Not surprisingly, patients search for both emotional and physical signs to affirm or deny the potential of pregnancy; all while watching the calendar turn at a turtle’s pace.  One becomes hyperaware of weight, the body’s reaction to elevating progesterone and the psychologic stress involved.  The amount of rent-free brain space afforded to becoming pregnancy often is greater than prior to presenting to the fertility center to initiate treatment.

This two-week time between anticipated fertilization and pregnancy test is related to biology.  Once the embryo is created from fertilization of the egg by the sperm, the embryo must develop.  As it develops, the implanting blastocyst (stage of embryo development) becomes more specialized forming both the fetus and the placenta.  This placental tissue much reach a critical mass as it is releasing pregnancy hormone into the maternal circulation.  Pregnancy hormone is hCG (human chorionic gonadotropin).  Patients return to the center on one of the first days that this level can be detected accurately.

We recommend that patients refrain from performing home pregnancy tests as they are not as sensitive as blood levels and can render both false-positive as well as false-negative results; thus, they can provide more angst than affirmation.

Pregnancy hormone, along with progesterone (natural and supplemented) causes very rapid transitions in the women’s body in preparation for providing the most accommodating environment for the pregnancy.   Some women perceive these changes and some do not.

They symptoms can include a perception in ability in changes in respiratory rate – pregnant women tend to breathe more rapidly with more shallow breathes; Bloating and constipation can be an issue – intestinal motility slows so maximal nutrition can be pulled from the gut.   Breast soreness and tenderness is a direct effect from progesterone exposure and it is exceedingly difficult to make it not noticeable.  Having more symptoms does not mean that pregnancy did not occur.  Ironically, many women are more hopeful the more uncomfortable they become.

One of the best ways to get through this time is to keep one occupied.  A calendar with daily projects and activities will help to pass the time.  Women should continue their healthful diets and ways as well continue to take their prenatal vitamins as discussed previously with their health care teams.  Remember, healthy mothers make healthy babies.

Caffeine
Studies have shown that small amounts of caffeine are not necessarily detrimental to conceiving. Caffeine intake of up to one-to two cups of coffee per day has not been shown to decrease fertility. However, caffeine consumption greater than five cups of coffee per day has been associated with decreased fertility up to 50%. Also, consumption of 2-3 cups of coffee per day has been associated with an increased likelihood of miscarriage but does not affect risk of congenital anomalies. In summary, women who consume 1-1.5 cups of coffee per day, before and during pregnancy, should experience no adverse effects on fertility or pregnancy outcome.

Alcohol
Small amounts of alcohol prior to conception, up to 3-4 glasses per week, have also not been shown to decrease a woman’s fertility. Greater than two alcoholic drinks per day has been shown to decrease fertility in women. Certainly, once a woman believes she may be pregnant, she should, without question, abstain from all alcohol intake.

Patients who consume more than the above recommended amount of caffeine or alcohol should decrease their intake. However, it not necessary to bring intake of caffeine and alcohol down to zero.

Diet and Weight
Women who are significantly underweight (BMI<19) and women who are significantly overweight (BMI>35) will experience a 2-4 fold increase in time to conception. However, there is little evidence that specific dietary variations, such as low-fat diets, or vegetarianism, affect fertility. Women attempting to conceive should take 400 micrograms of folic acid. This is to reduce the risk of neural tube defects in the fetus. To calculate your own BMI, go to this link: http://www.nhlbisupport.com/bmi/.

Smoking
Smoking (even small amounts) has substantial negative effects on fertility. Women who smoke cigarettes have a 60% increased risk of infertility, as well as an increased risk of miscarriage. Additionally, women who smoke cigarettes go through menopause an average of 1-4 years earlier compared with women who do not smoke.  Smoking cigarettes appears to cause increased loss of healthy eggs. Smoking marijuana seems to have similar negative effects on fertility.

Men
When it comes to men attempting to conceive, small amounts of alcohol and caffeine use do not appear to adversely effect sperm parameters (density, motility, and abnormalities in morphology). However, cigarette smoking and marijuana use have been shown to decrease all sperm parameters. Severly overwight men also have decreased sperm parameters and decreased fertility.

In Sum
As Aristotle  wrote 2,500 years ago, “Everything in Moderation”: there is no need to be an ascetic while trying to conceive.

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Uterine fibroids are associated with miscarriages and may be a cause of recurrent pregnancy loss.  A recent study from the United Kingdom (Human Reproduction 26:3274;2011) found that the intrauterine cavity was distorted by fibroids in 8.2% of women with a history of recurrent pregnancy loss.  They also found that surgical removal of these intrauterine fibroids increased the chance of their next pregnancy delivering a healthy baby by as much as 50%.  This study exemplifies the importance of a thorough evaluation including intrauterine cavity assessment for women with a history of recurrent pregnancy loss so that intervention can occur to prevent another miscarriage.

Toxins and other negative environmental aspects can interfere with reproduction. These negative effects may be ameliorated by adopting a healthy lifestyle including better nutrition. Many nutritional supplements have been promoted to enhance reproductive performance facilitating successful pregnancy.

Omega 6 fatty acids are pro-inflammatory which means your body senses injury, creating a wound response releasing free radicals that can be harmful. Antioxidants scavenge free radicals lessening their harmful effects. Antioxidants are in fruits and vegetables.  Omega 6 fatty acids are in many processed foods. So by simply supplementing processed foods with fruits and vegetables is a great start to enhancing fertility.

