Unexplained Infertility


 Almost one third of the couples that are having trouble conceiving are diagnosed with something called “unexplained infertility”. Having unexplained infertility almost adds a bit of insult to injury. All of the blood tests come back normal, semen analysis comes back fine, there are no mechanical obstructions yet a couple is still struggling to conceive. Coupes are left feeling powerless not knowing how to help themselves or where to seek help because there is nothing essentially wrong.

I feel there is no such thing as unexplained infertility.  There are only places that we still haven’t looked yet. Human being is more complex than just a snapshot of their body at a particular point of time. Any kind of imbalance or disease is really a hologram of a genetic, environmental, physical, nutritional, emotional, spiritual and even behavioral aspects. I always tell my patients that their infertility is not just confined to their pelvic region but it really is an expression of your overall health and well being. If you are one of these people that have been diagnosed with unexplained infertility there are still places that you can look to find answers. A lot of these places have to do with our lifestyle. I’ll list a few big ones here so that you can get a sense of where to look so you can peel some layers back in finding your answers and to feel more empowered and in control of your health.

The first place to visit is your sleep, are you getting enough? Are you only getting 5-6 hours versus 8-10?  Sleep deprivation is rampant in the US and we know that not having adequate rest can cause hormonal issues, predispose you to type 2 diabetes or heart disease and it can really cause many issues in your whole system. Getting adequate rest is extremely important.

Secondly, your weight. For fertility purposes you want to keep your BMI between 20 and 25. Being overweight and even underweight is not conducive to getting pregnant so if you are overweight, just losing 5% of your body weight increases your chances of getting pregnant by quite a bit. Same goes for if you are underweight.  Gaining a bit of weight can help you get pregnant faster.

Another aspect is exercise. Are you a couch potato or are you a gym rat? Most people are overdoing it or under doing it. Neither one is good for our fertility. If you are someone who doesn’t move your body much at all, then, it is really time to get off the couch and start moving. I think the secret is to find something you enjoy so that you can stick to it. Walking, dancing, yoga or whatever it is that sings to your heart, do it! On the other hand if you are someone going to boot camp five times a week, then you are probably overdoing it and you need to tone it down. Really intense exercise you want to limit to twice a week, more moderate things you can do daily.

Caffeine is another big one. People live off coffee and sugar nowadays so if you are drinking more than 200 or 300 milligrams of caffeine per day you are decreasing your chances of getting pregnant and staying pregnant. There are studies that show that having increased caffeine increases your chance of miscarriage.

Alcohol is another big one. There are conflicting opinions on how much alcohol is allowed when trying to get pregnant. Some sources show that more than 4 glasses of alcoholic beverages per week will decrease your chances of pregnancy. It will also have a negative effect on sperm. The good news is that if you abstain from alcohol while trying to get pregnant the sperm will regenerate in about 3 months of time.

Smoking is another obvious one. There is strong evidence that smoking ages our reproductive system in males and females. Please stop smoking if you are trying to get pregnant. Research shows that even if you are going through IVF, smoking still lowers your chances of a successful pregnancy.

There are so many other areas that we can look at to improve your fertility that we will get in to but it can get overwhelming, these are just a good place to start!

Is There Really an “Infertility Epidemic”?

Infertility diagnosis is usually established according to the amount of time that a couple has been trying to conceive as well as a woman’s age. According to those parameters, a couple is considered to be infertile if they have not conceived after a twelve month period of unprotected intercourse and the woman is under the age of thirty four. If a woman is older than thirty four, a couple is considered infertile if they have not conceived after six months of unprotected intercourse. Time and age are important parameters in establishing a diagnosis of infertility.

There is a prevailing belief that incidence of infertility in the United Sates is becoming greater. There has been extensive media coverage of infertility treatments, which leads more people to seek help. Moreover, there are many more doctors trained to treat infertility which usually results in more couples who receive advice and treatment. All this has lead, in the opinion of researchers at the National Center for Health Statistics, to a widespread, but erroneous perception of an infertility epidemic.

