Pregnancy is complex. And for some, that’s realized right away as you try to conceive a baby. Once thought of as an off-the-table topic that many dealt with privately, today it’s becoming more and more welcomed for women and men to share their fertility stories. Why? Because you are not alone. In fact, one in every eight couples have trouble getting pregnant or sustaining a pregnancy. But everyone’s journey is different and there are an array of factors that impact your ability to get pregnant and determine which treatment is best for you. So, to help give us the complete rundown on everything you need to know when it comes to fertility, we spoke with reproductive and infertility specialist, Dr. Andy Huang, M.D., who has helped such big names as the Kardashians and Chrissy Teigen on their road to conception.
“The stress of infertility is not insignificant,” says Huang. “Some people equate the stress of infertility to the stress of being diagnosed with cancer.”
That’s where Huang comes in to help. Here’s a guide of what you need to know when it comes to fertility and you.
Perelel: If someone is unsuccessfully trying to conceive, at what point should they see a fertility specialist?
Dr. Andy Huang, M.D.: That depends on age. Usually, infertility is diagnosed after 12 months of trying to get pregnant and not having any success. But over 35-years-old, we shorten that time and say six months. Eighty-five percent of the time you should be pregnant within a year of trying. So if you’re not pregnant within the year, you’re in that 15 percent, which is one in every eight couples.
P: Should women be tracking their ovulation on their own?
AH: Definitely, it’s one of the easier things to do. And if they track on their own and they think that they’re not ovulating consistently then they should see a fertility specialist sooner. If a woman has a period every 28 days and she’s tracking it and everything is appropriate, great. But if a woman has a period every three months and she’s not ovulating, don’t wait 12 months to see a fertility specialist because ovulation is clearly an issue. So it’s a great idea to track ovulation on your own and it’s a simple thing to do. You can buy an over-the-counter ovulation kit and just utilize that with calendaring to optimize timing.
P: What can someone expect from a fertility test?
AH: First, we get an initial history to find out any clues that may tell why the couple is not getting pregnant. Immediately after that, we will do a physical, which consists of four major tests. One, is a semen analysis to assess the male factor. The second test is an ultrasound that may be accompanied with blood tests and hormone panels to assess your ovarian reserve. The ovarian reserve is used to evaluate how young a woman’s ovaries are. The third test we do is to evaluate ovulation or how well a woman is ovulating. That can be done by ultrasound in combination with blood tests. And then the last test we use is called a Hysterosalpingogram (HSG), which looks at your anatomy. We’re looking at anatomical factors like a woman’s uterus and fallopian tubes. That’s the panel of the four elements that we will want to assess.
P: Once you make an assessment on what the issue is, what do treatment options look like from there?
AH: Right, so the first step is assessment where we figure out why. After assessment, we make a diagnosis. And then once you get the diagnosis, we go into treatment. So if it’s a sperm problem, depending on the severity, we will go into either IUI or IVF. If it’s an anatomy issue, we usually look to surgery to fix it. Or, if the tubes are blocked, we go straight to IVF. If it’s an ovulation disorder, then we try to induce ovulation using medication. And if it’s an ovarian reserve problem, meaning the ovaries are the issue, then sometimes we’ll do ovarian stimulation or IVF.
P: So many women have heard that they should go off of birth control early to give enough time for their bodies to adjust in order to get pregnant. Is that true? What role does birth control have on fertility?
AH: No, that’s an old wise tale. Birth control pills these days are very low dose and they’re very reversible. By stopping birth control pills, a woman should be able to get pregnant very easily and it doesn’t matter if she’s been on two weeks of birth control pills or ten years. The problem with birth control is that sometimes it can mask the real issue for someone who’s low reserve. So let’s say it’s someone who is 42-years-old and they’re going through menopause early, if you’re on birth control pills it can be hard to know. They wouldn’t know that their periods are going away if they’re on birth control pills. The birth control pills are masking that their ovarian reserve is low.
P: How can someone increase their fertility at home?
AH: The simplest thing you can do is have a healthy lifestyle. That means eating healthy, exercising, and avoiding processed foods, tobacco, alcohol and caffeine in excessive amounts, as that affects sperm and egg quality. Foods rich in antioxidants and vitamin C may actually improve sperm and egg qualities as well, like berries.
I always recommend supplements to my patients as well. Always. That’s because those are the simple things you can do. They might not reverse aging but they will definitely give men and women the best possible outcome. When patients come in, we have a whole list of supplements but Perelel gives us the opportunity for us to be very specific in terms of what stage a woman is in her pregnancy, because the requirements are not always the same.
P: And lastly, what about stress? What role does stress play in fertility?
AH: What you put into the body is what you get out of the body. And stress can negatively affect the body because it’s all connected. The most immediate effect we see is that stress can put you in a fight or flight response. When your body is in a fight or flight response, it’s not going to want to get pregnant. The most extreme example is that when you are overly stressed you stop having your period and when you stop having your period that’s because you don’t ovulate anymore. So stress can affect ovulation.
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Dr. Huang is a board-certified Obstetrician and Gynecologist with a specialty in Reproductive Endocrinology and Infertility. Throughout his career, he has published numerous journal articles and texts focusing on stem cell development, endometriosis and infertility, Polycystic Ovarian Syndrome (PCOS), and has examined whether an association exists between genetic defects and pregnancies conceived through IVF. For his work, Dr, Huang has been invited to speak at both national and international conferences and is the recipient of numerous awards and recognitions including: the UCLA Medical Center Outstanding Laparoendoscopic Award, Los Angeles Magazine Super Doctors, Best Doctors, Patient’s Choice Award, Compassionate Doctor Award, and Top Ten Doctor Award.
He currently chairs local and national committees for the Society of Reproductive Endocrinology and Infertility, American Society of Reproductive Medicine, and Pacific Coast Reproductive Society, is a reviewer for the journal Fertility and Sterility, a clinical instructor at the UCLA David Geffen School of Medicine, and a volunteer fertility consultant for the Los Angeles Zoo where he sits on its medical advisory board. He and his wife, Grace, are the proud parents of two boys and a girl.
1 Fast facts - RESOLVE: The national infertility association. Resolve.org.
2 Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-47.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.