sperm can penetrate and fertilize an egg, but also the health of the sperm, and the amount of DNA damage inside. "This is really a biochemical issue at the molecular level. Looking at sperm underneath a microscope is very important, but not a perfect way of assessing the ability of sperm to fertilize a woman's eggs or contribute to a birth," he says.
Dr Gelman says the test is able to screen a man for sperm DNA damage, and possible infertility and it is painless, non-invasive, and cost efficient in the sense that it can screen men who might have very unhealthy or damaged sperm before their female partners go through unnecessary infertility treatments. It entails the production of a semen sample and a standard semen analysis is done on one part of the sample and the other portion is frozen and sent to the specialized lab in South Dakota that performs the assay. The percentage of damaged sperm is calculated and the sperm is determined to have good, fair or poor fertility potential. The test determines three key factors:
Looking deeper
Dr Ken Gelman is a Cooper City, Florida-based endocrinologist and fertility expert, and one who is frustrated with the medical community that he says often negates the male role in infertility. As Dr Gelman explains, what matters is not only the sperm count, percentage of sperm that swim, how they appear and whether the sperm can penetrate and fertilize an egg, but also the health of the sperm, and the amount of DNA damage inside. "This is really a biochemical issue at the molecular level. Looking at sperm underneath a microscope is very important, but not a perfect way of assessing the ability of sperm to fertilize a woman's eggs or contribute to a birth," he says.
Dr Gelman says the test is able to screen a man for sperm DNA damage, and possible infertility and it is painless, non-invasive, and cost efficient in the sense that it can screen men who might have very unhealthy or damaged sperm before their female partners go through unnecessary infertility treatments. It entails the production of a semen sample and a standard semen analysis is done on one part of the sample and the other portion is frozen and sent to the specialized lab in South Dakota that performs the assay. The percentage of damaged sperm is calculated and the sperm is determined to have good, fair or poor fertility potential. The test determines three key factors:
- What is the likelihood of the sperm contributing to the birth of a healthy baby?
- What percentage of sperm has damage?
- Can the sperm sample be used for in-vitro procedures or should the male partner be treated to improve the quality of the sperm?
Planning for a healthy pregnancy
Ann Douglas
Hoping to win at Baby Roulette? Before you and your partner toss the birth control in the trash and embark on any serious babymaking efforts, you've got some important decisions to make.The choices you make right now are every bit as important to your future baby's health and well-being as the decisions you make after the pregnancy test comes back positive.
Here are 10 steps you should plan to take in the year prior to conception.
Six months to a year ahead of time
1. What's up, doc?
A generation ago, your doctor would have thought you were crazy if you called to set up an appointment to talk about your conception plans. Today, it's fast becoming the norm for couples to book a preconception health checkup.
You may have to do a little arm-twisting to get your partner to accompany you to your appointment -- a lot of guys feel that their role in Operation Conception is limited to heading up the elite Sperm Squadron forces! -- but, whether he's prepared to admit it or not, your partner also needs to do a little preconception health planning of his own.
2. Testing one, two, three
I know, I know lying spread-eagled on an examination table isn't my idea of a good time either, but the experts are pretty much unanimous on this point: the ideal time to schedule a pap test is before you start trying to conceive. That way, should anything abnormal show up, you and your doctor will be able to deal with the problem prior to rather than during your pregnancy.
3. All systems go
You wouldn't even dream of heading off on a cross-country expedition without checking to ensure that your car's equipment was in good working order.Well, you're about to embark on the ultimate of journeys -- the journey to motherhood -- so it's even more important to make sure that your body is firing on all cylinders.
Your doctor will generally give you the green flag if you are in reasonably good health (e.g. any chronic health conditions, such as heart problems, diabetes, or high blood pressure are under control, and you haven't tested positive for any sexually-transmitted diseases such as Chlamydia, syphilis, gonorrhea). Your doctor may also want to talk to you about any hazards that you may face in the workplace -- strenuous working conditions or exposure to hazardous agents, for example-- since they may impact on your pregnancy as well.
4. The human pincushion
Don't relish the thought of being turned into a human pincushion? Chances are you won't have to. While it's always a good idea to have your immunity to both rubella (German measles) and chickenpox checked before you start trying to conceive,most adult women are immune to these two diseases. If it turns out that you're not, it's time to roll up your sleeve: both diseases can be devastating to the developing baby.
What's more, if contracted during pregnancy, chickenpox can pose significant health risks to the pregnant woman as well.
5. Shaking your family tree
Something else you might want to do before you and your partner move into the "action phase" of babymaking is to find out what types of skeletons are swinging from your family tree.
Certain types of birth defects and serious -- even fatal -- diseases are genetic in origin, and it's possible that you and your partner may be carriers for certain types of these inherited diseases.A geneticist can help you to determine your odds of giving birth to a healthy baby.
Three months ahead of time
6. Lifestyle makeover
If your idea of vigorous exercise involves wrestling with your partner for the TV remote, there's no time like the present to start being more physically active. Not only will you strengthen your heart and lungs -- two organs that get a considerable workout during pregnancy -- you'll also be better psychologically equipped to weather the emotional highs and lows of pregnancy.
And if you're carrying around a few extra pounds, this is the perfect time to deal with that problem, too, and reduce your risks of experiencing certain types of fertility problems and pregnancy complications. (Studies have shown that women who are significantly over- or underweight face an increased risk of infertility, and overweight women face an increased risk of requiring a cesarean delivery or experiencing other pregnancy-related complications). Of course, crash dieting is a definite no-no.That can send your body into starvation mode, which will hamper -- not help -- your chances of conceiving anytime soon.
7. Nutrient check
Your baby needs a whole cocktail of nutrients in order to grow and develop -- nutrients that you may have a hard time serving up if you end up battling morning sickness during your first trimester. That's why it's important to try to "stockpile" as many as these nutrients as possible prior to pregnancy.
At the top of your nutrient wish list should be folic acid -- a "miracle nutrient" that has been shown to dramatically reduce the incidence of such neural tube defects as anencephaly and spina bifida if taken in the months leading up to and during the first trimester of pregnancy. How much folic acid you need will depend on your individual and family health history: if you've previously given birth to a baby with a neural tube defect or if you have epilepsy, anemia, insulin-dependent diabetes, or certain other health conditions, your healthcare provider may recommend that you consume a higher than average amount.
When you're ready to start trying to conceive
8. Kick any remaining bad habits
You don't have to be a saint to be a candidate for motherhood, but it doesn't hurt to have a few saintly habits.
