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The word testosterone conjures up images of all things manly.  Testosterone is actually a sex hormone that plays an important role in the male sexual development and is produced in the testes.  Hormones, in general, are chemical messengers that are transported all over the body through the blood and they regulate various things like growth, metabolism, reproduction and many other things.  In men, testosterone plays a role in developing the sexual organs, in certain characteristics like bone development, growth of hair, deep voice etc, in sperm production and in having a sex drive.  However, for the hormones to work properly there has to be a balanced equilibrium of the various hormones. 

How are testosterone levels controlled

When testosterone levels are low in the blood, the hypothalamus in the brain is stimulated to produce gonadotrophin-releasing hormone which in turn increases the production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) in the pituitary gland in the brain.  This increase in LH leads to increase in secretion of testosterone in the testes which in turn leads to increased levels of testosterone in the blood.  The increase in FSH leads to an increase in sperm production.  If there is too much testosterone in the blood the reverse happens leading to an eventual decline in testosterone.  So there is a fine balance in the production of various hormones.  Sometimes however, this balance is thrown off and it can lead to higher or lower levels of testosterone.

What could affect testosterone levels

There are many things that can cause too high or too low levels of testosterone.  Some of these include having certain illnesses like liver or kidney disease, diabetes, cancer, tumors, or some issues with the pituitary gland.  Lifestyle can also affect testosterone levels like too much or no exercise, obesity, poor diet, alcoholism, smoking or stress.  Certain genetic conditions like Klinefelter syndrome, injury of the testicles, certain medications, and chemotherapy or radiation can also affect testosterone levels.  Increased age can also decrease testosterone levels. 

Effects of low testosterone

Low testosterone, also known as hypogonadism, can delay puberty and its symptoms could include low sex drive, fatigue, decrease in muscle mass, irritability, erectile dysfunction and depression. Testosterone level is usually measured with a blood test done early in the morning because the levels can vary during the day with the highest during the morning and lowest at night.  Low testosterone can directly affect fertility by causing decreased sperm production and indirectly affect fertility by reducing his sex drive and causing erectile dysfunction.  If you have low sperm count and are trying to have a baby but are having trouble conceiving, your doctor may suggest going through invitro fertilization (IVF) where the sperm is fertilized with the egg in a laboratory setting and the resulting embryo is transferred back into the woman’s uterus for implantation.

Effects of high testosterone

High levels of testosterone can cause symptoms such as aggression, high blood pressure, high sex drive, increase in hair growth, and acne.  However, abnormally high levels of testosterone can actually decrease sperm production, especially if you are using steroids or supplements.

Treatment

Men with low testosterone levels could still have enough testosterone levels for sperm production because the concentration of the testosterone in the testes where sperm production occurs is much higher than in the bloodstream.  However, one needs to look at the root cause of why the levels are low or high especially if you are wanting to have a baby and are having trouble conceiving.  Other than a blood test to determine levels of various hormones, they might also do a semen analysis, ultrasound, biopsy of the testicles and genetic testing to find out what is causing the issue.  You might need to look at any underlying health conditions and lifestyle factors first to see if these could be affecting your testosterone levels and try to rectify this first.  Many people think having low testosterone levels can be fixed by taking testosterone supplements.  Taking testosterone supplements could shut off the body’s ability to make its own testosterone and sperm and could lead to infertility.  However, in most cases, the infertility caused by testosterone treatment is reversible.  So people on hormone replacement therapy or testosterone treatment have to be monitored closely by their physician.  Any form of testosterone supplementation can disrupt the normal hormonal balance required for sperm production. So men should avoid testosterone treatment if they want to have their own biological children or should consider freezing their sperm for later use. If a man has a pituitary disorder, for example, that is causing the low testosterone, then he can be treated with a pituitary hormone (hCG) that will increase his testosterone level without disrupting sperm production. When he no longer wants to have any more children and feels the low testosterone levels is affecting his sex drive, he could undergo testosterone treatment to treat his low testosterone levels.  However testosterone replacement therapy can affect each individual differently in that one might notice big changes and others might hardly notice any effect at all.  Dealing with decreased fertility could be mentally and emotionally draining.  You could try talking to your partner, a close friend or a professional or join a support group to help you cope with your particular situation.  If you have any questions about your testosterone levels or feel that you might be experiencing some of the symptoms, feel free to talk to the specialists at Xenith Advanced Fertility Centre to help you understand what you are dealing with.  Know that you are not alone in this situation and that there is always hope.

Ovarian cysts are fluid filled sacs inside the ovary or on the ovary. They are fairly common in women and they occur naturally.  Most women who have ovarian cysts don’t even know that they have them and it doesn’t affect your health or your ability to conceive because they develop and resolve on their own most of the time.  Its size can range anywhere from a very tiny pea to larger than an orange.

Types of cysts 

There are different types of cysts and they can be classified as either functional or pathological cysts.

1. Functional cysts are formed due to the natural processes during the menstrual cycle and are very common, often harmless, and disappear on their own in a few months. Each woman has two ovaries which are responsible for the production of eggs.  Every month, several follicles in the ovary, which contain an egg inside, begin maturing and eventually one of these follicles bursts to release the egg into the fallopian tube. But sometimes, the egg continues to develop and the follicle remains as a cyst for some time and these are a type of functional cyst called follicular cyst.  Corpus luteum cysts occur after the egg has been released and the shell of the follicle, which usually disintegrates after egg release, sometimes seals itself and becomes a cyst.  Most of the time, these cysts disintegrate over time and they are harmless with no pain or discomfort.  But some might rupture causing internal bleeding. 
2. Pathological cysts are more uncommon and are caused by abnormal growth of cells.  Dermoid cysts contain tissue and cystadenomas grow outside the ovary on a stalk and both can grow very big and might need to be removed by surgery.  They could block blood supply to the ovaries or even burst.  Endometriomas or chocolate cysts on the ovaries are formed due to endometriosis, a condition in which uterine endometrial tissue grows outside the womb.  These cysts could block the fallopian tubes causing infertility.   People suffering from polycystic ovarian syndrome (PCOS) often have irregular periods due to hormonal imbalance and have many small cysts in the ovaries also causing issues with infertility.

