Toronto Public Health is very clear on its relationship to alcohol and pregnancy. Its May 2014 communique references these very clear key messages: There is no safe level of alcohol exposure at any time in pregnancy, and that when planning a pregnancy it is safest to stop drinking alcohol before becoming pregnant.

Without doubt, these are reasonable comments.

At the same time, it puts women who are trying to conceive over an extended period, in a socially very awkward position.

The challenge that I see is that women who are trying to conceive for a month or two are socially in an entirely different position to women who are trying for a year or two.

It can be incredibly awkward to need to refuse all alcohol, in all social situations, at all times, for years at a time, while awaiting a pregnancy that, in many circumstances, should be a private story, or at least not one that you would wish to be exposed in a new social setting. How awful to get raised and knowing glances from others around the table when you decline a social drink!

But I cannot state unequivocally that alcohol is safe and appropriate while trying to achieve pregnancy. For one, some people do self-medicate with alcohol for sleep and anxiety, to serious concerns for those who are in fertility clinics and trying to achieve pregnancy.

The evidence very clearly indicates that alcohol does not promote egg quality or the safety of embryos. Perhaps there are antioxidants such as resveratrol in reasonable doses from red wines from wet regions in the world. But if resveratrol were your goal, it can be found in tablet or dietary form and red wine is not required as part of the process.

But, what of other data that suggests people who drink one drink a day are more likely to live longer than people who abstain? It is possible that alcohol is a vasodilator and increases blood flow, including to the pelvis; but again, I have seen no study and heard no evidence that alcohol in any way helps promote better egg development or uterine lining.

Alcohol is part of the big four substances that people wrestle with in their personal lives, the other three being coffee, cigarettes, and marijuana.

In my clinic, I routinely advise that one cup of coffee a day is fine, cigarettes are to be avoided as the residues have been clearly demonstrated to accumulate within the follicular fluid that surrounds eggs, and there is some evidence that marijuana may reduce implantation rates by interfering with the natural receptors associated with stress and with implantation.

I don’t know what to say about alcohol.

I know if it were my wife who was trying, I would encourage her to have a social drink from time to time throughout the process. If she were drinking alone in the basement, that would be one thing, but light social alcohol in moderation with friends, if it is part of your lifestyle, is a lot to give up for years at a time.

Perhaps, if you want to justify it this way, you could remember that implantation itself does not occur until approximately five to seven days after ovulation. If you know when you ovulate, does that mean it is okay to drink before that moment? I do not know.

I would ask that you be kind to yourself throughout this process of trying to achieve pregnancy, and if you are deciding to abstain from alcohol, I hope you are able to reward yourself in some other fashion. I hope you are able to achieve the same sense of social connection to those around you which is usually why people reach for a glass in the first place.

The post Alcohol when you’re trying to conceive. appeared first on Fertility.ca.

This is how it works: over the course of 10-14 days the egg will grow from immaturity within an antral follicle, and turn into a large, hopefully-soon-to-be-fertilized, mature egg in its dominant follicle. Both the egg and the follicle have to be functioning properly for the cycle to go well.

The dominant follicle makes estrogen, and once you ovulate, progesterone. Estrogen and progesterone together govern the activity of your uterus, which you experience as your menstrual cycle.

If you have a healthy egg, you have a healthy follicle and you expect a healthy menstrual cycle. This means the reverse is true too: when we think that your menstrual cycle is going well, we strongly suspect that you must be making healthy, high quality eggs.

Here are the factors that we look at when deciding if a given menstrual cycle is going well:

Menstrual Cycle History

Day of ovulation

Ideally ovulation will occur on days 11 or 12. Delayed ovulation – day 13 or later – is not a sign of egg quality concerns; in fact, it is more commonly a sign of an excess ovarian reserve, which is generally a good thing. But early ovulation – days 8,9, or 10 of the cycle – implies lower quality eggs.

Premenstrual Spotting

Once the egg is released, the leftover follicle (now called a corpus luteal cyst) makes progesterone. Progesterone stabilizes the lining of the uterus. A low-quality follicle is less likely to be associated with enough progesterone, and therefore the woman may notice a shorter luteal phase and/or premenstrual spotting.

Cycle Length

Long cycles are ok, but short cycles are not. If previously-28-day-cycles are now 26 days, it suggests egg quality is failing. Cycles are shorter because of the early ovulation and shortened luteal phases described above.

Menstrual Cycle Lab Values

Peak Estrogen

When a woman is about to ovulate, estrogen will be at its maximum level. Estrogen effects may be noticed as spinnbarkeit. We can also measure estrogen levels through blood tests; peak estradiol is between 500 and 1000 pmol/litre per healthy follicle. When cycle monitoring, ask your clinical team what your peak estrogen was: bigger numbers are better. If the level is towards 500 (or lower) per mature follicle, then egg quality may be a concern.

Peak Progesterone

Progesterone is made by a healthy corpus luteal cyst. Peak progesterone values, traditionally measured on “day 21″ of your cycle (but more accurately recorded 7 days after ovulation) is usually 30 ng/ml or higher for a fertile cycle.

I can write to all this in greater detail if you are interested; the relationships between eggs, follicles, hormones, and the menstrual cycle is complicated but fascinating. (Well, fascinating if you are a Reproductive Endocrinologist…)

But the important part is, because of these inter-relationships, we can help you to maximize the likelihood of releasing a good egg in the next cycle by manipulating hormones in this cycle. It is called estrogen priming, and will be the subject of another post.

The post “How does my menstrual cycle reflect the quality of my eggs?” appeared first on Fertility.ca.