But that doesn’t mean sexuality doesn’t matter.

Sexuality and fertility and, yes, love, are all mixed together for all of us.

If fertility is difficult, if your sex life is feeling stressful or unfulfilling, it can hurt your emotional well-being. It can hurt your relationship. It can hurt you.

For some couples, integrating your sexuality (your desires, preferences, and physical pleasure) into the process of trying to achieve pregnancy can make a big difference in the journey. Here are a few suggestions:

• Find a fertility counsellor. These counsellors specialize in fertility issues and are familiar with the stresses involved, including on your sex life. Here’s a list of Toronto-based ones.
• For women and their sexual partners — check out OMGYES. Based on a large-scale study of women (cisgendered), this modern website features thoughtful, graphic videos of sexual techniques that can elicit more pleasure, and assist you in reaching orgasm. It’ not a free service, but you can start with a free sample video to try it out.
• For men — it can be touch to talk about, but sometimes the pressures of “making a baby” can overwhelm sexual desire. If you have concerns, consider starting here and reach out to us if you are interested in referrals. Many men will temporarily use Viagra, for example, to assist in the fertility setting. And don’t hesitate to seek therapeutic support: for many, the quantification of sperm at a fertility clinic (the detailed discussion of how many, or how few, sperm are present) can take a toll on sexual self-esteem. Of course, logically we know that sexuality and sperm counts are different things. But for many men, the two feel like one and the same. An experienced therapist can help you, and your partner, regain confidence.
• Nowadays, many modern, independent sex shops offer educational courses and workshops led by professionals on sexual topics, including improving your sex life. While these events may not be geared specifically toward those trying to conceive, they can help you learn new techniques and approaches. These events also tend to be more LGBTQ-friendly.

Do you have other tips or resources? Feel free to share them in the comments.

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This is a fairly updated list of counsellors, therapists, psychologists, social workers, and psychiatrists in the greater Toronto area (GTA) who specialize in fertility issues. A few tips on how to select one:

• Contact a prospective therapist to find out his/her availability
• If you’re in financial need, ask about sliding scale pricing
• Go for an initial meeting to see if it’s a good fit
• If you haven’t seen a therapist before, try having meetings with a few different professionals, to get a feel for the kind of person who feels most supportive and helpful to you

If this is your first time seeking therapy, you can learn more about the basics of the process here.

The post How do I find a therapist/psychologist in Toronto who specializes in infertility? appeared first on Fertility.ca.

It’s our recommendation, and the Canadian National Advisory on Immunization, Motherisk, Mount Sinai hospital, World Health Organization, and Public Health Agency of Canada all support this as well: the H1N1 flu vaccine (and similar vaccines) have not been shown to cause harm to pregnant women or their babies.

What’s more, as someone who’s trying to (or already) pregnant, you’re considered a “priority group” to receive the vaccine — because you and your baby are at specially high risk of being endangered by H1N1. This isn’t just a doctor’s nervous speculation: it’s what the medical community learned in 2009.

In 2009, pregnant women who caught the H1N1 flu were a staggering 400% more likely to be admitted to the hospital because of medical problems, and also had greater chances of experiencing pregnancy complications — including premature birth and loss of their pregnancy.

If you’re vaccinated, not only will you be better shielded from these potentially severe flu-related health and pregnancy complications, but the protective effect of the vaccine will be passed through the placenta.

In other words, the vaccine protects your baby as well — babies whose mothers received the vaccine were 60% less likely to have influenza in their first year.

So, as a fertility doctor, I urge you to get the vaccine.

To learn more about the science behind the vaccine and its effects on a pregnancy, read about it at Motherisk.

References:

Motherisk. Drugs, chemicals, radiation & herbal products in pregnancy: H1N1 Influenza in Pregnancy: Risks, vaccines and antivirals. Available at: http://www.motherisk.org/women/commonDetail.jsp?content_id=914, Accessed October 21, 2015.

Public Health Agency of Canada. FluWatch Weekly Report Apr 19-Apr 25, 2009 (Week 16). Available at: http://www.phac-aspc.gc.ca/fluwatch/08-09/w16_09/index-eng.php, Accessed October 27, 2009.

CDC. Use of Influenza A (H1N1) 2009 Monovalent Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 MMWR 2009;58(No. RR-10) :1-8. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm. Accessed October 23, 2009.