Symptoms

Most people with ovarian cysts have no symptoms although some might have some abdominal pain or swelling, issues with urination or having sex, irregular periods, or feeling tired.  Some ovarian cysts can grow large and apply pressure to the organs around it like the urinary bladder or they may burst and spill their contents causing pain.  Sometimes large cysts can displace the ovary and cause it to twist causing ovarian torsion.  This can cut off blood supply to the ovaries causing pain, nausea and vomiting.  If that happens, surgery would be needed as soon as possible to prevent the ovary from dying. (1)  The cysts can be viewed by pelvic examination, ultrasound, minimally invasive surgery or by CT or MRI scans.  They could also test for presence of certain markers in the blood to test for ovarian cancer, endometriosis, or PCOS.

Cysts during pregnancy

Sometimes cysts are detected during pregnancy and that’s okay as long as the cyst is non-cancerous and is monitored routinely since most of them will go away on its own.  Some cysts might continue to grow during pregnancy and might cause some pain.  Even then, they don’t cause any problems for the pregnancy although it’s important to have it monitored routinely.  Even if a cyst ruptures, the fluid from the cyst will reabsorb on its own with time, and all that is needed is some medication to manage any discomfort and pelvic rest for a few days. If there is sudden abdominal pain along with fever, vaginal bleeding, vomiting or if there’s a feeling of weakness or having cold, clammy skin, it’s time to call the doctor.  In the case of the large cyst, not decreasing in size for several weeks, surgical removal might be recommended by the doctor.  The operation is not dangerous for the mother and child, especially if it is carried out before the middle of the second trimester.

Treatment

Treatment depends on the risk it poses and if there is a lot of discomfort or pain.

The first approach when a cyst is initially discovered is to monitor it routinely to see if the cyst is disintegrating on its own or if its growing in size. Sometimes the doctor might put you on birth control pills to prevent more cysts from forming although it cannot shrink an existing cyst.   If the cyst grows too large to cause pain or might have the potential to rupture, then it could be removed surgically.  Surgery could be carried out laparoscopically where a small keyhole incision is done to remove the cyst or it could be done as a laparotomy where a larger cut in the abdominal area is done to remove larger cysts or if it’s cancerous.  In rare instances, the ovary itself might need to be removed. There is no way to prevent ovarian cysts from forming. However, regular pelvic exams can ensure they can be detected as early as possible. Changes in the menstrual cycles and unusual symptoms that persist for many cycles should be reported to the doctor.  Make sure you visit a qualified, knowledgeable team for checkup and testing.  The professionals at Xenith Advanced Health Centre are well versed about ovarian cysts and would love to help you overcome any hurdles in order to have a healthy baby and mom.

If you have been trying for a year to conceive and have been unsuccessful, chances are you might be dealing with infertility and your doctor might recommend going through in vitro fertilization (IVF) in order to have a baby.  If you have decided to go this route, you will want to know all about IVF and how to increase your chances of making this IVF procedure successful.

What is IVF?

Preparing for IVF actually could begin months before the actual IVF procedure where you meet with your specialist who will look at your medical history and do some preliminary screening to decide how to ensure that you receive the best chance of success in your IVF treatment.  Ovarian stimulation will begin around the first day of your menstrual cycle and the doctor will prescribe the right balance of hormones and medications for your specific circumstances so that several eggs will mature simultaneously at the same time.  Once the eggs have grown to a specific size, they are ready to be retrieved and you will be given a trigger shot to help your body release the eggs and make it easier for the doctor to retrieve them.  After about 36 hours, you will need to go to the clinic and the eggs will be removed under guidance of ultrasound and under sedation.  This is a short 15 minute procedure and most people won’t feel any discomfort.  At the same time, the semen sample will need to be given for washing and concentrating the sperm.  The sperm will be tested for motility, quality and quantity.  The healthy sperm and eggs will be placed in a petri dish and incubated for natural fertilization to occur.  They might use intracytoplasmic sperm injection (ICSI) where one sperm is injected directly into the egg for fertilization.  Once the sperm and egg have combined to form an embryo, they will be monitored closely to view its development.  Assisted hatching might be done where a small incision in the embryo shell could increase the chances of implantation.  Preimplantation genetic testing might also be carried out to check for any genetic anomalies or diseases.  The viable embryos can then be transferred back into the uterus for implantation after 2 to 5 days from egg retrieval.  This procedure involves carefully injecting the embryo under ultrasound guidance using a soft, flexible tube into the uterus.  After about 12 days, you will need to do a blood test and visit your doctor to see if you are indeed pregnant.

How to increase IVF success rate

There are many things in the IVF treatment that you have no control over.  However, there are certain changes you can make in your own life to increase the chances of IVF success. 

1. Lifestyle changes- Studies have shown that being obese or underweight can decrease your chances of getting pregnant. (1)  You might need higher doses of medication and might decrease chances of implantation as well as increase chances of miscarriage.  So it’s important to maintain a healthy weight.

Healthy weight could be achieved through diet changes and exercise.  You need to eat a well-balanced, nutritious diet where you are getting all the nutrients, minerals and vitamins that are needed to conceive and stay pregnant.  The Mediterranean diet may improve your health and try following it 6 months prior to IVF treatment. (2)  It includes eating various fruits, vegetables, whole grains, legumes, nuts, seeds, chicken and fish.  Avoid processed foods as well as refined sugars, bakery items, fried foods, junk foods, decrease caffeine consumption, drink lots of water.  After embryo transfer, continue eating healthy. Avoid smoking, drinking too much alcohol and certain chemicals like nail polish, certain cremes, pesticides, and other items that may decrease chances of pregnancy.  Do regular, moderate exercise like walking, light yoga, but don’t do intense activity while you are going through IVF treatment.   It’s recommended that the man refrain from ejaculation 3 to 4 days before sperm collection.  Speak to your doctor to find out what’s best for your body.

