What to know about endometriosis and infertility

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. As the condition progresses, these growths can damage the surrounding reproductive organs, impacting fertility.

A type of tissue called endometrium lines the inside of the uterus. Throughout each month, the lining gets thicker, and it is at its thickest right before ovulation.
In a person with endometriosis, the abnormal tissue that grows outside the uterus behaves similarly. It thickens before ovulation, and during menstruation, it swells and bleeds into areas it should not be.

This swollen tissue may block the fallopian tubes or grow into the ovaries, which can make it more difficult for a person to get pregnant.
Read more about the link between endometriosis and infertility, how a person can manage the condition, and fertility treatment options for those trying to conceive.

Does endometriosis cause infertility?

Although endometriosis does not necessarily cause infertility, it can reduce fertility in many people. This does not mean individuals with endometriosis cannot get pregnant — instead, it means they may have a more challenging time getting pregnant.

Experts estimate that about half of women with infertility also have endometriosis.
Endometriosis is a progressive condition, which means it can gradually worsen over time. As more and more patches of endometriosis tissue grow in the pelvic and abdominal areas, they can block the reproductive organs. This makes it harder for sperm to reach the egg.

Additionally, these growths can damage the reproductive organs, preventing them from working properly.
Endometriosis can also affect fertility by:

• preventing an embryo from implanting
• scarring the fallopian tubes
• affecting egg growth
• creating a hormonal imbalance
• causing chronic inflammation in the pelvis

Endometriosis types and fertility

There are three main types of endometriosis: superficial peritoneal, endometriomas, and deeply infiltrating. These classifications describe where the endometriosis patches have grown in a person’s body.

A person can have one or multiple types.
Additionally, medical professionals divide endometriosis into stages. They range from I–IV, with stage I being the least severe and stage IV the most severe.

Summary

Endometriosis is a condition where endometrial-like tissue grows outside the uterus. It can impact a person’s fertility, making it harder to get pregnant.

People in the early stages of the disease may be able to conceive without medical assistance, but they are likely to need medication, IUI, or IVF in the later stages.
Living with endometriosis can be difficult, and support groups and resources can help those who are struggling.

Source: www.medicalnewstoday.com

Male factor infertility: myths, facts and advice for future fathers

It is estimated that approximately 1 in 6 couples worldwide are faced with infertility.
While female factors are considered to be mainly responsible, the truth is that in over 50% of cases, male infertility is a contributing factor and in 25% of cases it is the sole associated factor. In view of the above we shall explain below many aspects of male infertility and offer advice to men wishing to start a family.

1. When should I get worried?

A common phenomenon amongst couples trying to conceive is that they are quick to panic when they are having difficulties. Most fertile couples conceive on average within 4 months of trying (frequent intercourse during the woman’s fertile window), with longer time required in a significant number of cases. However, after 12 months of natural conception efforts, there should be a clinical suspicion of infertility, associated with female factor, male factor or both. For a more general guide to infertility and available courses of action, as well as advice, kindly also look into our article: “DIFFICULTY GETTING PREGNANT: WHY, WHAT TO DO AND WHEN TO SEEK FERTILITY CARE”.

2. What causes male infertility?

Multiple factors may be associated with male infertility such as:

3. Are there any warnings signs?

In most cases, the only warning sign is infertility itself. However, depending on the underlying cause, there may be warning signs, which combined with the difficulty to conceive, should raise awareness:

• Sexual intercourse disorders, such as ejaculation difficulties, small sperm ejaculate volume, reduced libido and/or erectile dysfunction.
• Pain, swelling and/or a palpable lump in the testicular area.
• Recurrent respiratory infections (possibly associated with cystic fibrosis).
• Anosmia (inability to smell).
• Gynaecomastia (breast growth).
• Decreased facial and/or body hair.

4. How is male infertility diagnosed?

Diagnosis of male infertility is performed via semen analysis, a test during which multiple sperm parameters may be assessed such as:

An abnormal semen analysis confirms the diagnosis of male factor infertility in most cases. Additional tests, such as semen culture, DNA Fragmentation Index (DFI) calculation, sample oxidative stress (assessment with MiOXSYS®), genetic testing eg peripheral blood karyotype, cystic fibrosis mutation testing, Y chromosome microdeletion testing, ultrasound, post-ejaculation urinalysis and/or testicular biopsy may be performed on individual cases.

