Medical App & Medical Advice with Hello Doctor

How stress can influence your fertility

Could stress really prevent you from getting pregnant?

Stress is often described as an event that a person sees or feels as threatening to their life. So, the body responds with a “fight or flight” response in order to protect itself.

According to research on the relationship between stress and infertility, the cause of infertility isn’t always clear. There may be a basic health condition like polycystic ovarian syndrome (PCOS), endometriosis, male infertility, or the frustrating diagnosis of unexplained infertility.

Stress, depression and anxiety are described as common consequences of infertility.

Stress and your behaviour

While stress alone doesn’t necessarily cause infertility, it can push a person toward unhealthy behaviours. These unhealthy behaviours can affect your fertility.

We all resort to unwholesome patterns or routines when stressed. But the following habits can actually affect your fertility:

  • Binge eating, emotional eating or not eating enough.
  • Sleeping too much or too little.
  • Not exercising enough or pushing yourself to overdo it.
  • Drinking too much alcohol.
  • Smoking.
  • Drinking too much caffeine, especially if you’re sleep-deprived.
  • Loss of interest in sex with your partner.

Infertility and stress

Stress can affect the gland in the brain that manages your emotions, appetite and the hormones that tell your ovaries to release eggs. When you’re stressed out, you may ovulate later in your cycle or not at all. So, if you’re only having sex around day 14, thinking that you’re about to ovulate, you may miss your opportunity to conceive.

Research has shown that people who get less than five hours of sleep each night are more likely to suffer from obesity, and obesity can lead to problems with fertility.

Don’t let stress get in the way

Reducing stress is good for your health, and may improve your chances of falling pregnant. Finding ways to keep stress in check by developing better coping strategies to help you feel more in control and improve your overall wellbeing.

Improve emotional health

Try these:

  • Acupuncture.
  • Aerobic exercise (may be reduced during treatment).
  • Journaling.
  • Listening to music.
  • Massage therapy.
  • Meditation.
  • Mind-body groups.
  • Mindfulness.
  • Progressive muscle relaxation.
  • Psychotherapy and cognitive behavioural therapy.
  • Self-help books.
  • Support/educational groups.
  • Walking/hiking.
  • Yoga.

References:

Struggling to fall pregnant? It could be an ovarian cyst

Ovarian cysts are more common than you realize. Often, they don’t present with symptoms, but sometimes they can create a lot of trouble – including infertility. 

A cyst is a fluid-filled sac that can form in many places in the body. Ovarian cysts form in or on the ovaries.

The most common causes of ovarian cysts include:

Hormonal problems or drugs used to help you ovulate. These cysts usually go away on their own without treatment.

Pregnancy. An ovarian cyst normally develops in early pregnancy to help support the pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later in the pregnancy and may need to be removed.

Endometriosis. Women with endometriosis can form a type of ovarian cyst, called an endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.

Severe pelvic infections. Infections can spread to the ovaries and fallopian tubes that can result in cysts forming.

In many cases, ovarian cysts have no real symptoms but can include:

  • Mild stomach ache.
  • Stomach swelling or a feeling of fullness or pressure.
  • Pain during sex.
  • Period issues, including a lack of bleeding, heavy bleeding or painful periods.
  • Painful, frequent peeing if a cyst presses against the bladder.
  • Sudden, sharp stomach pain, fever, and nausea if a cyst becomes twisted or “bursts”.
  • Unusual hair growth on the face and body caused by an increased production of the male hormone.

Diagnosis of ovarian cysts


A gynaecologist will help diagnose an ovarian cyst. If a lump or mass in the ovary is found, further tests will be done to check for ovarian cancer. These will include:

Pelvic exam


Usually ovarian cysts are discovered during a pelvic check-up. But, a pelvic exam can’t produce a final diagnosis, so the next step for your doctor would be to perform a vaginal sonogram.

Vaginal sonogram


This test allows the doctor to get the clearest picture of the ovary and cyst. The test is done by inserting a small instrument into the vagina that forms a picture on a monitor.

This image allows the doctor to figure out the size of the cyst and see inside it to check whether it’s solid or fluid-filled. While the vaginal sonogram can pick up a cyst, it won’t be able to tell whether there is a cancerous or non-cancerous growth. So, if the sonogram shows there’s a cyst, the next step may be the surgical removal of the cyst (laparoscopy) to find out if it’s cancerous or non-cancerous.

