To Drink or Not to Drink…Is the Bubbly Blocking Your Ability to Conceive?

Alcohol has been lauded and lambasted when it comes to health issues. The tide can turn so fast on spirits that it’s difficult to know whether that glass of red wine is going to make you live forever or take a few years off your life. However, while the medical benefits of daily consumption are still murky, what’s on the minds of many reproductive-age women is: does a glass a day really keep the baby away? The answer is, unless you have a really heavy hand, probably not.

While alcohol in excess is a no-no for a pregnant woman, there is not much out there on what it does (if anything) to one’s fertility. It has not been shown to decrease egg quantity or quality. Additionally, it has no impact on a woman’s ability to ovulate, the function of her fallopian tubes, or your partner’s sperm. In moderation, it has not clearly been linked to infertility or miscarriage. In fact, some studies have shown that women who drank wine conceived at a faster rate than those that didn’t!

But this is where who’s pouring is important. Moderate alcohol use is defined as less than two drinks a day. In most studies, one drink is equal to 10 grams of ethanol. But (as many of us have found out the hard way) not all drinks are created equal, and therefore, who’s mixing your cocktails matters.

Here’s a cheat sheet…In the United States, a standard drink (12-ounce beer, 5-ounce glass of wine, 1.5 ounces of distilled spirits) has about 14 grams of pure alcohol. Bottom line, before you go bottoms up, be aware of what you are imbibing.

Too much of anything is not a good thing. And while a big night out once in a while is not the end of the world (let’s face it, this is probably the cause of many unintended pregnancies!), limiting alcohol consumption is a good idea. Although you certainly don’t need to put away those wine glasses when trying to conceive, be smart about how much and how frequently you imbibe (and don’t forget, there is no safe amount of alcohol consumption in pregnancy). But if the bubbly is what keeps you  bubbly, that’s ok; it’s not blocking you from having a baby. This fertility journey can be long and rocky; a few drinks along the way will most certainly not derail you.

How Long Is Too Long? When Is It Time to Come in for a Fertility Evaluation?

As native New Yorkers, we don’t like waiting more than two minutes for our coffee, more than three minutes for a cab, and more than four minutes for the subway. We are as impatient as the next gal trying to get to and from work, home, and our workout class. Despite the unexpected (ugh, why did I have to get stuck behind the garbage truck? I’ll never make it!), we pretty much know how much time to allot to almost all of our daily tasks: one minute to make your coffee, 10 minutes to walk to the subway, 15 minutes to walk to the gym, and 20 minutes to walk the dog.

But while we have these routines down to the minute, what we often don’t know is when to seek medical advice for our bodies. Am I overreacting; will it just go away? Am I a hypochondriac? Maybe that pain is normal. And if something is really wrong, can it be fixed? The fear of the unknown, of what might be wrong, and what might need to be done to fix it can frighten even the strongest individuals.

For most of us, it’s hard to imagine that we won’t just pull the goalie (aka stop using contraception), have unprotected sex, and two weeks later see pregnant on the stick. The months of not pregnant, despite valid efforts, can become emotionally and physically exhausting. However, it’s confusing to know when it’s time to call the natural way quits and seek medical advice. Your mom will tell you “Relax, and it will happen.” Your friends will tell you, “It happened for me the first try!” and the Internet will tell you almost everything and anything. Whom do you believe?! A credible and comforting source in this process can be extremely hard to come by. Let us at Truly, MD, do our best to be your voice of reason.

Traditionally, infertility was defined as one year of unprotected intercourse. It didn’t matter if you were 24, 34, or 44 when trying to get pregnant—your OB/GYN generally did not refer you for further evaluation until you hit that one-year mark. Thankfully, this is no longer the case. Our current guidelines factor in the age of the female partner for when it’s time to call a time out from trying on your own. So get out your calendars, and start counting because here’s the latest advice: For women who are equal to or less than 35 years old, you can continue to follow the traditional recommendation and wait a year before seeking evaluation/treatment. Women who are older than 35 should, by the new guidelines, get the ball rolling after six months of trying. And lastly, women who are older than 40 should seek immediate evaluation/treatment. Come right to your fertility specialist.