• Find a great doctor and clinic– Look at the doctor’s credentials and the success rates of the clinic.  Do they use the newest technology and possess all the proper equipment for getting everything done at the clinic itself?   Also look for a doctor who you feel you can connect with.  Its important that you are understood and feel comfortable asking any questions you might have.
• Take the proper vitamins and supplements- take folic acid at least 3 months before conception since it’s vital for proper development of the spine and nervous system as well as preventing neural tube defects of the baby.  Also take Vitamin D if your levels are low, along with B12, C, E vitamins, zinc, selenium, and coenzyme Q10. (3)  Coenzyme Q10 has been said to improve oocyte quality.   Just keep in mind that it may take up to 60 days for any nutritional changes you make to have an impact on your success rate. After embryo transfer, continue taking folic acid, zinc and other supplements/vitamins. Speak to your doctor about any supplements and vitamins you are considering taking and it is beneficial for both the man and woman. 
• Decrease your stress levels- It might seem to be easier said than done when dealing with infertility and going through IVF treatment. But stress can negatively influence your success rate for IVF.  Because your mind can be a powerful tool, try stress relieving techniques like acupuncture and learn how to calm your mind.  During your embryo transfer and also during the 2 week nail biting wait to find out if you are pregnant, try to be very calm, think positive thoughts and do activities that relax you and keep you occupied.  You may also want to practice meditation, journaling, listen to music or other techniques to help you de-stress and unwind.   Try to scale back on commitments and try to be flexible during your IVF treatment because IVF schedules can be constantly changing depending on the results of the blood test and previous scan.  Try not to blame yourself or worry about the what ifs. Reducing your stress levels promotes an optimal environment for pregnancy to occur. (4)
• Get enough sleep- Study indicates that individuals who sleep 7-8 hours every night have a higher chance of success through IVF. Sleep can be very restorative and during this time, repair takes place throughout the body, amongst other processes, and it can contribute to a healthy pregnancy. (5)
• Have a support group- Try to have a support system around you, if you feel overwhelmed or feel anxious, whether it’s your partner, close friend or family.  There are also IVF support groups or professional counselors who may help you through difficult circumstances. (6)

Each individual is different and is dealing with various issues whether it be physical or mental.  To optimize success for IVF procedure, it’s important that you take a hard look at yourself and listen to your specialist about how to achieve a successful conception and pregnancy through IVF.  The staff and specialist at Xenith Advanced Fertility Centre are very caring and want to truly help you achieve your dreams of having a baby.  They are also extremely knowledgeable and have a lot of experience in dealing with all sorts of issues with infertility.

COVID-19 has played havoc in the lives of millions of people throughout the world since it was reported in Dec 2019.  The virus infects the body by attacking the healthy cells in our body, makes copies of itself and then multiplies throughout the body especially in the lungs.  The SARS-CoV-2 coronavirus that causes COVID-19, is transmitted through droplets expelled from an infected person’s nose or mouth when they cough, sneeze or sometimes even talk.

Phases of COVID

The COVID-19 disease is said to have 3 phases.  During phase 1 which is the early infection phase, the virus multiplies in the body and causes mild symptoms not unlike the common cold or flu. Its symptoms may include fever, chills, cough, shortness of breath, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion, runny nose, nausea or vomiting, and diarrhea.  In the second phase the virus moves to the lungs causing respiratory issues with pneumonia like symptoms.  Its symptoms may include persistent cough, shortness of breath, and low oxygen levels.  There might also be problems with blood clotting.  If the oxygen levels go too low, you might need to be admitted and you might be prescribed various medications, anti-virals, and steroids by your doctor.  In phase 3, there is injury to various organs like heart, and the kidneys and the immune system may begin attacking its own body leading to organ failure.

What is long COVID

Most people testing positive for COVID recover by the first or second week.  But some people experience long term effects and sometimes debilitating symptoms that is called long COVID and it occurs when people don’t come back to their normal health after four or more weeks after initial infection. (1)  Symptoms of long COVID could include fatigue, fever, coughing, difficulty breathing, difficulty concentrating (brain fog), joint or muscle pain, headache, diarrhea, loss of taste or smell, skin rashes, heart palpitations, chest pain, stomach pain, sleep problems, dizziness, feeling of pins and needles in the body, and changes in menstrual cycle.  Since it’s a new disease, there’s still a lot to be learned about long COVID.  People with long COVID are not considered infectious.  Vaccination might not prevent you for getting COVID but it could prevent severe illness and lower the risk of developing long COVID.  Currently there is no diagnostic test to confirm if someone has long COVID and issues like fatigue and brain fog are hard to diagnose.

Nutrition and its effects on long COVID

Diet and nutrition could help people struggling with long COVID.  Try eating a Mediterranean diet which includes eating a lot of fruits and vegetables, whole grains, pulses, legumes, olive oil, nuts, and protein sources like eggs, fish and chicken.  Proteins can give you energy especially if you are dealing with fatigue.  Because Covid is a disease of inflammation, it might help to eat anti inflammatory foods like ghee, turmeric and fish oils and avoid inflammatory foods like processed foods, refined sugars, and junk foods as well as red meats. Plant based diets also have anti-inflammatory properties. (2) Also make sure you are not deficient in certain vitamins and minerals like vitamin B12, Vitamin C, Vitamin D, zinc and iron.  They can improve your immunity and give you energy to fight the fatigue.  Use of probiotics like yoghurt can help the flora in your gut.(3)   Speak to your doctor about getting tested for any deficiencies and what to take.  Its also important to drink lots of water and stay hydrated.  Another factor to consider is the quantity of food you eat.  Because COVID can affect your sense of smell and taste, you might have a loss of appetite.  So practice mindful eating making sure you focus on what you are eating and how much you are eating.  Following a healthy balanced diet can help in getting your body back to tip top shape.

Does long COVID affect fertility?

