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National Women's Health Week and Your Fertility

a blog by Kim Griffiths, May 15, 2013

May 12-18 is National Women’s Health Week, so now is the time to think about ways your health could impact your fertility and how you can optimize your chances of having a baby.

There are several unsuspecting health conditions that impact fertility and pregnancy. Conditions like diabetes, thyroid disease, autoimmune disease, and endocrine system hormone imbalances can contribute to infertility. All medical conditions should be discussed with your fertility doctor, and you should discuss any medications you may be taking to assess potential risks to fertility and pregnancy.

Gail Whitman-Elia, M.D., medical director of Advanced Fertility & Reproductive Endocrinology Institute encourages women to be proactive about addressing health conditions and working with a fertility doctor who is specially trained in conditions which impact fertility.

Diabetes is one of several disorders of the endocrine system which can disrupt normal hormone production and can interfere with ovulation, embryo implantation, and overall development of the pregnancy. “Certainly with diabetes, we want the patient’s hemoglobin A1C to be within the normal range starting at about three months before trying to conceive due to the risk of neural tube defects as a result of elevated blood sugar levels,” says Whitman-Elia. Diabetes can increase the risk of pregnancy complications and health risks for the child later in life, so monitoring blood sugar and hormone levels is of utmost importance when trying to conceive.

Thyroid Disease
Thyroid disease is another condition which increases risk of pregnancy loss and development of fetal neurologic problems in the first trimester. Dr. Whitman-Elia believes that even a small amount of thyroid balancing drugs can reduce the risk of these complications. “An embryo won’t have a thyroid until ten weeks’ gestation, so it needs the mother’s thyroid,” she says. If a woman has an imbalance of thyroid hormones or elevated thyroid antibodies but a normal thyroid level, she will suffer a lower implantation rate and greater risk of miscarriage. It is important to test and treat the thyroid to promote healthy implantation and pregnancy outcomes.

Polycystic Ovarian Syndrome (PCOS) is a disorder of the endocrine system characterized by an imbalance in testosterone levels. Dr. Whitman-Elia advises women who suspect they have PCOS to have their hormone levels evaluated due to an increased risk of first trimester pregnancy loss. “Many women with PCOS are given Clomid to induce ovulation, but the first trimester loss is higher and Clomid is also associated with increased incidence of first trimester loss. This is due to higher testosterone levels and an endometrial lining that is not normal,” she advises. Women with PCOS can take Metformin to regulate hormone levels and increase their chances of conception. While Metformin can cause some gastrointestinal intolerance, the drug is available in several formulations which make it easier for the patient to take.

Autoimmune Disease
Autoimmune conditions like lupus, rheumatoid arthritis, multiple sclerosis, Grave’s disease, and Hashimoto’s disease cause your immune system to mistake the body’s natural tissue as foreign, which triggers an immune response. Elevated antibodies can impact embryo implantation by rejecting a pregnancy as a foreign invader. “We’ve tried to get women pregnant in active disease, but when the disease is in remission, it is more successful. We have to be aware of when they are in an active outbreak and avoid conception during that period,” Whitman-Elia advises.

Weight, Diet, and Stress
Dr. Whitman-Elia encourages patients to be mindful of their weight and body mass index (BMI), diet and exercise habits, and stress levels when trying to conceive. Women who manage any underlying health conditions may not need fertility treatment and may reduce the risk of infertility. Those who do need fertility treatment can better maintain a pregnancy by appropriately treating health conditions. Patients should be proactive in addressing their health concerns and working with their doctor to receive individualized treatment.


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