Laparoscopy


This operation is performed in the stomach or pelvis and allows your doctor to see and remove the cyst by making a small cut. The laparoscope is inserted through a small cut into your stomach and small instruments are then placed near the pubic bone to allow the doctor to remove the cyst.

Treatment of ovarian cysts

Ovarian cysts often disappear without treatment. Surgery to remove the cyst may be needed if cancer is suspected, or if the cyst doesn’t go away and is causing symptoms. In many cases, it can be removed without damaging the ovary, but sometimes the ovary must be taken out. In rare cases, an ovarian cyst may be drained during laparoscopy.

Your doctor may recommend hormonal therapy to help prevent future ovarian cysts.

If you experience any of the symptoms of ovarian cysts, see your doctor or gynaecologist. If you’ve been diagnosed with an ovarian cyst and you experience sudden, sharp stomach pain, fever, or vomiting, see a doctor immediately.

References:

Can you choose your baby’s gender?

You’ve wanted a little girl ever since you were a little girl yourself. Or maybe your husband is keen for a boy to play sports with. Is it possible to choose the gender of your baby? Let’s first understand how gender works.

All women’s eggs carry the X chromosome.
Sperm carries either an X or Y chromosome.

X is for girls, Y for boys. If the Y-bearing sperm penetrates the egg, then the baby is a boy. If the X-bearing sperm penetrate, then the baby is a girl.

It basically comes down to which sperm gets to the egg first, and there are 100 million sperm-cells swimming against each other! 50% carry the boy-gene, and 50% carry the girl-gene. So, your chances are basically 50:50 – just like flipping a coin!

Pink or blue?

There are a ton of old-wives tales about how to get a boy or girl: from taking a hot shower, having sex in certain positions, or eating certain foods. None of these have been proven, and, scientifically speaking, most of them do not make any sense.

What research does tell us, is that the girl-making sperm is large and slow, while the boy-making sperm is light and fast. The girl making-sperm can also live a bit longer than the boy-making sperm.

Because of this, scientists developed a technique called Sperm sorting, or Microsort. The scientists basically sort the sperm to get more boy-sperms or more girl-sperms together. With this technique, your chances increase from 50% to about 70% to 80%.

Sperm sorting is not available in South Africa.

The only way to choose with 100% certainty

The only way to choose your baby’s gender, would be to go for IVF (in vitro fertilisation). In this process, the eggs of a woman is fertilised with the man’s sperm in a laboratory dish. The doctors can check the gender of the different embryos before they re-implant them in the mother.

This process is very expensive! So, if you want to try some techniques at home, here are the ones that science suggest could work in your favour:

Timing

Timing is everything. It’s believed that the closer to ovulation you have sex, the greater the chance of having a boy as the Y-sperm is faster and gets to the egg first. If you want a girl, having sex three days or more before ovulation may work in your favour. Dr John Martin Young, an American sex selection expert, recommends women keep a chart of their monthly cycle. “If patients pay attention to the timing of their cycle their chances of conceiving the sex they’d like can be as high as two in three.”

Age

As women age, the theory goes that the chances of conceiving a boy increases. So if you’re in your late 30s trying to get pregnant, it may just be a boy!

In the end, the people who make the best parents, don’t care what gender their child is: they love them with the selflessness, fullness and dignity that every person deserves: man or woman.

References

Your sperm ages with you. Here’s how to save them

There’s no need to rush into fatherhood, but men, just like women, shouldn’t wait too long to have a baby. Even though most men can have children well into their 50s, fertility becomes challenging after the age of 40. This is because ageing affects every cell in your body, including your sperm cells.

Your swimmers age too

As you grow older, your sperm quality decreases. Their morphology (size, shape and appearance) and motility (the ability of sperm to move towards an egg) deteriorate with age, and the volume of semen also begins to decline.

Research published in Fertility & Sterility found that between the ages of 30 and 50, the average man’s sperm declines by up to 30% in volume, swims up to 37% slower, and is five times more likely to be deformed. This can make it more difficult for sperm to fertilise an egg. The older you are, the longer it will take for you and your partner to conceive – no matter the woman’s age.