And remember, while these recommendations are in place to guide the general population, there are certain situations where we would want to see a 32-year-old after trying for three months and a 35-year-old after trying for one. It’s super important that you share your medical, gynecologic, and family history with your OB/GYN. If your mom had menopause young, you might have it even younger! There are certain red flags, like this, that will prompt a referral to a fertility doctor before any alarm has even gone off.

So why are we lighting the fire under you? It’s not to scare you, rush you, or make a nerve-wracking situation even worse—we promise. It’s because, in this case, we sort of know how the story might end if you wait too long. We have shaken that Magic 8 ball (Will my mom let me stay out past curfew? Decidedly not!), and we know that female age is one of the most important factors when trying to conceive. Every month that passes, from the moment we are born, we are losing eggs. The rate or the slope (Algebra 101: y = mx + b!) of this line of loss is fairly gradual until we hit about 32. It picks up, or gets steeper, at about 37 and then nosedives at 40.

You’re not just losing quantity but also quality. The older the egg, the more likely it is to make an abnormal embryo (medically defined as an aneuploid embryo). And while abnormal or aneuploid embryos may get you pregnant, in most cases, they lead to a miscarriage.

There is a classic study that was done in France (They gave us more than just good wine and French Fries) that is mentioned frequently in the world of fertility medicine. Pourquoi?(That’s why, for all of you non-French speakers) The answer is because the women in the study all had partners with no sperm (medical term = azoospermia) and needed donor sperm insemination to get pregnant. Therefore, who got pregnant and who didn’t became all about female age (All donors were young, so male age went out the window, and the inseminations were timed so the appropriate time of intercourse became no big deal).

And voila, the results are as follows: As women aged, the pregnancy rates decreased significantly. The pregnancy rate after 12 insemination cycles was 74% for women less than 31 years old, 62% for women aged 31 to 35 years, and 54% for women older than 35. Bottom line: female age REALLY matters. The story ends pretty much the same way when we look at IVF success rates; pregnancy rates decline significantly as the age of the female partner rises. Translation…tick, tock, tick, tock…please make that clock stop!

While we can’t refuel your egg supply (when the gauge reads empty, you are truly on empty), we can help bring you in for gas before you hit that point. Unfortunately, we will all run out at some point. It’s part of being female. And while some cars lose gas faster than others, if you are aware of what makes them run low and seek evaluation and treatment earlier, your journey will be smoother, and you will reach your destination faster.

 

 

Got the All Clear, But Can I Really Re-Consummate This Relationship? Sex after Baby

The first six weeks after your baby is born are a major blur. Let’s be real: while there are magical moments, most of your days are filled with spit up, dirty diapers, milk stains, and sweats (don’t think we changed out of our workout clothes once!). Your home becomes a welcoming ground for friends, family, and all of those well-wishers who can’t wait to meet your little one.

And while you welcome a break from the routine (feed, burp, diaper, sleep), their presence can be beyond overwhelming. It’s not only the germs you see them bringing into your Purel-ed place or the gift that now requires a thank-you note (you could write a thank-you note for that cute onesie in your sleep!), but your energy level for entertaining is at an all-time low. It is not easy.

And to top it all off, your body still does not feel like your own. You’re still bleeding, your boobs are now enormous, and your belly still looks pregnant. (We have all been there. It is not fun one month after delivering, when that friendly neighbor says, “Any day now: you must be so excited!”). Additionally, you are now on pelvic rest—a.k.a. nothing in the vagina for six weeks post-delivery (whether or not your kid came out from below or through your belly). That includes no tampons and no sex.

So you make it through the first six weeks sleepless and sexless and go to your OB for the famous post-partum visit. She or he chats about life, how you are feeling, and how you are adjusting. They weigh you (ugh, still have 15 pounds to go) and examine your incisions (both abdominally and/or vaginally). Then they begin the discussion about birth control—pills versus patch, condoms versus IUD, or for those at the end of the baby line, tying your tubes versus tying his tubes (a.k.a. a vasectomy).

This subject transitions into “YOU are all good to go”; basically, you have the green light to have sex again. At this moment, you are probably thinking, Am I really ready to turn in my postpartum hospital-grade underwear? (Gotta admit, those are the best!) for my Hanky Pankys? Given your current state, sleepless and shaveless, it’s hard to imagine being intimate again.

