by Eduardo Hariton MD | Aug 15, 2020 | Fertility 101
Many women are acutely aware that age is a big factor in their ability to get pregnant, but what about males?
🥚 Unlike women’s ovaries which are born with a limited supply of eggs, the testicles can continuously produce sperm. Most men produce several million sperm per day.
🧬 While the percentage of female eggs that have an abnormal number of chromosomes goes up with time, recent studies have shown that this is not true for men. That is, the risk of aneuploidy (abnormal chromosome number) does not increase with age.
❗️ That said, some data increasing male age is associated with an increased time to pregnancy and decreased pregnancy rates. For example, a large study in the UK showed, after adjusting for female age, that couples with men over 40 were 30% less likely to get pregnant than those with men under 30, during 12 months
❗️ There are also slight but increased risks of psychologic disorders (such as schizophrenia and autism) and autosomal dominant disorders (such as achondroplasia) with increasing paternal age.
👨🏼⚕️ While it is not recommended that men freeze sperm to preserve their fertility, I do think it is worth bringing this up with your physician if you have questions or concerns regarding fatherhood after 40 or 50.
by Eduardo Hariton MD | Jul 15, 2020 | Fertility 101
⏳ This is one of the most frequent but also hardest questions I get, both in the clinic and in my personal life. It’s not because it’s difficult to answer, but because it is cruel and hard to swallow. Age is one of the factors we cannot control as physicians, so we do our best to help our patients start their families, regardless of their age.
📉 Women start with 6-7 million eggs before birth, which decreases to 1-2 million at birth, 300,000 to 500,00 at puberty, 250,000 at age 37, and about 1000 at age 50. While it only takes one egg, it is ultimately a numbers game.
💉 While our pregnancy rates go up every few years as our technology gets better, that doesn’t translate to better rates in older women. While fertility treatments are powerful tools to help treat many types of infertility (such as blocked tubes or sperm problems), the decline in fertility with age is much more difficult to overcome. This is because of the quality and quantity of eggs available decrease with age.
Let’s get to the numbers in terms of the chance of having a baby with your eggs after 1 and 3 IVF cycles.
🔹 At age 25: 49% and 81%
🔹 At age 30: 49% and 81%
🔹 At age 35: 41% and 73%
🔹 At age 40: 23% and 48%
🔹 At age 42: 16% and 35%
🔹 At age 45: 7% and 17%
🧪 As you can see, even with our best treatments, we cannot overcome the impact of age on your ovarian reserve. Do note, that I used averages from SART (Society for Assisted Reproductive Technology), but your fertility doctor can help you get a more personalized picture based on your ovarian reserve testing.
❓ These numbers are not fun to share, but I think they are important for people to be aware of. In the coming weeks, I will be sharing more about how to test ovarian reserve. What else do you want to know?
by Eduardo Hariton MD | Sep 4, 2019 | Fertility 101
💏 There are a lot of myths about what position is best to get pregnant. Missionary because of gravity, doggy style because of deep penetration, and many others. But do they make a difference?
🚫 There is no evidence that the position during ejaculation matters. In other words, there’s no specific position that will get you pregnant! Do what works for you, and sperm will find their way.
🚫 What about laying flat with your legs in the air after sex? Despite what many will tell you, no evidence of doing so will improve your chances of conceiving.
🚫 If I reach orgasm, are my chances better? Unfortunately no! There is no evidence that a female orgasm increases your chances of getting pregnant.
🚫 What about lubricants? Some lubricants can impair sperm transport! While water-based lubricants can inhibit sperm motility, they do not affect fertility, so if you need them to make sex comfortable and enjoyable, that is ok!
🤔 What can you do to make your chances worst:
🔹 Douche after sex: Sperm need a specific pH to survive, and altering it may affect it.
🔹 Use lubricants with spermicide: Make sure that if you do use lubricant, it does NOT contain spermicide.
❓ What other sex and pregnancy myths have you heard?
by Eduardo Hariton MD | Aug 22, 2019 | Fertility 101
🧔🏽 30% of infertility cases are related to male factor infertility, that is, a cause of infertility related to the male partner. As fertility doctors, even though we often care for women directly, we are also trained to evaluate males.