According to Susan Faludi, author of the book Backlash: The Undeclared War on American Women, the establishment of infertility diagnosis after one year of unprotected intercourse is a recent development inspired by “infertility specialists” marketing their high tech treatments. Faludi notes that:
“The one-year cutoff is widely challenged by demographers who point out that it takes young newly weds a mean time of eight months to conceive. In fact, only 16 to 21 percent of couples who are defined as infertile under the one-year definition actually prove to be, a congressional study found. Time is the greatest, and certainly the cheapest, cure for infertility. In a British longitudinal survey of more than seventeen thousand women, one of the largest fertility studies ever conducted, 91 percent of the women eventually became pregnant after thirty-nine months.”

How did medical professionals determine woman’s age parameters for infertility diagnosis? Does woman’s fertility really significantly decline ones she turns thirty? In 1982, the New England Journal of Medicine reported that woman’s chances of conceiving after the age of thirty drop by forty percent. Virtually every study up until then had found that fertility didn’t truly start declining until women reached at least their late thirties or even early forties. Three years later, in 1985, the U.S. National Center for Health Statistics unveiled the latest results of its nationwide fertility survey of eight thousand women. It found that American women between thirty and thirty-four faced only 13.6 percent, not 40 percent, chance of being infertile. Women in this age group had a mere 3 percent higher risk of infertility than women in their early twenties.

The concept of the ever deteriorating women’s biological clock was dramatically reinforced by spreading the findings of a New England Journal study through TV media and newspaper articles. This created “infertility epidemic” has produced significant panic among women who decided to postpone childbearing in order to pursue education, economic development or other goals in life.

I believe that establishing infertility diagnosis based on woman’s age while all other laboratory tests are normal has a negative effect on woman’s self esteem, stress levels and overall trust that her body is capable of conceiving and having a healthy pregnancy and birth. These types of “infertility” patients are a daily occurrence at my acupuncture practice. Educated and hard working women come to my practice feeling defeated and depressed after they hear the infertility verdicts from their doctors. In my clinical experience, it is not unusual to see women having irregular cycles or more premenstrual tension after they are told that they are infertile. According to Dr Christiane Northrup, author of the book Women’s Bodies Women’s Wisdom, beliefs are physical. Dr Northrup says, “A thought held long enough and repeated enough becomes a belief. The belief then becomes biology. Beliefs are energetic forces that create the physical basis for our individual lives and our health. If we don’t work through our emotional distress, we set ourselves up for physical distress because of the biochemical effect that suppressed emotions have on our immune and endocrine systems.”

Is it possible that we are rushing the diagnosis and thus premature treatment of infertility? Is our culture too focused on “instant gratification” even when it comes to making babies? In my opinion, it is important to find middle ground when it comes to diagnosing and treating infertility. For example, if a couple has not conceived within the time parameter that has been defined by medial doctors, it is important to proceed with baseline diagnostic tests like sperm analysis, female hormonal testing and hysterosalpingogram (an x-ray test that examines uterine cavity and fallopian tubes). If there is a severe sperm abnormality or a blockage of the fallopian tubes, then a couple should proceed to assisted reproductive technology treatments like IVF. If the baseline diagnostic tests are normal, it is important to look at other factors that may be causing fertility problems like diet and lifestyle choices.

Sloane, E. (1985). Biology of Women. A Wiley medical publication. New York: Wiley. Pg 462
Faludi, S. (1991). Backlash: The undeclared war against American women. New York: Crown. pg.42

Antidepressants And Sperm Quality


U.S. researchers at Cornell Medical Center in New York conducted a research study which showed a link between antidepressant medication use and lowered sperm quality.  Thirty five healthy men volunteered to take Paroxetine also known as Seroxat or Paxil (selective serotonin reuptake inhibitor) for five weeks.  All volunteers gave sperm samples before and after the experiment.  Initially, the results did not reveal the significant changes in sperm quantity, morphology or motility.  However, at closer examination, the findings showed that the percentage of sperm DNA fragmentation was significantly higher for men while on Paroxetine (30.3%) versus baseline (13.8%).  Also, up to 35% of men noted significant changes  in erectile function and up to 47% of men reported ejaculatory difficulties on medication.  Recovery to near-normal sexual function was noted after stopping treatment.  The conclusion of the study was that even though Paroxene use does not have measurable effect on standard semen parameters (volume, motility and morphology) the fertility potential of a substantial number of men on paroxetine may be adversely affected by the changes in DNA integrity.

