Is Yoga Safe When You're TTC?

The question of a woman's weight and her fertility is a frequent hot topic among circles of friends who are trying to conceive. Study after study points to connections between body mass index and ovulation. Treatments like IVF are now known to be more successful in women who are at a healthy weight. But "healthy" doesn't have to mean competition-level fitness. Women are often left wondering where the balance is:

"I used to run a few miles every day, but my fertility doctor said that I was actually too thin for healthy ovulation. We don't have a swimming pool, and biking around this city is out of the question for me. I was wondering if yoga might be okay for helping me stay in shape while trying to get pregnant?"

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

I'm personally very interested in maintaining my own physical fitness. The best thing about staying in shape, for me, is the boost in energy level it gives me. I have a full life with a lot to accomplish, and when I'm not at my best fitness-wise, it's tougher to get through every day.

Some of my patients swear by yoga, because it strengthens their muscles in a gentle way. No pounding the pavement, worrying about joint injury. And it helps them maintain a weight that seems to be just right.

There are different kinds of yoga, and not all are recommendable to women who are trying to conceive. Generally, I encourage patients to stick to moderation in the level of their exercise, whether it's yoga or running or weights or any other, but the key is making it a regular part of your life.

Are We Sure Fertility Treatment Babies Are Going to Be Okay?

No matter how complex fertility treatment can be, the goal is quite simple: conception and birth of a healthy baby. Having a baby by way of assisted reproductive technology is quite different from "the old fashioned way" -- but for many, therapies that include medications and laboratory techniques provide the only way to parenthood. It's normal and natural for hopeful parents-to-be to worry about how all that intervention might impact their resulting offspring:

"We're finally using IVF to get pregnant. And we're very excited, but a little scared. Is it a fact that babies born after IVF aren't all different in any ways from children born after natural trying-to-conceive efforts?"

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

As the mother of two kids, myself, I really understand my patients' worries about whether their children will be impacted by the fertility treatment that helped bring them about. Fortunately, I'm glad to be able to point them to statistics based on long-term studies, now that IVF's been used successfully for several decades.

The first thing fertility patients need to know is that problems may be associated with multiple pregnancies, whether those occur from fertility treatment or not. As I wrote in a 2005 newsletter article, "In all, most concerns about the kids of ART are related to whether or not the children are singletons or multiples." I refer to a patient fact sheet by the American Society for Reproductive Medicine called "Complications and Problems associated with Multiple Births". We make our protocol judgements with very careful consideration of each patient's diagnosis and treatment need in order to avoid multiple pregnancies.

A recent brochure published by an Australian reproductive medicine authority offers some more information on risks for everyone involved in ART -- men, women, and babies -- see Putting the Risks of IVF in Patients' Hands. But you should keep in mind the information is based only on data from Australian fertility patients and their children.

In this 2008 review of studies on the development of children after ART, the researchers concluded that main points to know include:

prematurity and low birth weight are the primary risk factors contributing to poor outcomes in ART offspring

parental characteristics inherent in many (but not all) fertility patients as a group may include mothers or fathers who are already at greater risk, with or without fertility treatment, for offspring born with developmental problems

"IVF babies" overall are more likely to be born prematurely and of lower birth weight than naturally-conceived children (and this may be related to my second point above)

Children of ART are more thoroughly examined as a group than are naturally-conceived babies, so a kind of "hypervigilance" may skew observational research data

and most importantly:

"Large-scale, well-designed studies have found most children born after ART to be healthy, typically developing young children."


~ Dr. Sonja Kristiansen MD

Is My OB/Gyn Right: I Have All The Time In The World?

It's no longer unusual for women to delay pregnancy until well into their 30's or even early 40's. Many young women want to dive into parts of life that are easier to do without children and then settle down with kids later. But plenty still want to grow their families first. Fertility specialists often hear from women in their 20's who've been told by their gynecologists to "be patient":

"We started trying to have a baby as soon as we got married. And even though it's been a year, my OB/Gyn says I'm just overly worried. He says I'm healthy, I have a period every month, there's no reason for concern. Should I really just kick back, relax, and I'll get pregnant, finally?"

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

You're not alone! I often talk to young women who want to get pregnant and feel like they're more frantic about it than everyone else. Sometimes, they've heard and read too many over-simplified stories about infertility. But there are times when they may be "on to something" -- a lot of women understand their bodies intuitively, even if they aren't physiology experts.

The unfortunate truth: there are many conditions that can cause you to be infertile and you never know until you try to get pregnant. If you've ever had abdominal or pelvic surgery of any kind, you could have internal adhesions or scar tissue -- most of which cause no pain -- that can be an obstacle for conception. The same is true of several infections, including sexually-transmitted ones and other, less stigmatized infections.

