Anovulatory Infertility is a condition of female infertility wherein a woman does not release an egg even when she’s having a menstrual cycle. This may be the culprit if you’ve had regular flow throughout and still have no luck conceiving. In this case, you’re only bleeding, but there’s no oocyte to fertilize, causing pregnancy to be out of reach.
Worry not, though, because this condition is curable through particular treatment regimens. Specifically, you could use either clomiphene citrate (Clomid), human menopausal gonadotropins (hMG), or follicle-stimulating hormone (FSH) with or without clomiphene. Note that while anovulation can be cured by medications, some common medications may cause it! These include treatments meant for other purposes, such as:
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs are one of the most accessible drugs you can find; they’re an over-the-counter remedy requiring no doctor’s prescription. It’s an effective remedy to fight off urinary incontinence. The drugs are widely used to relieve inflammation, pain, swelling, and fever. In fact, you may even have some of its variations stocked up in your medkit, like aspirin and mefenamic acid.
That’s right, these are medications you can freely access when you’re experiencing period pain. However, no matter how much they are blocking the discomfort, there are certain effects you should be aware of. NSAIDs can alter physiological processes, including those of your reproductive system.
Studies suggest that these drugs inhibit ovulation by directly affecting the dominant follicle. Instead of splitting open to release an egg, the follicle remains in its unruptured state. This condition won’t last for a lifetime, though. Withdrawal and avoidance of these drugs may lead to pregnancy.
Skin Creams and Other Topical Products With Hormones
Anovulation can also be due to skin creams and other topical products containing various hormones. For instance, there are brands that purposefully include progesterone and estrogenic chemicals in their formula. While these are effective in addressing wrinkles, dark spots, and melasma, they have an adverse effect on women’s fertility.
In particular, estrogens are a fool-proof way to increase collagen production and skin hydration. It’s a hormone known for decreasing skin aging, so they’re sought after in facial creams. However, in return, women gain an increase in estrogen exposure. These will have a great impact on hormone levels and can even affect ovum production in the long run.
On the other hand, progesterone is a handy addition to topical products as it can treat bloating, tenderness, and fatigue. There’s a lot to be gained from using creams made with this hormone, but there’s a certain disclaimer. You should only be using this if you’re done with ovulation and entering the luteal phase of your cycle. It’s because the body only produces progesterone for thickening the uterine lining for a possible pregnancy.
Steroids and Anovulatory Infertility
You could classify steroids into two: anabolic steroids, which are a charm for bodybuilders, and corticosteroids which reduce pain and stiffness. The latter is an effective medication against asthma, inflammation, and flare-ups. However, there’s one unpopular result it can bring with constant use – steroids affect fertility.
That’s right; if you’re planning on building a family, these drugs are a no-go. It’s a substance that can no doubt affect your menstrual cycle, making it irregular, heavier, and prolonged. It can even interfere with the body’s hormone production leading to anovulation.
On the chance that you get pregnant even while taking steroids, there are bound to be some congenital disabilities. Pregnancy complications may arise and may lead to failure in fetus development. The thing is, these types of drugs should not be in contact with your body if you’re keen on conceiving and giving birth.
Cortisone and Prednisone
Cortisone and Prednisone are types of corticosteroids meant to address various clinical problems. These include but are not limited to illnesses such as severe allergies, asthma, lupus, arthritis, and IBD. However, their downside is that they prevent the necessary hormone production for ovulation from occurring.
This is especially the case if you’ve taken both drugs in high doses as a regular routine. The organic chemicals in your body, namely follicle-stimulating hormone, and luteinizing hormone become blocked in production. For reference, FSH and LH are a pair of hormones known to stimulate egg maturation in the ovaries.
In general, corticosteroids are not recommended for those who are eager to conceive. Studies show that some women who took a single steroid shot had their menstruation cycles turn irregular. The fickleness of monthly periods is not a good sign, especially when it comes to reproductive health.
Herbs and Natural Remedies can Cause Anovulatory Infertility
If you believe you’re safe from anovulation because you’re all about the natural route, think again. Organic remedies may be eco-friendly and safer for your body, but they can also be the source of infertility. For instance, some herbs have hormone-like substances that can make your ovum production haywire.
