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In vitro fertilization or IVF is a series of procedures to help achieve a successful pregnancy.  The IVF treatment itself starts with ovarian stimulation where you will be prescribed medication so that more than one egg matures at the same time. These mature eggs will then be retrieved and placed together with healthy sperm in a petri dish for fertilization to occur. The resulting viable embryo is then transferred back into the uterus for implantation hopefully leading to pregnancy.  Many couples opt for IVF due to issues with fertility because they haven’t been successful in trying to conceive naturally for more than a year.  Male infertility could be due to abnormal sperm in terms of shape or motility, decreased quantity or no sperm, issues with the male reproductive system or other factors.  Female infertility could be due to decreased egg quality, issues in the fallopian tubes or uterus, hormonal issues or other factors.  By going through an IVF treatment, you could bypass some of these hurdles to help you conceive.  When you are going through your first IVF, you might be very excited about what the future could bring especially if you have been dealing with infertility for a while and yet you might also be anxious about doing everything correctly like the timings of various medications/injections, or what you should and shouldn’t do.  However, if after you have gone through the whole procedure ending with the two week nail biting wait to see if you are pregnant and that first IVF treatment fails, you may be left dejected with many questions about what could have gone wrong and what you should do now.  Sometimes an IVF procedure also gets cancelled if the eggs are of poor quality or if they are not getting fertilized or for some other reason.  You could also have undergone a successful first IVF treatment and you now want to follow up with a second IVF treatment to get a sibling for the first child.  Either way, there are some things you could do to be better prepared for the second IVF treatment.

Talk to your doctor

Have a frank conversation with your doctor about the possible reasons for failure of first IVF treatment.  Some questions that might come up could include: could it be the quality of the egg or sperm, could it be the receptivity of the uterus, was there any genetic issues with the embryo, is it due to any previous health condition, is it due to some medications, or is it due to your lifestyle.  Air out all your concerns to see if anything could be improved for the second IVF cycle. Talk to your doctor about what are the chances of success for the second IVF cycle in your special circumstances.  The doctor might need to tweak the medications or change the medications for the next round of IVF.  The doctor might suggest intracytoplasmic sperm injection (ICSI) procedure along with IVF where one sperm is injected directly into the egg for aiding in fertilization. You could find out if there are any new advances in IVF treatment that might increase the chances of a successful conception. Preimplantation Genetic Screening (PGS) involves screening the embryo for any genetic anomalies before implantation into the uterus.  This could reduce the chances of miscarriage.  If the egg or sperm quality is not good, it might also mean looking at egg or sperm donor or looking at surrogacy if you aren’t physically able to carry a baby to term.   Take your time to make the decision that’s best for you and your partner.  It might mean taking a vacation to relax before trying a second IVF cycle.  Do lots of research and ask all your questions you might have.  You could also check to see if the doctor has lots of experience in this field and offers the newest technology and equipment for you to have the best chance for success. If the first IVF treatment was successful, you might want to follow the same protocol to be successful in the second.

Do you have frozen eggs or embryos

Sometimes, if there are many eggs retrieved during the first IVF procedure, you can choose to have the eggs or the resulting embryos cryopreserved or frozen for future use.  This makes it much easier to prepare for a second IVF treatment because you don’t have to go through the whole process of stimulating your ovaries and the egg retrieval process all over again.  Couples should consider this option during the first cycle in preparation for the second.

Do not blame yourself

 Do not blame yourself for what happened or dwell on the “what ifs”. Sometimes there is no rhyme or reason for why the treatment didn’t work and it could be left unexplained.  Try to accept it for what it is and look ahead positively to the second IVF cycle. 

 Look at your lifestyle

Take a close look at your own and your partner’s lifestyle.  Stop smoking, drinking alcohol, and drinking too much caffeine.  Eat healthy food with lots of fruits and vegetables, cut out foods with refined sugars like baked goods and sugary drinks as well as avoid processed and fried foods.  Do moderate exercise and try to lose weight if you are overweight.  Take prenatal supplements like folic acid and various other vitamins as per your doctor’s instructions.  Get enough sleep and try to get rid of stress.  Take care of yourself and learn to relax.  Try yoga or meditation.  Take up a hobby to keep your mind occupied.

Make sure you are emotionally and physically prepared

You might have been a bundle of nerves when going through your first IVF treatment.  But now that you have already gone through one IVF cycle, you might already know what to expect and be more confident about it.  Try to stay calm and be optimistic.  It helps emotionally and mentally if you have someone to confide in, like your partner, a close friend or family member or you could join a therapy group or talk to a professional therapist or counsellor to alleviate your fears and concerns. If you feel your body is still not back to its usual self, take some time off before your next treatment because only you know your own body.  However, if you are older, try to do it sooner rather than later because egg quality decreases with age.