If you're only in your 20's and you've tried for a year to get pregnant without any luck, I and other fertility experts recommend you have some basic fertility testing done. You might not need the assistance of reproductive technology at all. But if you do, it's best to find out sooner than later.

Women's fertility naturally declines as they get older. So of course, older women's response to fertility treatment is generally not as optimal as that of younger women. If you're ready to have a baby, you've tried for a year already, and you're in your 20's, find out now if there's a real problem in the way. Then you can decide whether or not to proceed with fertility treatment.

~ Dr. Sonja Kristiansen MD

If I'm Using Donor Egg or Sperm, Does Everyone Have to Know?

There's a big leap in the minds of a fertility patient between IVF and third-party IVF. Just the thought of using another person's sperm or eggs to conceive a baby brings up the biggest questions about reproduction, namely, whose genetic material is being passed down the line of time. Compassionate fertility specialists understand the larger weight of decision that their third-party reproduction patients are under. Here's one of the common questions that may come up:

Now that it looks like we'll have to use a donor to help us have a baby, I'm wondering about our family and friends and how they'll react. Some people have very strong opinions, and I have enough on my plate to deal with -- do we even have to tell them? Are there laws that would reveal our use of a donor at some point down the road?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

Nearly every scientific or technological advance in reproductive medicine is met with both elation (on the part of patients who may finally have that baby they've wanted for so long!) and worry, sometimes by the rest of the world, including family and friends. Their worry is an indication of their concern for you. So one of the first things you can consider when talking to anyone about your impending fertility treatment is assure them that it is indeed safe, to both you and your resulting offspring.

Next is the matter of what to tell your child who may be the result of using a donor with IVF. That's an issue you and the other parent must discuss and decide. There are a number of books and studies that have been written on the topic of what is believed to be best for donor offspring. I encourage my patients to do their homework before the child is born.

Finally, there's the question of disclosure. It's hard enough to go through infertility and feel like the whole world is involved in this very private choice. When you have loved ones who are adamant or even just a little expressive of their fears and opinion, it can make you want to toss in the towel.

Essentially, the choice of who to tell is yours to make -- so far.

The good news is that, unlike some other countries in the world, the U.S. government will not reveal your use of a donor. The unsettling news is that each state can regulate this disclosure, and change is in the wind. The state of Washington is about to enact a law that would change things a bit. Donors there can no longer donate sperm or eggs anonymously, and any resulting offspring, once they turn age 18, can request their donor's information -- including identifying data and medical history -- from the fertility clinic. There's a caveat, however: The donor may sign a document that would prevent identifying information from being given out. A donor's medical history, especially related to genetics, is already routinely revealed to fertility patients. You and your child have a right to know of any potential health conditions that could arise.

For now, Washington is the only state that has such a law, and it's so new, many of us are interested to see how things will pan out as a result. But here in Texas, where I practice at the Houston Fertility Center, there are no laws mandating this new kind of family relationship. So it really is up to you who knows that you've used donor sperm or eggs.

~ Dr. Sonja Kristiansen MD

A few more details for patients using donor egg or sperm:

Talking to Your Children, by Carole Lieber Wilkins, MA, MFT on the RESOLVE website

Balancing the Rights of Donor Offspring With Those of Donors: But What About Parents?, an opinion piece on Forbes by Todd Essig

RESOLVE's list of professional members who provide counseling services to patients

Is There Something About IVF That Doesn't Work for Latinas?

If you're a fertility specialist in a metropolitan area of the United States, you likely have patients who identify as Latinas. Or you may not, given the cultural stigma and myths that keep many Hispanic women and couples from even inquiring about fertility treatment. If you're listening closely to your community, you've probably heard something along these lines:

We've been trying to get pregnant for a long time with no luck. I think we're doing everything "right" and I'm worried we have a problem that needs treatment. But friends have told me that IVF and other fertility treatments don't work as well for Latinas as it does for other groups. Is that true? Why would that be the case?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

In central Houston, where I've operated a fertility center for more than a decade, my staff and I have made special efforts to reach out to the community around us. Many of HFC's staff are Latinas, and they've heard a lot of myths in their own families about fertility treatment. The other day, I was really glad to hear some positive news coming from a colleague in San Antonio, Dr. Robert Brzyski, that lays to rest one of those myths.

Dr. Brzyski did a study of his clinic's IVF patients and found no difference in success rates between Hispanic and non-Hispanic anglo women who used IVF to get pregnant. He also found that more of the Latinas -- nearly all of whom were Mexican-American -- miscarried, which is a point of concern. But overall rates of success were equal.

There may be differences between ethnic groups in how certain fertility treatments work or not. If significant differences between groups is found, it's possible that the causes are more related to culturally-influenced daily living activities and not genetics. But I've learned from my own diverse patient group that the most important influencing factors are based on the individual, her health, her lifestyle choices (like diet and smoking and exercise), and not on ethnicity, race, culture or any other group demographics.