5. Are there any tips to improve sperm quality?

In most cases, dietary supplementation, lifestyle changes, awareness of environmental hazards and improved mental health may enhance male fertility.
Namely, beneficial changes may include:

• Smoking cessation.
• Reducing / ceasing alcohol intake.
• Maintenance of a normal weight (BMI: 18.5-25).
• Avoidance of having a vasectomy, prefer alternative contraception strategies.
• Avoid exposure to environmental health hazards (radiation, industrial chemicals, heavy metals etc).
• Psychological stress reduction.
• Acupuncture: stress reduction and sperm quality improvement.
• Exercise.
• Avoidance of substance abuse.
• Balanced diet and dietary supplements, most importantly:
  • Vitamin C
  • Vitamin E
  • Selenium
  • Zinc
  • Folic acid
• Avoidance of continuous sitting at work and cycling.

6. What if I still have issues?

Some cases can be resolved with such measures alone. However, there are many methods that facilitate selection of the healthiest sperms and increase your chances during Assisted Reproduction Techniques (ART), such as sperm centrifugation and the more advanced sperm separation technique (Zymōt).
It is important to remember that >10% of males who wish to father children are facing difficulties, you are not alone in your struggle. Thanks to modern Fertility Medicine, >90% of males with infertility manage to produce offspring of their own genetic material.

Please contact EmbryoClinic today to find out the solution that best suits you!

Gestational diabetes: can it affect my baby and me? What should I do?

Gestational Diabetes Mellitus (GDM) is an abnormal response to blood glucose levels, which may be initially diagnosed during pregnancy, in the second trimester in particular. It is amongst the most frequent pregnancy complications and may affect around 1 in 6 pregnancies. In this article we shall examine the causes, how it could affect your baby’s health or your own and what could be done to manage it.

1. What causes GDM?

GDM, as with regular diabetes, is caused by a dysfunction in glucose metabolism, with the added contribution of the placenta and fetus, which exacerbate it, by further increasing blood glucose levels.

2. Which women are more vulnerable? What are the risk factors?

The following are known risk factors for developing GDM:

• Advanced reproductive age (>40 years)
• Obesity (BMI>30 kg/m2)
• Family history of diabetes
• Personal history of GDM during previous pregnancy
• Latin, Asian or African descent
• Increased birth weight of previous baby (> 4,000 g)
• History of maternal, embryonic/neonatal complications (congenital abnormalities, polyhydramnios, intrauterine death etc)
• Multiple pregnancy
• History of recurrent miscarriage
• Polycystic ovary syndrome
• Sedentary lifestyle
• Infertility

3. Are there any warnings signs?

It is quite challenging to detect GDM based only on clinical findings, as it most frequently is asymptomatic (no noticeable symptoms) or its mild symptoms are considered part of the course of pregnancy. However, some women notice the following symptoms:

• Polyuria (frequent urination, large quantity of urine)
• Thirst
• Weight loss
• Tiredness
• Frequent infections (vaginal, urinary tract infections)

4. Is it dangerous?

GDM could seriously impact your and your baby’s health and could cause severe disorders. Namely, GDM has been known to cause the following embryo/neonate complications:

• Large foetus (macrosomia) or small foetus
• Foetal developmental disorders
• Neonatal delivery complication (hypoglycaemia, risk of Acute Respiratory Distress Syndrome, shoulder dystocia etc)

Additionally, there might be long term complication on your child, which potentially may include:

• Obesity
• Hypertension
• Diabetes
• Psychological disorders

Potential negative effects on the mother may include:

Pregnancy complications:

• Miscarriage
• Pre-eclampsia
• Urinary infections
• Premature delivery
• Post-partum haemorrhage/infection

Post-pregnancy complications:

• Recurrence of GDM in future pregnancy (30-80%)
• Development of diabetes post-partum
• BMI increase
• Cardiovascular disease

5. What should I do?

The aforementioned effects of GDM are definitely quite unsettling, however the intention of these extensive lists is not to frighten but to educate and prepare. With proper medical management, you can have a normal pregnancy, without any of the above potential effects. This is why GDM awareness, close monitoring and adherence to your doctor’s instructions is of vital importance.

