Foods for Dudes: Get in fertile-fighting shape with these 4 nutrition tips

For all those thinking about fatherhood, here are 4 honest tips from one of our top fertility nutritionists in NYC, Aishling Whelan, RD. 

1. Shed Some Pounds. Studies show that men of normal weight (BMI 20-25) produce more sperm and less abnormal sperm compared with men who are overweight or obese. Regular exercise combined with a diet rich in fruits, vegetables, and lean protein is a good place to start.  

2. Take Your Vitamins. A healthy diet is key for supplying your body with the nutrients it needs to function like the stud that you are. Unfortunately, many healthy diets still don’t supply the appropriate amounts of certain vitamins and minerals, which can put a damper on conception. For increasing your fertility focus on folic acid, vitamin E, vitamin C, and zinc--a standard multivitamin should provide you with sufficient amounts of each nutrient.  

3. Reduce Your Exposure to Pesticides: Eat Organic. There is a growing body of evidence supporting a link between pesticides and reduced sperm concentration as well as other sperm quality factors. One of the ways people are exposed to pesticides is by consuming conventionally grown fruits and vegetables. To stop your swimmers from taking a dive, choose organic fruits and vegetables whenever possible. For a list of foods to avoid, check out www.ewg.com for a list of produce with the highest quantity of pesticide residue. (‘The Dirty Dozen’) as well as the conventional produce shown to have the least amounts (‘The Clean Fifteen’). 

4. Reduce Your Alcohol Intake. This just in: Several thousand sperm with promising futures seriously injured in an alcohol related incident! The evidence is pretty clear that excessive alcohol intake can lead to the production of defective sperm. Defective sperm are less capable of fertilizing an egg and conceiving your future genius. When it comes to light or moderate drinking, the research is less clear. So, play it safe by not overdoing it and sticking with the recommended two drinks per day or less.  

Reception vs. Conception: Mobile Devices and Their Possible Effects on Male Fertility

Written by Matthew Wosnitzer M.D.Attending Urologist at Yale New Haven Health-Northeast Medical Group in Connecticut.  Dr. Wosnitzer is our go-to for all questions on male fertility.  Here, he summarizes why men trying to conceive may want to move that cell phone to a back pocket or ditch the iPad for a while.  


*originally published in The Daily, September 20, 2011.

Male fertility vs. heat: For men reading this on an iPad, chances are that you aren’t considering how your mobile device could affect your fertility.  With many young men using cell phones, 3G/4G-enabled tablets or laptops worldwide, the potential for damage from portable devices exists.  Testes function optimally at a temperature less than normal body temperature, and it has been well-documented that sperm production decreases when scrotal temperatures are elevated from heat generated by tablet, laptop or cellphone use or storage near them.

Male fertility vs. EMF: Mobile devices also produce electromagnetic frequency radiation (EMF).  Although the World Health Organization International EMF Project has been studying possible health effects of EMF radiation, results remain controversial.  The Federal Communications Commission has established specific absorption rate limits for all cellular devices in the United States.  These limits, however, don’t account for the amount of time that a mobile device is kept in a specific position, such as in a man’s pants pocket during an entire workday.  The FCC says, “Currently no scientific evidence establishes a causal link between wireless device use and cancer or other illnesses.”  Yet multiple studies have identified detrimental effects of EMF radiation from mobile devices on mice and humans.  The most researched area is the brain, but recent studies indicate that EMF radiation can decrease male fertility when men carry or use devices near the testes.  

Following puberty, sperm form in the testes, are warehoused in the epididymis, and leave the male body in fluid (semen).  Sperm cells grow rapidly and may be categorized based on shape, movement and total count.  Daily usage time of mobile devices continues to increase, including among teens (as a Kaiser Family Foundation/Stanford University report noted), and this may accentuate effects on sperm.  Physicians at the Cleveland Clinic report that electromagnetic waves cause increased stress and changes in DNA that can damage or kill sperm.  Cellphone radiation, especially with increased daily usage time and storage in pants pockets, is associated with decreased sperm count, according to researchers in the United States and Europe.  