Since no safe level of alcohol consumption has been established for pregnancy, most doctors suggest that you abstain entirely rather than flirting with the possibility of giving birth to a baby with serious developmental and behavioral problems, and other anomalies. Ditto for street drugs: they're just plain bad news for babies and mothers-to- be.
And as for smoking: well it shouldn't be news to you that smoking's a no-no, too. Not only has smoking been linked to premature birth and low-birthweight babies: it can also increase your newborn baby's susceptibility to SIDS and other health problems.
9. Slam the medicine cabinet shut
Don't pop any medication in your mouth -- prescription or over-the-counter -- without checking with your doctor to ensure that it's safe to use once you start trying to conceive. (He may want to fiddle with your prescription meds a little -- perhaps changing you to a less harmful drug or taking you off medications altogether for the foreseeable future.)
Bear in mind that even "natural" herbal products can pose a significant risk to a developing baby, particularly since many of these products have not been tested on pregnant women.
10. Lose the birth control
The final step in your countdown to conception is to lose the birth control. If you've been using the birth control pill or some other form of hormonal birth control (e.g. implants or injections), you'll need to wait for at least one normal period before you start trying to conceive -- something that makes it easier for your caregiver to pinpoint your due date.
If the intra-uterine device (IUD) has been your birth control method of choice, you'll still need to put on the brakes momentarily: most doctors recommend that you wait for at least one normal period before you start trying to conceive.
While there are no guarantees in the reproductive world, it only makes sense to do what you can to tilt the roulette wheel in your favor. With any luck, you'll walk away with the ultimate prize: a healthy baby.
Daddies in waiting
Preconception planning isn't just a girl thing. It's also important for fathers-to-be. Here are some important health issues you and your partner should be thinking about if there's a baby in your future:
Hoping to win at Baby Roulette? Before you and your partner toss the birth control in the trash and embark on any serious babymaking efforts, you've got some important decisions to make.The choices you make right now are every bit as important to your future baby's health and well-being as the decisions you make after the pregnancy test comes back positive.
Here are 10 steps you should plan to take in the year prior to conception.
Six months to a year ahead of time
1. What's up, doc?
A generation ago, your doctor would have thought you were crazy if you called to set up an appointment to talk about your conception plans. Today, it's fast becoming the norm for couples to book a preconception health checkup.
You may have to do a little arm-twisting to get your partner to accompany you to your appointment -- a lot of guys feel that their role in Operation Conception is limited to heading up the elite Sperm Squadron forces! -- but, whether he's prepared to admit it or not, your partner also needs to do a little preconception health planning of his own.
2. Testing one, two, three
I know, I know lying spread-eagled on an examination table isn't my idea of a good time either, but the experts are pretty much unanimous on this point: the ideal time to schedule a pap test is before you start trying to conceive. That way, should anything abnormal show up, you and your doctor will be able to deal with the problem prior to rather than during your pregnancy.
3. All systems go
You wouldn't even dream of heading off on a cross-country expedition without checking to ensure that your car's equipment was in good working order.Well, you're about to embark on the ultimate of journeys -- the journey to motherhood -- so it's even more important to make sure that your body is firing on all cylinders.
Your doctor will generally give you the green flag if you are in reasonably good health (e.g. any chronic health conditions, such as heart problems, diabetes, or high blood pressure are under control, and you haven't tested positive for any sexually-transmitted diseases such as Chlamydia, syphilis, gonorrhea). Your doctor may also want to talk to you about any hazards that you may face in the workplace -- strenuous working conditions or exposure to hazardous agents, for example-- since they may impact on your pregnancy as well.
4. The human pincushion
Don't relish the thought of being turned into a human pincushion? Chances are you won't have to. While it's always a good idea to have your immunity to both rubella (German measles) and chickenpox checked before you start trying to conceive,most adult women are immune to these two diseases. If it turns out that you're not, it's time to roll up your sleeve: both diseases can be devastating to the developing baby.
What's more, if contracted during pregnancy, chickenpox can pose significant health risks to the pregnant woman as well.
5. Shaking your family tree
Something else you might want to do before you and your partner move into the "action phase" of babymaking is to find out what types of skeletons are swinging from your family tree.
Certain types of birth defects and serious -- even fatal -- diseases are genetic in origin, and it's possible that you and your partner may be carriers for certain types of these inherited diseases.A geneticist can help you to determine your odds of giving birth to a healthy baby.
Three months ahead of time
6. Lifestyle makeover
If your idea of vigorous exercise involves wrestling with your partner for the TV remote, there's no time like the present to start being more physically active. Not only will you strengthen your heart and lungs -- two organs that get a considerable workout during pregnancy -- you'll also be better psychologically equipped to weather the emotional highs and lows of pregnancy.
And if you're carrying around a few extra pounds, this is the perfect time to deal with that problem, too, and reduce your risks of experiencing certain types of fertility problems and pregnancy complications. (Studies have shown that women who are significantly over- or underweight face an increased risk of infertility, and overweight women face an increased risk of requiring a cesarean delivery or experiencing other pregnancy-related complications). Of course, crash dieting is a definite no-no.That can send your body into starvation mode, which will hamper -- not help -- your chances of conceiving anytime soon.
7. Nutrient check
Your baby needs a whole cocktail of nutrients in order to grow and develop -- nutrients that you may have a hard time serving up if you end up battling morning sickness during your first trimester. That's why it's important to try to "stockpile" as many as these nutrients as possible prior to pregnancy.
At the top of your nutrient wish list should be folic acid -- a "miracle nutrient" that has been shown to dramatically reduce the incidence of such neural tube defects as anencephaly and spina bifida if taken in the months leading up to and during the first trimester of pregnancy. How much folic acid you need will depend on your individual and family health history: if you've previously given birth to a baby with a neural tube defect or if you have epilepsy, anemia, insulin-dependent diabetes, or certain other health conditions, your healthcare provider may recommend that you consume a higher than average amount.
When you're ready to start trying to conceive
8. Kick any remaining bad habits
You don't have to be a saint to be a candidate for motherhood, but it doesn't hurt to have a few saintly habits.
Since no safe level of alcohol consumption has been established for pregnancy, most doctors suggest that you abstain entirely rather than flirting with the possibility of giving birth to a baby with serious developmental and behavioral problems, and other anomalies. Ditto for street drugs: they're just plain bad news for babies and mothers-to- be.
And as for smoking: well it shouldn't be news to you that smoking's a no-no, too. Not only has smoking been linked to premature birth and low-birthweight babies: it can also increase your newborn baby's susceptibility to SIDS and other health problems.