Research shows that catching COVID can affect male and female fertility but getting the COVID vaccine does not affect it.  In one study, it was found that in men, semen quality, motility and sperm count is negatively affected due to lower testosterone levels immediately after infection and its magnitude depends on the severity and duration of the disease.  However, its not known if this effect is due to the virus itself or due to the body putting its resources toward fighting the disease or due to the side-effects of treatment with various medications like steroids or anti virals.  It was also found that these effects are temporary and the sperm profile seems to come back to its pre disease state after some time.   More research needs to be done on this.(4)

Catching COVID might also affect female fertility causing irregular menstrual cycles and affecting the ovaries and disrupting sex hormone levels.  It might harm tissues in the ovaries, reducing egg quality, and also might negatively impact ovarian reserve (the number and quality of eggs in the ovaries).  But it was also found that these effects were temporary in most cases.  So a study suggested postponing IVF treatment at least 3 months after COVID-19 infection.(6) After being tested positive for COVID, it may be harder for conception to occur in the short term although this is temporary. However, since this is still a very new topic, more studies are needed to find out the effects of COVID on fertility. There’s still a lot to learn about COVID.  If you are suffering from the impact of long COVID and have questions about when to have a baby, our experts at Xenith Advanced Fertility Centre can answer all your questions.

When trying to conceive, its useful to know when is your peak time for fertility, how fertile you actually are, what could affect fertility and is there anything you can do to become more fertile.  One is considered fertile if one can conceive within 1 year of having regular unprotected sex.  Whether your fertility is low or high, there are various things one can do to aid in this journey.

The menstrual cycle explained

The main purpose of the menstrual cycle is to prepare the body for pregnancy in case it happens.  The average length of the menstrual cycle is considered to be 28 days although it can vary anywhere from 21 to 35 days for different women.  The menstrual cycle begins and ends with the first day of menstruation and is divided by ovulation into the follicular phase, which is the time before ovulation, and luteal phase, which is the time after ovulation. Ovulation is considered to be the time when the mature egg is released from the ovary into the fallopian tube and, on average, it occurs around day 14.  So, ovulation day is considered to be the time of highest fertility.  The fertile window during which there is a high probability of conception from unprotected sex, is defined as the day of ovulation (the egg can survive for 12-24 hours) and the 5 days preceding it(the sperm can survive about 5 days).  So ideally, the sperm should be in place as soon as the egg is released in order to fertilize the egg.  If the egg is fertilized by the sperm, it will travel to the uterus.   The uterine lining thickens in order to prepare for possible implantation and the texture of the fluid in the cervix can change making it easier for the sperm to swim through.  If, however, the egg doesn’t get fertilized, the uterus sheds its lining along with the egg and the period begins again, starting another cycle.  So the level of fertility can go from low to high depending on which phase of the cycle you are in, with the highest during ovulation and the lowest during menstruation.  The characteristics of the menstrual cycle may be affected by age, where fertility declines rapidly after mid 30s, ethnicity, body mass index (BMI), overall health, stress, hormonal levels and lifestyle factors. 

Every girl is born with a fixed number of eggs which begin decreasing at the start of each period in puberty until menopause where there are no more eggs left in the 2 ovaries.  Each woman is different in that some women will get their period regularly at the same time each month and others may be more irregular.  Some may bleed heavily or for a longer period of time.  Your period could also be affected as you age or during certain stages in your life due to chronic health conditions or other factors. 

Signs of high fertility

1. Having a regular cycle- makes it easier to predict when you will ovulate, increasing your chances of conception.  So, keep track of your periods every month and write down when they start and end.  Note down any changes in the amount of bleeding and whether you have spotting between periods.  Also note down any irregularities as well as any symptoms you may have like cramping or breast tenderness.  One study found that the number of days you bleed as well as the total length of your menstrual cycle can determine how fertile you are. (2)
2. Levels of Anti-Mullerian hormone (AMH)– which is produced by the follicles in the ovaries, can be used to predict how many eggs you have remaining in your ovaries.  Women with higher AMH levels have a higher fertility and thus have a greater chance of conception. If you’re considering fertility treatments, it’s important to have your AMH levels tested. Your doctor can help you interpret your AMH levels and decide if fertility treatments are right for you. 
3. Consistency of cervical fluid- When cervical fluid resembles egg white consistency, seems stretchy or slippery, transparent, and there’s more volume of wet fluid, it is an indicator that you are nearing ovulation or already ovulating.  This is another way to track fertility although it can be tricky to interpret and subjective.
4. Basal body temperature- is the temperature of the body when you are fully resting.  You will find that your temperature is quite constant before ovulation and during ovulation, your temperature will increase slightly.  By tracking your basal body temperature over a few months, you can predict when ovulation will occur.  To measure this you need to use a sensitive thermometer that shows two decimal places and measure first thing in the morning before you get out of bed.
5. Hormone levels– Luteinizing hormone (LH) levels go up 24 to 48 hours before ovulation and is called the LH surge. LH tests detect the presence of LH in the urine sample.  You can measure for this hormone by using LH tests (also known as ovulation tests). These tests detect the presence of LH in a urine sample. However, these tests only indicate that ovulation is about to happen, they do not guarantee or confirm the release of an egg cell.
6. Testing Male Fertility – In males, fertility is determined by the number and quality of sperm produced. The number of sperm produced per ejaculate declines with age. In addition, the percentage of normal sperm decreases as a man gets older.

Signs of lower fertility- could include irregular or no periods, painful or heavy periods, spotting before period starts, facial hair growth or thinning hair on head in women which could be hormonal, sudden weight gain or weight loss, swelling or pain in testicles, problems with ejaculation, small and firm testicles amongst other signs.

Tools to track fertility

Nowadays, there are many mobile apps that are being used to keep track of fertility.  The calendar app looks at the length of your menstrual cycle and predicts when you will be most fertile.  The basal body temperature based apps look for the rise in temperature to predict when you will ovulate and other apps also include other parameters like cervical mucus consistency.  You can also use ovulation strips which detect the LH levels in the urine sample to predict ovulation.  Thus women who want to track their fertile days need to understand their own cycle characteristics rather than standardized cycles. (3)  Other tests measure your estrogen as well as LH levels.  All these data can be downloaded into your computer to make charts to predict when you will ovulate.  At the doctors office, they can do a transvaginal ultrasound and blood tests to determine when you will ovulate  and these results will be much more accurate than your at home tests. 

Supplements to support fertility(1)

Fertility can be affected by many things like genetics, health, lifestyle, diet amongst other factors.  Using supplements could help you come one step closer to successful conception.   Some of these supplements are folate which is essential in the first few weeks of pregnancy to prevent neural tube defects and for healthy cell division, Zinc to improve sperm and egg quality, selenium, Coenzyme Q10, Vitamin D and omega 3 fatty acids.  Begin taking prenatal vitamins especially folate at least 3 months before trying to conceive.  Consult your doctor about what supplements and amounts of each you need to take for your individual needs. Tracking when you are highly fertile can seem to be an arduous task.  Come speak to the experts at Xenith Advanced fertility centre to find out more details about fertility and what you can do to make your pregnancy dreams come true.