Let us give you a quick preview… It’s as dry as the desert in summer down there, and no matter how much lubricant you use, you will still feel like you are being set on fire. We are here to say not to worry; while completely unpleasant, it is totally normal. In a large study of post-partum women, nearly 85% of women reported sexual problems at three months’ postpartum (See, you are not alone).

Your mind and body have gone through some pretty serious changes, and it will take time for things to go back to normal. And the good news is that for most it will go back to normal. Research shows that about 50% of women reported dyspareunia (medical way to say pain with sex) at two months post-partum. By 18 months postpartum, this number decreased to 24% (See, time does heal all wounds!).

Post-delivery, your estrogen levels plummet. This drop is not only caused by the delivery of your baby and placenta, but also by the rise in prolactin (the hormone that produces breast milk). Prolactin levels remain elevated post-partum to allow for the continued production of milk. With this high comes the persistent low of estrogen.

In addition to the mood changes, the hair changes, the skin changes, and the headaches that come with low estrogen, you can also welcome vaginal dryness. And not just the mild “Oh, KY Jelly or Astroglide can fix that” vaginal dryness…it’s a dryness that requires an army of products. Medically, we call it “atrophy” or “friable.” Due to “atrophy,” you can often see bleeding post-sex. Again, we are here to say that this is not uncommon.

In addition to the discomfort experienced with sex post-partum, a significant number of women report decreased libido. Nearly 60% of women reported a decreased libido at three months post-partum. Not surprisingly, they cited fatigue, discomfort, and fear of making a bad situation worse. Women who breastfeed were even more likely to report a decrease in libido than non-breastfeeding women; this is likely because those who don’t breastfeed have a faster return of their hormones to baseline. However, the difference did not persist for the long term (again, nothing lasts forever!).

Ways to combat this problem include lubricants and vaginal estrogen creams. So even without a major makeover, in most cases, things will get better. Now, if you sustained a serious tear or had a complication with your laceration or episiotomy, the situation might be a bit more complex. It may require you to sit out on the bench for a bit longer and apply a more comprehensive armamentarium of medications and products. But don’t worry. Even in the most serious cases, with the help of an OB/GYN, a pelvic surgeon, and in most cases, physical therapists, this team can help restore the situation back to normal (although you may need to consider having a C Section for your next child to avoid a repeat event if the situation was really bad).

Bottom line is that your bottom will heal—it just takes time. If you don’t feel like you, physically and emotionally, it is totally normal. Don’t be afraid to give your body and your brain time to rest; the postpartum period is no joke! But rest assured, with a little rest and assurance, you will be back in the game in no time.

Get Out Your Checklist…It’s Screening Time!

One thing we can never stop or change is aging. And while it may bring us increased confidence and accomplishments, it does have some unwanted side effects: the aches, the pains, the wrinkles, and the grays. The maintenance alone can become a full-time job. And the cosmetic side is the least of it. Doctor’s visits go from twice a year to twice a month and, in some cases, twice a week. Arthritis sets in, blood pressure creeps up, weight becomes hard to shed, and hearing goes downhill. Sounds like a ball of laughs.

But the reality is that we women are kicking aging’s behind. We are living longer and longer, and today, the life expectancy for a woman in the US is 81. Go, girls, go! One of the ways to make sure you make it to 80 and beyond is to maintain good preventative care (a.k.a. see your doctor when you don’t feel sick) and follow health screening recommendations, as outlined by the ACOG (American Congress of Obstetricians and Gynecologists) and the U.S Preventative Services Task Force.

Here’s what is on our list of things to do for women who are over 40 each year.

