The fact that you know you’re a carrier for hepatitis B is the first step in ensuring that the condition will not harm your baby. Although some children born to some carriers (those with a certain antigen) are at high risk for infection, treating them within 12 hours of birth with hepatitis B vaccine and immune globulin can almost always prevent such an infection.

Be sure to tell your obstetrician that you’re a carrier so that a titer is taken to determine how contagious you are and that your baby is treated as needed. Treatment is repeated at 1 and 6 months, and the child is usually tested at 12 to 15 months to be sure that the treatment has been effective.

Yes it can. Over the past decade more and more studies have shown a link between sleep deprivation and a host of health problems, including obesity, depression, and infertility. Since the immune system is weakened when a person doesn’t get the sleep he or she needs, the body doesn’t work at its full capacity. This makes conception difficult.

South Australian scientists at the University of Adelaide also have recently discovered that “clock genes” that manage daily body rhythms may play a more important role in fertility than previously believed.

In their study of mice, they found that those without a gene that regulated body rhythms were “profoundly infertile.” In an article in the January 2005 issues of the journal Human Reproduction Update, they explain their theory of disrupted circadian rhythms in reproduction.

They plan to conduct further research into the behavior of clock genes and their interaction with the environment to find answers to some of infertility’s most puzzling questions, including why only some embryos grow in the laboratory and why some couples with no known reproductive problem cannot conceive.

The American Association for Reproductive Medicine (ASRM) and SART Practice Committee recently published new guidelines to aid assisted reproductive technologies (ART) programs and their patients. The new guidelines will help to minimize the incidence of multiple pregnancies that carry risks both to the mother and to the children.

The committee recommends that under ordinary circumstances, patients under age 35 should have no more than two cleavage-stage embryos be transferred. Older patients may have more than two transferred, but the number will be determined by the prognosis criteria.

At this point in time you don’t have anything to worry about. Urologists at the State University of New York at Stony Brook conducted the small study to which you refer. Although they found that long-term use of laptops could reduce sperm formation by raising temperatures in the genital area, more studies need to be conducted to determine whether these side effects are short-term or long-term.

The researchers found that keeping a laptop on the lap for an hour can raise scrotal temperatures by more than 2.5 degrees Celsius, enough to affect fertility significantly, according to a report published in the December 9th issue of the European journal Human Reproduction.

The best way to safeguard a man’s fertility while using a laptop is to put it on a desk instead of on the lap, say the researchers.

Yes there are, especially if you have cut back on cereals, crackers, and other foods made with grain fortified with folic acid. According to an article published by Dr. Gideon Koren, professor of Pediatrics, Pharmacology, Pharmacy Medicine, and Medical Genetics at the University of Toronto, with an estimated 10 to 15 percent of American and Canadian women on low-carb diets, a growing number of women are not eating enough folic acid from flour products to prevent neuro tube defects in their offspring.

According to the article before flour and other products were fortified with folic acid, the typical woman consumed slightly less than 200 mg of folic acid from dietary sources alone. This is far less than the daily-recommended 400 mg of folic acid per day for women of childbearing age.

Anyone who is trying to conceive, including those on low-carb diets, should take prenatal vitamins. Remember, as many as half of all pregnancies are unplanned which generally means that women may not know that they’re pregnant until four to six weeks of gestation. Unfortunately the fetus’ neuro tube has already closed by this time if the mother had not been getting her needed supply of folic acid.

Congratulations on deciding to make proper lifestyle changes to be the healthiest you can be when you conceive. Regular exercise has been proven to relieve stress. It also can help protect the cardiovascular and immune systems from the consequences of stressful events.

Tai chi is a good choice for someone who wants low impact exercise. The health advantage of this ancient Chinese system of physicial exercises lies in its breathing method and slow movements. These series of fluid motions are circular, slow, and together form one, larger posture. The deep breathing helps to relieve stress, while the coordination of upper-body moves with the shifting of weight from leg to leg promotes total fitness. Tai chi also has been found to improve flexibility, muscular stamina, and strength. Before beginning any new exercise regime, however, it’s important to consult with your physician.

No, they’re not, according to a recent article published in the August 2004 issue of OB/GYN News. “Many herbal preparations taken during pregnancy are innocuous, but some are ineffective and others are downright dangerous,” Dr. Tieraoana Low Dog of the University of New Mexico in Albuquerque told his colleagues at a meeting on botanical medicine sponsored by Columbia University and the University of Arizona.