For instance, some organic supplements contain ingredients that are high in estrogenic substances. Think of ginkgo, ginseng, clover, and other herbal plants effective in altering the sex-hormone concentration. In turn, egg production will be affected, and conception won’t occur.
This doesn’t mean you should completely stay away from herbs and natural remedies, though. They’re still a healthier, more sustainable alternative to chemically-processed substances. The best way to go is to schedule an appointment with your fertility doctor and take note of all the organic alternatives safe for use.
To Conclude
Anovulatory Infertility is a treatable condition that is experienced by thirty percent of women. It’s not as uncommon as you think and can be remedied by withdrawing from the substances causing it. You can also opt to get medications specifically addressing ovulatory irregularities.
Advancements in the medical world are growing rapidly, so you have access to various treatments in your hands. On the chance that you’re considering IVF, ask if they manage the patient journey with ART Compass. It’s a lab management software that can assist you with your conception goals through artificial intelligence.
Could Medicare cover fertility treatments, as the U.S. is faces an unusual population problem: fewer babies are being born each year. Demographer Brady Hamilton noted that fertility rates are reaching record lows, since the annual fertility rate has dropped to 59 births per 1,000 women. The decrease in fertility rates is due to the changing trends in women’s social behavior, since more women are opting to delay both marriage and childbirth. In fact, more babies are now being born to women in their late 30s up to their 40s. This trend in delayed childbearing is a big concern as fertility rates decline with age. Though some companies—notably Facebook and Google—are beginning to include IVF and other fertility treatments as part of their employee benefit packages, most do not. This puts the United States far behind other countries.
For example, in Spain since 2006, all women aged 18 or older have access to reproductive technology—including artificial insemination and in vitro fertilization (IFV). Women up to 50 are accepted by Spanish clinics, and they don’t discriminate against same-sex or single ladies, either. They also have 200 treatment centers—more than any other European country. In Denmark, IVF and artificial insemination, sperm mobility measures and basically anything you or your partner would need are 100% free of charge. Since 2006, ACT is not only limited to heterosexual couples but extends to same-sex duos and single women, too. It’s estimated that 8 to 10 percent of babies born in Denmark are by ART. Israel provides two IVF Cycles up to age 45 for free, In Australia the government covers half for the first IVF cycle and more for subsequent cycles, and the provinces of Canada all have varying levels of tax credits.
Qualifications for Medicare Coverage?
Medicare is widely known as health insurance for older adults aged 65 and above. However, individuals at a reproductive age can also apply for Medicare coverage under certain circumstances. For instance, you can apply for Medicare if you have an End-Stage Renal Disease that typically requires transplants or regular dialysis. Medicare Advocacy also points out that younger people with disabilities can apply for Medicare coverage. Furthermore, people with Alzheimer’s disease, mental illness, multiple sclerosis, and Parkinson’s disease are also qualified, if their doctors deem that they meet specific criteria. As such, consult with your doctor so that they can assess whether you can qualify for Medicare coverage for your health and fertility concerns.
Medicare and Fertility Treatments?
Does Medicare cover fertility treatments? There are different Medicare plans, and each of them offers various coverages. The Kaiser Family Foundation points out that reasonable and necessary services associated with treatment for infertility are covered under Medicare. This means that your doctor must consider a fertility treatment as a necessary medical option for you to qualify for coverage. As such, treatment can only be provided if the infertility is caused by a medical condition. However, patients under the original Medicare program can only use Part B for medically necessary fertility treatments, since it covers doctor’s services and outpatient care.
Couples struggling with infertility can also get more medical coverage through Medicare Advantage plans.
Medicare Houston outlines that these plans offer more benefits, such as prescription drug coverage for necessary medical cases involving infertility. Besides including part B and prescription drug coverage, individuals under Advantage plans also benefit from working with a wider network of doctors, hospitals, and providers. Therefore, you have more options if you want to consult a fertility doctor regarding your case.
The fertility rates in the US have been decreasing over the past years. Many people of childbearing age are struggling with infertility due to certain health conditions, making the extent that Medicare cover fertility treatments an ever more pressing need for the general population. To learn more about news and issues concerning fertility, check out the other resources on ART Compass. We have plenty of informative articles as well as our own lab management software for embryologists and IVF clinics.