Male fertility vs. Wi-Fi: What about Wi-Fi networks?  EMF levels from Wi-Fi devices are significantly lower than from mobile phones.  The Health Protection Agency in Britain is studying effects.  Researchers from Argentina demonstrated that semen samples exposed to Wi-Fi showed increased DNA damage and decreased sperm movement.  This is important since sperm DNA quality and movement are critical factors for normal sperm-egg fusion during fertilization.

Male fertility vs. the world: The ultimate bioeffects from EMF radiation remain under investigation.  Larger studies of heat, EMF and Wi-Fi produced by mobile devices are needed.  Monitor the guidelines of established international groups such as the WHO.  Consider suggestions from the FCC to reduce exposure.  Hold the device away from your body on a desk, use hands-free accessories and do not keep the device turned on in a pocket or use for extended periods.  Until there’s definitive conclusion, consider placing the iPad on a briefcase or pillow to increase the distance from the testes.  

SHOTS! SHOTS! SHOTS! 5 injection tips from seasoned pros

Injectable medications are a part of nearly all fertility treatments...and they're not fun. It’s okay to be nervous. Getting shots every day, multiple times a day? It isn't exactly a walk in the park. We talked with women from the preconceive community who conquered their nerves, became injection rockstars, and wanted to share the tips and tricks they learned along the way. That's what friends are for, right? 

Here's their advice for mastering injectable medications:

1. Rise and shine. Your doctor will tell you whether to take a certain shot in the morning or at night, but sometimes you can choose. Once you choose the time, you will have to stick to it throughout the duration of the cycle.  One preconceive member told us, “I find getting the shot over with earlier in the day can help to minimize the anticipation build-up--so it won’t be looming over you all day.”

2. Easier to do it yourself. Who knew?! You might think that having anyone else administer the shot--doctor or nurse, family or friend, significant other or man off the street--would be easier to handle. “For me, it turned out to be more complicated and time-consuming than just doing it myself. In the end, self-administering was actually the least painful option."

3. Pinch yourself. “Find your belly fat, pinch it, and poke the needle right in there--it should hurt less.” We’ve always known our tummies would come in handy one day. Plus, it turns out the more ice cream and cheese you eat, the higher your chances of conception. DONE.  

4. Rotate. Pick a different spot for each injection so you’re not sticking the same sensitive area every time. Women often bruise easily, so don’t be worried if you start to see small bruise marks around your shot areas. “Just keep rotating and picking fresh new spots.”

5. Gelous. Bad news: unlike other hormone injections, the progesterone shot goes into the muscle and is more painful than the ones that go into your belly fat. Good news: progesterone can come as either an injection or a gel. While the vaginal gel is more expensive, it may be worth it not to have to take as many shots every day. Ask your doctor about your options.  

BEWARE: Read each medication’s box very carefully, as some fertility drugs need to be refrigerated and some don’t. Luckily, most come with detailed instructions that anticipate any questions you may have about storage. Always feel free to consult the nurses at your fertility clinic--they’ve likely heard every question under the sun.

 

Straight to the point: a step-by-step guide to self-injections

Stabbing yourself with a sharp object might not seem like a thrilling proposition. We get it. 

We asked fertility expert Maryanne Williams Pitman, RN, CCRP, for a straight to the point (pun intended) guide on the how-to of self-injections.  Here’s her simple twelve-step guide:

1. Assemble everything you need on a clean, dry surface.

2. Wash and dry hands thoroughly (Shoot for 30 seconds of bubbles).

3. Pick an injection site. Common sites include: abdomen below the belly button, thigh, or upper outer arm. 

4. Verify the dosage your provider prescribed.

5. Dial in the dose on the injector (ie: 150 IU or 225 IU).

6. Prepare the skin site by using an alcohol wipe. Swipe in an expanding circular motion.

7. Let the site air dry.

8. Uncap the needle.

9. Firmly pinch about an inch of belly fat (or fat at desired injection site) between the fingers of your non-dominant hand.

10. Inject the needle into the pinched fat and depress the injector button. Tip: The action of injecting is all in the wrist. Don’t hesitate, work swiftly, and pinch firmly. It’ll be easy and over before you know it.

11. Blot the injection site with a clean tissue and carefully dispose of the needle-most medication deliveries come with a sharps container for disposal of the syringe.