Raspberry leaf, often taken to alleviate morning sickness, prevent miscarriage, and aid in childbirth, was found to be safe. A randomized controlled study of 192 women found that women who used raspberry tea from week 32 to delivery had no adverse affects. However, the herb had no perceptible effect on the timing of labor, the length of labor or the need for analgesia.

Ginger also is often taken to alleviate morning sickness. Three clinical trials have confirmed some benefit in this regard without finding harmful effects to the mother or infant. However Dr. Dog told the group, “to be on the safe side, women should limit ginger consumption to one gram per day.” In excessive doses, ginger may affect bleeding tendencies. One study that involved patients taking 10 grams of ginger was associated with significant reduction in agonist induced platelet aggregation.

The British Herbal Medicine Association considers chamomile, which is often ingested in tea made from its flower, safe for consumption during pregnancy. There have been no reports of adverse affects.

Blue cohosh, which is used to stimulate labor, should be wholly avoided in pregnancy, according to the University of New Mexico researchers. Often combined with black cohosh and taken as a uterine tonic or partus preparation during the last six weeks of pregnancy, blue cohosh has been used for these purposes since the 19th century. It is still widely prescribed by lay midwives. In one survey 52 percent of certified nurse midwives said that they recommended labor-stimulating preparations. Of these, 64 percent used blue cohosh and 45 percent used black cohosh. Complications, which were reported by 21 percent of the respondents who used either blue or black cohosh, included transient fetal tachycardia, meconium stained fluid, and nausea.

A study appearing in the June 2004 issue of the Journal of Human Reproduction suggests that it can. The researchers believe that since ultrasound can be used to measure the volume of the ovary, this volume may be able to predict when menopause will set in and how many fertile years a woman has left.

It has long been known that the number of eggs in the female ovary peaks at several million while she is still in the womb about halfway through gestation. From this point on, she experiences a continuous decline in the total number of eggs. At birth approximately one to two million eggs remain. The amount decreases to about 300,000 at the time menstruation begins. At around age 37 a woman has about 25,000 eggs left. In menopause she has only about 1,000 eggs left.

While these researchers have developed a tool to potentially help women plan their reproductive lives, a second study published in the Journal of Human Production warned that women might not want to wait too long before starting a family. Assisted reproductive technology (ART) cannot be relied upon to fully compensate for the lack of natural fertility after age 35. The authors used a computer simulation model to determine that the overall success rate of reproductive technology would be 30 percent for those trying to conceive at age 30, 24 percent at age 35, and 17 percent at age 40.

Even armed with such studies, patients should understand that it is at best difficult to predict at what point in their lives it will become too difficult to conceive.

Symptoms of PCOS include: irregular menstrual cycles (few or no periods) excess facial or body hair acne sudden unexplained weight gain problems maintaining a healthy weight darkened patches of skin on the neck, groin, under the arms, or in the skin folds depression or anxiety elevated cholesterol, especially LDL, and/or triglycerides and a family history of diabetes or heart disease.

According to a recent study conducted by Richard Schacterle, Ph.D., and Dr. Anthony Komaroff of Brigham Women’s Hospital in Boston, that’s usually not the case. They found that the symptoms of chronic fatigue syndrome usually do not worsen during pregnancy.

The study, which was published in the April 1, 2004 edition of OB/GYN News, involved 86 women with the condition who experienced a total of 256 pregnancies, some before and some after the onset of the syndrome. During pregnancy, 41 percent of the women reported no change in symptoms, 30 percent noted an improvement in symptoms, and 29 percent found that their symptoms worsened.

The investigators also found no significant difference in a host of maternal complications and outcomes when they compared pregnancies that occurred before the onset of chronic fatigue syndrome and those that occurred after the onset of the condition. The only exceptions were a higher rate of spontaneous abortions and a correspondingly lower rate of live births by vaginal delivery after the syndrome’s onset. These differences, however, could have been compounded by age or parity as stated by the researchers.

Before trying to conceive, you should consult with your physician.

To help your physicians determine why you and your husband have had trouble conceiving, a semen analysis is usually taken. The analysis is done the same day by a laboratory clinician. The sperm will be examined for a number of factors, including:

• the time for the semen to become liquid

• the semen’s volume, consistency, and pH (measure of its acidity).