Try not to compare your second IVF treatment with your first

Each treatment is unique and your body might react differently.  So try not to fret over why its not feeling the same as before.  Try not to research too much on the internet about every twinge you feel in your body and why you feel the way you do because some of the online forums might lead you to panic and do more harm than good.  Sometimes you might feel more emotionally vulnerable and cry at the drop of a hat which could be due to the effect of some hormonal changes in your body.  Feel free to cry and vent it out.  Speak to your doctor to answer any queries. In general, its important to take care of yourself if you are going to be carrying a baby.  Make sure you are healthy physically and emotionally and this can improve your success rate for your second IVF treatment.  Stay positive and be optimistic by keeping yourself occupied.  Talk to your doctor about what could be done to improve your chances of success.  The professionals at Zenith Advanced Fertility Centre have a lot of experience in dealing with this and would love to help you achieve your dreams of having a child.  Feel free to ask them any questions you might have.

The best time to conceive is around the time you are ovulating.  But what does this actually mean and how do you find out when you are ovulating.  First let’s find out what’s happening exactly during the menstruation cycle.

The follicles in your ovaries are a fluid filled sac containing an immature egg.  At the beginning of the menstrual cycle, a few of these follicles begin maturing.  But by the middle of the cycle, only one dominant follicle will be mature enough to release an egg and ovulation is the time when the egg is released from the follicle into the fallopian tubes. In the meantime, the sperm enter the uterus through the cervix and go through the fallopian tube to fertilize the egg.  Then the fertilized egg travels to the uterus for implantation, leading to pregnancy if the implantation is successful.  If the egg is not fertilized by sperm, it will disintegrate and the uterine lining will be shed as menstruation.

Ovulation cycle and calendar

The menstrual cycle is dependent upon a delicate balance between the levels of various hormones that are released.  The first day of your last period or the day you begin bleeding is considered day 1 of your menstrual cycle. The length of a menstrual cycle is the number of days between the first day of menstrual bleeding of one cycle to the first day of the next cycle. The menstrual cycle may be divided into two phases which are the follicular phase and the luteal phase. The follicular phase begins from the first day of menses until ovulation around day 14.  During this phase a few ovarian follicles begin developing and maturing.  The rest of the cycle is considered to be the luteal phase and is 14 days long in most women.  The average duration of menstrual flow is between four and six days. 

It is important to keep track of your own cycle because it can vary for each individual.  Ovulation occurs roughly halfway through your menstrual cycle which is between 13 and 15 days after your last period began, if you have your period every 28 days which is considered the average.  So the best time to conceive can be anywhere from a few days before ovulation (because sperm can live for three to six days) until about a day after the release of the egg, which is only viable for about 12 to 24 hours.  Thus, it’s good to keep track of your cycle length for a few months and be aware of the signs in your body.  It might help to write it down to help you remember how it felt in the previous month around the same time.

What are some symptoms of ovulation

Basal body temperature- During ovulation, the body releases the hormone progesterone, which brings on a slightly raised temperature of about 0.5 degrees a day or two later.  So you would need an accurate thermometer that measures every 10^th of a degree and the temperature should be measured when you are at rest preferably before you get out of bed in the morning.  Try to see a monthly pattern of the temperatures to predict when you will ovulate.

Cervical mucus becomes clearer and thinner with a more slippery consistency similar to that of egg whites when you are ovulating to protect sperm in their journey to the egg.  However, when you are not ovulating, the mucus is sticky and thick to prevent sperm from getting into your uterus

Other symptoms of ovulation may include softening of cervix, mild cramps, increased sex drive, light spotting, breast tenderness, and backache.

How to track for ovulation

You can use an app to help track your menstrual cycle.  You could also use a home ovulation predictor kit which checks for a surge in luteinizing hormone (LH) levels which means that you are about to ovulate. 

More accurate results could be gotten through ultrasound where the size of the developing follicle is monitored closely till it is ready to release the egg.  It will also monitor the thickness of the uterine lining.  This process which is called follicular study or monitoring, makes it easier to find out when you are most fertile accurately.  It could also diagnose any problems related to ovulation.

Once you have determined when you will ovulate, you can have sex 2 days before and a day after ovulation.  During this fertile window, you can have sex every day to increase your chances to become pregnant because it only needs one sperm to fertilize the egg.  It is also suggested to lay in bed for 10 to 15 minutes after intercourse.  You should see a fertility specialist if you have certain medical conditions, irregular menstrual cycles, endometriosis, PCOS, hormonal imbalances, pelvic inflammatory disease due to sexually transmitted diseases, previous pelvic or abdominal surgeries, or use anabolic steroids or certain medications which might prevent you from getting pregnant. Speak to the experts at Xenith Advanced Fertility Centre if you need advice about any of this.