  1. Talk
    The majority of what we as MDs do is talk (wait, all those years of training, and we mostly talk?). In all seriousness, we can make a pretty good assessment of a woman’s overall health just from chatting with her. It’s all about knowing which questions to ask and how to listen.
  2. Physical Exam
    Although no one likes the check-up part, it is a must. Getting into that gown and being weighed, poked, and prodded are no one’s idea of a fun day off. However, it is important that someone gives you a good onceover at least once a year to make sure nothing is out of place.
  3. Breast Exam
    An annual breast exam (a.k.a. the clinical breast exam) should be performed each year. It might surprise you to know that we, as MDs, can feel lumps and bumps that are really tiny and may go undetected by your monthly self-breast exams. While our exam does not replace a mammogram, it is definitely an important yearly checkpoint.
  4. Mammograms
    Recently mammogram screening has become more controversial than if you’re going red or blue during an election year. The U.S. Preventative Task Force changed their recommendations and no longer recommend that mammograms start at age 40 or occur every year—they now recommend a screening mammogram (in a woman with no personal or family history) at age 50. If all is ok, they want to see you back two years later. The every-two-year schedule (as opposed to the traditional every one year) will stay as long as nothing notable is noted (say that five times fast!). However, many, such as the ACOG, are going old school and recommend you start at 40 and go every year to your friend the mammographer. We tend to side with the ACOG on this one and still advise our patients to follow the more traditional screening protocol. Of note, family histories matter big time on this one. You may need to be screened even before 40 if your sis or your mom had early breast cancer. So be certain to share this info with your MD!
  5. Colonoscopy
    Once you hit the big 5-0, it’s time to get cleaned out and checked out! Colorectal cancer screening in the form of colonoscopies should begin at age 50 (unless you have a family or personal history that requires an earlier exam). In most cases, the intestines are inspected every five years.
  6. Bone Mineral Density Test
    In many ways, our bones resemble our ovaries—time is not on their side! As women age, their bones are prone to breakage and fracture. This condition is called osteoporosis, and it is fueled by low estrogen, low vitamin D/calcium, and age. Most women start getting bone mineral density testing (a.k.a. DEXA) starting at age 65. However, women with risk factors (think a family history of osteoporosis, history of fractures, or an elevated risk assessment on what is called the FRAX test) need to dial up the DEXA testing.
  7. Cervical Cancer Screening
    Pap smears are like the never-ending story—they just keep on going. However, the good news is that, due to a revamping of Pap smear guidelines, at some point most women can close the chapter on Pap smears. Women between the ages of 30 and 65 can hold off on Pap smears for five years if both cytology and HPV testing are done together and are negative. If you have passed the 65 mark, you may be done with Pap smears. What dictates where your finish line is, is your Pap smear history. It’s important to keep track of your tests (especially if you switch GYNs) and stay in touch with your GYN so that you know when you can throw in the cervical cancer-screening towel.
  8. Cholesterol Testing
    No matter how much you weigh, how much you eat, or how much you exercise, it’s important to check your cholesterol. Although obesity and a diet high in fats make you more prone to high cholesterol, there are genetic conditions that can predispose even the healthiest of us to cholesterol abnormalities. We have a whole slew of good medications to manage cholesterol, and therefore, the sooner you know, the sooner you can start treatment. Anyone who is above the age of 45 (or younger than 45 but with risk factors for heart disease) needs to sit in the blood-draw chair for a cholesterol check at least once every five years.
  9. Blood Pressure
    When it comes to blood pressure, higher is not better. Here, less is more. Elevated blood pressure is a predictor of heart disease and many not-fun medical conditions. It should be checked at the least every two years, if not every year. Don’t let the white coat scare you; it’s all good!
  10. Diabetes
    Diabetes is no joke. If untreated, it can have some of the most devastating medical complications, from blindness to limb loss. Being checked for diabetes should be at the top of everyone’s list. A simple blood test checking your glucose level will give us a hint as to how “sweet” things are. It’s important to be screened diabetes in a regular fashion (particularly if you have a family history of diabetes, elevated blood pressure, and obesity).
  11. STDs (a.k.a. gonorrhea and chlamydia)
    Just because you are not 23 does not mean you can’t acquire a sexually transmitted infection! For this reason, women who are sexually active should have STD testing (gonorrhea and chlamydia).
  12. HIV
    All women should have HIV testing at least once in their lifetime. If you are in a high-risk category (certain behavior patterns), the testing should be done more than once.
  13. Other
    We are not all the same. Our genetics and our environments differ big time. Your doctor will decide based on your past (and your family’s past) what tests should be done yearly to maintain your present. However, the only way this will work well—and allow your GYN to tailor a treatment plan to prevent what may lie in your path—is to be honest with your GYN. We need to know it all to know what tests need to be run.

The list may seem long, but checking the boxes can be pretty quick. We can tackle a lot of the issues at once at your yearly visit. Don’t brush us off because it seems like no big deal. Yearly checkups, preventative care, and screening can be the key to longevity. You’ll take that 81 and see you 10 more!