• sperm count

• motility (percentage of moving sperm)

• morphology (normality of shape)

• agglutination (“clumping”) of sperm

• the presence of elements other than sperm, such as white blood cells or bacteria.

A normal ejaculate has more than 20 million sperm per ml. More than 40 percent of the sperm should be moving forward, and, using strict criteria, more than 14 percent should have normal shapes.

The sooner you both have the tests needed performed, the sooner you can get the treatment you need to conceive the baby you always wanted.

It’s probably a good idea to have your husband give up his hot tub and steam room visits until after you have conceived. The testes are supposed to be five degrees lower than a man’s body temperature. The sperm can overheat if the testes’ temperature rises too high.

Characterized by disrupted eating habits, unhealthy weight management practices, and distorted perceptions about weight and body shape, eating disorders affect 10 million girls and women in the U.S. The top three eating disorders, anorexia nervosa (selfinduced starvation), bulimia (bingeing and purging), and binge eating disorder (uncontrollable eating) are considered psychological problems, but they have serious health complications and may be life threatening.

Besides damaging the heart, kidneys, electrolye balance, and many bodily functions, eating disorders also can make conceiving and delivering a healthy baby difficult. Infertility often occurs in women with eating disorders because menstrual cycles and hormones are out of kilter. Because they’re not eating or drinking enough of the proper foods, malnutrition and vitamin deficiencies occur. This unhealthy nutritional balance increases the likelihood of high-risk pregnancies and miscarriage. If carried to full-term, the likelihood of birth defects, stillborn babies, and death of chronic illness in newborns rises. Women with eating disorders also are at high risk of developing polycystic ovarian syndrome, a condition that makes it difficult for a woman to conceive and also increases the rate of miscarriage if she does conceive.

If your sister is serious about wanting to have a healthy baby, then she needs to overcome her problem. She should make an appointment with her physician to be referred to a counselor that specializes in helping victims of eating disorders. Once she’s on the road to recovery, then she should visit a fertility specialist.

One of the most common hormonal disorders, hyperthyroidism is a condition where the thyroid gland becomes overactive and secretes too many thyroid hormones, especially the hormone thyroxine. Hyperthyroidism is more common in females and usually occurs between the ages of 20 and 50. About 75 percent of its cases are due to Graves’ disease, an autoimmune disorder in which the immune system produces antibodies that attack the thyroid gland, resulting in excessive secretion of thyroid hormones. Graves’ disease runs in families and may have a genetic basis.

People with vitiligo (a rare skin disorder) and pernicious anemia (a blood disorder) may also develop hyperthyroidism. Thyroid nodules that secrete too many hormones also can cause hyperthyroidism. Thyroiditis (inflammation of the thyroid gland) can cause symptoms of hyperthyroidism to occur temporarily.

Common symptoms of hyperthyroidism include weight loss, persistent tremor, and quick and sometimes irregular heartbeat. Drugs for hyperthyroidism reduce the activity of the thyroid gland. These antithyroid drugs are usually taken for 12 to 18 months until the thyroid gland can produce enough hormones on its own. The drug you are taking propylthiouracil (PTU) is one of the most common and effective antithyroid drugs available.

With expert medical care and guidance, the pregnant woman with hyperthyroidism has just about as good a chance of having a successful pregnancy and healthy baby as any other expectant mother does. Your physician will prescribe levels of the drug for pregnancy use only. The risks of taking the medicine, if any, are quite small compared to the benefits of keeping you well. If you still have to be on the medication after delivery, the levels prescribed may also change.

Answers to your questions depend upon whether or not you had the chicken pox as a child. If you did, then you do not have to get the chicken pox vaccine. However, if you did not get the chicken pox as a child, then you should consider being vaccinated. If you’re not sure, your physician will recommend a blood test to determine whether you’re immune. If you’re not immune and do not have protective antibodies from prior exposure to the virus, you will be given the varicella vaccine (against chicken pox). Couples are then advised to wait at least three months to try to conceive.

A woman who is already pregnant should not receive the vaccine. Besides causing more severe symptoms in adults than in children, chicken pox can cause problems in fetuses. One risk is congenital varicella syndrome, a group of birth defects that can include scars, muscle and bone defects, malformed and paralyzed limbs, a less than normal size head, blindness, seizures, and mental retardation. Congenital varicella syndrome affects only about 2 percent of babies who mothers developed chicken pox during the first 20 weeks of pregnancy. If a mother contracts chicken pox after 20 weeks of pregnancy, the syndrome is extremely rare.