If there is one thing I need at least once a day, it’s a good old cup of joe. Who doesn’t love the smell of freshly brewed coffee in the morning? It might get you thinking though, about the effects caffeine has on your fertility. One cup of coffee has 95mg of caffeine. A cup of tea has 27mg and do not get me started on those energy drinks that you might need on those all-nighters. Caffeine is pretty difficult to cut out of our daily diet entirely so let’s explore the effects this energy-boosting goodness has on fertility!
Is there a relationship?
As of now, there is no clear and concise relationship that has been identified between the chances of becoming pregnant and caffeine intake. There is a relationship between caffeine intake during early pregnancy and the risk of experiencing a spontaneous abortion. The risk increased with increasing consumption of caffeine.
Nevertheless there are some studies that could prove to be of interest. One of them is a report published in 1998 in Reproductive Toxicology. It demonstrated that women who drank between 300 to 700 milligrams of caffeine a day suffered a 12% lower chance of achieving a pregnancy. As caffeine intake increased, the probability of conceiving fell by 37%. In 2008, Dutch researchers announced that in their study of nearly 9,000 women with fertility issues, those who drank four or more cups of coffee, or some other kind of caffeinated drink, on a daily basis were 26% less likely to become pregnant
Another study published in Clinical Epidemiology supported the hypothesis that increased caffeine consumption results in higher chances of spontaneous abortion. There was no relationship established between caffeine consumption and fertility treatment outcomes.
What dosage is recommended?
This one is a little difficult because again, we are still learning about the connection between caffeine intake and fertility. The European Food Safety Authority (EFSA) and World Health Organization (WHO) advise limiting caffeine consumption to a maximum of two to three cups of coffee/200-300mg caffeine per day.
Caffeine and Fertility Treatments
Fertility specialists often recommend not consuming caffeine and alcohol during fertility treatments. The study “Alcohol and Caffeine Consumption and Decreased Fertility,” published in Fertility and Sterility demonstrates just that. More than 100 women were included in the study. Their urine samples were analyzed each day. They were 50% less likely to become pregnant when drinking alcohol. However, alcohol is not our topic of interest here. The caffeine is. The role of the caffeine was interesting. Rather than directly decreasing fertility the caffeine enhanced the detrimental impact of the alcohol on fertility.
“Couples’ Pre-Pregnancy Caffeine Consumption Linked to Miscarriage Risk,” is another study of interest performed by National Institutes of Health. The study showed that the likelihood of a woman having a miscarriage increases when both her and her partner drink at least two caffeinated drinks a day. This possibly hints that the caffeine intake is not only impacting fertility in women but may influence the fertility in men too. The study also illustrated that if a woman consumed more than two caffeinated beverages a day during her first 7 weeks of pregnancy she is more likely to miscarry.
The takeaway
I don’t think I could give up coffee. It’s the only way I get through my day! However there seems to be some sort of correlation between caffeine intake and fertility though this relationship has not been completely established yet. Make sure you talk to your doctor and let them know about important aspects of your lifestyle (such as caffeine consumption) that could help them help YOU make the best decisions moving forward. Different aspects of our lifestyle can have drastic impacts on fertility. Would you like to see a series of blog posts about the influence of lifestyle on fertility? Let us know!
References:
- Lyngsø, Julie et al. “Association between coffee or caffeine consumption and fecundity and fertility: a systematic review and dose-response meta-analysis.” Clinical epidemiology vol. 9 699-719. 15 Dec. 2017, doi:10.2147/CLEP.S146496
- Mehta Rinku, “ The Facts About Alcohol and Caffeine During Fertility Treatment,” Dallas IVF, https://dallasivf.com/alcohol-caffeine-fertility-treatment/#:~:text=of%20becoming%20pregnant.-,Avoid%20alcohol%20and%20caffeine%20during%20fertility%20treatment,and%20caffeine%20during%20fertility%20treatment.
- “Couples’ pre-pregnancy caffeine consumption linked to miscarriage risk” National Institutes of Health, https://www.nih.gov/news-events/news-releases/couples-pre-pregnancy-caffeine-consumption-linked-miscarriage-risk#:~:text=Because%20their%20study%20found%20caffeine,Buck%20Louis%20said.
- Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility [published correction appears in Fertil Steril 1999 May;71(5):974]. Fertil Steril. 1998;70(4):632-637. doi:10.1016/s0015-0282(98)00257-x
Image by Brodie Vissers
Does Steroid use affect fertility?
Steroids and fertility? What’s the connection between those two?
Anabolic steroids are quite familiar amongst competitive athletes. They provide the user with an edge because of a “boost” in strength.
Some effects on both men and women are reversible while some aren’t. One of the effects, however, is infertility and is most prominently seen in men.
Does Steroid use affect fertility? The anabolic steroids disturb hormone signals that are essential in producing sperm. The severity of the consequences depends on the dosage taken and the duration they’re taken for.
Men possess the ability to recover their sperm production anywhere from 3-12 months post-steroid usage.
Does Steroid use affect fertility? Anabolic steroid use during pregnancy may result in the virilization of a female fetus. Other effects of steroids also seem to be polycystic ovarian syndrome and endometrial hyperplasia.
The data used to write this post is from Sports, Doping and Female Fertility by Vignera et al. and Performance Enhancing Anabolic Steroid Abuse in Women by The American College of Obstetricians and Gynecologists. Check them out!
Evaluating your IVF Lab
How do you know if your IVF lab is good??? Well, one way is to inquire about new-cutting edge technologies they’ve invested in. Or are they using outdated methods??
How do you choose a fertility clinic? What questions can a lay person ask to begin to understand the quality of an IVF Lab? Quality goes beyond pregnancy success rates to new technologies, inspections and accreditations, staff experience and more! Find out what to ask.
Start with SART! The federal government requires fertility clinics to report IVF treatment cycle success rates, and you can find those statistics on the SART website. It also has a tool that allows prospective patients to search for fertility clinics by ZIP code, state or region; plus, women can plug in information such as their age, height, weight, and how many prior births they’ve had to predict their chances of success with assisted reproductive technology. Most programs are proud of their results and will list them on their website, however, those results whether success rates or a number of cycles reported, should match the number of cycles reported to SART or found in the CDC Assisted Reproductive Technology Fertility Clinic Success Rates Report.
Look for verified lab accreditation on the CDC report or in the alb. Find out who the inspecting agency is, the College of American Pathologists? The Joint Commission?
Look what percentage of their patients are in your age range, or have the same infertility diagnosis as you do.
Consider how the clinic’s staff talk to you, what they say – how professional does the care feel? Use all of your senses. Is the care personalized and professional enough so you feel comfortable?” An example of dehumanizing behavior: some clinics have an application process to decide if you should be treated there. Does the clinic have a support group?
Failed to call in prescriptions to pharmacy
Lost paperwork
Lost appointments
Failed to call with results
Failed to order appropriate test
Look on Indeed, Glassdoor, or other job sites to get an idea of staff turnover and what staff have to say. Find out how experienced the providers are, how well-trained are they and how long have they been there? As with other fields of medicine, experience matters in reproductive medicine. Providers should be fellowship-trained and board-certified in the field, both of which are the standard. Also inquire how long the medical providers have been at the facility. If there seems to be high staff turnover, there could be leadership and organizational issues at the clinic.
Look for clinics that can offer the latest treatments and protocols. These might include blastocyst transfer, freeze all cycles, mini or low STIM IVF, preimplantation genetic screening of embryos and single embryo transfer, ERA testing. Don’t choose your clinic based solely on insurance coverage. base your decision on the performance of the individual clinic.
Weigh the cost of the treatments with the CDC success rates. Good clinics with high success rates may cost more up front but may get you pregnant faster and at a lower cost in the long run instead of paying for multiple treatments.
Consider inquiring about the technologies the clinic uses. Do they use an EMR? Does it have A patient Portal for easy communication? Is there an electronic consenting process? Does the lab have state of the art cryo-storage monitoring systems? Does the lab use “electronic witnessing”?
List of new cutting edge technologies
Embryologist training systems like ART Compass
Electronic “witnessing”
Reagent traceability
Laser biopsy vs. flick biopsy
Quality control applications and network of sensors “IoT”
Patient scheduling and medication management, patient portals, and EMRs
Electronic consent
Cryostorage alarm systems
Cryostorage management, including “blockchain” applications for traceability
Cervical mucus and fertility play a fundamental role in the TTC process by nourishing and protecting sperm as it makes the long, arduous journey through the female reproductive tract to meet the egg. So, as you become more familiar with your cervical mucus, you will be able to better time having sex in order to conceive.