12.  Relax! All done.


 

Male fertility test results 101

The 5 things you need to know to understand your semen analysis results.

When making your fertility to-do list, you may want to consider getting a semen analysis done before the female workup because it’s cheaper, faster and easier–both logistically and physically.  The analysis results can also immediately eliminate a long list of possible diagnoses (like asking about facial hair in a game of Guess Who?, so you can take your next steps with confidence.  Plus, all men should include at least two semen analyses in their fertility workup, so you might as well get the first out of the way early on.

Although a semen analysis interpretation looks at many different parameters of semen, urologist and male infertility specialist Dr. Matthew Wosnitzer tells us there are five main factors.  He outlines the criteria for each below with the benchmark reference values defined by the World Health Organization as the minimum “normal” values (i.e., 95 percent of men have results equal or better).

1. Sperm count/concentration

What it is:  Sperm count is the total number of sperm in the whole ejaculate.  Sperm concentration is how many millions of sperm per milliliter.

WHO benchmark:  At least 39 million sperm per ejaculate with a concentration of 15 million sperm per milliliter
Diagnosis:  Low sperm count (oligospermia) or no sperm (azoospermia)

Next steps:  Oligospermia could be a result of multiple causes including varicoceles, genetic or hormone abnormalities, medications, or systemic diseases such as cancer.  Have your urologist confirm sperm count with a follow-up analysis and then conduct further appropriate investigation based on findings of decreased sperm count.

2.  Volume

What it is:  The most straightforward parameter of the test, semen volume refers to the total amount of male ejaculate.

WHO benchmark:  1.5 milliliters or more semen per ejaculation
Diagnosis:  Low volume (hypospermia)

Next steps:  If the volume of ejaculate is low, it could be a inadequate collection of the semen sample or it could be an obstruction in the male reproductive tract (blocked plumbing system, like an ejaculatory duct obstruction).  Have a repeat semen analysis to confirm the collection was seamless, and then see a urologist to discuss possible causes.

3.  Motility

What it is:  Motility refers to the sperm’s ability to move in a straight line and/or large circle.  Healthy movement enables the sperm to navigate the female reproductive tract and ultimately unite with the egg.

WHO benchmark:  At least 40 percent of the sperm have healthy movement
Diagnosis:  Decreased motility (asthenozoospermia) or no motility at all (complete asthenozoospermia)

Next steps:  Moving sperm are alive and healthy.  If they are moving slowly, in an abnormal pattern or not at all, there may be an engine problem (e.g., insufficient energy production or overall health).  Decreased sperm motility can occur because of varicoceles, medications, systemic illness or anti-sperm antibodies.  See a urologist who specializes in male infertility to identify what factors may be causing the issue.

4.  Morphology

What it is:  Morphology refers to the size and shape of the sperm head, mid-piece and tail, each of which is judged by a variety of scoring systems.  In general, healthy sperm have an oval head and a long tail.  Sperm with severe morphological defects may have a more difficult time fertilizing an egg.

WHO benchmark:  Minimum 4 percent of sperm have regular size/shape
Diagnosis:  Poor morphology (teratospermia)

Next steps:  The health of the sperm should be evaluated further.  Abnormal sperm shape and/or size may be a response to heat or other environmental influences (such as a varicocele), or it could reflect a larger problem (such as a genetic issue like DNA fragmentation).  Although the relationship between poor sperm morphology and pregnancy remains unclear, there is recent research indicating that abnormally low morphology does not impact IUI or IVF/ICSI results (American Urological Association Annual Meeting, 2014).  See a urologist who specializes in male infertility and has experience treating men with abnormal sperm shape, in particular.

5.  pH

What it is:  pH refers to the acidity level of the semen.  Healthy semen is basic (low acidity, higher pH).

WHO benchmark: Higher than or equal to 7.2 pH
Diagnosis:  Acidic semen (low pH) may be caused by obstructed ejaculatory ducts or congenital bilateral absence of the vas deferens (CBAVD, which can occur with cystic fibrosis)

Next steps:  About 50 to 70 percent of the seminal fluid in humans is basic and originates from the seminal vesicles.  When those are blocked, the ejaculate becomes acidic.  The female reproductive tract is slightly acidic, so the basic pH of the seminal vesicle secretion balances this environment.  If the semen is too acidic, have a urologist analyze semen pH abnormalities and other seminal parameters.