Finding out you are infertile can come as a shock especially if you are ready to have kids but it just doesn’t seem to be happening.  It might be hard to deal with the emotions that come with this realization especially for men who sometimes find it hard to show it outwardly or discuss it openly.  They might have feelings of guilt, anxiety, sadness and many roller coaster of emotions even though they outwardly project themselves as the strong, stoic type.  Your doctor might suggest trying invitro fertilization (IVF) to have a baby.  However, there are some things that can be done to improve the chances of conception as well as support your partner as she seems to be doing the bulk of the work for undergoing IVF.

What’s involved in IVF

Pretesting-  Before starting IVF, a number of tests will be done to try to find out the cause for infertility and also to see if everything is within normal limits.  The men will be asked to provide a sperm sample for the lab to evaluate.  They will check the sperm for motility, shape, count and many other features.  You might need to have blood work done to check hormone levels, as well as test for infectious diseases or genetic testing.  Similar tests will be done on the woman to check her ovaries, blood tests, the quantity and quality of eggs present etc.

Once these pre-tests are carried out and everything looks normal, it’s time to move on to the actual IVF procedure.  The woman’s ovaries will be stimulated with hormone injections so that multiple eggs will mature at the same time.  When the eggs are mature, they are retrieved and they will take your sperm sample at the same time.  The eggs and sperm will then be fertilized in a lab setting to produce embryos and they will be monitored to make sure they are healthy and viable.   The embryo will then in turn be placed back in the woman’s uterus for implantation.  If there are extra embryos left over, it could be frozen and used at a later date.  Then there will be a nail biting 2 week wait to see if there was successful implantation and conception.

What can the man do?

First of all, try to start making changes at least 3 months before going for an IVF treatment because it takes anywhere from 42 to 76 days for sperm to go from production to maturation.

Here are some things a man can do to improve fertility

1. Prepare physically – Make some lifestyle changes like quit smoking, excessive drinking, doing recreational drugs, cut back on caffeine and try to eat healthy foods like lots of fruits and vegetables, whole grains, and legumes.  Avoid red meat and eat lean proteins like fish and poultry.  Avoid refined sugars, processed and fried foods as well as junk foods and bakery items.  Drink lots of water.  Get enough sleep of 7 to 8 hours daily because it can affect one’s testosterone levels and sperm quality.  Maintain a healthy body mass index(BMI) which is a measure of your body fat based on height and weight.  If you are obese, try to lose some weight.  Do moderate exercise daily to keep yourself healthy.  Some chemicals and toxins can affect your hormones and sperm quality.  So try to remove them from your home or stay away from them in your workplace.  Take a men’s multivitamin and talk to your doctor about the effects of any medication you are taking on sperm health like steroids, thyroid medicine, antidepressants or others.  Try to reduce any stress in your life.  Don’t stay in hot temperature environments like saunas because it can affect sperm health.  Also an abstinence period of about 2 days before sperm retrieval is usually advised.
2. Prepare emotionally and mentally-  Going through an IVF procedure can be emotionally draining especially if the first round of IVF was unsuccessful. IVF is not a guarantee to have a baby and it might take several rounds of IVF.  So try to plan ahead by discussing with your partner and your specialist about how many rounds of IVF you are willing to try.  Ask how many embryos will be transferred into the uterus and what will happen to any leftover embryos.  It’s better to think about these things beforehand rather than making decisions at the last minute under duress.  Feelings of anxiety, uncertainty, and sadness might wash over you at different times but know that these are all normal emotions. Try to be supportive of your partner and let her know that you are there for them and ask her how you can support her.  Communicate your feelings openly and listen to your partner’s needs.  You can help manage appointments and help out with the chores around the house.  Doing some research about what is involved in IVF, reading blogs can help you be better prepared for the IVF journey. However, do not do too much digital searching during the cycle as it may sometimes add to more stress.  Plan out what questions you need to ask your specialist together and take notes as to the do’s and don’ts.  Find out if there are any side effects of the medications and any other tests that might need to be done.  If you feel it’s too much to handle, seek professional counselling or find a support group.  You don’t need to suffer in silence.

So there are many things men can do while going through IVF.  If you have any questions for your particular situation or anything else in general, feel free to talk to the experts at Xenith Advanced Fertility Centre.

Many fertility clinics do ovarian reserve tests to evaluate women who are dealing with infertility and prior to undergoing In Vitro fertilization (IVF).  It can be used to estimate how fertile a woman is.  The results of these tests can help the doctor find out if the number of eggs is normal for that age and also to determine how much medication should be given to stimulate the ovary to produce multiple eggs.

What is ovarian reserve?

Every woman is born with all of the eggs she will ever have in her whole life (around 1 to 2 million) which means this quantity will be constantly decreasing until menopause.  By the time the woman reaches puberty, many follicles die off and this number goes down to around three to four hundred thousand.  Of these, only about 300-400 will actually mature over a woman’s lifespan.  Only at puberty, a certain part of the brain called the hypothalamus begins releasing certain hormones to stimulate some of the follicles to grow.  Follicles in the ovary start off very small as primordial follicles which contain the oocytes and lay dormant and which are too small to be seen by ultrasound.  Antral follicles are bigger follicles and measure between 2 and 10 mm and can be visible by ultrasound.  At each menstrual cycle, a few of these immature eggs enclosed in the follicle will have the potential to respond to hormones, mature and then usually only one egg will be released (ovulation) each month while the rest disintegrate.  As you age especially after 37 years, the number of follicles lost to attrition is accelerated and the quality of the eggs also decrease with age. The quality and quantity of these follicles in the ovary are called the ovarian reserve and establishes the woman’s potential to procreate.  Other than age, various other factors can decrease fertility like undergoing cancer treatment, certain genetic disorders, going through premature menopause, ovarian surgery, endometriosis, polycystic ovary syndrome(PCOS), obesity, stress, and smoking amongst other things.