9. Slam the medicine cabinet shut
Don't pop any medication in your mouth -- prescription or over-the-counter -- without checking with your doctor to ensure that it's safe to use once you start trying to conceive. (He may want to fiddle with your prescription meds a little -- perhaps changing you to a less harmful drug or taking you off medications altogether for the foreseeable future.)
Bear in mind that even "natural" herbal products can pose a significant risk to a developing baby, particularly since many of these products have not been tested on pregnant women.
10. Lose the birth control
The final step in your countdown to conception is to lose the birth control. If you've been using the birth control pill or some other form of hormonal birth control (e.g. implants or injections), you'll need to wait for at least one normal period before you start trying to conceive -- something that makes it easier for your caregiver to pinpoint your due date.
If the intra-uterine device (IUD) has been your birth control method of choice, you'll still need to put on the brakes momentarily: most doctors recommend that you wait for at least one normal period before you start trying to conceive.
While there are no guarantees in the reproductive world, it only makes sense to do what you can to tilt the roulette wheel in your favor. With any luck, you'll walk away with the ultimate prize: a healthy baby.
Daddies in waiting
Preconception planning isn't just a girl thing. It's also important for fathers-to-be. Here are some important health issues you and your partner should be thinking about if there's a baby in your future:
- Workplace exposure to lead, mercury, anesthetic gases, biological hazards, pesticides, herbicides, radiation or other health hazards on the job: These can affect a man's fertility and/or the health of his offspring.
- Medication use: Some medications are fertility impairing while others are linked to fetal abnormalities.The jury's still out on most herbal products.
- X-rays to the groin area: One US study indicated that such paternal X-ray in the year prior to conception can affect a baby's growth rate.
- Weight: The excess quantities of the female sex hormone estrogen that can be found in overweight men can interfere with communication between the testes and the pituitary gland, hampering a man's fertility.
- Groin injuries: Athletic injuries can temporarily or permanently hamper fertility and sexual function. What's more, some research links long-distance cycling with groin numbness and impotence.
- Avoid overheating the genitals: Wearing tight clothing, soaking in hot tubs and otherwise overheating the testicles can interfere with sperm production and leave a man less fertile.
- Skip the vices: Cigarettes, street drugs and excessive alcohol use have all been linked to reduced fertility and other negative health effects.
Conceiving after the snip: Vasectomy reversal vs. in vitro fertilization
Angeline Beltsos, MD and Meredith Martin-Johnston, MPH
So you or your partner has had a vasectomy... but now you have changed your mind, and would like to have a baby. What are your choices? There's both vasectomy reversal and sperm retrieval combined with IVF. Here's a look at the facts.
Vasectomy reversal
The procedure consists of a surgical procedure reconstructing your male partner's reproductive tract. This is usually a one day outpatient procedure, and is one of the more difficult procedures performed by urologists. Pregnancy most likely will not occur for 12 to 24 months after the procedure, but this also depends on discomfort and recovery time.
Usually, more recovery time will be needed than the time needed to recover from the first vasectomy procedure. In some cases, the reconstruction fails, and then sperm retrieval for IVF is recommended.
When a reversal is performed, a sample of sperm can be obtained and frozen which can be used for IVF in case the reversal is unsuccessful. This is easy to do and adds little cost to the procedure. Make sure to discuss this with your surgeon, since a repeat testicular surgery would be needed if the reversal does not work. Results are not immediate, and it may take 12 to 24 months to see the benefit of surgery.
Success rates
The success rates depend on what was cut, and what needs to be put back together. Depending on what needs to be reconstructed, a successful reconnection occurs 60 to 90 percent of the time, and the pregnancy rates that follow range from 40 to 70 percent. The longer the time between the initial vasectomy and the reversal, the less chance there is of success. Again, results are not immediate and may take 12-24 months to see the benefit of surgery.
Surgery costs
The cost of surgery is usually not covered by insurance since it is an elective procedure, and the cost can range from about $5,000 to $13,000. You should always check your coverage with your insurance company first.
Risks
Possible risks include postoperative pain, infection, tenderness, bruising, bleeding and swelling. There is also a chance of failure, in that the reconstruction of the reproductive tract does not take place. Risks also may include difficulty breathing, decreased urination or blood clots.
Other considerations include that the woman should also be checked beforehand to make sure that her fallopian tubes are open and that her ovaries are working properly. Also, if you want more than one child, a vas reversal may be a better choice. The advantages include that it is a one-day procedure; no drugs are needed for the female partner, and there is less chance of a multiple birth.
Sperm retrieval and IVF
This is a surgical procedure where sperm is extracted from the male partner's testes. In vitro fertilization, or IVF, involves both you and your partner. She will undergo ovarian stimulation with medication to produce several eggs. The egg retrieval is done with a small needle to remove the eggs from the ovary. The sperm are obtained from the testes with a surgical procedure. It is not as invasive as the reversal, with less expense, faster recovery and greater success.
This surgery can be done ahead of time and the sperm or tissue could be frozen or it can be done fresh on the same day as the egg retrieval. The sperm is injected into the egg, called intracytoplasmic sperm injection, or ICSI, and the fertilized eggs are placed back into your uterus. A pregnancy test can be taken two weeks later to determine pregnancy.
Success
IVF success rates can range from 25 to 50 percent. As women age, the success rates decrease significantly. A consultation with your OB/GYN or a reproductive endocrinologist is important before testicular surgery is done.
Cost
Insurance may cover for this procedure in certain states. Otherwise, you may be self-pay at a cost of around $5,000 to $10,000 for the procedure and around $3,000 to $5,000 for the medications.
Risks
Risks include ovarian swelling or hyperstimulation. There is a chance for complications of the egg retrieval, which is rare but may include bleeding or damage to the ovary. There is a 20 to 30 percent chance of a multiple pregnancy. The rare possibility of damage to the testicle or sperm can result from the sperm extraction.
Advantages include that it is a shorter period of time before you can begin to try for pregnancy. You may try immediately with IVF once the sperm retrieval has been done. This is much faster than the vas reversal where you may have to wait one to two years to see if it worked. IVF may also treat any female problems of infertility and it may be covered by insurance.
In summary, there are always choices and both of these should be considered after consulting both a doctor who does the reversal and a doctor who specializes in female reproduction to properly consider the best choice for you and your partner.
So you or your partner has had a vasectomy... but now you have changed your mind, and would like to have a baby. What are your choices? There's both vasectomy reversal and sperm retrieval combined with IVF. Here's a look at the facts.