Fallopian tubes are a pair of tubes that act as a conduit between the ovaries to the uterus and are part of the female reproductive system. During ovulation, which happens around day 14 of the menstrual cycle, the ovaries release a mature egg which travels through the fallopian tubes.  The sperm enter the uterus through the cervix and go through the fallopian tube to fertilize the egg.  Then the fertilized egg travels back to the uterus for implantation, leading to pregnancy. The fallopian tubes are lined with delicate hair-like structures which move in both directions to help the sperm reach the egg and for the fertilized egg to enter the uterus.  Because these tubes are small and delicate, they can be easily damaged and get blocked.

If a fallopian tube is blocked, the sperm cannot reach the egg.  Sometimes the fertilized egg cannot go back to the uterus if it’s partially blocked because the sperm can get through to the egg but the fertilized egg then cannot get to the uterus for implantation.  This could lead to an ectopic pregnancy where the implantation occurs outside the uterus and this will need immediate medical attention.

Symptoms

Blocked fallopian tubes often don’t have symptoms. Many women don’t know they have blocked tubes until they try to get pregnant and have trouble conceiving.  Sometimes, blocked fallopian tubes can cause some pain in the pelvis or abdomen or cause irregular periods or pain during intercourse. A hydrosalpinx is a condition that occurs when a fallopian tube is blocked and filled with fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like shape possibly causing pain, fever or bleeding.

What causes fallopian tube blockage

A blocked fallopian tube can be caused by several things, including infection, inflammation, scar tissue formation, adhesions, previous surgery, or trauma to the abdomen.

Pelvic Inflammatory Disease (PID): occurs due to infection causing inflammation in the pelvic region.  It can occur as a result of ascending infections from the vagina or bladder or can be due to a sexually transmitted disease and the bacteria moves from the vagina to the uterus leading to scarring and hydrosalpinx in the fallopian tubes

Endometriosis: This is one of the most common causes of a blocked fallopian tube.  During the menstruation cycle, the uterine lining is formed and shed every month.  For women who suffer from endometriosis, this uterine lining is formed outside the uterus, and in extreme cases even in the fallopian tubes, vagina or the rectum. This lining outside the uterus doesn’t get shed but starts getting built up causing blockage and scarring.

 Uterine fibroids or ovarian cysts: uterine fibroids are noncancerous tumors of the uterus and ovarian cysts are usually non cancerous, fluid filled sacs in or on the ovary.   They could grow close to the fallopian tubes and cause blockages.

Surgery: surgeries in the abdomen or pelvis, removing fibroids or operations for ovarian cysts could form scar tissue inside the pelvis and abdomen causing partial or complete blockage of the fallopian tubes.

Appendicitis: In some cases, a ruptured appendix can cause blocked fallopian tubes as well.

Congenital: Some women are born with uterine anomalies which could affect the tubes and result in subfertility or infertility.

How to diagnose blocked fallopian tubes

1. Hysterosalpingogram(HSG)  is a test where the doctor injects a dye into the uterus and views its flow into the fallopian tubes using X-ray.  If the dye doesn’t flow all the way through the fallopian tubes, there could be a blockage.
2. Sonohysterogram is similar to HSG where instead of dye, saline is used and they use ultrasound to view the fallopian tubes. A transvaginal ultrasound can also be used to examine the fallopian tubes and detect any abnormalities.
3. Laparoscopy– is a surgery where the surgeon inserts a small camera through a small incision in the body to view the fallopian tubes.

Treatment

If the fallopian tube blockage is due to small amounts of scar tissue or if they aren’t damaged badly, then a laparoscopic surgery can be conducted to remove the scar tissue and clear the blockage.

Salpingectomy is another surgical procedure, where the fluid filled or diseased tube is completely removed thus preventing the fluid from the tube spilling into the uterus.

If only one tube is blocked, it will most probably not affect fertility too much because the egg could still travel through the unaffected fallopian tube.  Fertility drugs could help improve the chances of conception at this time.  If both tubes are fully blocked, it would be impossible to get pregnant naturally.  If it’s fully blocked, or even if it’s partially blocked, the doctor might recommend in vitro fertilization (IVF) to avoid the risk of an ectopic pregnancy.  This is because during an IVF procedure, the egg and sperm are fertilized in a laboratory setting and the resulting embryo is transferred directly into the woman’s uterus bypassing the need for the fallopian tubes. So a blockage in the fallopian tubes could cause infertility although through surgery or through IVF, it is still possible to have children.  If you would like to know more about this, feel free to talk to our experts at Xenith Advanced Fertility Centre.

Did you know that the average man produces about 1,000 sperm per second?  Unlike women, who have a fixed number of eggs from birth, men produce sperm constantly. The sperm production process takes around 2 to 3 months.

