Fertility & Pregnancy
june 2009
A guide to family planning
Expecting?
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fertility & pregnancy
Fertility & Pregnancy Awareness
CONTENTS
Brian Armentrout
Communications
Director
The American Fertility
Association
2Foreword: Fertility & Pregnancy Awareness
4Male Infertility
4Egg Freezing
5Acupunture & Chinese Medicine
5 Male & Female Fertility Treatments
6Home Testing
7Planning Preparation
7Diet & Supplements
8 A Collaboration for Healthy Pregnancies
8 Pregnancy Wellness
10 Panel of Experts
11 Smart Food
fertility & Pregnancy
Publisher: Nicholas Read
nicholas.read@mediaplanet.com
1 646 922 1404
Contributors: Marlene Piturro
Cindy Riley
Scott Mauldin
G
eneration Fertility
Would you believe 7.3
million American women
have difficulty conceiving? Despite
popular belief, there are things men
and women can do to improve their
chances of having a healthy baby
one day. Non-profit organizations like
The American Fertility Association
(The AFA), RESOLVE and Fertile Hope
provide extensive online resources
to help with preventing infertility
whenever possible, to educate and
support you if you’re struggling with
your family building journey, particularly if faced with infertility. Everyone,
regardless of gender, should know
about the reality of their biological
clocks, why and how STD’s compromise fertility, and the repercussions
certain environmental toxins have on
your reproductive health, as well as
the effects of recreational drugs and
steroid use.
Help Yourself
How can you help? Do your homework, ask plenty of questions, and
take advantage of every resource out
there as we work together to help
you and the millions of other men
and women complete your family
building journeys, whether it’s infertility treatments, third party solutions,
adoption, or child free living. Visit
www.theafa.org and make use of
all our free services. You’ll be glad
you did.
Brad imler
President
American Pregnancy
Association
E
very year approximately 6 million pregnancies occur in the
U.S. resulting in approximately
4 million births. Although a usual
time of joy, birth defect, complication,
and premature birth stories create
questions for moms who want to
know what they can do to have the
healthiest pregnancy possible.
The good news is there are steps
that you can take to invest in the
health and wellness of both you
and your baby. Ideally these steps
are made in the months before
conception, however with 50% of all
pregnancies being unplanned, that
planning is not always an option.
You still have steps and changes you
can make to enhance the wellness
of both you and your baby. Take the
steps now whether trying to conceive
or already pregnant. It is a sound
investment in both time and energy
for you and your baby.
The American Pregnancy Association,
is a 501(c)(3) non-profit organization
committed to promoting pregnancy
wellness through education, advocacy and community awareness. The
services of APA are provided free to
women and families as they navigate
the journey of pregnancy seeking to
have the healthiest and most positive
experience possible. Learn more at
www.americanpregnancy.org.
And a very special thanks to...
Pacific Fertility Center is the Bay Area’s leading infertility clinic specializing in advanced infertility treatments. PFC’s
physicians are board certified and internationally known for their excellence in assisted reproductive technology. Patient care
is supported by an expert team of embryologists, a professional staff, and a state-of-the-art lab. PFC is committed to building
healthy families.
Design: Carrie Reagh
carriereagh@mac.com
Printer: Vertis
Photos: ©iStockphoto.com
For more information about supplements
in the daily press, please ­contact
Kayvan Salmanpour, 1 646 922 1400
kayvan.salmanpour@mediaplanet.com
This section was written by Mediaplanet
and did not involve USA Today News ­or
Editorial Departments.
www.mediaplanet.com
Microsoft® HealthVault™ is a free privacy- and security-enhanced online service that puts you in control of your health information. HealthVault lets you store health information from many sources in a single location, so that it’s always organized
and available to you online. With HealthVault, you can access a range of health and fitness web tools, upload data from health
and fitness devices, and share health information with your physicians and others you trust.
EMD Serono is a leader in the US biopharmaceutical arena, integrating cutting-edge science with patient support
systems to improve lives. Through its focus on specialized therapeutic areas, including neurology, reproductive health,
and metabolic endocrinology, as well as oncology and autoimmune/inflammatory diseases, EMD Serono is committed to
developing innovative products that address unmet medical needs
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fertility & pregnancy
Male Infertility: New Stats
Trying to have a baby?
by: Cindy Riley
T
he latest numbers from the
American Fertility Association
reveal that the male partner
is a contributing or sole factor when
couples fail to conceive, in roughly
40% cases.
“For a long time, infertility was
considered a ‘woman’s’ issue, and now
we know that’s inaccurate,” explains
American Fertility Association Executive Director Ken Mosesian.“That’s
why it’s essential to look at what’s
going on with men, as far as their reproductive health in general. Also, it
makes the relationship between two
partners a lot easier if there’s a recognition that they’re both responsible
for what’s happening.”
According to Mosesian, women
are typically willing to educate themselves in order to become pregnant,
while their mates are more resistant.
