Every month, Dr. Gleaton answers all your questions about fertility, pregnancy, birth and more. Follow us on Instagram to ask your questions!

 

By OBGYN Dr. Gleaton

Is there any way to know if you're infertile before trying for a baby? 

You can ask your OBGYN about fertility tests including labs testing egg quality/quantity, tubal assessment, and sperm assessment to get an idea of any challenges you may face. However, while these may offer useful information, the only true test is to start trying!

I’ve been trying to conceive while breastfeeding and my cycle is all over the place. Any advice? 

Irregular cycles can be a normal part of breastfeeding and can take up to 1.5 years postpartum to completely regulate. Consider abruptly dropping one feeding which can sometimes help. In addition, focus on optimizing your nutrition, ingesting sufficient calories, and learn to identify your body’s ovulation signals. Using ovulation tests can help. 

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Do I need collagen protein supplement when TTC/pregnant? 

Collagen protein is typically considered safe while ttc and during pregnancy and offers benefits for bone, hair, and joints. Everyone has individual needs based on their diet and risk factors. Discuss with your OBGYN provider if collagen supplementation is right for you.

I have been trying to get pregnant for two years. Is it beneficial to see a new doctor?

Although most couples will conceive within the first year of trying, this is not true for all couples. Everyone’s journey to parenthood is unique and different, and timeframes vary widely.

It's best to openly discuss your desires and expectations with your OBGYN early on. Ask for a specific plan to evaluate and achieve your fertility goals. If you’ve met with your OBGYN  and feel unsupported in your fertility journey, then by all means seek a second opinion. 

Tips to naturally get pregnant after having to receive fertility help the first time. 

The good news is that you’re more likely to have a successful second pregnancy if you already have a child. Read more great tips on increasing those chances each month. 

I have been seeing a lot of things about choline. Can you talk more about the need for it?

Approximately 90%–95% of pregnant women don't get enough choline through diet, and most prenatals contain little—if any—choline. Some evidence indicates that lower choline levels are associated with an increased risk of neural tube defects.

Most prenatals lack choline. But growing evidence of its benefits shows choline improves several pregnancy outcomes and protects against certain neural and metabolic disorders. 

What can I do (in addition to medication) to get my egg count up? 

Since women are born with all the eggs we’ll ever have, our egg count can’t be increased. However, there are certain practices that are associated with improved egg quality and in some cases improved fertility outcomes. 

For enhanced egg quality, focus on exercise, stress reduction, a healthy diet, not smoking, and maintaining a normal BMI. Several supplements have also been linked to improved egg quality including Vitamin D, DHA, and Coenzyme Q10.

What does it mean if your luteal phase is short? How do you lengthen it? 

A short luteal phase is one that lasts less than 8 days and is associated with low progesterone levels. Progesterone is vital for proper preparation of the uterine lining for implantation. In the last decade there has been considerable debate as to whether luteal phase defect (LPD) impacts fertility rates. However, if you suspect a problem with your luteal phase, discuss with your provider and aim to correct the underlying cause. Treatment may include progesterone supplementation, stress reduction, weight loss, and correction of other hormone imbalances. 

For someone with Endo (currently on birth control) should I TTC earlier?

I often advise patients with proven endometriosis to not delay childbearing once they are physically and emotionally ready. Even on birth control, menstrual cycles or breakthrough bleeding can affect the reproductive organs.

The association between endometriosis is not fully understood and goes beyond scarring and adhesions. Speak with your ob/gyn provider regarding your specific risk factors for infertility as age, past pregnancies, and stage of endometriosis also play an important role in reproductive success.

When should I start using the ovulation strips? After my period? Any time? 

For an average 28 day cycle, I suggest daily testing starting day 10.

Can people with endo conceive naturally? 

While getting pregnant with endometriosis can be more difficult in some cases, it is definitely not impossible by any means! Check out my article “Getting Pregnant With Endometriosis” for more information. 

How long should you wait to start TTC after giving birth?

ACOG recommends waiting at least six months, but further acknowledges optimal spacing as 18 months since intervals less than 18 months are often associated with adverse outcomes. Although most US data supports this association, studies have not consistently shown a cause-effect relationship. Read more on child spacing.