What are the various ovarian reserve tests?

1. Anti Mullerian Hormone (AMH) levels-reflect the number of growing follicles that can potentially ovulate and is the preferred test for determining the ovarian reserve. AMH is made by the cells inside the growing follicles which contain the egg. It can be done by a simple inexpensive blood test.  The level of AMH in a woman’s blood is stable throughout the menstrual cycle hence the blood sample can be taken at any time for testing. There are standard AMH levels for different age groups, and like your number of eggs, the AMH levels will also decline as you age. So very low AMH levels suggest decline in ovarian reserve.  However a very high level is suggestive of polycystic ovary syndrome(PCOS) which is a hormonal disorder and can also affect fertility.  That makes it a good indicator of fertility when considered along with the other tests.  Having low AMH levels might explain why it might be more difficult to get pregnant, but pregnancy can still happen because it only takes one healthy egg to combine with a sperm to form an embryo and begin conception.
2. Basal follicle stimulating hormone(FSH) levels- are determined by a simple blood test and it is a hormone released by the brain that stimulates a few follicles to develop and mature.  Its often done between days 2 to 4 of the cycle because estradiol (type of hormone estrogen) levels are at its lowest and estradiol tends to suppress FSH levels.  FSH can erroneously look normal if estradiol is too high.  So FSH level test are often done together with estrogen tests. If the FSH levels are high, it means that the brain needs to send higher FSH levels to stimulate the ovaries which in turn could indicate lower ovarian reserve.  However, there is no standard level that is accepted universally that is thought to be the cutoff value for a poor response.  Ovarian aging begins several years before any FSH level elevation and it cannot thus predict this for some women.  So one needs to look at the combined results from other tests too.
3. E2 or estradiol test- should also be done between days 2 to 4 of the menstrual cycle by a blood test.  As the follicles grow and mature, the hormone estradiol will be increasingly released from the ovaries so that there are not too many mature eggs.  If the estradiol levels are very high, it may be an indicator of low ovarian reserve.  Estradiol tests are done to see if FSH levels are accurate.  If FSH levels are normal but estradiol levels are high it means that there could be a problem with the ovarian reserve or its suppressing FSH levels.  Low estradiol levels could indicate problems due to PCOS, menopause, having eating disorders or doing excessive exercise which could all in turn affect fertility.
4. Antral follicle count (AFC) – are measured by ultrasound where the probe is placed in the vagina and it to is done between days 2 to 4 of your cycle to count the number of antral follicles in both ovaries.  Antral follicles are follicles that have been recruited for ovulation out of which only one egg is eventually released during ovulation.  The number of antral follicles decreases with age and it can also be used to help predict how many eggs a woman will produce if she undergoes IVF.  However, AFC only represents the number of follicles that can be seen in the ultrasound and not the smaller follicles that have yet to grow.  So a low AFC is indicative of lower ovarian reserve.

Does BMI affect ovarian reserve

Body Mass Index (BMI) is a predictor of your body fat by dividing your weight in kg with your height squared (m2).  A BMI of more than 25 is considered overweight while over 30 is considered obese.  Even though it’s a useful tool, it cannot differentiate between fat and muscle.  So a very fit individual might have a higher BMI.  Thus, the doctor may also have to look at other parameters like measuring their girth or if they have more fat in their stomach region.   There are conflicting results from studies looking at the relationship between obesity and ovarian reserve.   One study found that AMH and FSH levels are significantly lower in obese than in non obese women. (3) Yet another study found no significant difference in AMH, E2 and FSH parameters between women with high BMI and waist circumference and those in the normal range. (4)  However, it was also found that women with high BMI had higher chances of having irregular cycles or no periods at all.  They also had decreased chances of pregnancy.  Losing some weight through better nutrition and exercise can improve the chances of conception. Obesity may affect ovarian response, requiring a higher dose of clomiphene citrate or follicle-stimulating hormone (FSH) to trigger ovulation.  Obesity in men can also lead to fertility issues as it can affect sperm function and count.As noted above, there is no single test in isolation that can give an completely accurate picture of ovarian reserve and fertility. Therefore, a combination of various tests are used by specialists to improve their assessment of what is going on.  The specialists are Xenith Advanced Fertility Centre are very knowledgeable in this field and if you are struggling for answers, please come talk to them in order to move forward and improve your chances of pregnancy.

Miscarriage is the loss of pregnancy before the 20^th week and it can be a traumatic time in your life In many circumstances there might not be any reason for its occurrence, making it very hard to cope with the waves of sadness interspersed with the question of why it happened and feelings of guilt.  Miscarriages are quite common even in healthy women and its almost never caused by something the person did.  A miscarriage usually happens in the earlier part of the pregnancy because 80% of the miscarriages happen in the first 3 months. (1)  However, most women who have had a miscarriage go on to have a normal pregnancy after that. Sometimes, a woman can have a miscarriage in the first week or two without even realizing she’s pregnant and it may seem like period just came late.

Symptoms of a miscarriage might include bleeding, severe cramps, belly and or back pain, fever, contractions, blood clots passing from your vagina amongst other signs.

Cause of miscarriage

1. Genetic or chromosomal abnormality- Each person has 46 chromosomes and if something goes wrong randomly when the cells are dividing leading to missing or repeated chromosomes, it can cause a miscarriage.  About 50 percent of all first trimester miscarriages are because of chromosomal abnormalities. (2) This happens more often as the woman gets older.
2. Certain illnesses- like severe diabetes, thyroid problems, heart disease, hypertension are just some of the illnesses that may lead to miscarriage.  Clotting disorders like lupus can form clots in the placenta preventing much needed nutrition from reaching the baby and waste to be taken away.
3. Certain infections- like herpes, listeria and rubella can pass through the placenta to the fetus and harm it.  Other infections of the uterus or cervix could also cause miscarriage.
4. Defects in the structure of the uterus cavity or cervix as well as presence of fibroids- may lead to an inability to go through a healthy pregnancy.  Sometimes a weak cervix, which is also called cervical insufficiency, cannot hold the pregnancy and this usually occurs in the second trimester.
5. Major injury- A fall in the first trimester most probably will not lead to a miscarriage because the uterus wall is still thick and the pelvic bones will protect the tiny embryo.  In the second trimester, a lot of amniotic fluid surrounding the fetus could also provide protection.  Very major impacts which is a rare happening can lead to a miscarriage.
6. Age- The rate of miscarriage is high in women in their late 30s or older. (3)
7. Lifestyle choices- like smoking, drinking alcohol, using street drugs or being exposed to radiation or toxic substances. 
8. Medications– certain medications like  certain antibiotics, steroids, retinoids used for treating severe acne, as well as medications for rheumatoid arthritis are just some medications that may increase your risk of miscarriage.  Always consult with your doctor before taking any medications.
9. If you have had 2 or more miscarriages in a row- you are more likely to have another miscarriage.  Your doctor might recommend doing some blood tests, chromosome tests, ultrasound to see if there are any issues with the uterus, pelvic exam or various other tests to see if there are any reasons for your miscarriages. It could also be due to an autoimmune response. (4)