Another risk occurs when the mother is infected with the virus from five days before to two days after delivery. Without preventive treatment, about one-quarter of newborns become infected with a severe chicken pox infection and develop a rash between five and 10 days after birth. According to the March of Dimes, up to 30 percent of infected babies die if not treated.

The good news is that these infections can usually be prevented or the accompanying symptoms greatly lessened if the newborn is treated immediately after birth with a VZIG (varicella-zoster immune globulin) injection. New antiviral drugs also are helpful in managing severe symptoms.

Infertility problems and weight go hand in hand. Research has found that obese women are two times more likely to be infertile than women of healthy weight. They also suffer from irregular menstrual cycles and weakened immune systems, making conception difficult. In addition, obesity can cause men to produce inferior sperm, another reason for infertility in couples.

Many times severely overweight people can develop a relatively common, though not well-known, condition called “Syndrome X. ” This condition is caused by having too much insulin in the body. “Syndrome X” can not only impede a woman’s ability to become pregnant but her ability to carry to term as well.

If you do conceive, being obese also can make your pregnancy more difficult. The risk of hypertension and diabetes in the form of preeclampsia and gestational diabetes rises, and delivery can be complicated because overweight mothers tend to deliver large babies. That’s why it’s so important to be at a healthy weight while trying to conceive.

DVIFG has a nutritionist and expert on Syndrome X on staff to help overweight patients lower their weight and insulin resistance to conceive the children they always wanted.

Yes it can. Women who smoke have consistently been found to have decreased fertility. Researchers believe that smokers have higher rates of certain hormones that can lessen their chances of conceiving. Moreover, women who smoke are more likely to begin menopause at a younger age than average. Studies have also found that even during in vitro fertilization, eggs taken from women who smoke are less likely to be successfully fertilized.

If you want to start a family, you should quit smoking immediately. Besides affecting fertility, smoking during pregnancy can harm the fetus.

As more women delay pregnancy planning until their 30’s and beyond, the importance of studying their ovarian reserve of oocytes (eggs) becomes paramount. Women are born with a full complement of eggs in the ovaries, which reside in a resting pool until they are selected to move into a growing pool. Some of these eggs will become available for ovulation after menarche (a girl’s first menstruation cycle). This cycle of oocytes moving from the resting pool to the growing pool continues throughout the reproductive years until all of the eggs have been used (menopause). Menopause usually occurs around age 51.

An oocyte that leaves the resting pool takes about 220 days to participate in the ovulation process. When a woman’s age is advanced, problems can ensue because there aren’t as many ooctyes available for ovulation in each menstrual cycle. As these numbers decrease, the ovaries’ ability to produce normal eggs to undergo fertilization also is lowered (the ovarian reserve).

There are several tests that measure the ovarian reserve. One of them, the clomiphene citrate challenge test (CCCT) has been standardized and is widely accepted. For five days the patient takes 100 mg of clomiphene citrate (CC). Here FSH serum level is measured both before the test and after the five-day round of medication is completed. A decision about the ovarian reserve is made based on the levels of FSH.

Recently, other tests have been used to determine the ovarian reserve, but they have not become standardized or widely accepted. Measuring inhibin B, a hormone produced from the growing follicle that increases as the follicle and egg mature, for example, can be advantageous in certain cases. Since its levels vary less from cycle to cycle in comparison to FSH, inhibin B can be used to predict the ovarian reserve after stimulating the ovaries with gonadotropins. Ovarian volume and early follicle count are other methods undergoing further evaluation and study.

A major problem may occur if a woman wants to conceive and happens to have high levels of FSH early in any of her cycles. In some cases the problem cannot be resolved with any treatment, while in other cases it can be easily resolved. Therefore, any woman who has a single elevated FSH level should immediately undero further evaluation, and specific studies of treatment should be implemented in order to achieve her desired goal of conception.

Hemachromatosis is an inherited disorder affecting body chemistry in which the level of iron in the blood is too high. If left undetected and untreated, the condition can lead to health problems, such as cirrhosis of the liver, diabetes, and heart disorders.

More common in men than women, hemachromatosis can cause infertility. Common symptoms in men include difficulty in ejaculating, shrinking of the testes, loss of interest in sex, limited facial hair growth, and reduction in their sense of smell. These symptoms usually do not appear until age 40, but excessive alcohol drinkers may experience symptoms earlier because alcohol increases the amount of iron that is absorbed by the intestines. In women, it may cause amenorrhea (the absence or suppression of menstruation).

