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All about fertility.

  • Should I take supplements to enhance my egg or sperm health?
    🚨 There is a lot of bullshit and snake oil in the supplement space. The human body does its best absorption of vitamins and minerals when they are packaged together in food; they are not meant to be taken in isolation. That said, there are a few supplements that have clinically validated results on optimizing reproductive health. Adding in clinically validated supplements to your diet can be a good idea, ideally 3 - 6 months before an egg freezing cycle or pregnancy. Folic acid: This B vitamin is important for the development of the neural tube in the early stages of pregnancy. It's recommended for women who are trying to conceive to take a supplement that contains at least 400 micrograms of folic acid daily, starting at least one month before conception. Vitamin D: This vitamin helps regulate the menstrual cycle and is important for ovulation. It's recommended for women who are trying to conceive to take a supplement that contains at least 1000 IU of vitamin D daily. Omega-3 fatty acids: These are important for the development of healthy eggs and can help to reduce inflammation in the body. Fish oil supplements are a good source of omega-3 fatty acids. Iron: This mineral is important for the production of red blood cells and is crucial for ovulation. Iron supplements are recommended for women who are trying to conceive and have low levels of iron. CoQ10: This antioxidant is important for the health of the egg and sperm cells. It is found naturally in the body but levels decrease with age.
  • Does BMI affect fertility?
    We too feel the ick of discussing physical appearance and fatphobia is a serious cultural issue. A normal BMI does not mean that you need look like a runway model - far from it, as anovulation is higher in underweight women who typically take 4x as long to conceive. You should simply strive to be in the normal range for your biological sex and body type. Here are the facts about high BMI and fertility: An unhealthy weight, no matter the circumstance or why, dramatically impacts egg health, the ability to conceive, and the ability to support a pregnancy. Women who try to conceive with a high body mass index (BMI) take 2x as long to get pregnant and have high-risk pregnancies and deliveries. The negative effects of being clinically overweight or underweight on fertility are caused by the body’s stores of fat, which bring about hormone imbalances. Obese men have lower testosterone levels and poorer quality sperm that can be traced all the way back to the germ cells in the testes, as they too are physically and molecularly abnormal. Male obesity impairs the metabolic and reproductive health of future children through this affected sperm.
  • How does mental health correlate with fertility?
    The complex system of feedback loops and pathways that control the secretion of cortisol is called the hypothalamic-pituitary-adrenal (HPA) axis. The HPA springs into action after it is triggered by negative feedback loops. Feeling anxious, worried, or bigger stress-induced emotions like fear or trauma releases cortisol and norepinephrine which tell your liver to break down and release glucose. These cortisol flares cause suppressed LH secretion and disrupted ovulation. 29% less likely to get pregnant if stressed (high levels of alpha-amylase) High cortisol levels can lead to an increased risk of ovulatory dysfunction and menstrual irregularities in women, which can affect fertility. Chronic stress and elevated cortisol levels can cause inflammation in the body, which has been linked to infertility and subfertility in both men and women. Women with polycystic ovary syndrome (PCOS), a common reproductive disorder, often have elevated cortisol levels, which may contribute to the development of insulin resistance and hormonal imbalances that affect fertility. Increased cortisol —> make sugar cravings more acute and slow metabolism, leading to weight gain Depression can be an underlying cause of erectile dysfunction or a side effect of infertility.
  • How does my environment effect my fertility?
    Endocrine-disrupting chemicals (EDC) mimic natural hormones in the body, fooling it into thinking it should overrespond (i.e., inflammation) or do so at an inappropriate time. These chemicals are the most likely culprit of decreasing fertility rates, but they are a constant in our environment. Do your best to make good purchasing and consumption choices to optimize for reproductive health. YOUR DO NOT PURCHASE OR USE LIST Fast food or food that comes in plastic. Anything with BPA (toxic plastic) Parabens. Often found in beauty products. Pesticides. Try to eat organic foods. Aluminum chloride hexahydrate in deodorant Chemical sunscreens Formaldehyde in eyelash glue, hair straightening products, nail polish Hydroquinone for skin lightening Phthalates (perfume, nail polish, soaps, body washes, shampoos, and cosmetics but also in vinyl flooring and lubricating oils) Retinoids Salicylic acid in skincare Triclosan for bacteria in toothpaste, soap, deoderant Flame retardants
  • Should I utilize integrative/holistic medicine to enhance my egg or sperm health?