“It’s the idea that somehow having
a low sperm count or sperm that’s
not motile makes them less virile or
manly. Like it’s somehow a compromise in their masculinity, when that’s
certainly not the case. It has nothing
to do with it, but that’s how it’s perceived,” Mosesian said. “We need to
bring more attention to this issue, so
we can move that conversation into
the light.”
In order to protect fertility, men
can do a variety of things, including
avoiding STDs, steroid use and the
effects of alcohol and recreational
drugs, including cigarettes. Environmental toxins such as certain plastics
and insect repellents can also damage sperm production.
Dr. Natan Bar-Chama, Associate
Professor of Urology at Mount Sinai
School of Medicine , adds, “What’s
really important to realize is that
often the causes of male infertility are, unfortunately, not explored.
The technique used to overcome
it -- whether insemination or more
advanced technology such as in vitro
fertilization -- is able to address a low
sperm count and often the male factor is not evaluated appropriately. The
question of why the sperm count is
low is ignored.”
Dr. Bar-Chama says certain causes
of male infertility can be reversible.
Once these conditions, such as infection or dilated veins, are identified,
a man can improve his fertility and
sperm concentration and increase
the chances of a natural pregnancy
occurring.
“Sometimes the cause of low sperm
count has significant medical implications. A low testosterone level can be
tied to low bone density, fatigue, depression, diminished libido, increased
fat and low muscle mass,” he said.
Identifying the cause of low sperm
count can reveal underlying health
problems. It can possibly signal diabetes and cardiovascular disease. In the
worst case scenario, a man with low
sperm count might be suffering from
testicular or pituitary cancer. That’s
why physicians encourage evaluation and early detection which can
sometimes help boost a man’s sperm
count with proper treatment.
Egg Freezing: Preserving Your Fertility
N
ew technologies provide
women with the opportunity
to freeze their eggs to use later
in life. The fertilization of frozen eggs
has resulted in an increased number
of pregnancies in recent years.
“We’re a lot better at doing it now
than we have been in the past,” said
Eldon D. Schriock, MD, of Pacific Fertility Center.“The efficiency and survival
rate of eggs has improved.”
Egg freezing presents benefits for
women with health challenges or
personal reasons for not becoming
pregnant under age 35.
“We can tell women on chemotherapy that freezing eggs can
enable pregnancy later in life,” Dr.
Schriock said. “ Prior to freezing
eggs, chemotherapy presented a big
problem. Also, for women wanting
to delay child bearing, egg freezing
can preserve fertility for the future by
preserving eggs while they’re
younger and healthier.”
In order to study the safety and
efficacy of egg freezing techniques,
known as oocyte cryopreservation,
EMD Serono has created the Human
Oocyte Preservation Experience
(HOPE) Registry, a national patient
registry.
“We are thrilled to play a major role
in accumulating data on this new
fertility treatment,” said Fereydoun
Firouz, President and CEO of EMD
Serono. “As a leader in fertility health,
EMD Serono is proud to support the
HOPE Registry to validate oocyte cryopreservation techniques that may
prove to be a viable option to assist
women in preserving their fertility.”
The HOPE Registry aims to enroll
approximately 400 women of reproductive age over a three- year period.
Women participating in the Registry
will have their eggs (ooyctes) frozen,
thawed and the resulting fertilized
embryos transferred. All patients
should talk to their physicians before
considering the procedure. It is an
observational study open to qualified investigators across the country
who are freezing and later thawing
oocytes for embryo production. Local
ethics committee or Institutional Review Board approval will be required
for each participating center.
Information gleaned from the
Registry will provide insight into the
technology of egg freezing as well
as the health of children born by the
procedure.
We can help.
The Center for Reproductive Medicine and Infertility
(CRMI) of Weill Cornell Medical College is now known as
The Ronald O. Perelman and Claudia Cohen Center for
Reproductive Medicine.
We offer couples truly comprehensive care, including the most
advanced and effective treatment options available for both
female and male infertility.
s )NVITROFERTILIZATION)6&
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We accept United Healthcare and Oxford Health Plans
for most fertility treatments, please contact our office for
more information.
If you or someone you know is experiencing infertility, contact
us at (646) 962-CRMI or visit us on the web at www.ivf.org.
We can help.
The Ronald o. PeRelman
and Claudia Cohen CenTeR
foR RePRoduCTive mediCine
Formerly known as CRMI
Zev Rosenwaks, M.D.
Director
Owen Davis, M.D.
Ina Cholst, M.D.
Pak Chung, M.D.
Dan Goldschlag, M.D.
Hey-Joo Kang, M.D.
Isaac Kligman, M.D.
Glenn Schattman, M.D.
Katherine Schoyer, M.D.
Steven Spandorfer, M.D.
Linda Applegarth, Ed.D.
Elizabeth Grill, Psy.D.
Laura Josephs, Ph.D.