Vasectomy reversal
The procedure consists of a surgical procedure reconstructing your male partner's reproductive tract. This is usually a one day outpatient procedure, and is one of the more difficult procedures performed by urologists. Pregnancy most likely will not occur for 12 to 24 months after the procedure, but this also depends on discomfort and recovery time.
Usually, more recovery time will be needed than the time needed to recover from the first vasectomy procedure. In some cases, the reconstruction fails, and then sperm retrieval for IVF is recommended.
When a reversal is performed, a sample of sperm can be obtained and frozen which can be used for IVF in case the reversal is unsuccessful. This is easy to do and adds little cost to the procedure. Make sure to discuss this with your surgeon, since a repeat testicular surgery would be needed if the reversal does not work. Results are not immediate, and it may take 12 to 24 months to see the benefit of surgery.
Success rates
The success rates depend on what was cut, and what needs to be put back together. Depending on what needs to be reconstructed, a successful reconnection occurs 60 to 90 percent of the time, and the pregnancy rates that follow range from 40 to 70 percent. The longer the time between the initial vasectomy and the reversal, the less chance there is of success. Again, results are not immediate and may take 12-24 months to see the benefit of surgery.
Surgery costs
The cost of surgery is usually not covered by insurance since it is an elective procedure, and the cost can range from about $5,000 to $13,000. You should always check your coverage with your insurance company first.
Risks
Possible risks include postoperative pain, infection, tenderness, bruising, bleeding and swelling. There is also a chance of failure, in that the reconstruction of the reproductive tract does not take place. Risks also may include difficulty breathing, decreased urination or blood clots.
Other considerations include that the woman should also be checked beforehand to make sure that her fallopian tubes are open and that her ovaries are working properly. Also, if you want more than one child, a vas reversal may be a better choice. The advantages include that it is a one-day procedure; no drugs are needed for the female partner, and there is less chance of a multiple birth.
Sperm retrieval and IVF
This is a surgical procedure where sperm is extracted from the male partner's testes. In vitro fertilization, or IVF, involves both you and your partner. She will undergo ovarian stimulation with medication to produce several eggs. The egg retrieval is done with a small needle to remove the eggs from the ovary. The sperm are obtained from the testes with a surgical procedure. It is not as invasive as the reversal, with less expense, faster recovery and greater success.
This surgery can be done ahead of time and the sperm or tissue could be frozen or it can be done fresh on the same day as the egg retrieval. The sperm is injected into the egg, called intracytoplasmic sperm injection, or ICSI, and the fertilized eggs are placed back into your uterus. A pregnancy test can be taken two weeks later to determine pregnancy.
Success
IVF success rates can range from 25 to 50 percent. As women age, the success rates decrease significantly. A consultation with your OB/GYN or a reproductive endocrinologist is important before testicular surgery is done.
Cost
Insurance may cover for this procedure in certain states. Otherwise, you may be self-pay at a cost of around $5,000 to $10,000 for the procedure and around $3,000 to $5,000 for the medications.
Risks
Risks include ovarian swelling or hyperstimulation. There is a chance for complications of the egg retrieval, which is rare but may include bleeding or damage to the ovary. There is a 20 to 30 percent chance of a multiple pregnancy. The rare possibility of damage to the testicle or sperm can result from the sperm extraction.
Advantages include that it is a shorter period of time before you can begin to try for pregnancy. You may try immediately with IVF once the sperm retrieval has been done. This is much faster than the vas reversal where you may have to wait one to two years to see if it worked. IVF may also treat any female problems of infertility and it may be covered by insurance.
In summary, there are always choices and both of these should be considered after consulting both a doctor who does the reversal and a doctor who specializes in female reproduction to properly consider the best choice for you and your partner.
Can you conceive when he's on Viagra?
Nancy & Betsy
Viagra is a medication used to treat erection difficulties (including erectile dysfunction). So if your partner takes this little blue pill (generic name: Sildenafil), is it safe to try to conceive?
The answer to that question is yes, says Ob/Gyn David M Barrere, MD, FACOG. "There are no contraindications to conceiving while your partner takes Viagra," he says. "During the testing phase of Viagra, there was no effect on sperm motility, form or structure after single 100-mg oral doses in healthy volunteers." He also notes that, although the recommended dose is 50 mg, it may be increased to a maximum of 100 mg or decreased to 25 mg, depending upon the patient's response.
So how does Bob Dole's favorite wonder pill do its job, anyhow? Barrere explains, "Viagra works by inhibiting an enzyme, phosphodiesterase type 5 (PDE5), resulting in smooth muscle relaxation and flow of blood into the corpus cavernosum of the penis. This helps to achieve and maintain an erection."
According to the manufacturer Pfizer, erectile dysfunction is often the result of a decrease in blood flow to the penis. This can be caused by high blood pressure, high cholesterol and stress, among other things.
Once he takes it, Viagra can get the job done in as little as 30 minutes, and then works for at least four hours.
Keep up the good work, man.
Viagra is a medication used to treat erection difficulties (including erectile dysfunction). So if your partner takes this little blue pill (generic name: Sildenafil), is it safe to try to conceive?
The answer to that question is yes, says Ob/Gyn David M Barrere, MD, FACOG. "There are no contraindications to conceiving while your partner takes Viagra," he says. "During the testing phase of Viagra, there was no effect on sperm motility, form or structure after single 100-mg oral doses in healthy volunteers." He also notes that, although the recommended dose is 50 mg, it may be increased to a maximum of 100 mg or decreased to 25 mg, depending upon the patient's response.
So how does Bob Dole's favorite wonder pill do its job, anyhow? Barrere explains, "Viagra works by inhibiting an enzyme, phosphodiesterase type 5 (PDE5), resulting in smooth muscle relaxation and flow of blood into the corpus cavernosum of the penis. This helps to achieve and maintain an erection."
According to the manufacturer Pfizer, erectile dysfunction is often the result of a decrease in blood flow to the penis. This can be caused by high blood pressure, high cholesterol and stress, among other things.
Once he takes it, Viagra can get the job done in as little as 30 minutes, and then works for at least four hours.
Keep up the good work, man.
How often are tubal reversals successful?
Mark Kan, MD
Medical Editor Mark Kan, MD, offers some information about the reversal of tubal ligation and the potential of future pregnancies.
Your question
How often are tubal reversals successful? What needs to be done to reverse tubal sterilization?
The expert answers
Tubal sterilization is generally considered a permanent procedure. While it is not always possible, reversal of sterilization procedures can be attempted in appropriate patients. An alternative to tubal reversal surgery is in-vitro fertilization (IVF), which bypasses the tubes altogether, and can also lead to a successful pregnancy.