    There are several complementary health procedures that may be beneficial for fertility. Many of these practices have not been extensively studied and their effectiveness for improving fertility is not well established. However, 73% of fertility patients report utilizing these practices and 90% report benefit from doing so. Acupuncture Yoga Acupressure and massage Gua sha (using a stone tool to scrape the skin to relieve pain and tension) Cupping (using heated cups that act like vacuums to improve blood and lymph circulation) Chinese herbs Aromatherapy Meandering even briefly through a forest, or forest bathing, has physiological and psychosocial effects, inducing relaxation and stress reduction. Sunshine
  • Will SSRIs (Selective serotonin reuptake inhibitors) hurt my fertility?
    SSRIs For women, SSRI use causes issues with sexual function like low libido, but does not appear to affect ovarian function, egg quality, hormone levels, or negatively impact outcomes during IVF treatments. Taking SSRIs during pregnancy is not advisable unless there is no alternative, since they are linked to increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, and neurobehavioral effects later in life.
  • What are general diet and nutrition tips to enhance my fertility?
    EMPHASIZE: Fruits, vegetables, whole grains, and lean proteins in your diet. These foods provide important nutrients that are necessary for reproductive health, such as vitamin C, E, D, B6, folate, zinc and iron. Eat foods that contain omega-3 fatty acids, such as fish, flaxseeds, and walnuts, which can help to reduce inflammation in the body. The only clinically validated “diet” for fertility is The Mediterranean Diet: whole grains, lean protein, and healthy fats. More specifically fresh vegetables, oily fish, poultry, and moderate amounts of fresh fruit (not juice!). LIMIT: Processed and high-fat foods, which can contribute to inflammation and weight gain. Fast food or food that comes in plastic. Added sugar. Alcohol. ABSTAIN: Recreational drugs
  • Should I make exercise or behavior modifications?
    The official recommendation is that all adults between eighteen and sixty-four years old get 150 minutes per week (3.5hrs) of moderate-intensity physical activity. Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This can include activities such as brisk walking, cycling, swimming, or dancing. If you’re already tracking your period, the menstrual phase (days one through seven) is for gentle exercise, follicular phase (days eight through thirteen) is for more intensity, ovulatory phase (days fourteen through twenty-one) is for heavy weights, then it’s time to dial things back during the luteal phase (days twenty-two through twenty-eight) Avoid extremely excessive exercise. Women who engage in intense exercise, such as marathon running or competitive cycling, may have a harder time getting pregnant because the intense exercise can disrupt ovulation. PCOS is the cause of 80% of anovulatory infertility, and moderate exercise reduces symptoms for PCOS patients. Activity benefits babies too, so maintaining a healthy exercise routine is beneficial throughout your reproductive years. It protects them from developing metabolic problems even with a high-fat maternal diet. Infants born to mothers who exercised during pregnancy had better motor skills and cardiovascular function too. Read this if you’re a biological male. Sperm HATE heat. There is a reason the scrotum is outside of the body. Avoid hot tubs, saunas, and steam rooms. Men should not cycle. Yes, it kills sperm. Get a seat that lets the balls hang if the biologically male partner is a cycling enthusiast.
  • What to prepare: what are your next steps?