Weill Cornell Medical College
1305 York Avenue
New York, NY 10021
Tel: (646) 962-CRMI
Garden City, Long Island
1300 Franklin Avenue
Garden City, NY 11530
Tel: (516) 742-4100
Flushing Hospital
Medical Center
145-01 45th Avenue
Flushing, NY 11355
Tel: (646) 962-3638
Northern Westchester Hospital
400 East Main Street-3 North
Mount Kisco, NY 10549
Tel: (914) 242-8144
www.ivf.org
fertility & pregnancy
Acupuncture & Chinese
Medicine
by: Cindy Riley
D
escribed as one of the world’s
oldest healing practices, acupuncture is often prescribed
as a fertility treatment. Although there
are limited scientific research studies
regarding this technique, some
doctors recommend acupuncture
for women who have undergone in
vitro fertilization.
“We find it most useful in people
undergoing IVF, particularly just
before and just after the transfer,” says
Philip Chenette, MD, of Pacific Fertility
Center. “The embryo transfer is a time
of high stress for patients with the
fertility drugs and procedures. I think
acupuncture helps them be calmer,
helps the uterus relax, makes them
more receptive to the embryo.”
Acupuncture is only one aspect
of Traditional Chinese Medicine,
which can include pelvic massages,
herbs and dietary changes. While the
physiological mechanisms are not
completely understood, it is thought
that acupuncture enhances blood
flow to the pelvic region, according
to Dr. Chenette.
As part of the treatment, small,
sterilized needles are inserted into
key points of the body, where they
can remain for up to an hour. Hardly
felt by the patient, the needles
reportedly open up Qi , which is vital
energy defined by increased blood
flow and the benefits of the body’s
systems working together to break
down so-called blockages.
pacificfertilitycenter.com
“The most effective fertility treatments involve a combination of
acupuncture, herbal medicine and
traditional medical interventions,”
according to Dr. Mike Berkley, MD, of
the Berkley Center for Reproductive
Wellness. “However, conception does
sometimes occur when acupuncture
and herbal medicines are used with-
out traditional medical interventions.”
Acupuncture can be combined
with herbs to help regulate levels of
follicle stimulating hormone (FSH), or
to treat repeated pregnancy loss, un-
explained infertility along with several
other conception challenges, according
to the American Pregnancy Association.
Male & Female
Fertility Treatments
A
ccording to the American
Society for Reproductive
Medicine, it is recommended
that couples seek help from a fertility
specialist if unable to conceive after
one year of regular, unprotected intercourse, or six months if the woman
is over 35 years old.
With so many treatment options
now available, costs range dramatically and in this economic climate,
couples having difficulty getting
pregnant should know all of their
financial options before seeking fertility treatment. Treatment coverage
options include health insurance,
loans, IVF programs and financial discount and assistant programs.
FertilityAssist 2, a program offered
by EMD Serono provides financial
help to couples dealing with infertility
and will provide up to $500 in savings
patients during their second cycle on
Gonal-f® (follitropin alfa for injection),
the company’s recombinant human
follicle stimulating hormone (rFSH).
Approximately 60% to 65% of patients
who are under the care of a fertility
specialist discontinue their recommended treatment before completion, often due to cost. FertilityAssist
2 allows patients to stay in treatment
longer and gives hope to couples
who haven’t yet entered treatment.
A majority of the 7.3 million Americans struggling with infertility are
treated with conventional therapies,
such as medication and surgery; less
than 3% of couples are treated with
more sophisticated procedures. The
majority of patients who complete
treatment succeed in having a child.
fertility & pregnancy
Home Testing: The Benefit of Pro-Activity
It’s no wonder most women share similar worries
and wonders about pregnancy. The biological
complexities of pregnancy, along with the major life
step, present endless questions and raise anxieties
for many women. Home testing products can be a
pro-active way to find meaningful answers for some
important questions.
“T
hree questions I often
get asked by my patients
are: am I able to conceive,
am I ovulating and am I pregnant? ”
said Dr. Lisa Masterson, M.D., a Santa
Monica-based OB/GYN affiliated with
Cedars-Sinai, St. John’s and UCLA/
Santa Monica hospitals.
Medical research has introduced
accurate home testing products
which can help women find answers
about fertility, conception and pregnancy. Most of these products are
available over the counter at pharmacies and can help women gauge
several components of conception
and pregnancy.
“The fertility test empowers women
to ask the right questions, right from
the start, when they’re trying to get
pregnant so they can take charge of
their fertility future,” said Dr. Masterson.
Resources like fertility test kits
can help women answer questions
even before trying to conceive. These
simple home tests measure FSH levels
which are a strong indicator of a
woman’s ability to become pregnant.
Determining fertility is a first step
for many women, followed by the
need to uncover the days on which
they are most likely to conceive.
Ovulation home test kits can help
women predict which two days in
their menstrual cycle are best for
conception chances.
Home tests for ovulation can detect
the luteinizing hormone (LH) in urine.
A surge in LH levels can indicate when
a woman’s body is most fertile. Many of
the leading test kits contain products
to measure LH levels throughout a
week’s time, providing results which
are 99% accurate in laboratory tests.
Once LH levels surge, having intercourse within 36 hours can provide
effective timing for conception.
Products used in the privacy of
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6/10/09
home
go a long way in helping
many
by: Scott Mauldin
women understand how body chemistry plays a key role in pregnancy,
according to Barbara Collura, executive director of RESOLVE, the National
Infertility Association. She considers
home test products valuable tools.