The method of initial tubal sterilization is important. Because tubal sterilization requires the tubes to be tied, clipped or burned with electrical current, there is always fallopian tube damage. This damage often precludes successful reversal surgery. The operative report from the initial surgery will detail which technique was performed. A patient considering this procedure should have a complete work-up, checking for male infertility, normal ovulation and other causes of infertility.
A hysterosalpingogram (X-ray test of the uterus and tubes) is routinely performed to check the status of the uterine cavity and proximal fallopian tubes. These tests are performed to ensure there are no other reasons for infertility before an elective reversal surgery. Given the appropriate candidate, reversal techniques have reported success rates between 50 to 80 percent. Additional benefits include a lower rate of multiple gestation when compared to IVF and the ability for future conception without additional procedures. It is important to know that even in the best candidates, the surgery may not be possible or successful. In addition, there are routine surgical risks involved with laparoscopy and laparotomy.
A reproductive endocrinology and infertility specialist is a reproductive surgeon trained in both tubal surgery and IVF. These specialists can explain the risks and benefits of both procedures, and help you make the best decision for achieving pregnancy.
Medical Editor Mark Kan, MD, offers some information about the reversal of tubal ligation and the potential of future pregnancies.
Your question
How often are tubal reversals successful? What needs to be done to reverse tubal sterilization?
The expert answers
Tubal sterilization is generally considered a permanent procedure. While it is not always possible, reversal of sterilization procedures can be attempted in appropriate patients. An alternative to tubal reversal surgery is in-vitro fertilization (IVF), which bypasses the tubes altogether, and can also lead to a successful pregnancy.
The method of initial tubal sterilization is important. Because tubal sterilization requires the tubes to be tied, clipped or burned with electrical current, there is always fallopian tube damage. This damage often precludes successful reversal surgery. The operative report from the initial surgery will detail which technique was performed. A patient considering this procedure should have a complete work-up, checking for male infertility, normal ovulation and other causes of infertility.
A hysterosalpingogram (X-ray test of the uterus and tubes) is routinely performed to check the status of the uterine cavity and proximal fallopian tubes. These tests are performed to ensure there are no other reasons for infertility before an elective reversal surgery. Given the appropriate candidate, reversal techniques have reported success rates between 50 to 80 percent. Additional benefits include a lower rate of multiple gestation when compared to IVF and the ability for future conception without additional procedures. It is important to know that even in the best candidates, the surgery may not be possible or successful. In addition, there are routine surgical risks involved with laparoscopy and laparotomy.
A reproductive endocrinology and infertility specialist is a reproductive surgeon trained in both tubal surgery and IVF. These specialists can explain the risks and benefits of both procedures, and help you make the best decision for achieving pregnancy.
Male fertility and tobacco
Mark Kan, MD
Making a baby can take a little more time than we might expect, so when do we know when it's time to seek help from a specialist? Obstetrician/Gynecologist Mark Kan explains. (Have a question for our fertility expert or another advisor?)
Your question:
My husband is a smoker (about 1 pack a day). Has there been any research done on how the chemicals effect the male's fertiity or longterm health of the fetus.
The expert answers:
Great question. There have been many studies of smoking and fertility. Male smokers have decreased sperm parameters and decreased fertility. Female smokers also have decreased rates of fertility and decreased fallopian tube function. smoking can lead to all kinds of serious problems with the baby. Quitting smoking is the single most important thing you can do for your health and well-being, including your fertility. Smoking cessation programs are available through most major hospitals.
Making a baby can take a little more time than we might expect, so when do we know when it's time to seek help from a specialist? Obstetrician/Gynecologist Mark Kan explains. (Have a question for our fertility expert or another advisor?)
Your question:
My husband is a smoker (about 1 pack a day). Has there been any research done on how the chemicals effect the male's fertiity or longterm health of the fetus.
The expert answers:
Great question. There have been many studies of smoking and fertility. Male smokers have decreased sperm parameters and decreased fertility. Female smokers also have decreased rates of fertility and decreased fallopian tube function. smoking can lead to all kinds of serious problems with the baby. Quitting smoking is the single most important thing you can do for your health and well-being, including your fertility. Smoking cessation programs are available through most major hospitals.
Erectile dysfunction should not be a threat to your private life
ERECTILE DYSFUNCTION is no longer a taboo topic. This problem is not treated like a problem no more. It is more of a fact that needs a simple doctor's prescription. There are many and many medications that promise to give you a good result. But you have to remember one thing - no pill will promise to give you the desire to have sex when you don't want it. Erectile dysfunction pills are produced to help men feel strong again. As we all know good sexual life means a lot to men. Therefore those who do not receive joy from sex are not fully satisfied in life. As the result lots of complexes and insecurities appear.
Before you rush to grab your coat to purchase erectile dysfunction medication, we want to update you with some of the most important information on the drugs. Most impotence drugs resemble each other. Mainly this is so because of the fact that they are meant to cure impotency and their ingredients and effect on the body is the same. If you want to experiment and try different medication in order to choose the best one for yourself - you can do so, but it is better to get an advice from a good specialist that will prescribe you the dug according to your problem and budget. Usually erectile dysfunction medicine is quick and effective.
What is necessary to remember for every individual is that impotence drugs are good for 90% percent of people but not to everyone. It may depend on lots of things from overall health state to body reaction on the drug itself. It is not recommended to mix any medication with any other type of drugs as it may lead to unpredictable consequences. The reason why we always advice our readers to seek some professional advice is because anybody who suffers from side -effects while taking drugs can fall into category of people that will suffer more from the drug that is supposed to help than they have to really. The period of time that the drug stays active during is 36 hours so it may be too much to handle well.
Erectile dysfunction medication has been the matter of multiple researches that clinical staff studied. There researches gave a certain guarantee that the pills actually help those that address them for impotence help. Whether you have mild, moderate and severe erectile dysfunction - there will always be a pill that will control your sexual potency and make it better. But don't get caught up in lies when you hear that drugs like Viagra will give you an urge to have sex. The truth is that the drug will only help you stay sexually active when you have the desire to have sex but you can't. Satisfaction and the ability to maintain erections for successful sexual intercourse are the main promises of any impotence pill.
Cialis is one of the best impotence curing medication on the market right now. It is better than well-known Viagra as its effectiveness lasts slightly longer. But don't just trust our work like that and get it straight away. It is important to buy Cialis with a full awareness of the right choice made. Just like any other pill, this medication can be harmful to those who do not know how to treat themselves with pills. You can pre-order the drug from any online pharmacy or buy Cialis in the local drugstore. Either way you will make a right decision if that's what you need to take.
