Mayo Clinic Guide to Fertility and Conception

MAYO CLINIC

Guide to

Fertility and

Conception

A Member of the Perseus Books Group

---

MAYO CLINIC

Medical Editors

Jani R. Jensen, M.D.

Elizabeth (Ebbie) A. Stewart, M.D.

Senior Editor

Karen R. Wallevand

Editorial Director

Paula Marlow Limbeck

Product Manager

Christopher C. Frye

Contributing Editors

Charles C. Coddington III, M.D.

Gaurang S. Daftary, M.D.

Shawna L. Ehlers, Ph.D., L.P.

Dean E. Morbeck, Ph.D.

Landon W. Trost, M.D.

Myra J. Wick, M.D., Ph.D.

Contributing Writers

Rachel A. H. Bartony

Alicia C. Bartz

Kelly M. Kershner

Jennifer Koski

Laura Hamilton Waxman

Art Director

Richard A. Resnick

Creative Director

Daniel W. Brevick

Illustration and Photography

Michael A. King

Jodi O’Shaughnessy Olson

Malgorzata (Gosha) B. Weivoda

Research Librarians

Amanda K. Golden

Deirdre A. Herman

Proofreading

Miranda M. Attlesey

Donna L. Hanson

Julie M. Maas

Indexing

Steve Rath

Administrative Assistant

Beverly J. Steele

---

© 2015 Mayo Foundation for Medical Education and Research (MFMER)

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. For information, address Da Capo Press, 44 Farnsworth Street, 3rd Floor, Boston, MA 02210.

Cataloging-in-Publication data for this book is available from the Library of Congress.

ISBN 978-1-56148-787-5

ISBN EPUB edition: 9780795346019

Published by Da Capo Press
A member of the Perseus Books Group dacapopress.com

Note: The information in this book is true and complete to the best of our knowledge. This book is intended only as an informative guide for those wishing to know more about health issues. In no way is the book intended to replace, countermand, or conflict with the advice given to you by your own physician. The ultimate decision concerning care should be made between you and your doctor. Information in this book is offered with no guarantees on the part of the authors or Da Capo Press. The authors and publisher disclaim all liability in connection with the use of this book. The names and identifying details of people associated with events described in the book have been changed. Any similarity to the actual person is coincidential.

For bulk sales to employers, member groups and health-related companies, contact Mayo Clinic, 200 First St. SW, Rochester, MN 55905, or SpecialSalesMayoBooks@Mayo.edu.

MAYO, MAYO CLINIC and the Mayo triple-shield logo are marks of Mayo Foundation for Medical Education and Research.

---

Introduction

Deciding to start or build your family is a life-changing decision. Maybe you recently decided to try to become pregnant or perhaps it’s something you’ve been contemplating for a while. But once the decision is made, there’s a whole new set of unknowns, including whether the journey will be easy or difficult.

You may already have a lot of questions: How can you increase your chances of becoming pregnant? What health and lifestyle changes should you make to have a healthy pregnancy? And if you’re struggling to become pregnant, what medical treatments are available? Where can you get emotional support if you can’t get pregnant or have had a miscarriage? And when is enough?

The fertility experts at Mayo Clinic are here to guide you through the process of trying for — and achieving — a successful pregnancy. Mayo Clinic Guide to Fertility and Conception is an easy-to-use yet comprehensive resource that provides answers and explanations to many common questions of couples hoping to have a baby. From lifestyle and dietary recommendations to understanding your ovulatory cycle to medications and procedures that can improve fertility, this book covers it all.

In the pages that follow, you will also hear from couples and individuals who have struggled to have a family. For a variety of reasons — health conditions, unexplained infertility or life circumstances — getting pregnant or deciding to have a family was difficult for them. These personal stories are to let you know that you’re not alone in your journey, and to give you hope that with time and patience pregnancy is often possible.

A project of this scope requires the teamwork of many individuals. A special thanks to all of the people who helped make this book possible.

The Editors

---

Meet the Editors

Jani R. Jensen, M.D., (left) is a specialist in the division of Reproductive Endocrinology and Infertility and the co-director of the In Vitro Fertilization Program at Mayo Clinic, Rochester, Minn. She is an assistant professor at Mayo Clinic College of Medicine and directs the Obstetrics and Gynecology Clerkship for medical students.

Elizabeth (Ebbie) A. Stewart, M.D., (right) is the chair of the division of Reproductive Endocrinology and Infertilty at Mayo Clinic, Rochester, Minn., and a professor of obstetrics and gynecology at Mayo Clinic College of Medicine. A noted researcher, author and clinician, Dr. Stewart’s research interests focus on the epidemiology, diagnosis and treatment of uterine fibroids.