“Getting educated, arming themselves with the right tools, and starting a conversation with their doctors
can help women better plan for a
family,” Collura said.
Am I pregnant? This can be an
exciting question for women after
the planning and hoping involved
11:35 AM
with conception. Home testing can
provide the first answer to this life
changing wonder.
The female body starts changing
within moments of conception, but
it could be several days or longer before pregnancy makes itself obvious.
One way to determine pregnancy is
by measuring the hormone human
Chorionic Gonadotropin, often called
hCG. The levels can be detected in
urine. Most home pregnancy tests
can detect higher levels of hCG and
provide conclusive results.
Page 1
ADFRUSATDY
Preconception Checklist
Your mind and your partner may be ready for pregnancy, but
what about your body? Doctors at the Mayo Clinic suggests
taking this honest quiz and discussing the answers with your
doctor as part of your preconception checklist.
1) What type of birth control have you been using?
2) Are your vaccines current?
3) Do you have any chronic medical conditions?
4) Are you taking any medications or supplements?
5) Are you at risk of a sexually transmitted disease?
6) Do you have a family history of any specific medical conditions?
7) How old are you?
8) Have you been pregnant before?
9) Would your current lifestyle support a healthy pregnancy?
10) What about your partner’s lifestyle?
Take Action! Improve Pregnancy Chances
WEIGHT: Being overweight or underweight can raise the risk of ovulation
disorders. Use moderate exercise and a healthy, balanced diet to regulate
body weight.
TOBACCO: Usage of tobacco has negative effects on fertility and overall health.
If you smoke and are considering pregnancy, quit now.
STRESS: Reduce stress factors before trying to become pregnant.
CAFFEINE: Reduce intake to less than six cups of coffee each day.
fertility & pregnancy
Pregnancy:
Planning & Preparation
by: Cindy Riley & Scott Mauldin
F
rom health and wellness to
selecting a doctor, it’s crucial for
couples to optimize their lives
as they prepare and plan for a baby.
Health often comes as the first
priority, as doctors recommend a total
review of wellness and lifestyle for
women planning to become pregnant.
“Women should be taking prenatal
vitamins, and there’s evidence that
starting them well before pregnancy
is beneficial,” says Kate Schoyer, M.D.,
Assistant Professor at The Center for
Reproductive Medicine and Infertility,
Weill Cornell Medical College.
Doctors often suggest women
have a full physical exam before
pregnancy. A check-up can identify
a woman’s blood pressure, check her
nutrition, ensure she is up to date
with vaccines and gauge her overall
wellness related to conception. It can
also determine whether a woman is
at a healthy weight, which is a pregnancy key based on many studies.
“We have a serious concern about
obesity and the complications it can
cause during pregnancy and delivery
for the woman and her baby,” says
Alan Fleischman, M.D., medical director of the March of Dimes.
Health changes may not be limited
to a hopeful mother. Doctors say
pregnancy planning presents strong
motivation for a couple to eliminate
unhealthy lifestyle choices, such as
smoking, which can have a major
impact on an unborn baby as well as
children once they’re born.
“Lifestyle changes, although sometimes the hardest, are some of the
most crucial changes when it comes
to investing in the health and wellness of a pregnancy and the baby,”
says Brad Imler, Ph.D., President of
the American Pregnancy Association.
“Nicotine, alcohol, illicit drugs and
caffeine are all associated with birth
defects, low birth weights, prematurity or miscarriage.”
Dr. Imler encourages couples to
jointly begin practicing healthier lifestyles months before pregnancy.
Selecting a doctor is another key
to pregnancy planning. Women may
want to consider which hospital to
use for their prenatal care, even different birthing options for bringing a
newborn into the world. Many times
other couples can offer the greatest
suggestions about picking the right
OB/GYN and birthing experience.
“Talk to each other and friends
about the process,” says Dr. Schoyer.
Planning and preparing for pregnancy not only involves a growing
family, it calls for new choices to be
made outside the home. These can
include career decisions, insurance
changes and financial planning.
Women should review their employer’s maternity leave policies, as well
as their health insurance coverage,
according to the American Pregnancy
Association. Other new parents may
also provide advice based on their
recent pregnancy experiences.
Internet answers can go a long way
with pregnancy planning, but doctors
encourage women to be sure they’re
getting facts from reliable sources.
John Edwards, M.D., Medical
Director Sciele Pharma Inc., points to
online references such as the Patient
Education Reference Library.
“It’s a website where you may
download free educational illustrations, animations and informational
handouts,” according to Dr. Edwards.
Many other organizations, such
as the Centers for Disease Control
and Prevention and the American
Pregnancy Association, offer detailed
pregnancy planning material on
their websites. These internet re-
sources cover pregnancy health
topics along with material about
the many questions and decisions
required by couples who hope to
soon become parents.
Diet and Supplements:
Room for Two
T
he importance of diet and
supplements can’t be stressed
enough once a woman decides to become a mother, according
to Dr. John Edwards, Medical Director
of Sciele Pharma, Inc.