If you've heard otherwise -- like from friends that IVF doesn't work for Latinas -- then it's very likely they're basing their opinions on a few anecdotes, stories that they've heard through the grapevine themselves, and not on actual research.

~ Sonja Kristiansen, MD

How Many Eggs Does It Take To Get Pregnant?

This is a question that fertility specialists are asked, often by patients with worries about their upcoming IVF cycle:


I know that I'll be using ovulation medication to help my ovaries make more eggs. How many eggs is enough for one IVF cycle?


Sonja Kristiansen, Medical Director of Houston Fertility Center responds:


Healthy ovaries are accustomed to ovulating one egg at a time; in some instances, two, but that doesn't mean both eggs will be fertilized.

IVF is a bit of a numbers game, and it only makes sense that the more egg and sperm cells you can put together in petri dishes, the greater the chances of winding up with several high-quality embryos. Then, of course, how many embryos we transfer to your uterus depends on several variables. But for now, let's stick with the question: how many eggs is enough?

A recent study got a lot of attention for concluding that 15 is the "magic number" when it comes to eggs used in an IVF cycle. The researchers also said that more eggs than that increased the women's odds for OHSS, or ovarian hyperstimulation syndrome (essentially, over-worked ovaries that result in symptoms that are uncomfortable at least and require hospitalization at worst.)

It's interesting research, but it's not that useful on a patient-to-patient basis. We don't need each and every woman who's going through IVF to produce 15 eggs in order to achieve a healthy pregnancy and live birth. Ask around a little and you'll find stories of women whose ovaries churned out 20 or more eggs, with no OHSS and no resulting pregnancy. On the other end of things, you can hear plenty of women who produced a handful of eggs, resulting in a handful of embryos, and ending with a baby in their arms.


So while it's handy to have a nice, neat number to aim at, chances are good you won't find me or my colleagues calling off your stimulated cycle because there are only 5 or 10 eggs in there -- not for that reason alone. If there are other factors at play in a cycle -- for some other reason your health is at risk -- cancelling a cycle may be the best thing to do. But never just because your ovaries didn't hit the magic number!

~ Sonja Kristiansen, MD

Are There Egg Banks For Infertility Patients?

Not frequently asked, but still it's a question that may become more commonly heard in fertility clinics:

Are there egg banks, similar to sperm banks, that we can use to select donors for our IVF?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:


Sperm banks have been around for decades now. The existence of these third-party reproductive agencies has made accessing male gametes very convenient for fertility patients. So far, the idea of egg banks is still too new for the same circumstance to be the case. That's because the development of egg freezing technology has been more challenging than sperm cryopreservation.

But egg cryo has come a very long way in the last few years. In fact, I recently blogged about a study that showed pregnancy results were nearly the same regardless of whether fertility patients used fresh or frozen donor eggs. Besides being good news for patients, another possible outcome from this study's conclusions is the growth of egg banking.

What's so good about egg banking? The availability of frozen eggs will likely result in less expensive IVF procedures for many patients.

For now, the primary way to go about it, if you need to use a donor's eggs to conceive, is to use your fertility specialist's connections either directly to egg donors or to agencies that specialize in egg donor screening and selection. It seems a little more cumbersome than using an egg bank, but it's the standard until more growth in those services is seen.

~ Sonja Kristiansen, MD

How Many IVF's Does It Take?

Here's an FAQ that a lot of fertility specialists hear:

How many IVF's will I have to go through before I have a baby?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

Virtually nobody wants to resort to fertility treatment to have a baby! But if you find yourself in my office, you've likely already come to the conclusion that this is where you need to be to achieve your dream.

So your next question -- "How much of this fertility treatment do I have to endure?!" -- is understandable.

We cannot tell any patient at her first consultation exactly how many fertility treatment cycles she'll go through before she has a baby. In fact, we may not even be able to tell a brand-new patient if IVF is the final answer for her.

I just wrote a blogpost about the success rates (and risks) of IVF, and how success seems to come more often to women who manage to go through the procedure three times or more.

I know, it's not what you want to hear, especially at your first appointment. But remember -- those are statistics, which are mathematical versions of everyday life. Just because statistically your chances of a baby are greater with three or more IVF's, that's not necessarily a fact of life for you and your situation.

Everyone's body and medical history is different. Your causes of infertility, how your body responds to medications... many factors add up to fertility with or without treatment. So while I may not be able to answer the question of "How many IVF's" here on the Internet in a way that will be meaningful to any individual, I can certainly focus in on a good estimate once you and I have run a few diagnostic tests and gone over your personal health history.

~ Sonja Kristiansen, MD