6. How will I know if I have GDM?

Most physicians check blood glucose levels, at the latest by 24th-28th weeks of gestation, regardless of risk factors. The following tests are usually recommended:

• Fasting glucose
• Oral Glucose Tolerance Test (OGTT)
• HbA1c test

Of the above tests, OGTT is the most reliable and is used more frequently both as the basis of diagnosis and to confirm the findings of the other two. Typically, the two-step 75 g OGTT may be used. The following table shows normal values for each test:

7. What is the optimal management of GDM?

GDM management is based on two principles: monitoring and control. Should GDM be diagnosed, constant monitoring, either self-testing, fasting glucose measurement by the physician or midwife, or even constant monitoring via implant is a must. Monitoring is vital as it is the only means of assessment of GDM’s severity and response to treatment, given the lack of distinct clinical symptoms in most cases.

Regarding control, management ideally starts with a more conservative approach, namely proper diet and exercise. These measures usually achieve satisfactory control in most patients and even if they are not successful on their own, they are always recommended along with medication. It may be safer and more effective for each patient to be assessed individually and offered individualized care, however some general recommendations may include:

• Reduction of daily caloric intake (33% reduction, 1600-1800 kcal per day), avoidance of very low caloric intake diets (<1500 kcal).
• Carbohydrates: 35-45% of daily caloric intake, minimum of 175g/day divided in 3-5 daily meals/snacks.
• Reduction of high glycaemic index foods (white bread, white rice, potatoes and fries, cakes, cookies, sweet treats, sweet fruits and sweetened dairy products)
• Consume at least 28 g of fibre per day
• Maintain/reduce body weight (dependent on initial BMI)
• Exercise: improves glycaemic control via insulin resistance reduction. Personalized exercise programs are more effective, however these are some general guidelines:
  • Planned physical activity 30min/day
  • Brisk walking or seated arm exercises after each meal

Should such measures not suffice, then medication may be recommended. Insulin is the treatment of choice and an endocrinologist should be consulted and continue monitoring for some time after the delivery as well.

Epilogue – Conclusion

Gestational Diabetes Mellitus is a common complication in pregnancy, which could have very severe consequences if left unmanaged. However, they may all be avoided with vigilance, timely diagnosis and effective management, by experienced physicians.

If you want to discuss your particular situation and seek an individualized opinion contact us today via phone at 0030 2310 420020, email at info@embryoclinic.eu or online form.

8 tips for healthy eating

These 8 practical tips cover the basics of healthy eating and can help you make healthier choices.
The key to a healthy diet is to eat the right amount of calories for how active you are so you balance the energy you consume with the energy you use.
If you eat or drink more than your body needs, you’ll put on weight because the energy you do not use is stored as fat. If you eat and drink too little, you’ll lose weight.

You should also eat a wide range of foods to make sure you’re getting a balanced diet and your body is receiving all the nutrients it needs.
It’s recommended that men have around 2,500 calories a day (10,500 kilojoules). Women should have around 2,000 calories a day (8,400 kilojoules).
Most adults in the UK are eating more calories than they need and should eat fewer calories.

1. Base your meals on higher fibre starchy carbohydrates

Starchy carbohydrates should make up just over a third of the food you eat. They include potatoes, bread, rice, pasta and cereals.
Choose higher fibre or wholegrain varieties, such as wholewheat pasta, brown rice or potatoes with their skins on.
They contain more fibre than white or refined starchy carbohydrates and can help you feel full for longer.

Try to include at least 1 starchy food with each main meal. Some people think starchy foods are fattening, but gram for gram the carbohydrate they contain provides fewer than half the calories of fat.

2. Eat lots of fruit and veg

It’s recommended that you eat at least 5 portions of a variety of fruit and veg every day. They can be fresh, frozen, canned, dried or juiced.
Getting your 5 A Day is easier than it sounds. Why not chop a banana over your breakfast cereal, or swap your usual mid-morning snack for a piece of fresh fruit?

A portion of fresh, canned or frozen fruit and vegetables is 80g. A portion of dried fruit (which should be kept to mealtimes) is 30g.
A 150ml glass of fruit juice, vegetable juice or smoothie also counts as 1 portion, but limit the amount you have to no more than 1 glass a day as these drinks are sugary and can damage your teeth.

3. Eat more fish, including a portion of oily fish

Fish is a good source of protein and contains many vitamins and minerals.
Aim to eat at least 2 portions of fish a week, including at least 1 portion of oily fish.
Oily fish are high in omega-3 fats, which may help prevent heart disease.

4. Cut down on saturated fat and sugar

Saturated fat
You need some fat in your diet, but it’s important to pay attention to the amount and type of fat you’re eating.
There are 2 main types of fat: saturated and unsaturated. Too much saturated fat can increase the amount of cholesterol in the blood, which increases your risk of developing heart disease.
On average, men should have no more than 30g of saturated fat a day. On average, women should have no more than 20g of saturated fat a day.
Children under the age of 11 should have less saturated fat than adults, but a low-fat diet is not suitable for children under 5.