In simple terms, cervical mucus is a fluid secreted by the cervix, the production of which is stimulated by the hormone estrogen. Throughout your menstrual cycle, the amount and quality of cervical mucus that is produced will fluctuate, and by observing these changes you can begin to predict the most fertile days in your cycle. That being said, “should” be able to detect cervical mucus changes however, according to the Mayo Clinic, 23 out of 100 women practicing the cervical mucus method to prevent pregnancy in the first year of use, will actually get pregnant. What that says to me is that a lot of women have trouble detecting this exact physiological change- so if you don’t detect it, don’t worry!
As you approach ovulation, estrogen levels begin to surge, which causes the cervix to secrete more cervical mucus that is of a so-called “fertile quality”. This fertile-quality cervical mucus, also known as egg white cervical mucus (EWCM), is clear and stretchy, similar to the consistency of egg whites, and is the perfect protective medium for sperm in terms of texture and pH.
Having enough egg white cervical mucus during your fertile window will actually improve your chances of conceiving. And, by noticing when your body is producing egg white cervical mucus, you will be able to identify your most fertile days.
Cervical mucus plays and Fertility an important role in selecting motile, mostly morphologically normal sperm for fertilization. Insufficient production of fertile-quality cervical mucus or the presence of hostile cervical mucus may result from a variety of factors including diet, stress, hormonal issues, or even from taking prescription medications like Clomid.
The in vitro sperm–mucus penetration test (SMPT) is a sperm function test which measures the ability of sperm in the semen to swim up into a column of cervical mucus or substitute.
Normally, this cervical mucus is thick and impenetrable to sperm until just before release of an egg (ovulation). Then, just before ovulation, the mucus becomes clear and elastic (because the level of the hormone estrogen increases). As a result, sperm can move through the mucus into the uterus to the fallopian tubes, where fertilization can take place.
Abnormal mucus may do the following:
-Not change at ovulation (usually because of an infection), making pregnancy unlikely
-Allow bacteria in the vagina, usually those that cause infection in the cervix (cervicitis), to enter the uterus, sometimes resulting in the destruction of sperm
-Contain antibodies to sperm, which kill sperm before they can reach the egg (a rare problem)
However, problems with cervical mucus rarely impair fertility significantly, except in women who have chronic cervicitis or a cervix that has been narrowed (called cervical stenosis) by treatment for a precancerous abnormality of the cervix (cervical dysplasia).
Image by Sam Jotham Sutharson
Pollution BPA and toxins- something we don’t often hear about when speaking about fertility! That doesn’t mean there aren’t some things to be aware of regarding air pollution and toxins in certain everyday materials! Scroll down to find out why you need to learn about the relationship between pollution and fertility. And while we’re at it, let’s try and keep our amazing planet CLEAN for the generations to come! We must fight to keep our home healthy as it is OUR responsibility.
Pollution BPA and toxins: There is a growing body of evidence that suggests air pollution can have a negative impact on fertility. Women exposed to increased concentrations of nitrogen dioxide, carbon monoxide, and ambient particulate matter had lower rates of conception following fertility treatment and higher chances of early pregnancy loss compared with women exposed to lower concentrations of these pollutants. Men living in areas with higher air pollution are also more likely to have a higher proportion of abnormally shaped sperm. Ultimately, there is a limit to how much individuals can control their own air pollution exposures. Outdoor pollution is one of those problems we can only address through collective action.
BPA: Bisphenol A, known as “BPA” is an industrial chemical that has been used to make certain plastics and resins since the 1960s. In recent years, science has shown that exposure to BPA can result in reproductive endocrine disorders and neurobehavioral problems. Many manufacturers have started to use other chemicals as substitutes for BPA. Products containing these substitutes are sometimes marketed as “BPA-Free.” Plastics that do not contain bisphenol, however, may not necessarily be any safer than those that do. Be weary of marking claims!
Toxins: “Natural” does not always mean safe, especially when you are trying to conceive or are pregnant. Proceed with caution and care when using even the most natural of “Nature’s Remedies”. Try to minimize your overall exposure to toxins.