Before you rush to grab your coat to purchase erectile dysfunction medication, we want to update you with some of the most important information on the drugs. Most impotence drugs resemble each other. Mainly this is so because of the fact that they are meant to cure impotency and their ingredients and effect on the body is the same. If you want to experiment and try different medication in order to choose the best one for yourself - you can do so, but it is better to get an advice from a good specialist that will prescribe you the dug according to your problem and budget. Usually erectile dysfunction medicine is quick and effective.
What is necessary to remember for every individual is that impotence drugs are good for 90% percent of people but not to everyone. It may depend on lots of things from overall health state to body reaction on the drug itself. It is not recommended to mix any medication with any other type of drugs as it may lead to unpredictable consequences. The reason why we always advice our readers to seek some professional advice is because anybody who suffers from side -effects while taking drugs can fall into category of people that will suffer more from the drug that is supposed to help than they have to really. The period of time that the drug stays active during is 36 hours so it may be too much to handle well.
Erectile dysfunction medication has been the matter of multiple researches that clinical staff studied. There researches gave a certain guarantee that the pills actually help those that address them for impotence help. Whether you have mild, moderate and severe erectile dysfunction - there will always be a pill that will control your sexual potency and make it better. But don't get caught up in lies when you hear that drugs like Viagra will give you an urge to have sex. The truth is that the drug will only help you stay sexually active when you have the desire to have sex but you can't. Satisfaction and the ability to maintain erections for successful sexual intercourse are the main promises of any impotence pill.
Cialis is one of the best impotence curing medication on the market right now. It is better than well-known Viagra as its effectiveness lasts slightly longer. But don't just trust our work like that and get it straight away. It is important to buy Cialis with a full awareness of the right choice made. Just like any other pill, this medication can be harmful to those who do not know how to treat themselves with pills. You can pre-order the drug from any online pharmacy or buy Cialis in the local drugstore. Either way you will make a right decision if that's what you need to take.
Minggu, 24 Januari 2010
male fertility
tips on male fertility
male fertility
fertility and conception
information and resources for those trying to conceive plus fertility and infertility info
How to keep his swimmers swimming
by Monica Beyer
In order to get pregnant, a healthy sperm must meet a healthy egg. What you may not know is that there are a few basic practices that will keep his sperm production up and running!
Keep it cool
Avoiding heat is so important to sperm production. Reduce (or eliminate) time in hot tubs, saunas or hot showers. Keeping the testes away from excessive heat allows them to regulate their own temperature naturally, which is important for healthy sperm production. Heat causes a lower sperm count and slower movement of the sperm that are left behind, so keeping the area cool should be a high priority for the conceiving couple. It can also affect the shape of each sperm. Even using car seat warmers and laptops (on the lap, of course) aren't such "hot" ideas for the same reason.
Things to avoid
Bad habits may do more than just affect your health right now -- they can lead to fertility problems on both sides of the bed. Just as a woman who is trying to conceive should avoid smoking, drinking and using recreational drugs, so should her partner. Marijuana, for example, not only causes hormonal imbalances that can lead to sperm production issues, but it can also be toxic to the sperm itself. Sperm actually respond negatively to nicotine as well and smoker's sperm has a reduced ability to bind to the egg, which can prevent conception.
Even some doctor-prescribed medications can interfere with sperm production and quality (such as certain cancer-fighting drugs) so if you are trying to get pregnant you should mention this to your medical provider so recommendations can be made and alternative medications prescribed, if possible.
There are also certain environmental toxins that can damage sperm, such as pesticides, herbicides and heavy metals. Be sure to take proper precations to minimize exposure, especially if your job requires the use of chemicals such as these.
Healthy habits
Eating a healthy diet and exercising regularly is not only essential to overall health but to sperm health as well. Researchers have found that too much body fat on a man can lead to lower sperm production and a higher percentage of abnormal sperm. Men should also take a complete multi-vitamin to ensure they are not slighting themselves on any needed nutrition, particularly folic acid and zinc. Regular exercise can reduce body weight and fat percentage, and can also help with stress reduction as well, but be sure to not overdo exercise -- as with so much of health and nutrition, moderation is key.
It can be fun to enter into a healthier lifestyle together. Explore new ways to work out with your partner -- whether it be a jog in the park or meeting in the gym after work. Experiment in the kitchen with new and healthy recipes. Keep cut-up vegetables in the fridge for a handy snack. Instead of keeping unhealthy snacks in the house (and within easy reach), make it a point to buy a single serving of a decadent dessert occasionally and hopefully avoid a full-blown junk food relapse!
Keep him active
Regular sex can actually improve sperm count and quality. Sperm is constantly being created and replinished and in this case, using it is not losing it. If he has been diagnosed with a low sperm count a man may be advised by a medical professional to limit sexual activity but if he has a normal sperm count you can get it more often if you want to. Avoid lubrications, though, because they can interfere with and even kill sperm (even saliva can).
Have fun with baby-making sex as well as maintaining a healthy lifestyle. Your child will thank you for a terrific start to life and a healthy dad to see him grow up!
male fertility
fertility and conception
information and resources for those trying to conceive plus fertility and infertility info
How to keep his swimmers swimming
by Monica Beyer
In order to get pregnant, a healthy sperm must meet a healthy egg. What you may not know is that there are a few basic practices that will keep his sperm production up and running!
Keep it cool
Avoiding heat is so important to sperm production. Reduce (or eliminate) time in hot tubs, saunas or hot showers. Keeping the testes away from excessive heat allows them to regulate their own temperature naturally, which is important for healthy sperm production. Heat causes a lower sperm count and slower movement of the sperm that are left behind, so keeping the area cool should be a high priority for the conceiving couple. It can also affect the shape of each sperm. Even using car seat warmers and laptops (on the lap, of course) aren't such "hot" ideas for the same reason.
Things to avoid
Bad habits may do more than just affect your health right now -- they can lead to fertility problems on both sides of the bed. Just as a woman who is trying to conceive should avoid smoking, drinking and using recreational drugs, so should her partner. Marijuana, for example, not only causes hormonal imbalances that can lead to sperm production issues, but it can also be toxic to the sperm itself. Sperm actually respond negatively to nicotine as well and smoker's sperm has a reduced ability to bind to the egg, which can prevent conception.
Even some doctor-prescribed medications can interfere with sperm production and quality (such as certain cancer-fighting drugs) so if you are trying to get pregnant you should mention this to your medical provider so recommendations can be made and alternative medications prescribed, if possible.
There are also certain environmental toxins that can damage sperm, such as pesticides, herbicides and heavy metals. Be sure to take proper precations to minimize exposure, especially if your job requires the use of chemicals such as these.