    💡 Fertility clinics are overwhelmed with demand. Appointments are often booked months out, so you need to plan accordingly. Here are a few things you can do to prepare for your fertility services.\ Understand the cost: Understand the cost of the treatment options, and the financial resources you have for it. Review your insurance coverage: Understand your insurance policy and what fertility treatments are covered. Understand the criteria and requirements for prior authorization coverage and make sure you meet them before starting treatment. Choose a fertility clinic: Research different clinics in your area, and choose one that is reputable and has a good success rate. Gather all necessary medical records: Be sure to bring any relevant medical records, including previous test results and treatments, to your initial consultation. Make sure you have your insurance information. This will be used by the clinic to bill for your consultations and initial bloodwork and ultrasound office visit. Otherwise, you will have to pay out of pocket and this is even more expensive. Prepare questions: Before your consultation, make a list of questions you have about the treatment options, risks and success rates. See Loamy's question recommendations above. Make arrangements: Before starting treatment, make arrangements for work, childcare, or other responsibilities as needed. Most labs open at 6:00 or 7:00am. You will need to go into the lab for your initial bloodwork and ultrasound as well as every day during the treatment period (10 - 14 days). Emotional support: Infertility can be a stressful and emotional time, consider seeking emotional support from a therapist or Loamy’s community groups. Physical Optimization: In general, it is important to maintain a healthy lifestyle and avoid smoking, excessive alcohol consumption, and illegal drugs. See Physical Optimization tab in the FAQ.
  • What is the typical patient journey like?
    💡 Your initial consultation is often a video call (30 - 60 minutes). You likely won’t get ahold of the doctor again until the diagnosis and treatment plan conversation, which could be months away. Clinics, nurses, and doctors are extremely difficult to get ahold of during this time. Here is the typical patient journey. Initial Preparation: Gathering all documents, determining a payment plan, and preparing your physical readiness are all critically important to getting the results you want. See What to prepare: What are your next steps? Initial consultation: Schedule an initial consultation with a fertility specialist. During this appointment, the patient (you) will have the opportunity to discuss your medical history and fertility goals with the doctor. 1-2 Months from Initial Consultation | Initial Workup (lab work): Schedule your lab work to get blood drawn and ultrasound. Here you will determine your hormone levels and follicle count. A woman’s menstrual cycle is divided into four phases: menstrual phase follicular phase ovulation phase luteal phase To get optimal results in your screening, you need to be in the follicular phase of your menstrual cycle. For those who do not have a period, this may be hard to determine without bloodwork, meaning you may have to 1) do an initial workup to determine where you are in your cycle, then 2) Repeat the workup when you’re in the correct stage of your cycle. 1-2 Months from Initial Consultation | Diagnosis and treatment plan: After the initial consultation, the doctor will review the patient's (your) test results and develop a diagnosis and treatment plan. This may include a diagnosis of infertility and recommendations for treatment options such as medication, intrauterine insemination (IUI) or in vitro fertilization (IVF). 2-5 Months from Initial Consultation | Purchase fertility medication: For some patients, the treatment plan may include the use of fertility medication to stimulate ovulation. This medication is usually taken orally or via injection, and is used to increase the chances of ovulation and conception. Fertility drugs are typically prescribed by a fertility specialist and can be obtained through a few different channels. Fertility clinic: Many patients obtain fertility drugs through the clinic where they are receiving treatment. The clinic will typically have the drugs on-site and will provide the patient with instructions on how to take them. Pharmacies: Some fertility drugs can be obtained through a regular pharmacy with a prescription. These drugs are usually oral medications and can be obtained from most pharmacies. Mail-order pharmacies: Some patients may opt to obtain fertility drugs through mail-order pharmacies. This can be convenient for patients who live in remote areas or for those who have difficulty getting to a physical pharmacy. Compounding Pharmacies: Some fertility drugs may not be available in regular pharmacies, and need to be specially compounded by a compounding pharmacy. 2-5 Months from Initial Consultation | Controlled ovarian stimulation (COS) Process & Monitoring: Regardless of your drug/hormone regimen, you will typically administer the drugs via subcutaneous injection, meaning the medication is injected just under the skin, usually in the abdomen or thigh for 10 - 14 days beginning on day 2 - 4 of your period. Patients report great comfort in having a partner or trusted companion to assist you with the injections. But remember — you are absolutely capable of doing this alone! During the treatment process, the patient will likely need to visit the clinic for regular monitoring appointments. These appointments may include ultrasound and blood tests to track the progress of ovulation and the growth of the patient's eggs. Physical experience: The physical experience of COS may vary from person to person, but some common side effects include: Bloating and abdominal discomfort Headaches Mood swings Fatigue Injection site discomfort Once the eggs have reached the appropriate size, the patient is given a trigger shot, usually HCG, to induce ovulation. 2-5 Months from Initial Consultation | Egg retrieval (transvaginal oocyte retrieval): 36 hours after the trigger shot, the eggs are retrieved through a procedure called transvaginal oocyte retrieval, which is done under conscious sedation or general anesthesia. You will need to schedule a ride to and from the procedure. The procedure is typically done in the morning. Clear your schedule for the rest of your day and take it easy for 1 - 4 days after. 2-5 Months from Initial Consultation | Fertilization (if undergoing embryo preservation or IVF): Once the eggs have been retrieved, they are fertilized with sperm in a lab. The fertilized eggs will then be allowed to grow for a few days, becoming embryos. 2mo - 5 years from Initial Consultation | Embryo transfer: After a few days, one or more embryos will be selected and transferred to the patient's uterus. 3mo - 5 years from Initial Consultation | Pregnancy test: The patient will need to wait a couple of weeks before taking a pregnancy test to confirm if they are pregnant or not. 3mo - 5 years from Initial Consultation | Follow-up care: If the patient becomes pregnant, they will need to continue to see the doctor for regular prenatal care. It's also important to keep in mind that each individual's fertility journey is unique and there may be additional steps that you need to prepare depending on your specific circumstances.