The condition is usually diagnosed with a blood test, and treatment is targeted at removing some of the excess iron from the body. About 1 pint of blood is removed each week until the iron levels return to normal levels. People with this condition should not drink alcohol or eat iron-rich foods.

Despite its frequency (affecting 3 in 1,000 people in the U.S.) and effect on the endocrine system, hemochromatosis is given little attention in endocrinology and infertility textbooks. This is certainly a disorder that should be considered when taking case histories.

Occurring in about 1 in 100 pregnancies, an ectopic pregnancy is a pregnancy that implants outside the uterus, usually in a fallopian tube. If the condition is not detected and treated early, the pregnancy will continue to grow in the tube and the tube will eventually burst. If this happens, the tube will no longer be able to carry fertilized eggs on their way to the uterus in future conceptions. If the tube ruptures and is not immediately treated, the mother’s life also could be threatened.

Symptoms of an ectopic pregnancy include brown vaginal spotting or light bleeding accompanied by diffuse abdominal pelvic pain on one side or shoulder pain, and lightheadedness or fainting spells.

The good news is that new techniques for early diagnosis and treatment of ectopic (tubal) pregnancy have removed most of the risk for the mother and also have improved her chances of remaining fertile.

Besides high-resolution ultrasound to visualize the uterus and early gestational sac development, detection of the condition also is made through highly sensitive pregnancy tests that track the level of the hCG hormone in the mother’s blood. If the hormone level does not rise appropriately but still rises as the pregnancy progresses, an ectopic pregnancy may be suspected.

Transvaginal sonography is at the forefront for treating patients with a possible ectopic pregnancy. When the BhCG reaches around 2000 in a normal developing pregnancy, a small gestational sac should be visualized within the uterus. Between five to six weeks gestation, a yolk sac (visualized as a small, bright ring) should be seen within the gestational sac. If the BhCG is elevated enough to expect an intrauterine gestational sac, and one is not seen, an ectopic pregnancy is suspected.

Sometimes in the case of ectopic pregnancy, a small collection of fluid accumulates within the endometrial cavity (psuedosac). If the patient experiences pain, it may be due to a ruptured tube and fluid in the free spaces behind the uterus or around the liver and kidneys. Color doppler sonography can add information for further analysis. This technique utilizes color flow mapping to visualize increased blood flow to a suspicious area in the region of the fallopian tubes. A developing pregnancy outside of the uterus will demonstrate an increase in blood flow due to early placental tissue implanting in the fallopian tube. With transvaginal sonography a patient can be diagnosed earlier with an ectopic pregnancy and can be given the proper treatment in order to safeguard her ability to conceive again.

Laparoscopic surgery to remove the abnormal pregnancy is now routinely done. Less invasive than regular surgery, laparoscopic surgery also gives patients shorter hospital stays and quicker recoveries. But surgery is not the only route to take. If an ectopic pregnancy is diagnosed early enough, oral doses of the drug methotrexate can successfully treat the condition without the need for surgery.

If you have any questions regarding transvaginal sonography, please call Laurie Miller, DVIFG’s sonographer, at (856) 988-0072.

Hormonal fluctuations are a normal part of the reproductive cycle in the human female. When you add fertility drugs to the mixture, some, but not all, women may experience strong emotions and mood swings. Should these swings become disabling in their intensity or frequency, medications and/or psychotherapy are available to “cut the edge.” Oftentimes “forewarned is forearmed” and not being taken by surprise can be of great support in going through this period of time. Knowing that it is a temporary phenomenon and oriented toward achieving the goal of having a baby will greatly aid a patient in retaining her perspective. A knowledgeable and supportive partner may also play a critical role.

The Delaware Valley Institute of Fertility & Genetics (DVIFG) can help you cope with the uncertainty of infertility. Through a unique program designed to help you discuss and work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph..D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington,DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility.

To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

Infertility support groups can often be a highly supportive milieu for a couple as they navigate their way through the maze of the infertility workup. It can be very helpful, supportive, and validating for a couple to see, hear, experience, and communicate with other couples that are on the same journey as they are. In some cases, issues may arise during the support group discussion that can then be addressed by the couple with or without professional support.