Semen is the fluid released during ejaculation and it contains sperm along with other substances like fructose and protein.  A semen analysis test is done mainly to assess male fertility.   If you are unable to conceive after trying for 1 year of having unprotected sex if you are less than 35 years old or for 6 months if you are older than 35, then you might be dealing with infertility.   The semen analysis test might therefore be recommended by your doctor in order to check the sperm health and also look for any abnormalities and infections that could be the reason for infertility.  If the results indicate poor fertility, it doesn’t necessarily mean that conception isn’t possible and there are steps that could be taken to improve semen health and aid in conception. Usually this test should be done more than once to get accurate results because the sperm count can vary from time to time due to heat, stress, hormonal fluctuations, illness, or other factors.

Things to remember if you are getting your semen analyzed:

Avoid harmful substances like alcohol, drugs and caffeine for a week before the test.

Avoid ejaculation for a minimum of 3 days and a maximum of 7 days before the test.

Avoid certain medications like hormonal medications before the test.  Speak to your doctor if you are unsure about its effect on sperm.

It is preferable to collect the sample at the laboratory that is doing the testing because the semen sample has to be tested within 60 minutes in order to calculate the liquefaction time and the sample should be stored between 20 and 37^oC to keep it viable.

How to interpret semen analysis report:

1. Ejaculate volume: the average ejaculation volume is between 2 to 5 ml with the lower limit at 1.5ml set by the World Health Organization (WHO).  Low volume could be due to hormone imbalances, aging, nutritional deficiencies, illness, injury to the testicles or a blockage of the seminal vesicles
2. Sperm concentration: of more than 15 million sperm per milliliter is considered normal.  Less than 5 million sperm per ml is considered a low range. If no sperm is found, there could be an obstruction not allowing sperm to come through.
3. Sperm motility- is the percentage of sperm that moves around.  It should be over 42% in the collected semen sample.  Less than that can cause issues with a successful conception. Normally at least 60% of sperm are moving properly.  Sperm movement, or motility, is important to fertility because sperm must travel to fertilize an egg. 
4. Sperm morphology: a “normal” sperm should have a smooth, oval head, a midpiece and a tail. As per WHO guidelines more than or equal to 4% normal sperm morphology is considered normal.  The ideal sperm shape is not made in high concentrations.  An abnormal shape makes it more difficult to fertilize the egg.
5. pH: The normal pH range for semen is between 7.2 to 7.8.   A pH higher than 8.0 might indicate signs of infection and less than 7.0 might suggest blockage in the persons reproductive tract or that the sample became contaminated.  Excessively high or low pH levels could lead to sperm cell death or affect their motility and function.
6. Liquefaction: Semen is initially thick to help it adhere to the cervix and becomes more watery over time which then aids in sperm motility.  The normal time for liquefaction should be within 20-30 minutes.  Certain infections may increase the liquefaction times.
7. Sperm count – is the total number of sperm in the ejaculate.  A typical semen sample should contain between 20 to over 100 million sperm. The lower limit for WHO guidelines is 39 million sperm.  Total motile count is also helpful to determine what kind of procedure to undergo for conception.  The availability of very few motile sperm could warrant using Intracytoplasmic sperm injection (ICSI) along with In Vitro fertilization (IVF) where just one healthy sperm will be injected directly into the egg along with IVF procedure.  The presence of more sperm might only need Intrauterine insemination (IUI) where a man’s sperm is concentrated, washed and transferred directly into the uterus when the woman is ovulating to aid in conception. Also, illness can impair semen count and function. It can take several months for semen quality to return to normal, especially after a high fever. In this case, semen specimens should be provided after a few months to ensure a more accurate result.
8. General appearance- the normal semen color should be whitish or grey and opalescent.  The color may change due to infection or presence of red blood cells.  Semen that has a red-brown tint could indicate the presence of blood, while a yellow tint could indicate jaundice or be a side effect of medication.
9. White blood cell count- white blood cells fight infection and inflammation in the body.  Normally, there shouldn’t be too many white blood cells in the semen at all. The appearance of white blood cells indicates the presence of inflammation or infection in the testicle which could damage sperm. Some antibiotics might thus be needed to fight off the infection.  In some men, antibodies are produced against their own sperm and affect its viability due to trauma, surgery or other unknown reasons.  
10. 10)  Fructose level: fructose is an important sugar produced by seminal vesicles and its function is to provide energy to the sperms for swimming. WHO verifies the normal value for fructose level as 13 mmol per sample.

Infertility in men can cause anxiety and stress.  Doing a semen analysis test could help identify the cause of infertility due to issues with the sperm or something else.  This information could be helpful in going forward to address these issues and alleviate some of the stress and possibly aiding in conception.  A poor result doesn’t always mean that you cannot have children and there could be ways to navigate around this.  The experts at Xenith Advanced Fertility Centre would love to answer any questions you might have in this area.

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.