  • Questions to Ask Your Doctor.
    Outcomes/Success Rates What are the clinic's success rates for egg freezing? For women with my demographic and physiological situation? What are realistic thaw rates for egg freezing? What is the clinic's success rate of pregnancy and live birth for my specific demographic/physiological circumstances? How can I enhance my egg or sperm health for improved outcomes? Do you have a database of donor information? How will you handle complications? What are the next steps if the cycle is unsuccessful? Treatments What fertility treatments does the clinic offer? What are the risks and side effects associated with these treatments? What is the timeline and number of cycles to be expected for this treatment? What is the best treatment for me? Clinic's Qualifications and Policies What are the qualifications and experience of the clinic, as well as the REIs, nurses, staff, embryologists, and lab? With egg freezing, specifically? What is their policy on cryopreservation and storage? What is the clinic's policy on Genetic testing? How does the clinic operate? Will I have one doctor or multiple treating me throughout my cycle? Or will I mostly see a nurse during a cycle? Do you prefer PGT-A tested over non-PGT-A tested? Policies and use of ICSI? What specific method does the clinic use for freezing eggs? Vitrification vs slow freezing? Clinic's Support How does the clinic support patients emotionally during the process? Do they offer telemedicine appointments? Do you have weekend appointments? How often do you communicate with your patients? Through which channels? Costs/Coverage How many cycles will be covered by insurance? How much will it cost including medications, storage and the consults? Do you offer any grants? Does the clinic offer any payment plans or any discounted rates for working with X insurer? What to Expect: Patient Journey What happens during an initial consultation? How long is an individual cycle, and how many times will I need to go to the physical office? Will I need to take time off from work before, during, and after retrieval? What other testing I (and my partner) need to do before treatment? Will I have to take a lot of medications? What are the medications for? How long after the transfer will I get my results?
  • What are some statistics on fertility— give me the facts?
    1/6 couples struggle to conceive. In infertile couples, half the time the women is infertile and half the time men are infertile. You should get tested to know your reproductive baseline as soon as possible. Knowledge is power. Generally speaking, the best biological time to freeze your eggs is in your early twenties. This is when the least amount of people can afford it and are usually unpartnered. This does not mean that your early thirties are a bad time! We repeat, this does not mean that your early thirties are a bad time! Simply by biological status of your egg health, the ordered “best” times are as follows. Ages 25 - 30 and 30 - 35 are recommended due to the social correlates of financial and partnership status, on average, at this time in women’s lives: [20 - 25]: Highest number of mature eggs and highest percentage of genetic normality. Likelihood of live birth extremely high. [25 - 30]: High number of mature eggs and high percentage of genetic normality. Likelihood of live birth very high. [30 - 35]: Large number of mature eggs and significant percentage of genetic normality. Likelihood of live birth high. [35 - 40]: Lower number of mature eggs and approximately fifty percent of genetic normality. Likelihood of live birth average.
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