Your hormones may also be working against you. Around the age of 40, your testosterone levels may go down. Low testosterone can affect your ability to make sperm, and result in low sperm count. It can also reduce your libido and lead to infertility. Illnesses that cause infertility are also more common among older men. These include erectile dysfunction (the inability to achieve and maintain an erection), varicocele (the abnormal dilation of the testicular veins in the scrotum), and orchitis (inflammation of the testicles).

The risks

There’s also a high risk of not being able to conceive at all and miscarriage. The risk of miscarriage is twice as high for women whose male partner is over the age of 45 than for those whose partners are under 25, says the Infertility Awareness Association of South Africa (IFAASA).

Fertility is ageist. Older men typically have older partners. Female fertility starts to decline after the age of 30, and drops more sharply after the age of 35. The older your partner, the more difficult it may be to conceive.

Age also affects your chances of having a healthy child. Children of older fathers have a greater risk for mental health problems and autism spectrum disorders. According to statistics from IFAASA, children with fathers aged 40 or older are more than five times as likely to have an autism spectrum disorder than children fathered by men under 30. Down’s syndrome, schizophrenia, and Type 1 diabetes are other conditions that seem to be more common among babies with older fathers.

Keep your swimmers healthy

  • Eat right. A diet high in fat and low in plants can shrink sperm count and quality. Fill up on antioxidant-rich foods like fruits, vegetables, and wholegrains to improve the health of your sperm.
  • Limit your drinks. Alcohol can harm your sperm and interfere with sperm production. Stick to two units of booze a day.
  • Quit smoking. Tobacco reduces sperm count and motility. Nicotine can also negatively affect sperm morphology.
  • Keep cool. Heat slows down sperm production and lowers sperm count. Avoid tight-fitting underwear and clothes, hot baths and using your laptop directly on your lap.
  • Stop stressing. Too much stress can degrade and permanently damage your sperm. Protect your boys by finding healthy ways to deal with stress. Take a timeout, get enough sleep, or vent to someone.

Save your swimmers

If you are planning for children later in life, it may be a good idea to get your sperm frozen. This ensures that, even if your body changes, you have a few billion copies of your younger self, ready and waiting to reproduce. You can do this at places such as http://medfem.co.za/sperm-freezing-and-storage/ .


If you and your partner have been trying to have a baby for over a year, but haven’t been successful, see your doctor – especially if your partner is over 35 or either of you have a history of infertility. There may be a medical reason for your difficulty to conceive.

References

Infertility: there is hope!

It’s heartbreaking to realise you may not be able to get pregnant. Infertility is not the end of the road, though. Medically defined, infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or the inability to carry a pregnancy to term.

In South Africa, it’s estimated that one in six couples struggle with infertility.

As doctors and experts understand, lifestyle factors can wreak havoc on fertility. Dr Paul le Roux from Cape Fertility concedes that infertility is on the increase in SA, at least 10% each year. “Women are now delaying childbearing until they’re older. This is a global trend and all around the world with women having children at an older maternal age, until after they’ve completed their studies, established a career, and found the right partner. Unfortunately, medical science cannot always assist due to the deteriorating quality of their eggs. Excessive alcohol and smoking is bad for fertility, as is being over- or underweight when trying to conceive.”

A particularly sad aspect of infertility is the age factor. Age does affect fertility, especially in women. Studies show that a woman’s fertility starts to decline at age 30, and then even further in her late 30s and early 40s. According to the Society for Assisted Reproductive Technology (SART), in America, a healthy 30-year-old woman’s odds of getting pregnant during a specific ovulation cycle is approximately 20%.

Why is age such a big issue? All women are born with a finite amount of eggs, as they get older, the eggs too get older. These eggs don’t have the same “potency” as they age to respond to fertilisation. “It’s true that women have a limited number of eggs,” confirms Dr le Roux. Here, knowledge is power, and a scan of the ovaries and a blood test (called an AMH) can tell you how many eggs remain.

Male infertility is also a smoking gun, and can be brought on by the same lifestyle factors that affect women. Stress, excess body weight, smoking, too much alcohol, drug use and erectile dysfunction are all possible risk factors.

The good news

Tackling the issue of ineffective eggs, egg freezing is a viable and successful procedure that’s worked for many couples. The process of preserving eggs or oocytes is called vitrifcation. This involves stimulation with injections and getting the ovaries to product a number of eggs which are then retrieved through the vagina. Once these eggs have been extracted, they can then be frozen for the future.