“A healthy diet is important during
pregnancy. Multiple studies correlate
some birth defects to poor diet during pregnancy. Many of the effects of
poor diet are seen in the developing
nervous system of babies before they
are born,” Dr. Edwards said. “Generally good nutrition leads to healthier
pregnancies and healthier children.”
Along with a healthy diet, vitamin
supplements can be a vital resource
for pregnant women.
“Pregnancy is a time of depletion
of the body’s resources,” Dr. Edwards
said. “Pregnant women are eating for
by: Scott Mauldin
two and they need the vitamins for
two.”
Iron in a woman’s body is absorbed
as the developing baby’s blood supply is formed. Calcium from a mother
is routed towards the skeletal growth
of her baby.
“Specifically with regard to pregnancy, low levels of vitamin D during
pregnancy have been associated
with preeclampsia, bacterial vaginal
infections, early childhood cases of
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rickets, dental caries, and potentially
even autism,” said Carole A. Baggerly,
Director of Grassroots Health, a public
health organization.
In fact, D*action is an international
study being done with individuals as
well as clinics to track the health characteristics of getting vitamin D levels
to the recommended 40-60 ng/ml
level. The study is being conducted
by Grassroots Health.
The importance of vitamin D is now
a growing concern, as many women
do not get enough for their baby,
while too much may be dangerous.
The same is true for any other vitamins or minerals ordinarily needed
by the human body -- mothers need
more, but they should discuss their
diet and supplement changes with
their doctor.
Vitamin D may play a role in allowing fertilized ova
to implant in the uterus, according to evidence produced
by Dr. Judith Bulmer and the Royal Victoria Infirmary.
For fertility purposes the father-to-be is of prime
importance. Six months prior to desired conception,
both must make lifestyle changes, no smoking, no
drinking, no sodas, eat fresh fruits, vegetables, LOTS
of pumpkin and sunflower seeds.
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fertility & pregnancy
Microsoft HealthVault and Mayo Clinic:
A Collaboration For Healthy Pregnancies
F
or some of the 1.5 million
American women who give
birth annually, a powerful new
tool, Mayo Clinic Health Manager,
can help moms-to-be to track baby’s
development, prepare for physician
appointments, and access decision
guides about pregnancy and pre-natal
health. “Mayo Clinic Health Manager
was developed based on a collaboration between the Mayo Clinic and
Microsoft Corporation, leaders in
their respective fields of health care
and software. Mayo Clinic Health
Manager helps pregnant women
manage health information for
themselves and their families using
Microsoft HealthVault, a free, privacy
and security-enhanced online
platform. A personal health application that combines Mayo Clinic’s
body of medical expertise with the
user’s personal health data stored
in HealthVault, Mayo Clinic Health
Manager provides personalized
guidance and recommendations for
each member of the family.
Roger Harms, MD, Vice Chair of
Mayo Clinic Obstetrics and Gynecology, and specialty contributor to
Mayo Clinic Health Manager explains
that Mayo Clinic Health Manager helps
patients monitor their conditions
and manage pregnancy-related health
data by storing data in HealthVault.
“It allows us to both store information
by: Marlene Piturro
and give recommendations to the user.
For example, for a woman who is over
age 35 and in the third month of her
pregnancy, Health Manager can
deliver guidance on prenatal tests,
the challenges of an over age 35
pregnancy, and over the counter and
prescription medications’ impact
on the pregnancy. “ He adds: “Health
Manager is very dynamic. If a patient
logs in during her pregnancy’s
fifth month, tests appropriate to the
first trimester tests aren’t provided.”
For high risk pregnancies, Mayo
Clinic Health Manager gives guidance
on a range of conditions. Advanced
maternal age (8-10% of women over
35 years nationally), for one, predis-
poses to chromosomal abnormalities, higher risk of Caesarean section,
diabetes, hypertension, and large
infants at delivery.
Mayo Clinic Health Manager also
helps patients prepare for office visits.
“We built our expertise into the Health
Manager, so the patient can print the
details about issues likely to arise
such as potentially available tests,”
explains Dr. Harms. “We’ve also got
a nice built in patient safety feature
showing what steps should be taken
when, a reminder for our busy providers.” For example, 11 to 14 weeks
is the time to test for chromosome
abnormalities. Beyond that time the
test can’t be used. Another example
Pregnancy Wellness: Diet, Exercise, Lifestyle
W
hen a woman chooses to
conceive, her diet, health
habits and exercise are
primary elements for a healthy
pregnancy. As if having a baby isn’t
change enough, lifestyle changes are
often the keys to ensuring proper
nutrition and overall wellness before
giving birth.
Diet and nutrition can be managed
on a daily basis while a woman is
pregnant. Food intake as well as supplements can ensure better health for
a woman and her baby.
“There is a correlation between
healthy diet and healthy babies,” says
John Edwards, M.D., Medical Director
of Sciele Pharma, Inc. According to the American College
of Obstetricians and Gynecologists,
pregnant women should have 3
servings of milk, yogurt, and cheese,
3 servings of protein, 3 servings of
fruits, 4 servings of vegetables, and
9 servings of whole grain products
each day.