 

IVF treatment explained step by step

Here’s our 101 guide to help you understand what is required during the IVF treatment process.

 

Ovarian stimulation

In a typical menstrual cycle, one ovary makes one follicle that releases one egg when you ovulate.  However, to maximize the chances of success of ART treatment, we try to increase the number of follicles the ovaries are producing in a single cycle.  For IVF, this is so your doctor can retrieve the maximum number of eggs from which she can create embryos.

Your stimulation protocol will be tailored by your fertility doctor specifically for you.  Almost all protocols involve one or two daily hormone injections, and sometimes will also include another injectable medication to prevent you from ovulating on your own (i.e., before your doctor can retrieve the eggs).  The hormones you take are the same as those that tell the ovary to grow a follicle in a natural cycle, just in higher doses.  The shots are done with very small, thin needles in the tissue just under the skin.  Your doctor will expect you to administer these medications by yourself (or your support team), at specific times each day.  This part of the process take on average about 9 to 12 days, but may be a bit longer or shorter depending on your response.

 

Monitoring your cycle

Throughout the process, your doctor will monitor your progress very closely, watching the growth and behavior of your follicles in order to know how many eggs you are producing and when they will be ready for retrieval.

For a standard IVF cycle, you should expect to visit the fertility clinic at least five or six times during the stimulation process.  Initially, you’ll have to go every three days or so; as you get closer to ovulation, this may increase to as often as every day.  Daily monitoring involves an ultrasound to measure the size of your follicles and thickness of your uterine lining, and may also include a blood test to measure your estrogen level as well.

Don’t be surprised if your doctor changes your IVF program a few times as your follicles develop based on what she sees in your test results.  She’s tweaking your medications to make sure you get the best, safest response possible.

 

The trigger shot

As the follicles grow, the eggs inside them are developing too.  When a follicle gets larger than about 13 mm, its egg is more likely to be mature and therefore capable of being fertilized.  Once the largest follicles reach about 17 to 18 mm, they (and you) are ready for egg retrieval.  Just one more step: an injection of human chorionic gonadotropic hormone (hCG, brand name Pregnyl or Ovidrel) and/or gonadotropin-releasing hormone agonist (leuprolide acetate, brand name Lupron), either of which trigger ovulation.  You can give yourself the injection or schedule an appointment with the nurse.

For this shot, timing is crucial: it has to be taken a specific number of hours before your scheduled egg retrieval (typically 36 hours).  Be sure to set an alarm!

 

Egg retrieval

Prepping for the egg retrieval is important.  Often, you’ll be asked not to eat or drink anything after midnight the night prior and need to arrive about an hour before your appointment to check in and give the nurses time to get you settled.  We recommend that you take the rest of the day off after the procedure.  Clinics also may require that you have someone to escort you home afterwards.

The actual egg retrieval procedure is surprisingly short after all the hard work you’ve been doing for the past few weeks.  Your doctor will use a thin needle with a hollow point to remove the egg from each follicle that has developed, guiding it with an ultrasound probe.  The procedure is done through the vaginal wall, which sounds worse than it is–there is usually minimal pain and no need for any stitches or other incisions.  All in all, the procedure itself takes only 20 to 30 minutes.

Different clinics use different types of anesthesia for the egg retrieval procedure.  If this is something that you’re worried about (or if you have any allergies), be sure to talk with your doctor about it beforehand.  Typically, clinics give a moderate anesthesia, meaning that you will be asleep but breathing on your own and, most importantly, won’t feel or remember anything.

As the eggs are retrieved, they are handed over to the waiting embryologist to be counted and prepped for the next step of the process: fertilization.

 

Fertilization

Fertilization is the process of combining the sperm and the egg.  This can be accomplished one of two ways (you should discuss with your doctor which one is appropriate for you).

1.  Standard insemination
Basically, the sperm is placed on top of the egg and allowed to make its way into the egg on its own.

2.  Intracytoplasmic sperm injection, or ICSI
Here, the sperm is injected directly into the egg using a very thin needle.  Traditionally, ICSI is used in cases where the sperm counts are low or the appearance of the sperm is abnormal.  However, today many clinics will use ICSI for other reasons, such as poor fertilization in a prior cycle, in cases when fewer eggs are retrieved, or simply because it has become the lab’s standard practice.