If you have been trying to conceive without success and your male partner is taking antidepressants, it might be worth looking into different ways to manage your partner’s depression.  Getting off antidepressants should never be done “cold turkey”.  It is a gradual process that has to be monitored by  primary care physician.  Recent research has shown that depression has been linked to poor digestive health and chronic levels of inflammation.  Making lifestyle changes to address these problems can improve depression.  For more information on how to treat depression naturally, please refer to Dr Kelly Brogan’s blog here.

Wish you all the best in your fertility journey!


How To Survive Portland’s Damp-O-Rama

qca6eulmskk-luca-bravo (2)I absolutely love Portland. It’s a city that has so much to offer. However, there is a price that we pay for living in such a beautiful and lush place. Once this cold rainy weather creeps up on us, it can be challenging, even for the most optimistic folk, to remain happy and energetic.

Cold, dark and damp days tend to slow most of us down. You might feel sluggish, cold, achy and just blah. Some people might even feel nauseated and chronically congested. All these symptoms are common in populations who live in damp environments.

So, what’s a person to do?

Good news is that there are few simple things you can do in order to make Portland’s winter much more tolerable.

-My favorite is – going to a sauna. On the days when you feel really down, sluggish and cold, get into a dry hot sauna. I guarantee that you will feel amazing afterwards. You don’t need to stay for an hour or sweat profusely. Just stay in for about twenty minutes or until you feel like you’ve finally warmed up your bones. Ideally, you want to finish up with a short cold shower. Alternating hot and cold temperature increases metabolism, enhances immunity, reduces pain and improves your mood.

-Keep moving! Exercise stimulates heat production in our body so not only will you feel warmer, your mood will be improved as well.

-Stay away from cold drinks and uncooked foods. Eating stews and soups is the best way to stay warm and cozy in the winter. In Chinese dietary therapy, barley is an excellent grain used to counteract dampness. So are warming spices like ginger, garlic, cinnamon and onions. Pungent, decongesting foods can be used to accompany rich foods such as meat. Mustard and horseradish are particularly useful in cold and damp climates.

-Check your vitamin D levels. During dark winter months, it’s so common for people in Pacific Northwest to have vitamin D deficiency. Stay on top of it and ask your primary care provider to test your levels. Supplement if necessary. It can make a world of difference!

Now, I would love to hear from you. What keeps you happy during winter time?

Power Of Community


Yesterday morning, our neighbor texted my husband and I to let us know that he has passed a huge exam that he has been preparing for for over two years. We were elated! Later in the evening, we were invited to his house for a little impromptu dinner party so that we can celebrate his success.

During the dinner, our neighbor made a heart felt toast. He mentioned that he couldn’t have passed the test without the help of his family and his neighbors. He thanked everyone for providing help, encouragement and love during this very challenging time in his life. He also said that he is a rich man because he is surrounded with such great community.

Many toasts later, everyone took turns to talk about the things that we appreciate in our lives. Everyone concluded that having a supportive community is one of the biggest treasures a person can have.

This, my friends, is the secret to a happy, healthy and fulfilling life.

You could be eating a perfect diet, going to the gym every day but it’s impossible to create health completely alone.

I encourage your to use the power of your community to help you succeed in whatever you are trying to achieve. Don’t hesitate to ask for help. Don’t hesitate to offer help. None of us can do it alone.

Wrinkle Scam


Yesterday I went to the mall with my four year old son because he needed new shoes. I usually just
try to go in and out of any shopping place as fast as possible. There are many other things I’d rather be doing instead of roaming around the energy sucking vortex called mall.

Moments after I entered the mall, I spotted a cosmetics stand where a man with a nice suite and a very polished look was trying to get my attention. As I looked into his eyes (mistake #1), like a hawk, he came up to me and asked me if he could give me a free sample. Trying to be nice, I said “Sure!”, took the sample and thought to myself “Phew, that was easy. I am free to go now.”