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What basic tips do you have for getting pregnant? 

  1. Get to know your fertile window by using ovulation tests - aim to have sex every other day during this window
  2. Eliminate smoking, drinking, and any drug use 
  3. Get your BMI in a healthy range
  4. Start taking a prenatal

For more tips about on TTC best practices, check out our article “Tips to Increase Your Chances of Getting Pregnant This Month.”

TTC while breastfeeding (an 18 month old). I’m having trouble. Is it possible? Do I have to wean?  

When you are exclusively breastfeeding, your body naturally stops ovulating. And if you’re not ovulating, you can’t get pregnant.

Tips for getting pregnant with only one fallopian tube after ectopic pregnancy? 

Pregnancy can still be achieved in the setting of only one tube. However, when one fallopian tube is damaged or blocked, it's important to ensure the health of the opposite or remaining tube and confirm that it is open. This can be done with a hysterosalpingogram - an xray dye test or sometimes a special ultrasound procedure utilizing fluid.  The basic principles of conception also still apply, so identify your fertile window, optimize your health, and work on stress reduction.Lastly, tubal factor infertility should most often be managed with an early REI referral to discuss treatment options that can bypass the fallopian tubes if needed. 

If all my labs come back normal, is it possible to still have a hormone imbalance from foods, skin products, etc leading to my “unexplained fertility?”

Yes. Hormone levels can easily confirm abnormalities that may affect fertility. However, if these are normal, certain practices may still affect pregnancy rates. Focus on eliminating or reducing processed foods, artificial substances, parabens, dyes, etc and increasing fertility friendly supplements such as CoQ10, vitamin D, prenatal vitamins, and folic acid. 

Any info on CHEK2 genetic mutation and family planning (IVF or natural pregnancy)

It is well-known that the CHEK2 gene mutation not only affects a woman's risk for developing various cancers, including breast cancer, but also plays a critical role in timing of menopause and thus egg performance.

I’d recommend consulting with both an REI as well as a geneticist versed in reproductive genetics for the most current information, guidelines, and treatment recommendations. 

Can taking melatonin occasionally for sleep negatively impact TTC?

Not at all. Most studies suggest that melatonin and its oxidative properties may improve odds of conception

High prolactin and fertility issues? 

High prolactin levels aka Hyperprolactinemia can affect ovulation frequency by fooling your body into thinking you are pregnant.

After a thorough exam to search for causes, ask your provider about medications that are available to normalize prolactin levels and increase chances of pregnancy success!

I’m taking prenatal vitamins in anticipation of IUI next month. Do they increase libido?

I haven’t heard of prenatal vitamins increasing libido! However, if this is true, I’m heading to Whole Foods to get another stash of Natalist prenatals for her today! 

Hypothyroidism - how long after taking levothyroxine until ready to TTC?

Hypothyroidism affects fertility and levothyroxine can help. TTC timeframe depends on your labs pre- and post-medication. I would recommend repeat labs at 8-12 weeks after starting levothyroxine to ensure your levels have normalized prior to TTC.

Also in these instances, it is always advisable to have a preconception visit with your OBGYN provider to discuss a plan for your particular situation. 

How long before TTC should you start prenatal vitamins?

While there is limited hard data, most experts recommend starting prenatal vitamins about one to three months prior to TTC to correct any underlying deficits. This is because many people don't realize they're pregnant until they're well into their first trimester, and by then, a great deal of fetal development has already taken place.

Nine months PP trying to get pregnant again but I haven’t had a period yet. What are the chances?

Chances are that you’ll ovulate in the next 3-4 months. Once so, and your cycles return, you are fertile again. Happy Trying!

When to have sex during fertile window?

The “fertile window” is the six-day window that includes the five days before ovulation and the day of ovulation. I recommend having sex daily or every other day during this time, especially the 2 or 3 days leading up to ovulation day.  

I’ve been off BC for 1.5 years and haven’t conceived. What am I doing wrong?

There are many factors that contribute to fertility, including luck. You might be doing everything right and there could simply be underlying health factors working against you or your partner.

If you have been unable to conceive after a year and are under the age of 35, it is generally recommended to consult a fertility specialist.

 

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