Fertilization takes place the same day as the egg retrieval.  The next day, the embryologist determines how many of eggs fertilized successfully (on average, this will be about 75 percent of what was retrieved).  These are your embryos, and they are immediately transferred to a special environment that mimics the tubal fluids inside the body.  There, they continue to mature for up to six days while embryologists monitor their growth and appearance (called “morphology”) daily to ensure that they are developing normally. Embryologists also use the morphology of the embryos to help determine which ones to select for your transfer.

 

Embryo transfer

Although emotionally this will probably be a very stressful day, the actual embryo transfer procedure is one of the easiest.  It takes just a few minutes and doesn’t require any anesthesia or recovery time.

After reviewing your health and your embryos’ development, your doctor will load the chosen embryos into a thin catheter and gently place them in your uterus, often using an ultrasound to guide them to the correct location.  Afterwards, you will have some time to relax and then can go about the rest of your day.

 

The pregnancy test

Two weeks after the embryo transfer, you’ll take a pregnancy test at your doctor’s office or your local lab.  Unlike an at-home urine test, this one measures the hCG level in your blood and is very sensitive.  It is typically repeated one to two more times, 48 hours apart, to confirm a diagnosis and make sure that the hCG level is rising appropriately in the case of a positive test result.  Your doctor will then schedule a vaginal ultrasound at around six weeks (which is about two weeks after your positive pregnancy test) to make sure that the pregnancy is in the right place and looks healthy.  Many clinics repeat the ultrasound in another one to two weeks to check for appropriate growth.  After that, you’ve graduated–your work at the fertility clinic is done and your work with your OB/GYN begins.

If the tests are negative, it’s time to start planning for the future.  Are you going to try another IVF cycle?  Take a break?  Is it time to consider other options?  Talk to your doctor about next steps, take your time, and make the decision that is best for you.

 

 

Top 7 things to consider when choosing a fertility clinic

Dr. Martha Noel outlines the most important factors that distinguish the right fertility clinic for you.

1. How much you like it: Before beginning any treatment it’s a good idea to check out a few different clinics in your area to get a feel for each because you’re going to be spending a lot of time at the clinic office and lab, and doing a lot of intense, hard work with its team.  There are lots of different styles of clinic to choose from, so be sure to think about which one right for you as an individual, not just as a patient.

Dr. Noel’s advice

Fertility specialists see patients in a wide variety of clinic settings, ranging from private practice to large academic hospital centers.  There are benefits to both–for example, academic practitioners are often involved in cutting-edge research, while private practitioners are more likely to devote 100 percent of their time to their clinical practice–and the decision is very personal.

Ask your general OB/GYN for recommendations, or look up fertility clinics in your area at www.sart.org.  Many of these clinics will have meet-and-greet events or info nights for you to attend as you make your choice.

2. Clinic success rates: Clinics are required by law to report their success rates to the Centers for Disease Control and Prevention (these can be found on the CDC website), but what do these rates mean to you?  Depending on your specific case and what course of treatment you pursue, you may want to look at different data.

Dr. Noel’s advice

Be careful when choosing a clinic based on the pregnancy rates it reports to the CDC.  These statistics can be ‘doctored’ (pun intended) by the clinic—by controlling the patients a clinic accepts (e.g., taking patients based on their age or other success factor), by the way in which patients are selected for fresh embryo transfer, and by the embryology lab procedures a clinic recommends.  Choose a clinic where you feel most comfortable with the physicians and the teams who will be providing your care.

3. The fertility doctor: How much does bedside manner matter to you?  Do you want a doctor who is very straight-forward?  Or more warm and fuzzy?  How much time do you expect to spend with your doctor?

Dr. Noel’s advice

Fertility clinics vary in the number of physicians that make up the practice.  Having a solo practitioner means you’ll see the same doctor for all of your visits, but keep in mind that because there is no back-up person, there may not be as much flexibility in scheduling.  In a group practice, you may not see your own physician as frequently, but oftentimes these clinics are open 365 days a year, and perform IVF cycles during almost all of that time.