Apparently, for him, the fact that I accepted his free cream sample meant I was ready for a conversation. So, he started with his sales spiel that went something like this: “You are a beautiful lady. But, you are aging and your wrinkles make you look tired. I have this collagen cream that you need to use only once per week that will make your tired look go away.” My answer to him was:
”Aging is a normal human process. We all age. It doesn’t bother me that I have wrinkles around my eyes” He seemed a little a bit surprised with my response but he wasn’t going to let me off the hook so easily: “Well, do you use any cream on your face?” he asked. “Yes, I do. It helps my dry skin.” I answered sheepishly. “You see! You do use something!” he said with a vindictive face.
“ Why wouldn’t you just add one more thing that will make you look much younger. This bottle of collagen usually runs for $200 but today, I can sell it to you for $100!”.

Wow! I couldn’t believe his determination.

Now, don’t get me wrong. I have nothing against people wanting to look and feel good. If you think that a certain product or procedure will make you feel happier about yourself or more confident, go for it! However, what bothers me about my encounter with that man yesterday is that he was intentionally trying to make me feel bad about myself in order to sell me something. And that, ladies and jellybeans, bothers the crap out of me!

We all know that we are being bombarded with messages about our inadequacies multiple times a day. Our pores are too big (I really want to know who came up with that one!). Our hair is not shiny enough. Our skin is sagging. Basically, we are imperfect, messy blobs who constantly need to buy lots of products just to make it through each day.

I am not going to lie. Just for a split second I thought to myself yesterday: “What if that man is right?! Maybe I should spend a $100 for the magic collagen cream that will make me look younger and less tired.” As that thought crossed my mind, I looked at my son. He looked at me with his huge brown eyes and asked if he could give me a kiss. He seemed worried about me. Even a four year old could sense that there was something wrong with our encounter. My son could care less about my tired look. To him, I am his world. His everything. He loves me. This is exactly the kind of love that we should have for ourselves. Unpretentious, unlimited, non judging. If we love ourselves, only then, we can have love for others.

I leaned down to give my son a kiss, gently took his hand and we walked away.

8 Tips To Help You Prepare For IVF Transfer

Preparing for an IVF transfer can be a scary and stressful experience. You have invested so much into the whole IVF process that you want to make sure you are doing as much as you possibly can to maximize your chance of success. Here are few tips that can help you make the whole journey smoother, more comfortable and hopefully more successful.

1. Listen To A Guided Meditation:
There are lots of guided meditations that are specifically created for people undergoing IVF or other forms of assisted reproductive technology. Some meditations are designed for different parts of the IVF process e.g. suppression phase, stimulation phase, transfer and waiting for your test results. It does not matter if you chose to be very specific or just listen to any meditation that will help you relax. The whole point is to keep your stress hormones at bay which has been shown to increase your chance of conception.

2. Get Acupuncture
About 14 years ago, researchers in Germany performed an acupuncture trial which involved giving standardized acupuncture treatment right before and after embryo transfer. The result of the trial showed an improved pregnancy rate (42.6% in women who received a treatment vs. 26.7% in women who did not receive acupuncture). Since then, many other trials were performed which yielded inconsistent results. An acupuncture researcher Dr Rubin LAc, DAOM, who also happens to be a dear colleague of mine, helps to explain why there are many inconsistencies in the research. You can read about it here

According to Dr Rubin’s research, it is important to receive acupuncture not just right before and after embryo transfer but for about 3 months leading up to your transfer. Treatment plans usually involve doing acupuncture once or twice per week for about 12 sessions. Apart from acupuncture, it is important to incorporate diet and life style changes that can increase conceptions success. Each individual is different and practitioners of Chinese medicine work by tailoring treatment to each individual’s situation. If you are reading this just few days before your transfer, you should still request acupuncture before and after your transfer. Anything to increase your chance of success is worth a try!

3. Eat Iron Rich Foods and Fats:
The embryoblast spends approximately 72 hours ]in the uterine cavity before implanting. In that time, it cannot receive nourishment directly from the blood of the mother, and must rely on secreted nutrients into the uterine cavity, e.g. iron[7] and fat-soluble vitamins. Eating iron rich foods and fat soluble vitamins are crucial if you are trying to conceive. Examples include: red meat, lentils, green leafy vegetables, full fat dairy including butter and cream (you can use coconut milk and cream if you are allergic to dairy), avocados, eggs, bone broths, nut butters etc.

