sex position matters so that is a myth
ivf guarantees pregnancy oh boy
it's a tough myth for patients to hear
eating pineapple can increase fertility
oh that's a good one
pineapple by itself if you have
infertility
is unlikely to reverse your infertility
i'm dr cindy i am a fertility specialist
based in las vegas nevada
and i work with patients who are seeking
to
boost their fertility preserve their
fertility
or build their families hello i'm dr
sriram ella swarfu
and i'm a urologist at ucla my focus is
on reproductive medicine for men as well
as individuals born with testicles such
as trans women
and today we'll be debunking myths about
infertility
tight underwear is bad for sperm counts
so there have been a number of studies
looking at this issue for many decades
and the inevitable question is boxers
versus briefs
in truth it doesn't matter a whole lot
and we know that
if the testicles are a little bit warmer
that they are more
at risk of having sperm count issues or
sperm motility issues which is the way
the sperm move
in the body but in general it shouldn't
matter too much just pick what's
comfortable if you're
going to be going on vacation and using
hot tubs every day for hours a day
i would recommend against that if you're
going to be trying to get pregnant
because prolonged warmth and repetitive
warmth
affecting the testicles can drive sperm
counts down and i have seen that in my
practice
sex position matters so that is a myth
no matter what position you engage in if
you ejaculate you have the sufficient
propulsion of the semen
to make it up to the cervix any way you
do it and a number of people around the
world have actually studied it and no
one position has been proven to be
better than another
putting your legs up after sex can
increase your chance of pregnancy
that is also a myth long before i even
understood
what pregnancy entailed i was seeing
imagery on tv and stuff of people
almost on a handstand upside down i
think the thought is oh we need to
counteract gravity but the truth is you
don't need to
lay and sit upside down or anything like
that
ivf guarantees pregnancy oh boy
yes that is definitely a myth and it's a
tough myth for patients
to hear the ibm does present the highest
chances of pregnancy absolutely there
are a number of factors that play into
ivf success
one of them has to do with the age of
the eggs being used
it also has to do with the quality of
the sperm
and the egg when they come together it
has to do with the
embryo that is ultimately formed it also
has to do with the genetics of the
embryo and the chromosome makeup
but then on top of that it has to do
with the womb in which the embryo will
be placed
and a number of factors are not yet
fully
known so we know the immune system plays
a role
diet exercise probably play a role but
we're still investigating that
so biggest thing to know is it's not 100
stress causes miscarriages i think we're
starting to get
get away from the term miscarriages
we're starting to use the term early
pregnancy loss is that right
that's correct and i think it's because
you know miscarriage also comes with
certain connotations where
blame is also ascribed and the truth is
most early pregnancy losses there's
nothing the individual could have done
about it
at all and so now we call it early
pregnancy loss before
the end of the first trimester versus
second and third trimester pregnancy
loss
we do not believe stress causes loss
i know in everyday common conversation
people believe that
we know stress can impact one's immunity
but we also know that
many people around the world across
millennia
have gotten pregnant and remain pregnant
despite tremendous stress so we know
it's not simply
stress nowadays though we know the
number one reason for
pregnancy loss is chromosomal
differences
in the formed embryo and so that's
called aneuploidy
67 of first trimester pregnancy losses
are due to chromosomal issues within the
embryo
itself other reasons would be if the
thyroid was not functioning well
if vitamin d is low if there's a fibroid
in the uterus
if you have a uterus and you've had
two or more pregnancy losses you should
be evaluated
for many decades we always expected that
it would be the individual with the womb
and the eggs to be the one that gets
evaluated for
a pregnancy loss now the tide is
shifting and
individuals who contribute the sperm are
also being evaluated
when there's a pregnancy loss in the
couple there's emerging data
that things like dna fragmentation where
the dna that are normally supposed to be
very
tightly wrapped up in the sperm are
somehow
unraveled and might have little breaks
in the dna strands
and those breaks can contribute to the
pregnancy loss
freezing your eggs guarantees that you
can have kids
later myth and the myth is in the word
guarantee if you freeze your eggs you
can stop the clock
and so you're basically freezing the
youngest version of yourself
at that point however there's no
guarantee that eggs
even when frozen will thaw and yield a
lifeborn baby
so it's really a conversation that needs
to happen
with your specialist based on your age
based on your
egg number not every egg that's thawed
after freezing will survive the thought
not every egg that is injected with
sperm
will actually yield an embryo not every
embryo that's created meaning not every
fertilized egg will
ultimately form a pregnancy but on top
of that affordability is an issue
access to clinics that have great
protocols and great
uh success rates with their egg fars you
really need a clinic that has a good
track record of successfully flying eggs
and having
pregnancies from bod eggs peeing or
showering
after having sex will lower your chance
of pregnancy
by the time you even get up off the bed
and make your way to the bathroom
sperm have made their way up the uterus
and are on their way to an egg
and so that should not be a form of
contraception now
what can decrease your chance of
pregnancy is if you're
someone who douches after sex and so
we strongly recommend against douching
in general
it doesn't work for your vaginal
microbiome it doesn't work for your
general
health myths we hear the most sperm
quality doesn't decline with age
we have this term that we use a lot in
medicine called advanced
maternal age so there was not this term
advanced
paternal age but that is starting to
emerge and there's a lot of data now
that is showing that individuals with uh
sperm that is older
uh say in the fifth sixth seventh
decades of life and beyond
is more at risk of forming embryos that
have chromosomal abnormalities getting
exercise
eating well are things that can improve
the general
biology of an individual certainly if
it's good for the heart and it's good
for the brain then it's probably good
for the penis and the scrotum and the
testicles as well we talked about egg
freezing
but sperm freezing has its role
particularly for individuals who may not
be in a relationship or may not be
thinking of a family at this time
but later on down the road they might
want to produce a family
it's impossible to get pregnant after
35.
