Lighting up Will Make You Lose Your Eggs!

There are not many things in this world you can be sure of. In the words of Ben Franklin (shout out to all our fellow Penn alums), “In this world, nothing can be said to be certain except death and taxes.” And while we love you, Mr. American, we would like to add a third: cigarettes are bad for you! Despite the Marlboro Man’s best efforts, we all know nothing good can come out of lighting up. The litany of negatives when it comes to tobacco is so long, it couldn’t even fit on one page! Brain, lungs, heart, blood vessels, esophagus, stomach, hands, and feet are all victimized by the tar and tobacco filling that little white stick. While this may have been obvious to you, you may not have known how bad smoking is for your reproductive system.

Simply stated, smoking sucks for your reproductive system. Years of data have shown that smoking can lead to infertility and early menopause. In fact, women who smoke will go through menopause one to four years earlier than nonsmoking women. (Who wants hot flashes, headaches, and vaginal dryness before you need them?) And it seems that, the more you smoke, the more damage you do; with every puff you take, you are not only burning out your lungs but also your egg supply. Additionally, women who smoke are more likely to miscarry once pregnant. The chemicals in cigarettes can damage the DNA (genetic information) inside your egg and lead to a miscarriage. But it’s not only eggs that fizzle in the face of cigarettes; the fallopian tubes also sustain damage. Think of the tubes as tunnels. Their job (most of us have two!) is to transport the sperm to the egg and the fertilized embryo to the uterus. If blocked or damaged, the sperm or egg either never get together, or if they do, the embryo is more likely to get stuck on its way to the uterus. That’s called an ectopic pregnancy (pregnancy located outside of the uterus). Ectopics can be life threatening if not treated appropriately. How and why does this happen? Well, there are little hairs called cilia (we have them in our nose as well) that line the inside of our tubes. Imagine a car wash; think of the wipers that come beating down on the car when the wash first starts. That’s sort of like what the cilia look like, but rather than beating the dirt off your car, they are propelling the sperm to the egg and the embryo to the uterus. If they don’t work, you have a problem.

But get this. Even if you don’t smoke but your partner does, you are also in trouble. There are significant effects on a woman’s fertility from passive smoking (a.k.a. second-hand smoke). The effects of smoking on male infertility are less clear. Sperm function tests are poorer in smokers. There is not clear, conclusive evidence that men who smoke are more likely to be infertile, but given the impact it has on your female partner, guys, we urge you to put it out!

So let’s say you can’t quit and you find yourself pregnant and smoking. Then what? What impact is your habit having on your unborn child? If you have ever taken biology, you probably guessed it: not a very positive one! Babies born to women who smoked are at risk for growth restriction (stunted growth) inside the uterus, small birth weight, early/preterm delivery, stillbirth, and problems with the placenta.

But we get it. Despite all that, going cold turkey can be hard. Habits, no matter how bad, are hard to break. And because of all the “yuck” that is inhaled, it is actually not only okay but preferable to start nicotine replacement therapies (the patch, the gum, etc.) during pregnancy and when trying to conceive rather than continuing to smoke. Yes, they have their effects and are no prenatal vitamins, but they are way better than the tar and tobacco that you are inhaling. There are no ifs, ands, or buts about it, butts are bad for your lungs, bad for your heart, bad for your brain, bad for your skin, bad for your ovaries, and unbelievably bad for your unborn baby. You will burn through your wallet, your lungs, and your eggs. So take it from us. Put out that cigarette, and never pick one up again!

No Y, No Way? How to Achieve a Pregnancy in a Same-Sex Relationship

Long gone are the days of June Cleaver, her dress and pearls, and her white picket fence. Nowadays, the face of families has had a major facelift. Two mothers, two fathers, working mom with a stay-at-home dad…it has all changed. Kudos to choice and change! But while you can mold your family to take whatever shape you want without an egg and sperm source, you will need some outside help manipulating the “clay.” Cue your friend, the fertility doctor.

While all pregnancies require an egg, a sperm, and a uterus, how these three sources meet and where they come from can be quite variable. It is our job (a.k.a. that of the fertility specialist) to help make these necessary introductions and ensure that, from this meeting, comes a baby!

The first order of business when we meet with a same-sex female couple is to figure out preferences and timing. Simply stated, do both partners want to give an egg, do both partners want to give a uterus (a.k.a. carry), and if so, when? And taking it one step further, do both partners want to carry their own genetic child or their partner’s genetic child? (Don’t worry if this sounds confusing; we will explain!) We then use this information to formulate your fertility plan. Here’s how.

Timing is not only everything in relationships but also in family planning. Which partner should go first (#getPREGNANT) is not only based on personal preference but also on medical factors (egg quality, egg quantity, and uterine receptivity). Therefore, before any final decisions are made, it’s a good idea for both partners to visit a fertility specialist and get checked out.

What your MD finds might have a major impact on what fertility options are available and in what order. For example, if you are 35 and your partner is 38 but your ovarian reserve is approaching that cliff (a.k.a. about to take a sharp decline), we may recommend that you go first in the pregnancy process. On the flip side, if your partner is 40 and you are 30 and you were hoping to have your little one before 31, we will probably recommend that you put your baby button on pause and let your partner go first. Nuances like this are not apparent unless you get down to the nitty gritty (blood work, ultrasounds, and a full exam) with a fertility doctor.

After you have been checked out, there are a few options for you to check out. Unbeknownst to most, there are a couple of ways (other than the obvious) to get egg and sperm to meet. These include inseminations (IUI) or IVF.

And the variety doesn’t stop there. When it comes to IUI, you can do it as bare bones as possible (a.k.a. time the inseminations to when you are ovulating) or add medications to boost your fertility (e.g., Clomid, letrozole, gonadotropins). Which route you choose to take is often made after recommendations from your doctor. If IUI isn’t working out, we might recommend that you amp it up a bit (#IVF). If other medical issues exist (low egg reserve, advanced maternal age), we may suggest skipping IUI altogether and going right to IVF.

In many ways, same-sex female couples have the most options on how to make and carry children. Let’s face it: although you may be at a loss for sperm, you have double the eggs and double the uterus. This doubling will come in very handy when mapping out how you want to enter motherhood. The reason is that, if you want, you can switch things up. You can carry the embryo created with your partner’s egg and donor sperm, and she can carry the embryo created with your egg and donor sperm. It’s a unique way to build a family, though it requires IVF, creativity, and cash. (We too believe the lattermost is unfair. We have added our voices to the fight against insurance inequities!).

Think about a cake. While the core ingredients are always the same (think flour, sugar, and butter), there is more than one way to mix it up (add cinnamon, nutmeg, or chocolate chips). The same goes for building a family—although you need those core ingredients (an egg, a sperm, and a uterus), how you combine these three can vary. Today’s family should have the flavor and flair of you and your partner—rigid guidelines are “rotten.” Anyone who tells you otherwise has way passed his or her expiration date.