4. Keep Yourself Warm:

Women’s temperature increases after ovulation and during pregnancy because certain amount of heat is necessary in order to conceive as well as maintain a pregnancy. It is important to keep yourself nice and cozy during and after your transfer. Wear enough layers to keep yourself comfortable. If your feet are cold, make sure you put on your socks. Bring a warm sweater or ask your nurses to bring you a blanket if you are feeling especially cold right before or after your transfer. Refrain from drinking ice cold liquids. Keeping yourself warm and comfortable will help you maintain proper blood flow throughout your body which is helpful if you are trying to conceive.

5. Don’t Be Afraid To Ask For A Bed Pan:

Full bladder is one of the biggest complaints after the transfer since you will have to drink about 20oz of water beforehand. Since you will not be able to walk to the bathroom right after your transfer, chances are, you will feel very full and uncomfortable. Please ask your nurse to bring you a bed pan if you are feeling very full. So many women feel embarrassed to ask, but the truth is, your nurse does not mind at all. It will make your time after the transfer a lot more relaxing.

6. Prepare For Bed Rest:
While lying in your bed and doing nothing for two days may sound like a great way to rest, most women do get bored and a little antsy. Make sure that you prepare movies, books, magazines that you enjoy. Now might be the time to catch up with few friends or family members over the phone. You can finish knitting a sweater that you have been trying to knit for ages. Be creative and make sure to keep yourself busy.

7. Journal:
If you decided to share your fertility journey with close friends and/or family members, you might feel like they cannot completely understand how you feel. They might say things like “Oh, just relax, it will all go well!”. On the other hand, if you are keeping your IVF experience to yourself, you might feel isolated. In any case, putting your thoughts on paper will help you release pent up emotions. If you are feeling especially stressed out, just take out a piece of paper and write whatever comes to your mind. It’s a very helpful exercise.

8. Avoid Strenuous Exercise:

Time pre and post transfer is definitely not the time to start a new exercise program. If you are an active person, you want to take it easy during the stimulation phase of your IVF cycle, right before and for about ten days post transfer. After that, check with your health practitioner about how to continue with your exercise. Biggest things to avoid are abdominal workouts, heavy lifting, running and any kind of activity that increases your heart rate above 140 bpm. Walking is almost always the safest thing to do. Please consult your doctor for more information.

Hope that this helps you. I wish you all the best in your journey of becoming a parent.

Jelena Stefanovic LAc, DAOM

Chinese Medicine for Pregnancy, Birth and Postpartum Wellness

Acupuncture and Chinese herbal medicine are phenomenal tools to support you from conception through postpartum. Pregnancy is a time of growth and change, during which many women experience discomfort. Chinese medicine brings balance to the body and reduces these common discomforts: nausea, vomiting, edema, fatigue, emotional stress, abnormal bleeding, threatened miscarriage, musculoskeletal pain, and much more. It is recommended you receive weekly treatment during the first trimester, monthly treatment during the second trimester and biweekly treatments during weeks 37 through 40.

Birth preparation treatments are focused on descending and optimizing position of baby, relaxing and softening the cervix and pelvis, relieving stress and anxiety and promoting energy to sustain birth. Kat is a trained gentle birth doula. She combines her gentle birth philosophy with her Chinese medical training and offers on site birth acupuncture at home, birth center, and hospital births. However you choose to give birth, acupuncture can support you through this process. The benefits of acupuncture during early and active labor include: ripening cervix, reducing anxiety and stress, shortening length of labor, and promoting natural pain relief.

Nutritional and emotional nourishment are key components to sustaining the common stressors new moms encounter. Acupuncture and Chinese herbs effectively nourish and rebalance the body after birth. Common conditions treated include: low milk supply, mastitis, retained lochia, after-pains, prolapse, urinary or digestive symptoms, postpartum depression, painful or cracked nipples, and much more. Kat offers postpartum home-visits for those who prefer.

We invite you to contact us and look forward to working with you.

Anti-depressants Linked to Increased Risk of Miscarriage

Recent case-control study published online on May 31 in the Canadian Medical Association Journal (CMAJ) found that pregnant women who use antidepressants have a 68% increased risk of miscarriage compared with those who do not take the medications. The investigators found that the use of the selective serotonin reuptake inhibitor (SSRI) paroxetine alone and the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine alone were also associated with an increased risk for spontaneous abortion.