Healthy habits
Eating a healthy diet and exercising regularly is not only essential to overall health but to sperm health as well. Researchers have found that too much body fat on a man can lead to lower sperm production and a higher percentage of abnormal sperm. Men should also take a complete multi-vitamin to ensure they are not slighting themselves on any needed nutrition, particularly folic acid and zinc. Regular exercise can reduce body weight and fat percentage, and can also help with stress reduction as well, but be sure to not overdo exercise -- as with so much of health and nutrition, moderation is key.
It can be fun to enter into a healthier lifestyle together. Explore new ways to work out with your partner -- whether it be a jog in the park or meeting in the gym after work. Experiment in the kitchen with new and healthy recipes. Keep cut-up vegetables in the fridge for a handy snack. Instead of keeping unhealthy snacks in the house (and within easy reach), make it a point to buy a single serving of a decadent dessert occasionally and hopefully avoid a full-blown junk food relapse!
Keep him active
Regular sex can actually improve sperm count and quality. Sperm is constantly being created and replinished and in this case, using it is not losing it. If he has been diagnosed with a low sperm count a man may be advised by a medical professional to limit sexual activity but if he has a normal sperm count you can get it more often if you want to. Avoid lubrications, though, because they can interfere with and even kill sperm (even saliva can).
Have fun with baby-making sex as well as maintaining a healthy lifestyle. Your child will thank you for a terrific start to life and a healthy dad to see him grow up!
The right time: When sperm and egg meet
tips on male fertility
male fertility
fertility and conception
information and resources for those trying to conceive plus fertility and infertility info
The right time: When sperm and egg meet
Jennifer Newton Reents
You are so ready to have a baby, that it makes you crazy, and besides, getting pregnant should be easy, right? So how do you make it happen? Well, of course, we know you know HOW, but when it comes to getting that sperm and egg together, believe it or not, it can get a little tricky.
Ovulation facts
In a typical 28 day menstrual cycle, ovulation usually occurs around Day 14 -- with Day 1 as the first day of your menstrual bleeding, says Fady I. Sharara, MD, medical director of the Virginia Center for Reproductive Medicine and associate clinical professor at George Washington University School of Medicine. While the egg "fertilization window" is short he says (just 12 to 24 hours), sperm can live up to five days -- and sometimes longer -- in the cervical mucus, which is most abundant close to ovulation.
"Every woman who is attempting to conceive should know whether her cycles are regular and whether she experiences the 'ovulation signs,'"he says. "These signs include increasing cervical mucus close to ovulation, and what is called Mittleschmerz, or the midcycle cramping that some, but not all, women feel."
While everyone is different, Randy S. Morris MD, a board-certified reproductive endocrinologist and associate clinical professor at the University of Illinois at Chicago, says most women have menstrual cycle lengths between 26 to 30 days. "Ovulation in these women is usually occurring between Day 12 and Day 16," he explains. "The first part of the cycle from menstruation until ovulation is called the follicular phase. The second part from ovulation until the next menstruation is called the luteal phase. The luteal phase is relatively constant at around 14 days."
Dr Morris cites a study published in 1995 in the New England Journal of Medicine which looked at the timing of intercourse relative to ovulation. He says the following conclusions could be made from this study:
First, figure out the length of your cycles from the first day menstruation begins until the next first day of bleeding -- for example, 26 or 29 days.
Next, subtract 14 days for a good estimate of when you usually ovulate. (e.g. 26-14=12 and 29-14=15. Ovulation in this example would be expected between day 12 and 15 of any given cycle).
Then, have intercourse every two to three days leading up to ovulation (In this example, intercourse on days 10, 12 and 14 would maximize the chance for conception. Couples who want to have intercourse more often such as every day, may do so without compromising their chances for success, he says. Some doctors suggest couples have sex every other day.
Knowing when
There are a number of ways to see if you are ovulating, from keeping track of the changes in your cervical fluid, to charting changes in your basal body temperature. There are also ovulation predictor kits (OPKs) on the market today that test for signs of ovulation by looking for hormonal changes in urine and even changes in the salt of the saliva brought on by hormonal changes.
William B Hummel, MD, co-founder of the San Diego Fertility Center in San Diego, California, says if you have an irregular cycle, urine OPKs that test for a hormone surge of luteinizing hormone (LH) help women identify their most fertile time. "Generally, the most fertile time of a woman's cycle is the day after the LH surge. This fertile period of time may be associated by an increase in one's basal body temperature the day after ovulation," he says.
Dr Sharara says many women chart their basal body temperature (BBT), which is done by taking your temperature as soon as you wake up -- before getting out of bed or doing anything -- and recording it on a special chart. "Impending ovulation is often associated with a drop in the temperature from the baseline, followed by an increase the next day," he says.
Temperature charting does not predict ovulation, says Dr Morris, but it can detect ovulation only after it has already occurred. "There is no reliability in predicting ovulation. It is useful for women with irregular or infrequent menstrual cycles to determine if they are ovulating," he says.
Today, says Dr Sharara, the most "scientific" approach involves using a urine-based OPK. "When the kit turns 'positive' that implies that ovulation will occur within 24 hours," Dr Sharara notes. "Therefore intercourse has to be timed as close to ovulation as possible to achieve the highest chances at conception."
Know thyself
Lawrence Werlin, MD, FACOG, reproductive endocrinologist and founder and director of the Coastal Fertility Medical Center in Irvine, California, says women need to understand what changes occur in their own cycles and to understand what those changes mean. "For example, when her (cervical) mucus begins to change, and become thin (watery), clear and sticky, she is close to ovulation," says Dr Werlin.
For Leslie, a frequent poster on the Pregnancy & Baby Baby Dust message boards (who is now expecting a child in February 2004), taking her BBT seemed to help her become familiar with her cycles, especially since she was taking fertility drug injections to help her ovulate. "I had high temps after (ovulation) this cycle, similar to my other medicated cycles except I had one day with a 98.8 temp which was the highest temp I had ever had in all my temping. I thought that was rather unusual. At 11 and 12 days past ovulation, I had spotting, which was very unusual as I never have spotting before (my period). It was strange too. I only had it in the morning and it was always brown."
Your healthcare provider will also be able to guide you in the right direction when it comes to trying these techniques.
Dr Sharara says it is also important your partner be tested, to ensure he doesn't have a low sperm count. "Male-related infertility accounts for 40 percent of all infertility causes, and in an additional 20 percent, both partners have fertility problems," he says.