---

How to use this book

Mayo Clinic Guide to Fertility and Conception is a comprehensive medical reference that provides answers and explanations to questions and concerns related to fertility. To help you find what you’re looking for, the book is divided into five sections.

Part 1: Getting Ready for Pregnancy

From exercise and eating right to medications and chronic illness, this section discusses daily habits and medical conditions that may affect your ability to become pregnant. Find out what steps you can take to prepare for pregnancy.

Part 2: How to Get Pregnant

Part 2 covers the intricacies of getting pregnant. In this section you learn how to determine when you’re ovulating, when is the best time for sexual intercourse, and steps you can take to increase your chances of a successful outcome. You’ll also read about early signs of pregnancy and of warnings of a possible problem.

Part 3: Common Fertility Problems

Sometimes infertility is the result of a specific health disorder. This section addresses both common and unusual problems that can affect female and male fertility. There’s also a discussion of age and pregnancy. With more women waiting longer to have their first child, understanding how age affects female fertility is important.

Part 4: When You Need Some Help

Here you’ll learn about the latest in medical treatments to help you get pregnant. You’ll find information on medications to improve fertility, as well as procedures such as intrauterine insemination. There’s a detailed discussion of in vitro fertilization and other assisted reproductive technologies. You’ll also learn about third-party reproduction, which may involve the use of donor sperm, eggs or embryos, or the assistance of a gestational carrier.

Part 5: Special Considerations

The last section of the book addresses unique situations — the options available and factors to consider. It also tackles the tough issue of moving forward when pregnancy is unobtainable.

---

Contents

PART 1 Getting Ready for Pregnancy

Chapter 1 Adjusting your lifestyle

Weight

Why it matters • Find your BMI • Managing weight

Exercise

Moderate exercise is best • Athletes and fertility • Exercise and weight • Getting started • A well-rounded fitness program

Stress

Your body and stress • Fertility and stress • Sex and stress • Relaxation techniques

Sleep

Sleep and your overall health • Night shifts and fertility • 8 steps for good sleep

Alcohol, tobacco and other toxins

Alcohol • Tobacco • Other recreational drugs • Other toxic substances

Diet

Dawn’s story

Chapter 2 Eating to conceive

Carbohydrates: Natural, not processed

Carbs explained • Carbs and blood sugar • Carbs and fertility

Dietary fats: Go for good fats

Phasing out trans fat • Look at the label • What should you eat?

Protein: Eat more beans and nuts

A protein plan

Dairy products: Creamier is better

Caffeine and conception

Focus on your health

Chapter 3 Additional preparations

Going off birth control

Medications and supplements

Prenatal vitamins

Vaccinations

Guide to vaccinations and pregnancy • Vaccines during pregnancy

Chronic medical conditions

Genetic tests

Take heart

Chapter 4 Producing healthy sperm

Sperm health and fertility

Quantity • Structure • Movement

How to improve sperm health

Maintain a healthy weight • Eat a healthy diet • Exercise • Manage stress • Prevent and treat infections

What to avoid

PART 2 How to Get Pregnant

Chapter 5 How babies are made

Reproductive organs

Female organs • Male organs

Ovulation

Fertilization

Implantation

Pregnancy

Multiple babies

Chapter 6 Ovulation and fertility signs

Your menstrual cycle

The follicular phase: Prep time • The ovulatory phase: Go time • The luteal phase: Resolution time

Your fertility window

Use a calendar • Monitor your temperature • Watch for cervical changes • Putting it all together

Products that can help

Ovulation predictor kits • Fertility monitor • Other devices

Don’t be afraid to seek help

Amber’s story

Chapter 7 Tips for increased success

Plan ahead

Know your window

Have sex often

Frequent sex and semen quality

Forget about positions and routines

Avoid lubricants

Have fun

Chapter 8 Are you pregnant?

Early signs and symptoms

Home pregnancy tests

Reading the results • Test accuracy • Follow-up blood test

When to see a care provider

Bleeding • Emergency symptoms • Miscarriage and ectopic pregnancy

Chapter 9 Miscarriage and ectopic pregnancy

Miscarriage

Signs and symptoms • Causes • Getting medical attention • Treatment • Recovery

Recurrent pregnancy loss

Causes • Evaluation • Treatment

Ectopic pregnancy

Signs and symptoms • Treatment • Heterotopic pregnancy • Future pregnancies

Trying again

Emotional recovery • Physical recovery

Kristen and Chris’ story

PART 3 Common Fertility Problems

Chapter 10 Effect of age on pregnancy

Female reproductive life span

Female fertility and age

Fertility over the years • What about today?