Like most other things in life, there is no “one-size-fits-all” solution, and each couple must determine if a support group can play a positive role in their infertility workup. Some couples may prefer a support group with only their peers, while others may be helped more by a support group led by a professional counselor.

The Delaware Valley Institute of Fertility & Genetics (DVIFG) can also help you cope with the uncertainty of infertility. Through a unique program designed to help you discuss and work through your feelings and concerns, you will learn effective strategies to live each day to its fullest while trying to conceive.

Geoffrey D. Nusbaum, Ph..D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, is uniquely qualified to help you cope while trying to conceive. A Fellow and Diplomate of the American Board of Medical Psychotherapy and a Fellow of the International Council of Sex Education and Parenthood at American University in Washington,DC. Dr. Nusbaum holds a clinical certificate from The American Association for Marriage and Family Therapy and is a Founding Member of the Mental Health Issues Section of the American Society for Reproductive Medicine. He has over 25 years of experience counseling people on how to deal with the stress associated with a medical condition, including infertility.

To make an appointment with Dr. Nusbaum, please call (856) 988-0072.

Being on a vegetarian diet, regardless of whether or not you also eat dairy products, is actually healthier than regular diets containing meat products. In answer to your question regarding your ability to conceive, it’s not the vegetarian diet that causes problems but the reasons why you’re on it and how you take it that are more critical.

If a person goes on a vegetarian diet to lose weight and happily stays on it for weight control, then it’s unlikely to affect the reproductive system and fertility. On the other hand, if the vegetarian diet is difficult for her to follow and causes a lot of stress, then it will disrupt the reproductive system and create infertility problems.

From a physical point of view, if a woman loses too much weight while on a vegetarian diet and becomes underweight, then her reproductive system will be compromised or disrupted due to inadequate nutrition. This can lead to ovulatory dysfunction and infertility problems. On the other hand, if a woman consumes excess food, even on a vegetarian diet, and becomes overweight or obese, then she may develop a metabolic disorder such as insulin resistance, leading to ovulatory dysfunction and infertility.

Therefore, one cannot simply say that a vegetarian diet will affect infertility. It is why she is following this diet and where she stands as far as her mental and physical condition that will determine if this situation can affect her fertility.

If you plan to stay on a vegetarian diet, you should know that it lacks omega 3 fatty acids, important fatty acids that are essential to our health. They cannot be synthesized in our bodies, so they have to come from food intake, usually from fish or from some special plant such as flaxseed. Most vegetables do not have enough omega 3 fatty acids. Therefore, you may want to consider taking flaxseed oil capsules for omega 3 fatty acid supplementation, or fish oil. Ask your physician for advice on the proper amounts to take as supplements.

You should wait at least three months after discontinuing the use of birth control pills before trying to conceive. This will give the body sufficient time to clear the estrogens and progestins present in the oral contraceptives and to enable the hypothalamus-hypophyseal-gonal axis to generate a healthy follicle/oocyte for a pregnancy to be achieved. Even in cases where women have unprotected intercourse soon after discontinuing birth control pills, conception has occurred. Studies indicate that oral contraceptive use does not affect the ability to conceive.

Pregnancy, however, does become more difficult to achieve as women age. In general, the later women try to conceive, the harder it is to become pregnant.

The benefits of taking oral contraceptives at an early age is that they may help prevent endometriosis, a common cause of infertility that occurs when tissue fragments of the endometrium (the innermost lining of the uterus) grow outside the uterus, causing scarring on the ovaries and the fallopian tubes. They also may offer some protection against sexually transmitted diseases, and lower a woman’s risk of developing certain types of cancer.

According to Geoffrey D. Nusbaum, Ph.D., director of DVIFG’s Medical Psychotherapy and BioMedical Ethics Service, there are numerous clinical studies indicating that reducing stress and anxiety through supportive intervention, such as counseling or stress management programs, can often prevent or stop preterm labor.

The important thing to remember is that you can control your attitudinal response to the stress of infertility. For help in coping with the stresses involved with infertility, call Dr. Nusbaum at (856) 988-0056.

You’re correct about wanting to lose weight in order to conceive. Infertility problems and weight go hand in hand. Research has found that obese women are two times more likely to be infertile than women of healthy weight.This is due to having too much insulin in the body resulting in a condition called “Syndrome X.”

