Duke: “Sex position matters.”
Eleswarapu: So, that is a myth.
“IVF guarantees pregnancy.”
Duke: Oh, boy. It’s a tough myth for patients to hear.
Eleswarapu: “Eating pineapple can increase fertility.”
Duke: Oh, that’s a good one. Pineapple by itself, if you have infertility, is unlikely to reverse your infertility.
I’m Dr. Cindy. I am a fertility specialist based in Las Vegas, Nevada. Hello,
Eleswarapu: I’m Dr. Sriram Eleswarapu, and I’m a urologist at UCLA. And today we’ll be debunking myths about infertility.
Duke: “Tight underwear is bad for sperm count.”
Eleswarapu: So, there’ve been a number of studies looking at this issue for many decades, and the inevitable question is boxers versus briefs. In truth, it doesn’t matter a whole lot, and we know that if the testicles are a little bit warmer that they are more at risk of having sperm-count issues or sperm-motility issues, but, in general, it shouldn’t matter too much. Just pick what’s comfortable.
Duke: “Sex position matters.”
Eleswarapu: So, that is a myth. No matter what position you engage in, if you ejaculate, you have the sufficient propulsion of the semen to make it up to the cervix, any way you do it.
Duke: People around the world have actually studied it, and no one position has been proven to be better than another.
Eleswarapu: “IVF guarantees pregnancy.”
Duke: Oh, boy. Yes, that is definitely a myth. And it’s a tough myth for patients to hear. IVF does present the highest chances of pregnancy, absolutely. There are a number of factors that play into IVF success. One of them has to do with the age of the eggs being used. It also has to do with the quality of the sperm and the egg when they come together. It has to do with the embryo that is ultimately formed. It also has to do with the genetics of the embryo. But then, on top of that, it has to do with the womb in which the embryo will be placed, and a number of factors are not yet fully known. So, we know the immune system plays a role. Diet, exercise probably play a role, but we’re still investigating that. Biggest thing to know is it’s not 100%.
Eleswarapu: “Stress causes miscarriages.”
I think we’re starting to get away from the term “miscarriages.” We’re starting to use the term “early pregnancy loss.” Is that right?
Duke: That’s correct. And I think it’s because “miscarriage” also comes with certain connotations where blame is also ascribed, and the truth is, both early pregnancy losses, there’s nothing the individual could have done about it at all. So now we call it early pregnancy loss before the end of the first trimester, versus second- and third-trimester pregnancy loss. We do not believe stress causes loss. Many people around the world across millennia have gotten pregnant and remain pregnant despite tremendous stress. So we know it’s not simply stress. Nowadays, though, we know the No. 1 reason for pregnancy loss is chromosomal differences in the formed embryo. And so that’s called aneuploidy. 67% of first-trimester pregnancy losses are due to chromosomal issues within the embryo itself. Other reasons would be if the thyroid was not functioning well, if vitamin D is low, if there’s a fibroid in the uterus. If you have a uterus and you’ve had two or more pregnancy losses, you should be evaluated. We always expected that it would be the individual with the womb and the eggs to be the one that gets evaluated for a pregnancy loss. Now the tide is shifting, and individuals who contribute the sperm are also being evaluated when there’s a pregnancy loss in the couple. There’s emerging data that things like DNA fragmentation, where the DNA that are normally supposed to be very tightly wrapped up in the sperm are somehow unraveled and might have little breaks in the DNA strands, and those breaks can contribute to the pregnancy loss.
“Freezing your eggs guarantees that you can have kids later.”
Myth. And the myth is in the word “guaranteed.” If you freeze your eggs, you can stop the clock. And so you’re basically freezing the youngest version of yourself at that point. However, there’s no guarantee that eggs even when frozen will thaw and yield a live-born baby. So it’s really a conversation that needs to happen with your specialist based on your age, based on your egg number.
“Sperm quality doesn’t decline with age.”
Eleswarapu: There’s a lot of data now that is showing that individuals with sperm that is older, say in the fifth, sixth, seventh decades of life and beyond, is more at risk of forming embryos that have chromosomal abnormalities. Getting exercise, eating well are things that can improve the general biology of an individual. Certainly if it’s good for the heart and it’s good for the brain, then it’s probably good for the penis and the scrotum and the testicles as well. We talked about egg freezing, but sperm freezing has its role particularly for individuals who may not be in a relationship or may not be thinking of a family at this time but later on down the road they might want to produce a family.
“It’s impossible to get pregnant after 35.”
Duke: It is possible to get pregnant after 35. The truth is, though, that the chance of pregnancy progressively declines as the age of the egg increases. And so you might find greater and greater need for fertility treatments. When you’re born, if you’re someone born with ovaries, you’d have somewhere between 1 million to 2 million eggs in those ovaries, usually. By age 30, 70% of those eggs are gone, and by age 40, 97% of those eggs are gone. At the same time, those eggs are also aging. And so what we see is that the chance of pregnancy declines very quickly, and then for some people it declines even faster. So if you have endometriosis, if you’re someone who’s maybe had surgeries of the ovaries or needed to be on medications, chemotherapy, radiation, all of those things can also further the decline in the egg number. So my recommendation is, if you have ovaries, at age 30, you should at least be asking your doctor to do a check of your egg number, or what’s called your ovarian reserve.
“The best way to get pregnant is to have sex every day.”
Eleswarapu: It comes down to the ovulatory cycles and making sure that you’re sort of timing things and tracking things, particularly if you’re trying to conceive deliberately. We always get this question, and I want to know what your thoughts are. Should the couple be trying to conceive every other day during ovulation, or every day during ovulation? I say every other day. One, we need to give the sperm and semen enough time to sort of reaccumulate so we can get those millions of sperm. The other is sperm actually survive in the female genital tract for up to five days. So once the egg is released from the ovary, think of the fallopian tube as an arm with a catcher’s mitt at the end. The catcher’s mitt captures the egg, pulls it into the arm, and then the egg sits around there for 12 to 20 hours waiting for sperm. And then if you have intercourse anywhere within the next 24 hours, sperm will also get to the egg. So that’s why we say every other day around ovulation. There is this movement now, particularly on the internet, discussing what’s called abstinence from pornography, masturbation, and orgasm, or PMO. It’s also a movement called no NoFap. And those individuals say to have the best reserve of sperm or the best sort of power with erections or orgasm, that they should conserve for days, weeks, months at a time. This stuff is not scientific at all. And, in fact, after a week of storing up, the sperm may not necessarily be healthy.
“Eating pineapple can increase fertility.”
Duke: That’s a good one. Pineapple by itself, if you have infertility, is unlikely to reverse your infertility. We know that pineapples have bromelain inside of them, which is a compound that is known to be a blood thinner to a certain degree, but it’s very, very weak, and you’d have to eat so much pineapple to even have enough bromelain to have a little effect. You should be having a meal balancing protein, complex carbohydrates, and fiber. So getting your usual multivitamins and folate into your diet, because folate is really important for once you’re pregnant. But technically, no, pineapple by itself does not boost fertility. Infertility, while a daunting thought, really there are lots of options available. The first step is actually an evaluation. Fertility and infertility constitute this huge spectrum, and there are many, many ways to get pregnant and many things one can do to help facilitate that. And you don’t have to stay at home feeling embarrassed about it. If you talk to a specialist like myself, like Dr. Eleswarapu, we are experienced with this and know how to treat you or direct you to the right person who can help.