Myths about miscarriage:

1. Sudden shock or fright during pregnancy doesn’t cause miscarriage.
2. Minor injuries don’t lead to miscarriage.
3. Exercise- during pregnancy is not linked to miscarriage.  In fact, it is better to stay active during pregnancy to decrease the chances of gestational diabetes or having high blood pressure. Have a discussion with your doctor if you want to do some high intensity exercise.
4. Straining or lifting do not increase risk of miscarriage.
5. Being emotional or getting stressed is not linked to higher risk of a miscarriage.  Mood changes during pregnancy can happen due to fatigue, or changes in hormone levels.
6. Working during pregnancy is not associated with increased risk of miscarriage although make sure you aren’t exposed to radiation or certain chemicals at work. 
7. Having sex during pregnancy cannot lead to a miscarriage as long as you don’t have any preexisting conditions like placenta previa or preterm labor
8. Air travel is considered safe during pregnancy although many airlines don’t allow travel after the 36th week of pregnancy.
9. Eating hot and spicy food does not lead to a miscarriage.
10. You should wait for some time preferably 2- 3 months before trying to get pregnant again.  However depending on how early the miscarriage happened, you could start trying as soon as after your first period.  But consult with your doctor as to your physical and mental health before trying again.

If you have had an early miscarriage, get in touch with your doctor before planning your next pregnancy. If during the pregnancy you have severe pain or heavy bleeding, it could be a sign of threatened miscarriage, so consult your doctor immediately. At times if after the miscarriage heavy bleeding with or without passage of clots continues the doctor might need to remove any remaining fetal tissue in the uterus.  You might also be given medication to speed up the removal of any tissue.  The doctor might also do a follow up by asking you to do some blood tests and ultrasound to be sure no tissue from the pregnancy remains in your body.

A single miscarriage can happen in 15% of pregnant women and usually a lot of work up is not necessary after a single miscarriage, though after two miscarriages a thorough workup is indicated.   Try to stay positive and focus on your physical and emotional health.  You could lead a healthy lifestyle like eating healthy foods, avoiding smoking and drinking alcohol.  Getting moderate exercise can definitely help keep your body and mind healthy.  If you do get pregnant, get regular prenatal checkups from your doctor. You might experience a range of emotions following a miscarriage and its absolutely okay to feel this way.  It might help to talk to your partner, close friend, family or a professional counselor or joining a support group to vent your feelings and know that it’s not your fault.  Take time to heal physically and emotionally before trying again.  There is nothing to be ashamed about since it’s not your fault.  Everyone heals differently and make sure you take your time to decide what to do next.  Talk to your doctor as well about your next steps.  If you have experienced one or several miscarriages, come talk to us at Xenith Advanced Fertility Centre and we can help you have a successful pregnancy outcome.

Male infertility occurs if problems in conception are due to an issue in the reproductive capability of the male.  Male infertility could be due to an issue with the sperm itself or a problem with its delivery into the woman’s vagina.  The testicles produce the sperm and are also responsible for secreting the hormone testosterone which is thought to regulate the sex drive in men amongst other things.

There are many reasons for male infertility some of which could be due to low sperm count, decreased sperm motility, abnormally formed sperm, blocked sperm ducts, illnesses, injuries, lifestyle choices, health issues or various other reasons.  Sometimes sperm are affected temporarily due to injury of the testicles or due to drug abuse, smoking or drinking too much alcohol.  Fertility could also be impacted by age.  Also, sometimes infertility in men could be unexplained because routine tests seem to be within normal levels. This can at times  be due to fragmentation in the sperm DNA for which advanced tests are needed.

Symptoms

Male infertility symptoms can be sometimes vague and one might not even know they are infertile until they are having problems conceiving and go to see a doctor.  Some symptoms might include:

1. Problems with ejaculation- occurs if ejaculation doesn’t occur at all or occurs too early or too late.  Sometimes, there might be low volume or no semen during ejaculation.  Retrograde ejaculation occurs when the semen goes backward into the bladder rather than out of the penis leading to problems with conception.
2. Reduced or no sexual desire- could be due to hormonal issues like a decrease in testosterone levels.  It could also be due to chronic stress, fatigue or depression.
3. Testicles are very small- could be due to various reasons like trauma, undescended testes (the testicles don’t move down into the scrotum before birth itself), testicular torsion (where testicle rotates within its sac and blocks its own blood supply) or hypogonadism (body doesn’t produce enough testosterone). It could also be due to varicocele where veins within the scrotum get enlarged usually due to problems with blood flow and it may look like a bag of spaghetti with one testicle smaller than the other. This occurs due to valves in the testicular vein not functioning properly allowing blood to get pooled in the scrotum.  Having small testicles or different sized testicles does not necessarily mean that there is an issue.  However, a sudden change in shape or size of testicles might indicate a problem.
4. Erectile dysfunction- is the inability to maintain an erection during sexual intercourse and could be due to various reasons like heart disease, diabetes, obesity, high blood pressure, prostate problems, drug use, depression, hormonal issues amongst other reasons.
5. Pain, swelling or a lump in and around the testicles- could be due to many reasons like infection, twisted testicles, fluid buildup around testicles or hernia.  You should seek immediate medical attention if you have these symptoms.
6. Obstruction in the testicles- not allowing the sperm to travel through the tubes and nothing coming out during ejaculation could be due to infection, surgery like vasectomy, or a defect during development. 
7. Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality

Treatment

Treatment depends on what’s causing the infertility. Many problems can be fixed with medication or surgery. This could allow for conception through normal sex.