Syndrome X can not only impede a woman’s ability to become pregnant, but her ability to carry to term as well. The good news is that with the help of a board certified Medical Nutrition Therapist, you can lose the weight and keep it off.

A professional who practices medical nutrition therapy is a crucial part of the infertility treatment team. A medical nutrition therapist can help you and your family understand why eating particular foods are crucial to good health and how to follow a sensible diet/exercise regimen to achieve a healthy weight. A medical nutritional therapist understands that these changes take time and develops gradual plans for changing food intake patterns. The goal of medical nutrition therapy is:

• to help you separate food and weight-related behaviors from psychological issues.

• to develop an action plan for changing food intake patterns.

• to create a life-long sensible diet/exercise program for maintaining a healthy weight.

• to promote overall good health to increase your chance of conceiving, to enhance self-esteem, and to improve metabolic control.

• to help couples make behavioral changes and to utilize support and referral sources to keep them on track.

At DVIFG we offer medical nutrition therapy with a registered dietitian and Certified Diabetes Educator in charge of the service. Melissa Bennett received her B.S. degree in Dietetics from the University of Delaware and has over a decade of experience as a clinical dietitian and educator. Besides individualized counseling, Ms. Bennett can provide you with educational literature on nutrition, personalized meal planning, exercise tips that really work, and easy low-fat cooking tips.

To make an appointment with Ms. Bennett, DVIFG’s Medical Nutrition Therapist, please call (856) 988-0072.

The biomedical ethics community is still divided on both the safety and ethical aspects of this emerging technology. At this point in time the Ethics Committee of the American Society of Reproductive Medicine (ASRM) has stated in its journal, Fertility and Sterility: “As long as the safety of reproductive SCNT [cloning] is uncertain, ethical issues have been insufficiently explored, and infertile couples have alternatives for conception, the use of reproductive SCNT by medical professionals does not meet standards of ethical accredibility.”

The jury is still out on this one, but a recent study conducted by Australian researchers found that the shocks and vibrations from the activity may cause physical damage and compromise men’s fertility. The scientists found that pressure from the bicycle seat can damage blood vessels and nerves in and around the scrotum. Since mountain biking often involves riding over rough terrain, the shocks to the groin only compound any preexisting problem.

More studies need to be conducted to determine whether frequent mountain biking can reduce sperm count. In the meantime, the study researchers suggest that male mountain bikers pad both the bike seat and their shorts and visit a bike shop to ensure that the seat is positioned high enough and at the proper angle.

The study did not mention the impact of mountain biking on female fertility. It did, however, mention that many activities done in excess can damage a man’s fertility, including cigarette smoking and beer drinking. Until more studies are performed, the safest route for men to follow is to mountain bike and exercise in other ways in moderation.

Depending upon your reproductive history and other medical factors, you and your husband may benefit from preconceptional counseling and/or preimplantation genetic testing.

Preconceptional counseling is recommended in cases where couples have suffered early pregnancy loss, preterm labor, or other reproductive problems or where there’s a family history of certain genetic diseases. By screening couples for these genetic diseases before they conceive, it can help them understand the risks and plan accordingly.

Carrier screening can detect certain genetic diseases, including alpha- Thalassemia, beta-Thalassemia (a type of anemia affecting the production of hemoglobin), cystic fibrosis (a condition that affects all of the fluid- and mucus-secreting glands in the body and this leads to thick, abnormal secretions, especially in the lungs and pancreas), Sickle cell disease (a type of anemia usually affecting African Americans in which red blood cells become sickle shaped), Tay-Sachs disease (a fatal childhood disorder in which harmful chemicals accumulate in the brain that is most common in the Ashkenazi Jewish population), and many others.

Preimplantation genetic testing helps couples that choose IVF have a successful pregnancy. This new testing can identify genetic defects at two different stages, in an ovum (unfertilized egg) before fertilization or in an embryo (before implantation). Since approximately 60 percent of all reproductive losses in pregnancy are linked to a chromosomal abnormality, performing this testing may help prevent unsuccessful IVF pregnancies. In fact, a recent study found the pregnancy rate with IVF patients ages 35 to 45 increased from 16 to 30 percent when preimplantation genetic testing was conducted.