World Health Organization. WHO recommendations on pandemic (H1N1) 2009 vaccines Available at http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090713/en/index.html. Accessed October 29, 2009.

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What can happen if you have hypothyroidism?

You can think of the action of thyroid hormone as revving up your body and keeping it functioning at the proper rate. Too little and things slow down, and too much causes things to go too fast. Common symptoms of hypothyroidism include fatigue, weight gain, constipation, loss of sex drive, hair loss, dry skin, loss of periods, and miscarriages.

What causes you to get hypothyroidism?

Most commonly hypothyroidism is a result of an autoimmune process (your immune system attacks your thyroid gland with antibodies) called Hashimoto’s thyroiditis. Other causes include surgery or radiation treatments.

How do we test for hypothyroidism?

The most sensitive way to track thyroid activity is indirectly, by measuring Thyroid Stimulating Hormone (TSH), a hormone that stimulates your thyroid to produce thyroid hormone. When thyroid function is low, the brain detects this and raises the TSH to stimulate the thyroid. A higher than normal TSH suggests that your body is detecting hypothyroidism.

What is a normal TSH level?

Traditionally, TSH levels from 0.5 to 5.0 were considered normal. Above 5, we would diagnose and treat for hypothyroidism. (If the patient doesn’t actually have any symptoms, we call it “subclinical hypothyroidism”).
More recently, some researchers suggest we should treat subclinical hypothyroidism when TSH is over 2.5. There is some controversy around this. When the TSH is elevated your doctor will often ask for additional tests to look for the antibodies that would indicate that this is the autoimmune form of hypothyroidism.

How can hypothyroidism affect fertility?

For starters, hypothyroidism can lead to irregular cycles. It also affects babies because they rely on their mother’s thyroid hormone levels for the first trimester because its thyroid is not fully functional until around 20 weeks of gestation. If you are hypothyroid early in the pregnancy, your baby is as well. This is clearly a problem when you have untreated overt hypothyroidism but it is debated how much of a problem is posed by subclinical hypothyroidism. Most physicians will err on the side of treatment for subclinical hypothyroidism when you are trying to become pregnant.

How is it treated?

Hypothyroidism is treated with a synthetic form of thyroid hormone called Levothyroxine. It can take some time to make sure the dose is correct and so often a repeat blood test will be done in 4-6 weeks. It takes about that long for the TSH to adjust to the Levothyroxine or for any change in the dose of this medication. Monitoring is important to make sure you are getting enough thyroid hormone and also to make sure you are not getting too much.
Levothyroxine is a synthetic hormone with few impurities, very few side effects and produces almost no allergic reactions.

Once a patient is pregnant we will often increase dosing as pregnancy hormone interacts with TSH. We check TSH levels for all of our pregnant patients. If you are taking Levothyroxine there is no harm in reminding us that you too may need to have your dose increased.

What is “natural” thyroid hormone and should you take it?

The main hormone secreted by your thyroid gland is T4 hormone. Your body will then convert this to T3 hormone, which is the more active form of thyroid hormone. Natural thyroid hormone is desiccated thyroid gland and contains T3 and T4. It may be dangerous as the levels are difficult to predict. Most endocrinologists prefer to give synthetic T4 and let your body decide how much to convert to T3.

More questions?
Ask us here! We want to help.

You can also visit www.thyroid.ca.

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Sperm’s ability to fertilize an egg is dependant on healthy DNA. But some sperm are fragmented.

Healthy DNA is arranged in a double-helix spiral bound by cross-bonds resembling a ladder. DNA damage means the bridges become unstable or broken causing instability in the DNA ladder.

That instability is referred to as fragmentation or damage of the DNA. If there is a high amount, you’ll likely see a reduction in male fertility, poor embryo development and lower rates of implantation.

Scientific literature shows that the extent of DNA fragmentation has little relevance to the basic semen quality parameters (concentration, motility, morphology, etc.) For example, a “good” sperm sample with high concentration, motility and morphology doesn’t guarantee you’ll get pregnant if there’s poor DNA Fragmentation Index (DFI).

Why is DNA Fragmentation important in the assessment of male fertility?

The test (flow-cytometry or TUNEL assays) is used to count the number of sperm cells per sample that contain suboptimal, damaged or fragmented DNA.

What are the values and what do they mean?