When you decide to take a pregnancy test, try to remain positive, even if you get a negative result, advises Hollie, a visitor to the Pregnancy and Baby message boards who has been trying to conceive more than six months. "Do the best you can -- baby dance (have sex) at the right time and then let it go," she says. "Get involved in something -- work, being romantic with your husband, a hobby, reading, a sport. Something to take your mind and pressure off your body."
And remember that the best is yet to come. "Think of the surprise when you finally get that (positive pregnancy test) and you weren't even stressing about it," says Hollie. "Your body will listen and respond when it knows you can handle a baby."
male fertility
fertility and conception
information and resources for those trying to conceive plus fertility and infertility info
The right time: When sperm and egg meet
Jennifer Newton Reents
You are so ready to have a baby, that it makes you crazy, and besides, getting pregnant should be easy, right? So how do you make it happen? Well, of course, we know you know HOW, but when it comes to getting that sperm and egg together, believe it or not, it can get a little tricky.
Ovulation facts
In a typical 28 day menstrual cycle, ovulation usually occurs around Day 14 -- with Day 1 as the first day of your menstrual bleeding, says Fady I. Sharara, MD, medical director of the Virginia Center for Reproductive Medicine and associate clinical professor at George Washington University School of Medicine. While the egg "fertilization window" is short he says (just 12 to 24 hours), sperm can live up to five days -- and sometimes longer -- in the cervical mucus, which is most abundant close to ovulation.
"Every woman who is attempting to conceive should know whether her cycles are regular and whether she experiences the 'ovulation signs,'"he says. "These signs include increasing cervical mucus close to ovulation, and what is called Mittleschmerz, or the midcycle cramping that some, but not all, women feel."
While everyone is different, Randy S. Morris MD, a board-certified reproductive endocrinologist and associate clinical professor at the University of Illinois at Chicago, says most women have menstrual cycle lengths between 26 to 30 days. "Ovulation in these women is usually occurring between Day 12 and Day 16," he explains. "The first part of the cycle from menstruation until ovulation is called the follicular phase. The second part from ovulation until the next menstruation is called the luteal phase. The luteal phase is relatively constant at around 14 days."
Dr Morris cites a study published in 1995 in the New England Journal of Medicine which looked at the timing of intercourse relative to ovulation. He says the following conclusions could be made from this study:
- Pregnancy can be achieved when intercourse occurs up to five days prior to ovulation. At three to five days before ovulation, the probability of conception averaged around 10 percent.
- The highest chance for pregnancy occurs when intercourse happens two days before, one day before or on the day of ovulation. On those days, the probability of pregnancy averaged about 35 percent. Statistically, there is no better chance for conceiving on any of those three days.
- The probability for pregnancy drops off significantly (maybe to zero) the day after ovulation.
- The frequency of intercourse made little difference in the probability of conception.
First, figure out the length of your cycles from the first day menstruation begins until the next first day of bleeding -- for example, 26 or 29 days.
Next, subtract 14 days for a good estimate of when you usually ovulate. (e.g. 26-14=12 and 29-14=15. Ovulation in this example would be expected between day 12 and 15 of any given cycle).
Then, have intercourse every two to three days leading up to ovulation (In this example, intercourse on days 10, 12 and 14 would maximize the chance for conception. Couples who want to have intercourse more often such as every day, may do so without compromising their chances for success, he says. Some doctors suggest couples have sex every other day.
Knowing when
There are a number of ways to see if you are ovulating, from keeping track of the changes in your cervical fluid, to charting changes in your basal body temperature. There are also ovulation predictor kits (OPKs) on the market today that test for signs of ovulation by looking for hormonal changes in urine and even changes in the salt of the saliva brought on by hormonal changes.
William B Hummel, MD, co-founder of the San Diego Fertility Center in San Diego, California, says if you have an irregular cycle, urine OPKs that test for a hormone surge of luteinizing hormone (LH) help women identify their most fertile time. "Generally, the most fertile time of a woman's cycle is the day after the LH surge. This fertile period of time may be associated by an increase in one's basal body temperature the day after ovulation," he says.
Dr Sharara says many women chart their basal body temperature (BBT), which is done by taking your temperature as soon as you wake up -- before getting out of bed or doing anything -- and recording it on a special chart. "Impending ovulation is often associated with a drop in the temperature from the baseline, followed by an increase the next day," he says.
Temperature charting does not predict ovulation, says Dr Morris, but it can detect ovulation only after it has already occurred. "There is no reliability in predicting ovulation. It is useful for women with irregular or infrequent menstrual cycles to determine if they are ovulating," he says.
Today, says Dr Sharara, the most "scientific" approach involves using a urine-based OPK. "When the kit turns 'positive' that implies that ovulation will occur within 24 hours," Dr Sharara notes. "Therefore intercourse has to be timed as close to ovulation as possible to achieve the highest chances at conception."
Know thyself
Lawrence Werlin, MD, FACOG, reproductive endocrinologist and founder and director of the Coastal Fertility Medical Center in Irvine, California, says women need to understand what changes occur in their own cycles and to understand what those changes mean. "For example, when her (cervical) mucus begins to change, and become thin (watery), clear and sticky, she is close to ovulation," says Dr Werlin.
For Leslie, a frequent poster on the Pregnancy & Baby Baby Dust message boards (who is now expecting a child in February 2004), taking her BBT seemed to help her become familiar with her cycles, especially since she was taking fertility drug injections to help her ovulate. "I had high temps after (ovulation) this cycle, similar to my other medicated cycles except I had one day with a 98.8 temp which was the highest temp I had ever had in all my temping. I thought that was rather unusual. At 11 and 12 days past ovulation, I had spotting, which was very unusual as I never have spotting before (my period). It was strange too. I only had it in the morning and it was always brown."
Your healthcare provider will also be able to guide you in the right direction when it comes to trying these techniques.
Dr Sharara says it is also important your partner be tested, to ensure he doesn't have a low sperm count. "Male-related infertility accounts for 40 percent of all infertility causes, and in an additional 20 percent, both partners have fertility problems," he says.
When you decide to take a pregnancy test, try to remain positive, even if you get a negative result, advises Hollie, a visitor to the Pregnancy and Baby message boards who has been trying to conceive more than six months. "Do the best you can -- baby dance (have sex) at the right time and then let it go," she says. "Get involved in something -- work, being romantic with your husband, a hobby, reading, a sport. Something to take your mind and pressure off your body."
And remember that the best is yet to come. "Think of the surprise when you finally get that (positive pregnancy test) and you weren't even stressing about it," says Hollie. "Your body will listen and respond when it knows you can handle a baby."
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