Related risks

Pregnancy loss • Chromosomal abnormalities • Other complications

Male fertility and age

Effect on pregnancy rates • Health of aging sperm

Related risks

When to seek help

Jane’s story

Chapter 11 Female problems: Common and unusual

Ovulation and hormone issues

Thyroid problems • Elevated prolactin • Hypothalamic dysfunction • Polycystic ovary syndrome • Primary ovarian insufficiency • Luteal phase defect

Structural and anatomical issues

Fallopian tube damage or blockage • Hydrosalpinx • Endometriosis • Congenital abnormalities • ‘Tipped uterus’ • Uterine growths • Cervical narrowing or blockage

Unexplained infertility

Chapter 12 Male problems: Common and unusual

Sperm matters

What causes a low sperm count? • When there’s no sperm • Leukocytospermia

Structural and anatomical issues

Varicoceles • Undescended testicles • Sperm duct abnormalities • Hypospadias • Tumors

Hormone imbalances

Primary hypogonadism • Secondary hypogonadism

Ejaculation issues

Retrograde ejaculation and anejaculation • Erectile dysfunction

Chromosome defects

What happens next?

Evaluating infertility: A summary

PART 4 When You Need Some Help

Chapter 13 Seeing a doctor

When to see a doctor

Who should you see? • How to choose a fertility doctor or clinic

What to expect

Medical history • Physical exam • Fertility tests

Tests for women

Ovulation tests • Ovarian reserve tests • Uterine and fallopian tube tests • Hormone tests

Tests for men

Semen analysis • Other tests

Keeping a positive outlook

Lisa and Scott’s story

Chapter 14 Medications and surgery

Many options

Fertility medications

Clomiphene • Aromatase inhibitors • Gonadotropins • Human chorionic gonadotropin • Metformin

Medications for specific conditions

Fertility procedures and surgeries

Intrauterine insemination • Surgical procedures for women • Surgical procedures for men

Looking ahead

Chapter 15 Reproductive assistance

What is assisted reproductive technology? • The first test-tube babies • IVF today

How IVF works

Superovulation • Egg retrieval • Sperm collection or retrieval • Fertilization • Embryo transfer • Freezing extra embryos • Risks of IVF

Advanced ART

Zygote intrafallopian transfer (ZIFT) • Gamete intrafallopian transfer (GIFT) • Assisted hatching • Preimplantation genetic testing

The success of ART

Costs • Extra embryos

Treating infertility: A summary

Chapter 16 Third-party reproduction

Donor eggs

Do you need donor eggs? • How egg donation works

Donor sperm

Do you need donor sperm? • How donor sperm works

Donor embryos

Surrogates and gestational carriers

Do you need a gestational carrier? • How gestational carriers work

Selecting a donor

Egg donor • Sperm donor • Gestational carrier • Known donor

Costs and contracts

Donor sperm • Donor eggs • Donor embryos • Gestational carriers • Known donors

Take your time

Ashley and Susie’s story

Chapter 17 Coping and support

Stress and infertility

Causes of stress • Sexual dysfunction • When to seek help

Coping techniques

Support groups and counseling • Other coping techniques

PART 5 Special Considerations

Chapter 18 Fertility preservation

Reasons for fertility preservation

Cancer • Other medical conditions • Personal reasons

Seeing a specialist

Options for women

Embryo cryopreservation • Oocyte cryopreservation • Radiation shielding • Ovarian transposition • Conization and radical trachelectomy

Options for men

Sperm cryopreservation • Radiation shielding

Looking forward

Chapter 19 Unique circumstances

Choosing single parenthood

Issues to consider

Reproduction options

Women without a male partner • Men without a female partner • Same-sex couples

Cultural and religious considerations

Concerns about in vitro fertilization • Intercourse restrictions • Sperm collection

Melissa’s story

Chapter 20 Other options

When to consider alternatives

Deciding as a couple

Adoption

Issues to consider • Selecting an adoption resource • How to begin the process • Forums and support groups

Child-free living

Myths and facts about child-free living • The benefits of child-free living • Other ways to get involved with children

Finding support

Additional resources

---

PART 1

Getting Ready for Pregnancy

---

CHAPTER 1

Adjusting your lifestyle

Planning to have a baby is exciting. You may have thought about the possibility before, but now you’re ready — ready to make it happen. Or at least try to. But hold on. Like many other women, until now you may have been more preoccupied with avoiding pregnancy than with getting pregnant. And now that you’d like to become pregnant, you’re not quite sure that it’s really all that easy! Sure, it can be simple — you have sex and you get pregnant. But it can also be more complicated than you might have thought. If that’s the case, or if that’s what you’re worried about, this book is here to help.