This isn’t to say that the eggs, in a few years’ time, will be completely viable. Experts still debate the success rate of thawing and fertilising at a later stage. It really depends on the experience and expertise of the individual fertility centre. Some institutions have a pregnancy rate of 20-25%.

Egg donation is another possibility. This is used for women with poor quality eggs or those who are premenopausal or menopausal. The treatment involves stimulation of the egg donor’s ovaries, retrieval of the eggs and fertilisation of the eggs with the recipient’s partner’s sperm. You’ll then carry the baby, but it won’t be your DNA.

Millions of couples have also successfully opted for IVF (in-vitro fertilisation). In this process, eggs are surgically removed from the ovary and mixed with sperm. This is done outside the body in a dish and after about 18 hours, the eggs are examined to see if the sperm has fertilised them.

Other options like sperm donation and surrogacy can be helpful in certain patients, and of course – adoption. So, there are always avenues to explore.

As always, before it gets to this stage though, it’s a good idea to watch for infertility culprits (taking care to manage stress, and make healthy lifestyle choices).

  • Go for regular check-ups if you want to get pregnant soon so if there are any potential threats, you can take steps to fix the problem as soon as possible.
  • Always be safe when having sex. Sexually transmitted diseases can harm your reproductive system.
  • Smoking and other recreational drugs can do a lot of damage to your infertility so stop well before you want to conceive.

References

The top 5 factors that affect male fertility

When it comes to making a baby, everyone knows it takes two to tango, but did you know that male fertility issues account for around half of the problems a couple might experience when trying to conceive? Here we take a look at the Top Factors that Affect Male Fertility. Don’t forget to also check out our infographic on the Top 5 Factors that Affect Female Fertility.

Continue reading “The top 5 factors that affect male fertility”

Putting the FUN into fertility

Amazingly, you have only around a 20% chance of conceiving each month – and this is only if everything is working as it should be. This percentage decreases with certain factors like increasing age (especially over 30), certain medical conditions and medication, being overweight, smoking and lack of exercise.

Continue reading “Putting the FUN into fertility”

Can you reverse a female sterilization?

The answer to this question is complicated- the short answer is maybe.. and here is the long answer!

First let’s look at Tubal Ligation (female sterilization). This procedure is done to prevent pregnancy. There are two tubes (Fallopian tubes) in the womb: at the end of these tubes, the woman’s egg waits for the sperm to fertilize it. In tubal ligation, we simply block these tubes, so that the egg and sperm cannot meet. We do this either by:

  1. Sealing the tubes with a clip or a ring
  2. Burning (cauterizing) the tubes so that they become blocked with scar tissue
  3. Cutting the tubes and then tying them closed

The procedure is classified as a permanent method of birth control as reversal is difficult and not often successful.

So what happens if you have had this done and want to fall pregnant? Can it be reversed? Yes it can, but the success depends on many factors:

  1. Your age (the older you are, the less likely)
  2. The type of tubal ligation you had (some are easier to reverse- for example clips)
  3. The health of your reproductive organs (ovaries, uterus, length of the remaining fallopian tubes, have you had PID before, do you have endometriosis, etc.)
  4. Time since you had the procedure (more recent will make it easier)
  5. Did you have any successful pregnancies before the procedure?

If your doctor is happy that there may be a good chance of success you will need to have a number of tests done before the reversal- blood tests, ultrasound of the uterus and ovaries for example. Your partner will also need to have his sperm count checked. All this is to see if there will be any other factors affecting you ability to fall pregnant.

Once the sterilization is reversed, in general success rates for a healthy pregnancy are between 40-80% and the best chance is within the first year.

Risk: Pregnancy outside the womb

Since the tube has been damaged in the first operation, it’s possible that after the doctor repairs the tube, there still remains a gap somewhere. This means the fertilized egg can escape from the womb, resulting in a pregnancy happening outside the womb – this is a potentially life-threatening condition.

Are there any other options?

The good news is yes- there are! In-Vitro-Fertilization (IVF) can be done. This is when the egg is fertilized by the sperm outside the womb in a laboratory, and then placed straight into your womb to grow. This means the sperm doesn’t have to travel through the damaged tube – isn’t medicine great!?

IVF has a few risks of its own, so it would be best to chat to your doctor about what is best for you.

Author: Dr Lynelle Hoeks