🔬 The first step in evaluating male infertility is a semen analysis. To do this, the male partner can provide a sample (through masturbation) which is then processed in the andrology lab and looked at under the microscope. (Sometimes males have a hard time producing a sample in the clinic, so they can bring one from home within 1-2 hours)
🧫 In a semen analysis, we look for:
✅ Semen volume and pH
✅ Sperm concentration
✅ Count
✅ Motility
✅ Morphology
✅ Debris and agglutination
✅ Leukocyte (white blood cell) count
🔎 This test can provide important information on the specific cause of infertility and can help us figure out what other tests are necessary. Depending on what we find, we often work with reproductive urologists to further evaluate and fix the problem, or we can use ICSI (intracytoplasmic sperm injection) to correct the problem.
👨🏼⚕️ How do you know if semen analysis is normal? Well, we use averages. A World Health Organization conducted a study with 4500 samples from 14 countries and compared semen analysis among couples who were fertile vs. men in the general population. They assumed that men in the lowest 5% were abnormal, and that is how they came up with ranges.
🤕 What can make a semen analysis abnormal? Previous chemotherapy, previous pelvic surgery, certain medications, testosterone injections, excessive alcohol or drug use, and extreme heat (hot tubs).
❓ I will discuss specific causes and treatments of male infertility in future posts. Any burning questions?
by Eduardo Hariton MD | Aug 20, 2019 | Pregnancy 101
This is one of the most common questions I get in the office and I get why: It’s confusing! By convention, we start counting from your last menstrual period (LMP).
👨🏼⚕️For most women, your due date (also known as EDD: estimated due date or EDC: estimated date of confinement) will either be calculated by your LMP or an ultrasound.
📅Using LMP: This is the best measure for those with regular periods who are sure of their LMP.
The easiest way is to google “pregnancy wheel” and use an online one.
For the nerds like me, you can use the Naegals rule (assumes 28-day cycles). LMP (say 9/1/19) -> Add a year (9/1/20)-> Minus 3 months (6/1/20) -> Plus 7 days = EDD of 6/8/20 (6/7 this year due to an extra day on Feb 29).
🖥Using ultrasound: Most accurate in the first trimester. We use this for patients with unsure LMPs, irregular periods, or when the LMP differs from a first-trimester ultrasound by more than a week (because we assume the LMP is wrong).
For people that don’t find out we are pregnant until the second or third trimesters (yes, it happens), we can use ultrasound, but it is less accurate as the pregnancy goes on.
💉For patients undergoing IVF: We assume the day of the retrieval is the day of ovulation. So for example, if you have a day 5 transfer, the day of your transfer is assumed to be 2 weeks and 5 days after your “LMP).
🆒Fun fact, pregnancies are not 40 weeks, they are closer to 37 weeks from implantation to your due date!
🙈If this is overwhelmingly confusing, don’t worry! As a doctor trained for +15 years for this, I have your back!
Any questions?
by Eduardo Hariton MD | Aug 10, 2019 | Pregnancy 101
This is a very common question I get from patients. For most patients, the answer is yes.
🤰🏻 In the absence of obstetric or medical complications, ACOG (the Ob/Gyn society) recommends that pregnant women observe the same general precautions for air travel as the general population and can fly safely up to 36 weeks of gestation. If you need to fly after that, make sure to get a doctor’s note (or they may not let you board).
Tips for flying safely:
✈️ Water, water, and more water: Staying hydrated is key (you may want that aisle seat for your frequent bathroom trips)
✈️ Stretch your legs: Pregnant women are at higher risk of having blood clots, so frequent walks and stretching your legs can help prevent one.
✈️ Avoid gassy foods and drinks preflight: Gases expand at altitude (due to lower atmospheric pressure), which can cause discomfort.
✈️ Check your airline policy: Many will allow you to fly up to 36 weeks, but each varies and it is better to find out before you are boarding.
✈️ Radiation exposure associated with air travel at high altitudes isn’t thought to be problematic for most who fly during pregnancy unless you are flight attendants and pilots.
✈️ It’s perfectly safe for you to walk through airport security scanners when you’re pregnant, no matter what type of scanner is used. That said, if you are worried, you can always ask for a manual pat down.
🏩 The main issue with flying is that if you need immediate medical care, it won’t be available until you land, even if they land the plane sooner for you. For most people, this is ok, but for those at high risk of complications, it may not be worth the risk.
🚫 Pregnant women at significant risk for preterm labor or with placental abnormalities should avoid air travel. If you are unsure if this is you, check with your doctor before flying.
❓ Any other questions about flying during pregnancy? Are any exciting baby moons coming up?
by Eduardo Hariton MD | Jul 31, 2019 | Pregnancy 101
I get this question all the time from patients who are trying to conceive or pregnant.