Sugar
Regularly consuming foods and drinks high in sugar increases your risk of obesity and tooth decay.
Sugary foods and drinks are often high in energy (measured in kilojoules or calories), and if consumed too often can contribute to weight gain. They can also cause tooth decay, especially if eaten between meals.
Free sugars are any sugars added to foods or drinks, or found naturally in honey, syrups and unsweetened fruit juices and smoothies.
This is the type of sugar you should be cutting down on, rather than the sugar found in fruit and milk.
Many packaged foods and drinks contain surprisingly high amounts of free sugars.

5. Eat less salt: no more than 6g a day for adults

Eating too much salt can raise your blood pressure. People with high blood pressure are more likely to develop heart disease or have a stroke.
Even if you do not add salt to your food, you may still be eating too much.
About three-quarters of the salt you eat is already in the food when you buy it, such as breakfast cereals, soups, breads and sauces.

Use food labels to help you cut down. More than 1.5g of salt per 100g means the food is high in salt.
Adults and children aged 11 and over should eat no more than 6g of salt (about a teaspoonful) a day. Younger children should have even less.

6. Get active and be a healthy weight

As well as eating healthily, regular exercise may help reduce your risk of getting serious health conditions. It’s also important for your overall health and wellbeing.
Being overweight or obese can lead to health conditions, such as type 2 diabetes, certain cancers, heart disease and stroke. Being underweight could also affect your health.
Most adults need to lose weight by eating fewer calories.
If you’re trying to lose weight, aim to eat less and be more active. Eating a healthy, balanced diet can help you maintain a healthy weight.

7. Do not get thirsty

You need to drink plenty of fluids to stop you getting dehydrated. The government recommends drinking 6 to 8 glasses every day. This is in addition to the fluid you get from the food you eat.
All non-alcoholic drinks count, but water, lower fat milk and lower sugar drinks, including tea and coffee, are healthier choices.

Try to avoid sugary soft and fizzy drinks, as they’re high in calories. They’re also bad for your teeth.
Even unsweetened fruit juice and smoothies are high in free sugar.
Your combined total of drinks from fruit juice, vegetable juice and smoothies should not be more than 150ml a day, which is a small glass.
Remember to drink more fluids during hot weather or while exercising.

8. Do not skip breakfast

Some people skip breakfast because they think it’ll help them lose weight.
But a healthy breakfast high in fibre and low in fat, sugar and salt can form part of a balanced diet, and can help you get the nutrients you need for good health.
A wholegrain lower sugar cereal with semi-skimmed milk and fruit sliced over the top is a tasty and healthier breakfast.

Source:www.nhs.uk.

Difficulty getting pregnant: why, what to do and when to seek fertility care

Motherhood is a very important aspect of life for many women and the greatest step in starting a family. However, many couples nowadays are facing difficulties despite their efforts. In this brief article we will discuss several tips for improving the odds at home and the cases where professional fertility care is advised.

1. Are you certain you are having problems?

Despite the answer seeming obvious, many couples are actually quick to panic and unnecessarily so. By the medical definition, infertility is diagnosed after at least one year of frequent attempts to achieve pregnancy, especially during the fertile days of the menstrual cycle (also read below). So, during the busy routine of current times in particular, it is important to take your time and make enough attempts prior to seeking further assistance.

2. Proper intercourse practices – maximize your fertility potential

It is vital to ensure optimal conditions to achieve pregnancy, therefore intercourse is advised during the fertile days of the menstrual cycle, namely on the day of ovulation, as well as on the day before and the day after, with up to five days before ovulation being considered fertile as well, though not to the same degree. In women with a stable menstrual cycle, ovulation occurs 14 days before menstruation, therefore menstruation journals and phone apps can assist with the timing. If you are experiencing instability, or are unsure, ovulation tests or a visit to your gynecologist will help you.

Regarding intercourse itself, it should take place every 1-3 days during the fertile period of the cycle and ejaculation must occur within the vagina. Different positions or resting afterwards don’t affect the odds and some lubricant agents have been shown to affect sperm motility, therefore instructions and side-effects must be checked prior to use, or avoided completely.