it is possible to get pregnant after 35
the truth is though that the chance of
pregnancy
progressively declines as the age of the
egg
increases and so you might find
greater and greater need for fertility
treatments
but when you're born if you're someone
born with ovaries
you'd have somewhere between 1 million
to 2 million eggs in those ovaries
usually by age 30 70
of those eggs are gone and by age 40
97 of those eggs are bond
at the same time those eggs are also
aging
and so what we see is that the chance of
pregnancy
declines very quickly and then for some
people it declines
even faster so if you have endometriosis
if you're someone who's maybe had
surgeries on the ovaries or needed to be
on medications
chemotherapy radiation all of those
things can also
further the decline in the egg number so
my recommendation is if you have ovaries
at age 30
you should at least be asking your
doctor to do a check
of your egg number or what's called your
ovarian reserve
the best way to get pregnant is to have
sex
every day it comes down to the ovulatory
cycles
and making sure that your you're sort of
timing things and tracking things
particularly if you're trying to
conceive deliberately
we always get this question and i want
to know what your thoughts are
should the couple be trying to conceive
every other day
during ovulation or every day during
ovulation
i say every other day and it's because
one we need to give
the sperm and semen enough time to sort
of re-accumulate so we can get those
millions of sperm in the ejaculate so
that's the first thing the other
is sperm healthy sperm actually survive
in the female genital tract for up to
five
days so once the egg is released from
the ovary
think of the fallopian tube as an arm
with a catcher's mitt
at the end the catcher's mitt captures
the egg
pulls it into the arm and then the egg
sits around there
for 12 to 20 hours waiting for sperm
and then if you have intercourse
anywhere within the next 24 hours
sperm will also get to the egg so that's
why we say every other day
around ovulation so what that means is
if you're someone who ovulates on day 14
you should really be trying to have
intercourse starting day 12
then day 14 day 16 i usually say go out
to day 18.
there is this movement now particularly
on the internet
discussing what's called abstinence from
pornography
masturbation and orgasm or pmo it's
also a movement called nofap and those
individuals say
to have the best reserve of sperm
or the best sort of power with erections
or
orgasm that they should conserve for
days weeks
months at a time this stuff is not
scientific at all
and in fact after a week of storing up
this sperm may not necessarily be
healthy
you are most fertile 14 days after your
period starts
that is only true if someone has a
28-day
cycle if your cycle is 35 days you're
actually going to ovulate on day 21
if your cycle is 25 days you're actually
going to ovulate on day 11
after your period for some people they
ovulate on day 9
after their period if they have like a
20 to 23 day cycle
so it really takes getting to know your
body
know your cycle track your cycle so you
can truly understand
your frequency for your cycle you can
never have children
after a vasectomy it is in fact possible
there are a number of ways to conceive a
pregnancy after a vasectomy
the simplest way to think about it is to
get a vasectomy reversal
there are ways of getting pregnant after
a vasectomy that don't involve reversing
the vasectomy
one of those ways is to go looking for
sperm in the testicles
or in the epididymis which is the
storage organ
behind the testicles that holds the
sperm that can be as simple as a 10 to
15 minute procedure
that's done in the office but that sperm
will then have to be used with in vitro
fertilization
eating pineapple can increase fertility
that's a good one pineapple by itself if
you have infertility
is unlikely to reverse your infertility
we know that pineapples have bromelain
inside of them which is a compound that
is known to be
a blood thinner to a certain degree but
it's very very weak
and you'd have to eat so much pineapple
to even have enough bromelain to have a
little effect
but if you're looking to add it as an
adjunct to your meals
etc go for it you should be having a
meal balanced in protein
complex carbohydrates and fiber so
getting your usual multivitamins
and folate into your diet because folate
is really important for
once you're pregnant but technically no
pineapple
by itself does not boost fertility you
can't have children if you're unable to
ejaculate
you can have children from your own
biological material
if you cannot ejaculate if the inability
to ejaculate
is a medical condition because of prior
surgery or because of a medication one
is taking
or if they were born with that condition
there may be ways of
reversing that condition there are
individuals who come to me who
the problem is not so much ejaculation
but the problem is erectile dysfunction
for those individuals we can use
medications there's
injections there's hormone treatments
there's a variety of things that can be
done to
sort of treat or cure the erectile
dysfunction more common