DNA Fragmentation Index (DFI) is used to quantify DNA damage in the sperm. DFI is inversely related to sperm’s ability to fertilize an egg and produce a viable embryo. DFI of less than 15% in sample is considered optimal. DFI between 16-29% is considered to be good or fair fertility potential. Sperm with DFI over 30% is considered to have poor fertility potential. Although exceptions do exist, these percent ranges have been established based on numerous scientific publications over many years of research.

What does testing mean for our ability to conceive?

• More accurate assessment of semen sample quality
• May explain previous failed attempts to conceive
• Determine suitability for IUI versus IVF/ISCI
• Assessment of efficacy of medical intervention or treatment of infectious diseases to improve
• Ultimately improve fertility potential of the male partner

What are the causes of DNA damage?

We don’t yet know all of the factors that lead to DNA damage. Most common ones we do know are chemical/toxin exposure, heat exposure, varicocele, age, infection, smoking, alcohol, radiation or testicular cancer.

The post What is DNA Fragmentation? appeared first on Fertility.ca.

We cannot really comment on the necessity of the test. But we can say unequivocally: no procedure should hurt. With modern anaesthesia, there really is no excuse for it. For example, in your case, you could ask about misoprostol (to soften the cervix), Ativan (for you), and a local-freezing-spray for your cervix. The procedure itself should never stand in the way of your desire to become pregnant. Hope that helps.

The post What can I do about pain during procedures?  appeared first on Fertility.ca.

I was reading about the success rates of FSP (fallopian sperm perfusion) for unexplained infertility and how FSP may be more effective than IUI. It is suggested that couples with unexplained infertility may benefit from FSP over IUI, resulting in higher pregnancy rates.

I was just wondering what your thoughts were on FSP vs IUI and if you offer FSP treatments?”

We use a modified FSP technique much of the time.

FSP was developed in the 1990s, before ultrasound could be used widely. It addressed the concern: is it better to have the sperm highly concentrated and thus quite possibly left in the fundus of the uterus (“IUI”) or dilute the fluid 8x, put a balloon or other device to make sure nothing comes back, and thus ensure through higher pressure and volume that sperm must go up the tubes (“FSP”).

It took randomized controlled trials to see if there was a difference. The result: both techniques appear to deliver the same pregnancy rates. You can read more about this in The Cochrane review, here.

At our clinic we do a combination of IUI or a FSP variant with every insemination: we focus on ultrasound guidance and, when necessary, using a balloon catheter to keep the sperm up and inside. We’ve been doing this for about four years or so. When we started we saw a 50% boost in pregnancy rates from previous techniques. Now we find success rates are the same whether we use ultrasound or not (but M-F we use ultrasound).

In our opinion, pregnancy rates are maximized when your team is focusing on what you individually need. Its less about IUI FSP or ultrasound, more about your clinician taking care when completing the procedure.

Hope that helps!

The post What’s more effective: IUI or FSP? appeared first on Fertility.ca.

That said, while Betabase shows the broad range of normal, its numbers are also fallible: self-reporting can result in inaccuracies. Historically, this data has been collected by clinics, which keeps the numbers accurate and reliable…but the sample size quite small.

So which is better: traditional clinic data collection or self-reported online data collection? We don’t know, but our guess is neither is inherently better, just different. The information each individual patient is personally seeking will ultimately determine which data set is more valuable and enlightening, and until we know more about the differences or similarities between these data pools, it can’t hurt to look into both.

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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.

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You can talk to your doctor to find out whether HCG, clomiphene, letrozole, and rFSH preparations will be helpful for you.

Vitamin therapy is one of the easiest steps to take. We suggest Vitamin E up to 400IU/d, Zinc up to 70mg/d, Selenium up to 250mcg/d, Folate (1-5mg/d), Vitamin C (500-1000mg/d), and Co-enzyme Q10 (200mg/d). If red meat isn’t a part of your diet, L’carnitine supplements may be helpful.

A recent analysis of 12 studies from around the world found that lycopene could contribute to greater sperm health. Either way, a diet rich in red fruit and vegetables such as tomatoes, strawberries, peppers and watermelon isn’t bad for your health.

The good news is that the majority of men will see a sperm quality increase through some basic lifestyle changes. Stay away from the sauna and hot tub for a few months, get plenty of exercise, rest up and reduce or quit smoking.

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