Besides screening for the same genetic conditions as preconceptional testing, preimplantation testing can detect certain gender-linked chromosomal disorders, Huntington’s disease (a brain disorder that causes personality changes, involuntary movements, and dementia), Lesch-Nyhan syndrome (a metabolic disease that affects only males, in whom mental retardation, aggressive behavior, self-mutilation, and renal failure are exhibited), muscular dystrophy (a group of genetic conditions in which muscles become weak and wasted), Hemophilia A (a blood disorder), and Retinitis pigmentosa (a progressive disease in which the retina progressively degenerates).

In vitro fertilization (IVF) is a type of assisted conception that involves mixing eggs and sperm outside the body.

IVF offers a chance at parenthood to infertile couples where women have blocked or absent fallopian tubes, where men have low sperm counts, and where other infertility problems occur.

In IVF, eggs are surgically removed from the ovary and mixed with sperm outside the body in a petri dish. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized eggs (embryos) are then placed in the woman’s uterus. (IVF makes it possible for couples to conceive without the use of the fallopian tubes.) The overall success rate of IVF is approximately 21 percent.

The overall health of both partners has an important effect on fertility. Like you, he should eat a healthy diet, exercise regularly, and find ways to reduce stress. He should also not wear tight underwear, avoid hot baths, saunas, and hot tubs, and limit his exposure to hydrocarbons and other chemicals in the workplace because these factors can affect sperm quality.

He should also reconsider taking the following prescription drugs due to their association with infertility in men: cimetidine (Tagament®), nitrofurantoin (an antibiotic), sulfasalazine (a drug used to reduce inflammation of the intestines), spironolactone (a potassium-sparing diuretic drug), and calcium channel blockers (such as nifedipine®). If he smokes, he should quit immediately. Secondhand smoke can affect your fertility as well.

You should also make sure that your husband is getting enough folic acid in his diet. A recent study conducted by scientists at the University of California, Berkeley and the Western Human Nutrition Research Center (WHNRC) in Davis published in the February 2001 issue of Fertility and Sterility, found that low levels of folic acid in men are associated with decreased sperm count and decreased sperm density. Good dietary sources of folic acid include fortified breakfast cereals, leafy greens, legumes and orange juice.

The researchers now plan to study the effect of too little amounts of other vitamins on male reproductive health. The scientists found in a previous study conducted in 1991 that men with low levels of vitamin C had more genetic damage in their sperm and that smokers were at even greater risk.

Men trying to help their partner conceive may also want to steer clear of St. John’s wort, echinacea, and gingkgo biloba, three popular herbs on the market. According to a preliminary study published in Fertility and Sterility, all three of these herbs affected sperm in some way. The researchers found that the herbs made it more difficult or impossible for the sperm to penetrate eggs and/or changed the sperm’s genetic makeup, making them less viable.

Since heavy alcohol consumption has been found to reduce sperm count, he should drink no more than two alcoholic drinks occasionally. You should also have frequent intercourse (several times per week) to boost your chances of conceiving.

After adopting these healthy lifestyle changes, you should be able to conceive after six months to one year of trying. If you aren’t successful after that period of time, ask your physician for a referral to a physician specializing in infertility. For most couples, it’s only a matter of time before they achieve pregnancy. In fact, 80 percent of couples are successful within six to eight months. Good luck!

Although many women over age 35 have little difficulty conceiving a child, age is a factor in fertility. The older a woman gets, the greater her chance of miscarriage. Fertility problems, however, usually don’t seriously develop until a woman reaches age 40, although women in their mid to late 30s may have problems conceiving due to a natural decline in ovarian function. Although men experience a decrease in sperm production after age 25, some men remain fertile into their 60s and even their 70s. Due to the fact that more and more couples are delaying starting a family until their 30s or beyond, infertility is becoming more common. That’s why in women over 35, a fertility evaluation should be given after six months of unprotected intercourse.

Other factors regarding age and infertility include:

• A decreased ovarian reserve suggests a poor prognosis for fertility.

• Older women hoping to conceive may need aggressive treatment to capitalize on the “window of infertility.”

• Egg donation is usually the best option for women over 40 who have elevated basal FSH (follicle-stimulating hormone) levels.

Yes, there is, and treatment will be based on your diagnosis. If tests have shown that you are not ovulating due to low levels of FSH, drugs will probably be prescribed to stimulate ovulation. These drugs are used when the inability to conceive results from a hormonal imbalance in either the male or the female. Fertility is influenced by hormones produced in the brain by the hypothalamus and the pituitary gland. The hypothalamus produces gonadotropin-releasing hormone, which regulates the release of gonadotropin hormones from the pituitary