A few quick tips-
- Read labels on cleaning solutions and gardening products
- Minimize eating deep sea fish such as swordfish, shark, king mackerel and tilefish all of which have a more concentrated level of mercury
- Check for lead-based paint in your home (in older homes).
OHSS: the dreaded ovarian hyperstimulation syndrome, a rare but significant side effect of IVF.
Today’s post is all about ovarian hyperstimulation syndrome! It is one of the hurdles one might face when undergoing an IVF cycle so we want to help clear up what the risk factors are and what might help reduce the risk of developing it!
OHSS occurs in 1-10% of IVF patients. Risk factors for OHSS include:
- young age
- development of many ovarian follicles under stimulation
- extreme elevated serum estradiol concentrations
- use of hcg for final oocyte maturation and/or release
- continual use of hCG for luteal support
- the occurrence of a pregnancy (resulting in hCG production).
The risk of OHSS is smaller when using GnRH antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. The underlying mechanism is that, with the GnRH antagonist protocol, initial follicular recruitment and selection is undertaken by endogenous endocrine factors prior to starting the exogenous hyperstimulation, resulting in a smaller number of growing follicles when compared with the standard long GnRH agonist protocol. Have more questions about OHSS?
Have you ever wondered what the connection is between BMI and Fertility? They are intertwined!!!
Obesity (higher than average (BMI) affects fertility in both women and men. The male and female reproductive systems rely on a delicate balance of hormones to function properly. When stress is placed on these systems as a result of a low or high body weight, their natural chemical rhythms begin to break down.
In particular, women who are obese have a higher rate of infertility and a lower IVF pregnancy rate. Obesity in men negatively impacts male fertility as it relates to sperm count and sperm motility (the rate at which sperm move).
Healthy lifestyle changes will not only help you conceive, but they will help you maintain a healthy pregnancy, and give you energy for raising a child. Not to mention- ensure that you will have a nice, long life to enjoy your children and grandchildren!
The #1 way to lower BMI and increase fertility
The number one recommendation for weight loss is to cut refined carbohydrates drastically!
Some experts are suggesting that women who are TTC should limit carbs to one portion a day and cut out all white bread, pasta and breakfast cereal, since doing so greatly increases the chance of conceiving.
The recommendation to go low carb is based in part on a small 2013 study from the Delaware Institute for Reproductive Medicine (DIRM). The authors analyzed the diets of 120 women who were going through IVF. They found that women who got at least 25 percent of their diet from protein and no more than 40 percent from carbohydrates were four times more likely to get pregnant as women who had less protein and more carbs before and during IVF.
How does BMI affect fertility?
If you’re overweight or have a history of polycystic ovarian syndrome (PCOS), your body produces more androgen hormones (a.k.a., testosterone), which can lead to irregular periods or anovulation (where you don’t ovulate).
Women with PCOS produce more insulin. When you eat lots of carbs, your body has to produce even more insulin, which increases androgen production. And that decreases ovulation.
Healthy lifestyle changes will not only help you conceive, but they will help you maintain a healthy pregnancy, and give you energy for raising a child, plus ensure that you will have a nice, long life to enjoy your children and grandchildren! You are only 18, you have so much time left to make some healthy changes and plan for your family.
Carrying a few extra pounds has a large effect on the fertility of both women and men. The male and female reproductive systems rely on a delicate balance of hormones to function properly, and when stress is placed on these systems as a result of a low or high body weight, their natural chemical rhythms begin to break down.
Harvard Medical School has made several recommendations – including;
Healthy foods to lower BMI and increase fertility
Plant-based foods, including whole fruits and vegetables.
Seafood rich in omega-3 fatty acids such as salmon, mackerel, and lake trout.
Whole grains.
Raw nuts.
Legumes (beans, lentils, etc.).
Extra virgin olive oil (monounsaturated fat).
What should I avoid?
Simple or refined carbohydrates.
Trans fats.
Highly-processed foods.
Alcohol (couples actively trying to get pregnant or undergoing fertility treatment should avoid drinking alcohol).
Excessive caffeine intake (more than 500mg per day).
If your BMI is above normal; diet, exercise, and lifestyle changes have been shown to make a significant difference in a woman’s fertility potential. Even small differences, just 5-10% of body weight can make a huge difference!