“Most moms know and understand
that what she eats is what her baby
eats,” says Brad Imler, M.D., President
of the American Pregnancy Association.“It is important to focus on eating
well-balanced smaller meals throughout the day versus three larger typical
mealtimes.”
Dietary supplements can further
improve pregnancy wellness. A 2002 study for the Society for Women’s
Health Research points to docosahexaenoic (DHA) as an example of
the difference supplements can
make. Maternal DHA supplementation resulted in improved eye-hand
coordination and improved attention
skills for toddlers.
A University of Pittsburgh study,
released in May, 2009, points to pregnancy problems in women with low
vitamin D levels.
“It is not only associated with a
number of gynecologic conditions,
but also may contribute to premature delivery, the leading cause of
neonatal mortality,” says Lisa M.
Bodnar, Ph.D., M.P.H., R.D., assistant
professor of epidemiology, obstetrics
and gynecology, at the University of
Pittsburgh.
Healthy weight is another aspect of
pregnancy.
New guidelines from the Institute
of Medicine, released in May, 2009,
set stringent guidelines for a woman’s weight while pregnant. Obese
women should only gain between 11
and 20 pounds the report says.
“Weight is a risk factor that can
be modified,” says Alan Fleischman,
M.D., medical director of the March of
Dimes. “If a woman starts pregnancy
at a healthy weight, it can lower the
risk of a preterm birth, birth defects,
and other complications, including a
c-section.”
Exercise while pregnant can help
many women regulate weight and
reduce health issues that follow child
birth.
“Exercise throughout the pregnancy makes the labor and birth
process easier,” Dr. Imler says. “Losing
weight after the birth is usually faster. Exercise improves circulation, is related to reducing or alleviating many
common discomforts including con-
stipation, hemorrhoids, swelling and
varicose veins.”
Many health care providers and
fitness professionals say swimming
is the safest exercise for pregnant
women. Walking is safe for the body.
A stationary bike is good exercise, as
there’s less chance of falling, while
stair climbing helps raise the heart
rate.
Many women face health concerns
while carrying a baby. It’s common for
women to suffer discomfort which
may include back pain, dizziness,
headaches, heartburn, insomnia,
morning sickness, sciatic nerve pain,
swelling and skin changes.
“Patients should see their OB/GYN
as soon as they are pregnant,” advises Dr. Lawrence B. Werlin, director
of Coastal Fertility, Irvine, California.
“It is important to be on a healthful
diet, exercise, and follow guidelines as
instructed by their doctor.”
Pregnancy health involves components which can come together if a
woman relies on what some doctors
call a wellness team. An expectant
is a woman who knows she has an
Rh negative blood type, only about
5% of the population. “She needs
special care at 28 weeks to ensure
the baby’s safety. Armed with that
information, she should be tenacious
about receiving that care.”
Mayo Clinic Health Manager
content was developed based on
patient demand. Medication use,
nutrition, exercise/fitness, required
and optional tests, and gestational
development broken down week by
week are most popular.
by: Cindy Riley
mother should be comfortable with
her doctors, along with other health
care professionals. If needed, she
should take time finding the right chiropractor, yoga coach, midwife, doula,
childbirth educator or counselor.
Powered by
Microsoft HealthVault
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™
™
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including medication safety, nutrition and tests.
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The “Prepare for Appointment” tool, which helps you make the most
of your doctor visits and queues up questions that you might have at
various stages of pregnancy. You can add additional questions, print-out
the document and take it to pre- and post-natal visits to share with your
doctors.
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data, such as weight, blood pressure, mood, fetal movement and fitness.
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10
fertility & pregnancy
Panel Of Experts
Roger Harms, MD
Kate Schoyer, MD
David Stern
Philip Chenette , MD
Vice Chair of Mayo Clinic Obstetrics and Gynecology,
and specialty contributor to
Mayo Clinic Health Manager
Weill Cornell Medical College
Assistant Professor, The
Center for Reproductive
Medicine and Infertility
EMD Serono, Inc.
Executive Vice President,
Endocrinology
Pacific Fertility
Reproductive Endocrinologist
& Infertility Specialist
Q: What aspects of pregnancy and delivery are
the most overlooked in terms of safety for the
mom and baby?
Q: What issues of pregnancy wellness are
commonly overlooked by women?
Q: What advances in the field of fertility are often
unknown by couples trying to conceive?
Q: What issues surrounding fertility do you
believe are commonly overlooked or unknown
by women or couples?
A: Infertility is both a medical issue and a
profoundly emotional issue for most couples so
providing education and support at many levels
is critical. It’s crucial for couples to optimize their
health as they prepare and plan for a baby.
If a patient is overweight, it’s good for her fertility
and for the health of the pregnancy to lose
weight prior to conceiving. Women should be
taking prenatal vitamins. Both women and men
should enjoy activities they usually partake in,
such as exercise.
If a couple is having trouble conceiving, they
should seek the care of a medical professional
to determine why they are having a difficult
time. It is vital for a patient and her partner to
have a thorough evaluation prior to treatment,
because depending on the etiology, treatments
will vary.