3. Impact of psychological factors: stress and depression

Years of medical research have proven the correlation of stress and depression with infertility, with 35-55% of women seeking fertility care exhibiting symptoms. Several activities may help in combating these symptoms, namely sequential muscle relaxation, breathing techniques, yoga exercises, hobbies and outdoors activities, in particular with your significant other and, as cliché as it might sound, positive thoughts, probably assisted by keeping a journal of positive experiences. Note that some methods might be less effective than others, which should not disappoint you or make you give up. You should find the activities that suite you. However, there might also be cases where professional help is required.

4. The importance of healthy diet and body weight

The cornerstone of combating any health problem, a diet rich in fruits and vegetables, whole-grain products, poultry, fish and with minimal saturated fats, red meat and sweets has been shown to significantly improve fertility potential in females and sperm quality in males. Dietary supplements, namely folic acid (400-500mcg daily) and less so omega-3 fatty acids, antioxidants and Vitamin D have been shown to positively impact fertility as well. Normal body weight, namely a BMI of 19 to 25 is also important, as extreme deviations to either side of the spectrum can lead to anovulation, unstable cycles, drop in oocyte quality and in endometrium receptivity, thus to an overall reduction of fertility potential. However, keep in mind that achieving normal weight must be a gradual process and that in extreme cases a nutrition specialist should be consulted.

5. Dropping bad habits

The usual suspects, namely alcohol and smoking are at play in infertility as well. Alcohol consumption should be limited to 1-2 alcohol units for women and 4 for men weekly, though ideally it should cease altogether, as it greatly diminishes fertility potential, especially in males, causing a drop in sperm quantity and quality. Smoking of conventional, as well as of more modern tobacco products also negatively impact fertility in both genders. Caffeine may also impact fertility, although to a lesser extent, with 1-2 coffees per day being a safe quantity.

6. Treating chronic ailments

Several common endocrine/metabolic diseases, such as diabetes or thyroid disease can impact fertility if not effectively treated. Consult your physician and ensure proper control for optimal fertility potential.

7. When to seek professional fertility care

In general, a young, healthy couple has a 25-30% chance to conceive within the first months of attempts and an 80% chance within the first year. If you have followed all the aforementioned tips and still were unsuccessful, then a fertility specialist might be the solution you need. Additionally, you should seek fertility care in the following cases:

• When there is a genetic disease in your or your significant other’s family.
• When you are under medication for chronic diseases, as many drugs affect fertility and alternative medication might not be available.
• If you are 35 or older and have unsuccessfully tried for 6 months
• If you are 40 or older, immediate fertility care is advised, since precious time should not be wasted beyond this age
• When you have prominent symptoms associated with infertility, namely:
  • Females: unstable menstruation and or complete lack of it (amenorrhea), pain during intercourse, heavy and painful menstrual bleeding, intermenstrual bleeding (spotting), hormonal disorder symptoms (acne, increased face and body hair etc)
  • Males: testicular swelling or pain, impotence, loss of libido, ejaculation difficulties etc
• If you have a personal history of autoimmune disorders or a family history of premature ovarian failure or recurrent miscarriage.
• If you or your significant other have undergone chemotherapy and/or pelvic radiotherapy

Overall it is important to remember that up to 2 out of 10 couples are facing difficulties conceiving and that it not something to be guilty or shameful for. When all other alternatives fail, keep in mind that capable professionals are there to help you.

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The journey of spermatozoa to achieve fertilisation naturally versus IUI

Fertilisation is a complex series of events, beginning with the activation of the oocyte by the spermatozoon and resulting in the development of a diploid organism.

Everything starts after ejaculation, when the seminal plasma is deposited into the vagina and millions of spermatozoa start their long journey to reach the oocyte. Before moving into the uterus, spermatozoa will be exposed to the acidic environment of the vaginal fluid and many hostile leukocytes. Another barrier is the presence of the immunoglobulins IgG and IgA in the vagina and the cervical mucus respectively.

In the field of assisted reproduction, the intrauterine insemination technique bypasses the vagina and the cervix. More specific, the semen sample that has previously been washed and concentrated is placed directly in the uterus with the use of an intra-uterine catheter.

The next challenge is for the spermatozoa to traverse the uterus, where under endocrine control, uterine contractions mediate their transport. The last stop of this journey is the fallopian tube, a friendly environment which can host the spermatozoa for up to 3-5 days (time that spermatozoa can remain viable in the female reproductive tract) until ovulation.

At the end of this challenge only few spermatozoa (around 200) will approach the oocyte.