Data were examined on 5124 women between the ages of 15 and 45 years from the Quebec Pregnancy Registry who had clinically verified miscarriages between the years 1998 and 2003. A total of 10 matched control patients were also randomly selected for each case.

The investigators found that of the women who miscarried, 5.5% (284/5124) had taken antidepressants during their pregnancy compared with 2.7% (of 51,240) of the matched control patients.

After adjusting for potential confounders, “antidepressant use during pregnancy was found to be associated with an increased risk of spontaneous abortion compared to those with no use” the study authors wrote.

In addition, SSRIs used alone, SNRIs used alone, and a mix of antidepressants from different classes used together were also associated with an increased risk for spontaneous miscarriage.

When the investigators compared type of antidepressant used vs not used, they found that paroxetine alone and venlafaxine alone were both significantly linked to an increased risk for miscarriage.

Source: http://cme.medscape.com/viewarticle/723297?src=cmenews&uac=123618HT

IVF Tourism

Few people have to use IVF as their only hope for conceiving a child. Unfortunately, the cost of the IVF procedure may be a huge obstacle for many. I have been receiving quite a bit of inquires from my patients about the possibility of flying to other countries and arranging IVF procedure there for much lower cost. One of my patients decided to take a leap of faith and fly over to the Check Republic in order to have her IVF done there. After doing quite a bit of research, she picked a reproductive clinic in town of Brno where the staff seemed more than prepared for a visitor interested in IVF tourism. I am thankful that she was kind to share her experience and answer a few questions:

How did you arrange your IVF trip to the Check Republic?
We used the Reprofit International Clinic in Brno. This was scheduled for us through My IVF Alternative (MIA), a US contact who made sure that we had all of our health records and tests done, advised when to start which medications, and acted as a go-between for Reprofit. MIA also arranged for our accommodations, airport transfers, and someone to take us to our appointments (there were 4 appointments total).

Did you have any problems along the way?
One issue that I had with MIA was that they claim to assist you with getting your medications for free. Although they did send me the paperwork to apply for the medications through a US non-profit, they did not let me know that I needed a US doctor to write me the prescription until after I had paid for their services. This ended up costing us an additional $1700 because my doctor would not help me with the prescription, so I could not use the non-profit. If MIA had told me this detail in advance, I would have researched other options. I felt that this was a bit sneaky on their part. When I called them with my concerns about this extra cost, my contact in Phoenix labeled me a “problem case” when she accidentally sent an email to me rather than the owner of MIA.

Where did you get your medications before the trip?
I ended up getting the prescription for the ovulation drugs through a British company, using the prescription from Reprofit, which was less expensive than using my local pharmacy.

How was your experience at the clinic in Brno?
The clinic in Brno was very clean and professional. I went in twice after my arrival for ultrasounds, to make sure that I was responding to the ovulation drugs. The third visit was to retrieve my eggs, and for my husband to give his sperm sample. After the egg retrieval, I could call daily to see how the fertilization process was going. The last visit was to have the embryos implanted. The staff was very nice to work with, and all of the people we saw spoke English. I would highly recommend this clinic.

Any recommendations about the city of Brno?
Brno is a pretty boring city, especially if you stay there the entire 2 weeks needed for this procedure. Be sure to make arrangements to travel – Vienna is nearby via train, as is Prague. We ended up renting a car with a GPS so that we could explore more of the area and only stayed in Brno around the times of our appointments.

Would you do this again? Any other tips?
I would go back for another IVF at Reprofit if needed – but book it directly through them. We ended up pre-paying all 2 weeks hotel/apartment through MIA, plus we had to pay for our hotel nights when we were not staying in Brno (a price we were willing to pay to get out and see other areas). There are many hotels within walking distance to the clinic, but we would rent a car again. Plus, MIA’s website says that they assit you with travel arrangements to visit outside of Brno. This is not true. When we asked our local contact about travel, she was not any help. We had tried to make some of our travel arrangements prior to leaving the US, but were advised that it was best to wait until we arrived in Brno.

If you have not traveled internationally before, I do recommend using a go-between, like MIA (there is another Reprofit in Zlin and they have a similar company like MIA who books US couples). But, if you consider yourself pretty adventuresome, you could easily do this on your own.

I am happy to report that my patient’s IVF trip was a success. She is currently expecting a baby girl.