We also recommend and offer the support
of a psychologist for those couples needing
additional help with stress reduction or other
personal issues .
A: Whether couples have just started thinking
about fertility issues or whether they have
already started fertility treatments, they are
not alone in their quest to conceive. Those with
infertility may feel like they are losing their mind
and probably have had a hard time remembering
what their true personality was like before trying
to get pregnant—the myriad emotions can
strike any time of day and for any or no reason.
A majority of the 7.3 million Americans struggling
with infertility (85% to 90%) are treated with
conventional therapies, such as medication and
surgery; less than 3% of couples are treated with
more sophisticated procedures. The majority
of patients who complete treatment succeed in
having a child.
New technologies now provide women with the
opportunity to freeze their eggs to use later in life.
The fertilization of frozen eggs has resulted in an
increased number of pregnancies in recent years.
In order to study the safety and efficacy of egg
freezing techniques, known as oocyte cryopreservation, we have created the Human Oocyte
Preservation Experience (HOPE) Registry.
The HOPE Registry aims to enroll approximately
400 women of reproductive age over a threeyear period. Women participating in the Registry
will have their eggs frozen, thawed and the
resulting fertilized embryos transferred.
One group that has benefited from this tech-
nology is women who have been diagnosed
with certain types of cancer during their reproductive years and wish to preserve their fertility
before treatments.
A: Many actions taken during pregnancy are
intended to prevent abnormal outcomes,
or detect the rare case where medical action
is necessary. Examples include folic acid
supplementation, basic screenings for gestational diabetes and infectious diseases, and
attention to diet and exercise to maintain normal
weight gain. These actions promote wellness or
have a reasonable chance to detect a problem
for which effective treatment is available.
Interventions on behalf of either the mother’s
or baby’s health during pregnancy are necessary in only a small minority of cases, but seem
to be used in a high proportion. For example,
the dramatic rise in C-section delivery in the
past thirty years has not altered the incidence
of cerebral palsy one iota. Although a frequent
hypothetical benefit of expanding such deliveries,
only a tiny proportion of cerebral palsy cases
are related to events that could be altered with
a C-section.
All interventions have a cost, not only monetary,
but in complications inherent in their use.
Often these costs are warranted to benefit
patients. Anesthesia care is a good example.
However, other common interventions have
failed to benefit women and their babies,
but the costs in dollars and complications are
readily measured.
Evidence of good pregnancy outcomes is always
more reliable than evidence suggesting concern.
Action altering the course of normal pregnancy
should be taken only with strong evidence that
the benefit warrants the risk.
A: The most commonly overlooked issue is
one everyone knows. It’s the effect of age on
female fertility. I believe it has gotten through
to everyone that eggs don’t work as well with
age. There’s the chance of many complications.
Everyone knows that, but it still comes as a
surprise to many people.
Also, a fairly large percentage of couples suffer
from the male fertility factor, where the sperm
just doesn’t work as well. They don’t know it
until they until they seek medical advice.
One of the most important issues for women
and men is nutrition. The most important thing
you can do for fertility is to take care of yourself. Concentrate on proper nutrition, omega-3,
vitamin supplements, those all go along way
with fertility and can make a huge difference.
We talk a fair amount about timing. The best
time is all the time. You don’t really want to
precision time sex. Studies show that having
sex early in the cycle and frequently during the
woman’s cycle works best. It doesn’t work to
wait for sex at the right time.
I think it’s important for people to get a good
education on the problems of fertility. You
just have to be aggressive and get a complete
picture of your fertility status. It goes a long
way in identifying the issues you face. You’re
combining two bodies. That’s an incredibly
complex event. There are so many things that
influence that event, you have to be detail-
oriented about finding and fixing those problems.
11
fertility & pregnancy
Smart
Food:
DHA and
Your Baby
by: Scott Mauldin
C
ould there be smart food for
babies? Proper nutrition goes
a long way in adult health
and wellness. The same is true for
infants before they’re born. What a
mother consumes is shared with her
baby, which makes consulting with a
physician about proper diet crucial
for a healthy newborn.
“The proof of a relationship between proper diet and healthy babies
is clear. The number of birth defects
has dropped as public education about
diet has improved,” according to Dr.
John Edwards, of Sciele Pharma, Inc.
Many pregnant women underestimate the importance of some
dietary supplements, according to
the Kelton Study sponsored by the
Society for Women’s Health Research
in Washington DC. The report singles
out docosahexaenoic (DHA), stating
that 50% of the women surveyed did
not know about the need for DHA,
considered a critical nutrient for the
healthy development of a baby.
DHA, found in foods such as Atlantic
salmon, tuna and Pacific cod is thought
to play a key role in brain and nervous
system development. 68% of recent
moms and mothers-to-be surveyed
in the Kelton Study said even their
doctor did not tell them about DHA.
Scientific research, including a 2002 report, shows maternal DHA supplementation resulted in improved
eye-hand coordination at 2.5 years
of age, and infants whose mothers
had higher blood DHA levels showed
better sleep patterns.