4. Location, location, location: While you’re “in cycle” you’ll be going to this place every day.  Consider picking a clinic and lab that’s close by and investigate what your commute will be like to each place

Dr. Noel’s advice

When you are undergoing an IVF cycle, you’ll likely be asked to come in to the clinic for monitoring 5 or 6 times over a 2-week period before you have your egg retrieval.  Often these visits will be early in the morning.  Even for patients who are not doing an IVF cycle, most fertility treatment requires at least 1 to 2 visits for ultrasounds and/or procedures.  Keep this in mind when trying to decide how much you are willing to travel.

If you have your heart set on a particular clinic or doctor but live far away, ask them about “outside monitoring”–can you have all your ultrasounds and blood tests at another center but keep all treatment decisions with your doctor and procedures at your clinic.

5. Dolla dolla bills y'all: No doubt about it, fertility treatments are expensive.  It’s worth a call to your insurance company to get a statement of benefits and find out if any clinics in your area are in their network.

Dr. Noel’s advice

Insurance companies vary a LOT in the amount of fertility coverage they offer–some provide no coverage, some have a cap (for example, they will cover up to $20,000 but no more), and some cover certain procedures/medications/visits but not others.

This becomes very important as you think about your treatment strategy.  Most clinics have a patient liaison who can help you navigate the insurance world, so it’s a good idea to get in touch with them as soon as you can in the process.

6. Credentials: Does it matter where your doctor went to residency and did their fellowship?  Do all doctors specialize in the same area, or should you find a doctor who specializes in your particular cause for infertility?

Dr. Noel’s advice

In order to be credentialed as a fertility specialist (technically a “reproductive endocrinologist”), your doctor will have completed 4 years of medical school, 4 years of a residency in OB/GYN, and 3 years of a fellowship specifically in reproductive endocrinology and infertility.  What this means for you is that your doctor has been very highly trained, so it probably doesn’t matter quite so much where she did that training (particularly because there are only about 40 fellowship programs in the entire country).  Things like location, insurance networks and the general vibe of the practice are probably going to be more important to you than the diplomas hanging on the wall.

7. Clinic support team: Fertility treatments are a team effort.  Your fertility doctor is obviously an extremely important part of this whole process, but there are lots of others involved as well.  Nurses, cycle coordinators, medical assistants, billing staff, et. al. are all a part of your clinic experience.

Dr. Noel’s advice

The nursing staff is the front line of the clinic.  They help scheduling visits, ordering medication, answering questions and providing general TLC.  You may spend more time over email and on the phone with your nurse than you do with your doctor, and depending on the scope of the practice, many doctors have more than 1 nurse helping to care for their patients.  When you come for your initial visit, ask if you can meet the nurse who’ll be coordinating your care (and make him or her your new best friend!).

 

The 20 Minute Rule

Infertility doesn’t just happen to one person in a relationship.  It happens to both.  But, as we all know, everyone processes conflicts and hardship differently, which means that sometimes you can feel like your partner is on a totally different wavelength when you’re dealing with infertility.

But the stress of creating new life doesn’t have to come between you and your partner.  In fact, experiencing infertility together may even bring you closer together.  We asked Dr. Linda Applegarth, Director of Psychological Services at the Cornell’s Center for Reproductive Medicine and Infertility, to give a few words of wisdom to help you and your partner stay on the same wavelength when trying to conceive.

Dr. Applegarth’s advice

Even the most stable and supportive of couples can encounter issues that bubble to the top when they are trying to get pregnant.  Perhaps one member wants to talk about it a lot–she may feel that talking about it can change things.  And the other may want to check out because he feels helpless to change the situation.  Talking calms her anxiety, but he gets frustrated that they are talking in circles.

My simple rule:  limit the time you are allowed to talk about it.  Set a timer for 20 minutes.  That way, the opportunity to communicate for the partner who wants to vent is balanced by an end time for the partner who would rather not talk about their feelings.

Also, give yourself permission to seek help when you go through this, both individually and/or as a couple.  This is often the first crisis you experience in your marriage or as a couple, and you may be ill-equipped to handle it alone.  Therapy doesn’t have to be a long-term solution–seeking professional help can help you get through this difficult stage and build communication tools for the future.