Omega 3 fatty acids do many beneficial things including decreasing inflammation, decreasing the pain response associated with endometriosis, and promoting progesterone response and receptivity which supports normal pregnancy. Since humans cannot synthesize omega 3 fatty acids, we must get them from our diet, primarily from the fish we eat (from the algae they eat). Although fish oil can be supplemented, it is always best to get your vitamins and minerals from their natural source. Omega 3 fatty acids should outweigh our intake of Omega 6 fatty acids. Currently, the typical American diet consists of omega 6 fatty acids outweighing omega 3 fatty acids by 15 fold.

Other vitamins that can fight inflammation are: vitamin C which has a positive effect on percent of “normal” sperm and can increase sperm motility, Vitamin E which has been linked to reducing age related ovarian decline, Vitamin D which may enhance egg quality and whose deficiency is related to pain, and vitamin K. B vitamins are of special interest due to their role in flushing out estrogen. Your liver depends on B vitamins to filter estrogen from the bloodstream via the bile duct into the intestinal tract. If estrogen is not eliminated from the body it will re-circulate which can lead to estrogen dominance. An unhealthy weight and exposure to xenoestrogens which accumulate from ingesting pesticides disrupt endocrine function.

Oral contraceptives can deplete certain vitamins and minerals including vitamin C, B12, B6, B2, folic acid, magnesium and zinc. Therefore women using oral contraceptives should also be taking multivitamins.

Although, the thought of toxins and unknown chemicals in your body is scary to think about, there is something you can do about it. You have the power to improve your own fertility as well as your overall health though nutrition by cutting out processed foods, eating more fruits and vegetables, and incorporating more Omega 3 fatty acids into your diet. Remember, optimal nutrition before pregnancy is extremely important in helping you have a healthy baby.

On the day of fertilization, still within the comforting confines of the fallopian tube’s ampullary region, the genetic material of the sperm (male pronucleus) and the genetic material of the egg (female pronucleus) fuse to form an early embryo called a 2PN for two pronuclei. By the second day following fertilization the embryo develops into a two to four cell embryo and continues its journey down the fallopian tube into what is called the isthmic region. These embryonic cells continue to divide producing a ball or cluster of cells by the fifth day after fertilization called a blastocyst. At this blastocyst stage of development the embryo leaves the fallopian tube and enters into the uterine cavity via the tubal ostia. Once in the uterine cavity the blastocyst literally hatches from its zona-like shell. After an additional two days of wandering, seeking a safe and secure place to land, the hatched blastocyst finally burrows into the luxurious uterine wall from which, if all goes right, a baby is born nine months later.

Only a few hundred of the millions of sperm deposited actually reach the egg. The sperm like hounds to the hunt are thought to be guided to the egg by her alluring secretions acting like homing beacons. Upon finally reaching the egg by those that could follow directions, the sperm (still as yet a team effort) become hyper-activated, beating their tails in frenzy (like a Golden Retriever with a new toy). This passion provides the mechanical energy necessary for sperm to disperse the cumulous oophorus and bind to the zona pellucida. At this time a chemical is released by the attached sperm in a bombarding-like process called the acrosome reaction. Acrosomal enzymes like barbarians at the gate barrage the zona pellucida by making small holes like individual battering rams so that one victorious sperm of the hundreds lucky enough to be there out of the millions who tried can now triumphantly swim through and reach the egg surface. Once the egg recognizes that her defensive wall has been breached, she transforms her zona into an impenetrable barrier preventing additional sperm from entering and is thereby left alone to dance with the now only one intrepid intruder.

Potentially modifiable lifestyle factors can affect your ability to have a baby.  These factors include age, smoking, caffeine consumption, alcohol consumption, weight, diet and exposure to environmental pollutants.  We have previously reviewed the impact of aging on fertility and in this installment we review the adverse effects of smoking and infertility.

SMOKING

Smoking either by men or women can adversely affect the ability to conceive and deliver a healthy baby. In men, smoking can negatively affect sperm production, motility and the way they look (morphology). Smoking can also cause DNA damage leading to chromosome abnormal sperm. Men in couples having In Vitro Fertilization (IVF) and Intra-Cytoplasmic Sperm Injection (ICSI) have decreased success rates if they smoke compared to couples having these fertility procedures in which the man does not smoke.

In women, cigarette smoking can alter hormone levels critical for successful pregnancy. Both active and passive (second-hand) smoking can hinder egg production, fertilization, and implantation. Smoking is also associated with an increased chance of miscarriage. Smoking can reduce your chances for pregnancy even with IVF. Women having IVF who smoke do not respond to ovulation induction medications as well as non-smokers. In smokers where eggs are obtained, their ability to fertilize is decreased and if they are able to fertilize, embryo quality and implantation potential are decreased compared to that in non-smokers. Twice as many IVF cycles are needed to achieve pregnancy for smokers compared with non-smokers. In one large study of 8457 women having their first IVF cycle there was a 28% decrease in having a child in smokers compared with those who did not smoke. Studies from fertility centers across the country have reported that if a woman ever smoked in her lifetime her risk of not becoming pregnant from IVF more than doubled and the risk increased with each year of smoking. Smokers who are pregnant following IVF also have twice the risk of early pregnancy loss compared to non-smokers.