While doctors consider DHA
an important component in early
development, it is certainly not the
only key to infant development, and
must be considered along with other
nutritional factors.
®
A smart generation
builds on the legacy.
prescribed
branded
prenatal
vitamin1
Prenate DHA features 365 mg of total omega-3 fatty acids, including 300 mg of DHA and 9
essential vitamins and minerals*
• 9 essential vitamins and minerals
• 365 mg of total omega-3 fatty acids,
including 300 mg of DHA
• Includes 400 mcg folic acid and 600
mcg Metafolin, an active form of
folate2
• Softgel capsule is well tolerated and
easy to swallow
*Supportive but not conclusive research
shows that consumption of EPA and DHA
omega-3 fatty acids may reduce the risk
of coronary heart disease. One tablet
of Prenate DHA provides 365 mg
of DHA omega-3 fatty acids.
DESCRIPTION:PRENATE DHA® is a prescription prenatal/postnatal
multivitamin/mineral/essential fatty acid softgel. Each softgel is blue-green in
color, opaque, and imprinted with “Prenate DHA” on one side.
Each softgel contains
Vitamin C (ascorbic acid) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 mg
Vitamin D3 (cholecalciferol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 IU
Vitamin E (d-alpha tocopherol) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 IU
Vitamin B6 (pyridoxine HCl) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 mg
Folate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 mg
(L-methylfolate as Metafolin® 600 mcg)
(folic acid USP 400 mcg)
Vitamin B12 (cyanocobalamin) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 mcg
Calcium (calcium carbonate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 mg
Iron (ferrous fumarate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 mg
Magnesium (magnesium oxide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 mg
Docosahexaenoic Acid (DHA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300 mg
(from 365 mg omega-3 fatty acids)
Other Ingredients: Soy lecithin, beeswax, ­sh oil, hydrogenated vegetable oil,
gelatin, sorbitol, glycerin, propylene glycol, titanium dioxide, vanillin, FD&C
blue No.1, hypromellose.
INDICATIONS: PRENATE DHA is a multivitamin/mineral/essential fatty acid
nutritional supplement indicated for use in improving the nutritional status of
women throughout pregnancy and in the postnatal period for both lactating and
non-lactating mothers. PRENATE DHA can also be bene­cial in improving the
nutritional status of women prior to conception.
CONTRAINDICATIONS: PRENATE DHA is contraindicated in patients with
a known hypersensitivity to any of the ingredients.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids (such
as DHA) per day has been shown to have potential antithrombotic effects,
including an increased bleeding time and International Normalized Ratio
(INR). Administration of omega-3 fatty acids should be avoided in patients
taking anticoagulants and in those known to have an inherited or acquired
predisposition to bleeding.
WARNING: Accidental overdose of iron-containing products is a leading
cause of fatal poisoning in children under 6. Keep this product out of reach
of children. In case of accidental overdose, call a doctor or poison control
center immediately.
PRECAUTIONS: Folic acid alone is improper therapy in the treatment of
pernicious anemia and other megaloblastic anemias where vitamin B12 is
deficient. Folic acid in doses above 1 mg daily may obscure pernicious anemia
in that hematologic remission can occur while neurological manifestations
progress.
ADVERSE REACTIONS: Allergic sensitization has been reported following
both oral and parenteral administration of folic acid.
DOSAGE AND ADMINISTRATION: Before, during, and/or after pregnancy,
one softgel daily or as directed by a physician.
HOW SUPPLIED: Unit-dose packs of 30 softgels.
NDC #59630-418-30
KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN.
Store at 20°-25°C (68°-77°F). Excursions permitted to 15°-30°C (59°-86°F).
[See USP Controlled Room Temperature]
WARNING: Accidental overdose of iron-containing products is
a leading cause of fatal poisoning in children under 6. Keep this
product out of reach of children. In case of accidental overdose,
call a doctor or poison control center immediately.
WARNING: Ingestion of more than 3 grams of omega-3 fatty acids (such
as DHA) per day has been shown to have potential antithrombotic effects,
including an increased bleeding time and International Normalized Ratio
(INR). Administration of omega-3 fatty acids should be avoided in patients
taking anticoagulants and in those known to have an inherited or acquired
predisposition to bleeding.
References:
1. IMS National Prescription Audit Plus [March 2009]. Norwalk, Conn: IMS Health Inc; 2009.
2. Metafolin®: about the product. Merck KGaA Web site. Available at: http://www.metafolin.com.
Accessed November 18, 2008.
Please see adjacent full Prescribing Information.
PDHA.05.09.19.01
U.S. Patents #5,997,915; #6,254,904; #6,011,040; #6,451,360; #6,673,381;
#6,808,725; #6,441,168.
Metafolin® is a registered trademark of Merck KGaA, Germany
For inquiries call 1-800-849-9707 extension 1454.
PND-PI-4 Rev 08/08
Manufactured for:
Sciele Pharma, Inc.
Atlanta, Georgia 30328
Manufactured by:
Cardinal Pharma Solutions
Swindon, UK
Made in the United Kingdom
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