in my practice is premature ejaculation
and there are different kinds of therapy
different kinds of medication that we
can try to
prolong the ejaculatory latency time
you can't get pregnant right after
stopping birth control
that is a yes or no it depends on the
type of birth control
so when we use the term birth control
we're referring to
tablets we're referring to injections
we're referring to iuds
once we remove the iud you can start
working on getting pregnant the
following month
if you're someone who is doing the shot
like the depo
provera shot it can take up to a year
for your ovaries to wake up and start
ovulating again
if you're someone who was on a
progesterone only pill
they're usually able to ovulate again
within a month to two months of
discontinuing
if you were on birth control for an
extended period of time or what we call
the combined
oral contraceptive pills it could take
up to a year
myths parents used to believe if you've
already had children then you'll always
be fertile
that is a myth and in fact there's
something called
secondary infertility secondary
infertility
refers specifically to people who
already were able to have a child
without any difficulty and then later on
go on
to develop issues so we've talked about
age related
changes with sperm so just because
someone with sperm has caused pregnancy
before
it does not mean that they cannot now
have issues with their sperm in fact
50 of the time uh when we're seeing
infertility
it involves not just something with the
person who makes eggs
but something going on with the person
who's making this work
irregular period cycles are a sign of
infertility
i've definitely seen people who thought
that because they were
ovulating irregularly meaning irregular
periods they didn't need to use
birth control or contraceptives and then
were quite shocked
when they became pregnant and so it's
important to clarify that irregular
periods
while they need irregular ovulation they
do not mean
absent ovulation there are other people
for whom their irregularity
literally means they don't ovulate ever
and if that's the case then whether you
wait a year or six months you actually
need help from someone
with that taking prenatal vitamins will
increase
fertility i know nowadays in the
fertility space
it's not uncommon to meet a person who's
taking 10
12 tablets per day because they're
looking for
every tablet they can find that says may
boost fertility but you can certainly
try to make sure your body is in its
healthiest state
when you start trying we recommend one
multivitamin
for a menstruating person in part
because every month when you menstruate
you're losing blood meaning you're
losing iron you're losing some other
minerals and nutrients so
having a prenatal that will have extra
iron in it
is very helpful to just help keep your
pounds up and also
once you become pregnant if you are
trying to conceive
your body has to share its nutrients
with the pregnancy
and so a prenatal vitamin helps when
people talk about them they're really
talking about them in the context of
maybe
improved egg quality in terms of looking
at them
uh under the microscope etc but the
question as to whether or not it leads
to better birth rates more lifeborne
babies
the jew is generally out of that from a
sperm standpoint there's been some
recent
very highly publicized trials that have
shown that supplements are not
necessarily useful
contrary to that however there have been
some smaller studies that show
a benefit in antioxidants in general for
overall healthy living and so if you
have
a healthy lifestyle that will improve
your sperm quality
you should try for over a year before
seeing a specialist
if you're under 35 you should try for a
year but
trying is relative if you're someone
in a partnered relationship and you guys
have
access to sperm and egg you've been
having regular
unprotected intercourse around the time
of ovulation with regular periods
and it's already been a year and you
haven't achieved i don't
think you necessarily have to wait a
whole year before you come see someone
like
me um it's okay to come in and get
things checked out
if you're 35 or older if you haven't
tried at all then
try for six months and then go in to see
a specialist
i would also caveat that at 40 i
wouldn't even necessarily wait six
months
i would go in no later than three months
into trying
if an individual knows that they're
going to be trying to conceive or if
they've been having
in the couple unprotected intercourse
for say a year or a year and a half
and no pregnancy has emerged just walk
in get a semen analysis
see where you're at but ultimately it
comes down to eat well
sleep well and move your body
infertility
while a daunting thought really there
are lots of options available the first
step is actually an
evaluation fertility and infertility
constitute
this huge spectrum and there are many
many ways to get pregnant
and many things one can do to help
facilitate that
and you don't have to stay at home
feeling embarrassed about it if you talk
to a specialist
like myself like dr ellis who we are
experienced with this
and know how to treat you or direct you
to the right person who can help