1. Surgery for varicoceles- Varicoceles are repaired with surgery to block off the abnormal veins. This might improve fertility.
2. Lifestyle choices– like no drugs, smoking or alcohol can aid in issues with fertility.  Avoid hot baths or whirlpools because high temperature can affect sperm.  Get adequate sleep, exercise and eat healthy.  Certain medications like steroids can also affect infertility.
3. Hormonal abnormalities like hypogonadism, can sometimes be treated with hormone replacement therapy
4. Obstructions in sperm travel can sometimes be fixed by surgery. Transrectal ultrasound could be used to see if there is any blockage or unusual structures causing problems.
5. Assisted reproductive techniques(ART) like IVF could be used to collect, wash and concentrate sperm and could aid in conception to help men with very low amounts of sperm.  If no sperm is coming out, they could be collected from testicles in case of blockage or from the bladder or urine in case of retrograde ejaculation.
6. Remove stress, anxiety- if one is able to ejaculate normally but not during sex, then it might be a psychological issue.  It might help to have an open and frank discussion with your partner and this might relieve some anxiety and help resolve your issue.
7. 7)     Medications could be used for treating erectile dysfunction
8. Certain medications that you are taking for some previous underlying health condition, might itself be causing infertility like medications for arthritis, depression, high blood pressure, cancer or other problems.
9. In many cases, an undescended testicle moves into the proper position on its own within the first few months after birth.  If it doesn’t, surgery might be needed to move the undescended testicle to the proper location.

Many men might feel embarrassed about problems with sexual health and may thus avoid seeing a doctor.  It is important to seek medical treatment because it may be due to some serious underlying condition.  At Xenith Advanced Fertility Centre, we value your privacy and can help you find answers to your issues with infertility and help you in having a child. We have a specialized Andrology Clinic, where it is not just about infertility in the male and all advanced options for treating it, but also for other issues such as erectile problems, ejaculatory disorders etc.

Intrauterine insemination (IUI) is a type of non-invasive treatment for infertility where the sperm are introduced directly into the woman’s uterus when she is ovulating.  In natural conception, the sperm travel from the vagina through the cervix, into the uterus and up through the fallopian tubes to meet the egg which is released from the ovaries.  IUI just gives an extra little help to this natural process by the sperm being cleaned and concentrated and then placed directly into the uterus closer to the fallopian tubes and the egg.  This shortens the journey the sperm has to make to the egg. It also ensures that sperm is in the body at the best possible time for conception.  If IUI is unsuccessful after a few attempts, then one may have to try the more expensive Invitro fertilization (IVF) route.

IUI is usually recommended for people dealing with unexplained fertility, issues with sperm motility or quantity, issues with cervical mucus or the cervix, mild endometriosis, issues with ejaculation or few other reasons. 

IUI procedure

1. What to expect before the procedure

Upon visiting the fertility specialist, you will be asked detailed questions about your medical history and how long you have been trying to get pregnant.  So take any paperwork that gives this information and have on hand, any relevant dates that might be helpful.  A physical exam will also be performed during this time for the doctor to determine if IUI would be your best option.

If you along with the doctor feel that IUI is your best course to pursue, then they will start out with some basic tests which will include a transvaginal ultrasound on day 2 to 5 of your menstrual cycle to see the anatomy of the uterus as well as determine the number of follicles in each ovary.   They might do some blood tests for measuring hormonal levels and other parameters as well as an Anti Mullerian hormone (AMH) blood test for determining the total number of eggs in your ovaries.  They might do a hysterosalpingogram which is an Xray of the uterus and pelvis to see if the fallopian tubes are open.  Semen analysis will be done to determine the sperm count, morphology, motility and various other factors.  If everything looks okay then you can proceed with IUI.

They might then start you on some medication which can stimulate your ovaries to release more than one mature egg at one time and will monitor this progress through ultrasound.  So you might have to go for a scan routinely every few days to monitor the follicle size.  If you want to go the natural route, you will be going through the same process stated above without the aid of medications. Once the follicle has reached a specific size, you will be given a trigger shot which will cause you to ovulate in about 36 hours.

• What to expect during the procedure

Usually the IUI procedure will be planned on the day of your ovulation.  The semen sample will be taken from your partner or the sperm donor ( if a donor insemination has been planned) on this day.  It will be washed and concentrated in order to remove the seminal fluid and other debris and doesn’t irritate the uterus.  The procedure itself is very quick and typically painless and doesn’t need anesthesia.  You’ll lie on an exam table with stirrups and your doctor will use a speculum to gently open the vagina so that they can see your cervix.  The sperm will then be transferred through the cervix and placed into the uterus using a long, very thin tube.  This whole procedure will only take about 10 minutes and they might ask you to stay reclined on the table for 10 min following the procedure.  It is generally painless and done quickly.

• What to expect after the procedure

After your IUI procedure is completed, most women will hardly feel any discomfort but some may have some mild cramping and light spotting and this too is normal.  Some doctors may prescribe progesterone after the procedure and during the early stages of pregnancy whereas others may not.  There could be a small risk of infection following the IUI procedure although this is very rare.

After the procedure, you can go back to your regular activities because bed rest is not necessary.  However, you shouldn’t do any high intensity activities like strenuous exercise.  Continue taking prenatal vitamins including folic acid, eat a healthy diet and try to avoid stress.   In the days following an IUI procedure, you may feel overwhelmed or be anxious to find out the results.  So keep yourself busy by doing things that you enjoy like watching a good movie, going out with friends, reading a good book, listening to music, following a hobby or anything else.  Also, have a plan beforehand about what you will do if the results are negative so that this will not eat away at you during this waiting period.

You can take a pregnancy test two weeks after the IUI procedure. If you have any questions about this procedure or if you are unsure about what to do about infertility, please feel free to contact the experts at Xenith Advanced Fertility Centre .