The short answer is: Yes, in moderation!
🔷 Long answer: In pregnancy, physical activity is safe and beneficial for most women, though you will find that some modification of your routine may be needed because of changes in your body’s anatomy and physiology.
⛹🏻♀️ For many, working out is part of your routine and a key component of your sanity! You should not give that up in pregnancy unless absolutely necessary!
🏊🏼♀️ Healthy women with uncomplicated pregnancies should continue to exercise before, during, and after pregnancy. You should shoot for moderate-intensity exercise for at least 20–30 minutes per day on most or all days of the week.
🧘🏽♀ Women with medical or obstetric complications should seek guidance from their obstetrician as to what is safe. Often, you can modify your activities and still exercise with limitations.
🚫 Bed rest, though very commonly prescribed, is almost NEVER indicated and can even be detrimental to a woman’s health (immobility can lead to blood clots). Check with your obstetrician if you have been advised of bed rest.
🚴🏽♀️ Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychologic well-being.if you have any questions about exercise during pregnancy, leave them in the comments bellow
by Eduardo Hariton MD | Jul 17, 2019 | Pregnancy 101
👨🏼⚕️ A preconception visit is a term used to refer to a visit where a physician reviews a patient’s medical history and does an exam with the goal of optimizing a woman’s health and chances of a good pregnancy outcome.
👩🏽⚕️ Most doctors use this visit to help identify any risks to the mother or fetus, educate women about what these risks entail and how to reduce them, and connect her with any resources or specialists she may need.
👍🏽 While most patients do not see a physician for a preconception visit, the American College of Obstetrics and Gynecology (ACOG) states that seeing a doctor prior to getting pregnant is “a good idea.” I agree!
There are several groups where this would be especially important. These include (but are not limited to):
⭐ Women with chronic medical conditions such as diabetes, hypertension, rheumatoid diseases, obesity, etc. For some of these, you may be referred to a maternal-fetal medicine specialist (high-risk obstetric physician) to review your condition more in detail.
⭐️ Women who take medications daily, to ensure that these are safe to take in pregnancy.
⭐️ Women who are affected or have family members who are affected by inheritable genetic conditions, such as Down syndrome, phenylketonuria, etc.
⭐️ Women who have difficulty fully quitting the use of alcohol, tobacco, or recreational drugs.
🤷🏾♀️ If you aren’t sure if you should see a physician, or merely want to discuss your specific situation with your doctor, you should absolutely seek one. It can only be beneficial to you, and it will help you build a relationship with your physician which you can hopefully continue through your pregnancy (if your doctor practices obstetrics).
by Eduardo Hariton MD | Jun 21, 2019 | Fertility Fact
🔵Ovulation predictor kits are commercially available at-home tests that can detect your LH (luteinizing hormone) surge, which happens about 36 hours prior to ovulation.
🔵The kits work by measuring your urine concentration of LH, which can be detected about 12 hours after the LH surge. This can be helpful in confirming that you are about to ovulate and helping you time intercourse.
🔵However, the fertile window ends at ovulation, so hopefully you have been having intercourse in the days prior to your LH surge as well.
🔵Most women begin testing 2 days prior to their expected surge, or every 1-2 days if they have irregular periods. It is very important to follow the exact instructions of the kit you are using, as they vary widely in how and when to use them.
🔵There is some evidence that using these kits may improve your likelihood of conceiving each month, especially in couples with irregular periods or who have intercourse infrequently, but they are not a must, especially in those with regular cycles.
by Eduardo Hariton MD | Jun 14, 2019 | Fertility Fact
Many think that infertility is rare and only happens to older women, but infertility can affect ANYONE!
🔵1 out of 8 couples will have difficulty getting or staying pregnant.
🔵This number may seem high, likely because there are a lot of stigmas associated with the inability to get pregnant, so many couples keep their struggles private.
🔵A third of infertility is due to a female factor (blocked tubes, poor ovarian reserve, etc.), a third due to male factors (low or absent sperm, hormonal imbalances, etc.), and the last third is unexplained (all testing is normal, so we don’t know).
🔵If you are <35 and trying for 12 months, go see a doctor. If you are >35 and trying for 6 months, go see a doctor. If you have irregular cycles, uterine anomalies, or are >40, go see a doctor before you start.
🔵And remember, infertility is a disease and there are treatments to help you. We are here for you!
