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  • sex position matters.

  • So that is a myth.

  • IVF guarantees pregnancy.

  • Oh boy.

  • It's a tough myth for patients to hear eating pineapple can increase fertility, that's a good one.

  • Pineapple by itself.

  • If you have infertility is unlikely to reverse your infertility.

  • I'm dr Cindy.

  • I am a fertility specialist based in las Vegas Nevada and I work with patients who are seeking to boost their fertility, preserve their fertility or build their families.

  • Hello, I'm dr Sriram Ellis Warapu and I'm a urologist at U.

  • C.

  • L.

  • A.

  • My focus is on reproductive medicine for men as well as individuals born with testicles such as trans women.

  • And today we'll be debunking myths about infertility, tight underwear is bad for sperm counts.

  • So there have been a number of studies looking at this issue for many decades and the inevitable question is boxers versus briefs.

  • In truth, it doesn't matter a whole lot.

  • And we know that if the testicles are a little bit warmer that they are more at risk of having sperm count issues or sperm motility issues, which is the way the sperm moves in the body.

  • But in general it shouldn't matter too much.

  • Just pick what's comfortable if you're going to be going on vacation and using hot tubs every day for hours a day.

  • I would recommend against that if you're going to be trying to get pregnant because prolonged warmth and repetitive warmth affecting the testicles can drive sperm counts down and I have seen that in my practice sex position matters.

  • So that is a myth.

  • No matter what position you engage in.

  • If you ejaculate, you have the sufficient propulsion of the semen to make it up to the cervix anyway.

  • You do it.

  • And a number of people around the world have actually studied it.

  • And no one position has been proven to be better than another.

  • Putting your legs up after sex can increase your chance of pregnancy.

  • That is also a myth.

  • Long before I even understood what pregnancy entailed.

  • I was seeing imagery on tv and stuff of people almost on a handstand upside down.

  • And I think the thought is, do we need to counteract gravity?

  • But the truth is, you don't need to lay and sit upside down or anything like that.

  • IVF guarantees pregnancy.

  • Oh, boy.

  • Yes, that is definitely a myth.

  • And it's a tough myth for patients to hear the IVF does present the highest chances of pregnancy.

  • Absolutely.

  • There are a number of factors that play into IVF success.

  • One of them has to do with the age of the eggs being used.

  • It also has to do with the quality of the sperm and the egg when they come together, it has to do with the embryo that is ultimately formed.

  • It also has to do with the genetics of the embryo and the chromosome makeup.

  • But then on top of that, it has to do with the womb in which the embryo will be placed.

  • And a number of factors that are not yet fully known.

  • So we know the immune system plays a role.

  • Diet, exercise probably play a role but we're still investigating that.

  • So the biggest thing to know is it's not 100% stress causes miscarriages.

  • I think we're starting to get get away from the term miscarriages were starting to use the term early pregnancy loss.

  • Is that right?

  • That's correct.

  • And I think it's because your miscarriage also comes with certain connotations where blame is also ascribed and the truth is both early pregnancy losses.

  • There's nothing the individual could have done about it at all.

  • And so now we call it early pregnancy loss before the end of the first trimester versus 2nd and 3rd trimester pregnancy loss.

  • We do not believe stress causes los I know in everyday common conversation people believe that um we know stress can impact one's immunity.

  • But we also know that many people around the world across millennia have gotten pregnant and remain pregnant despite tremendous stress.

  • So we know it's not simply stress.

  • Nowadays though, we know the number one reason for pregnancy loss is chromosome all differences in the formed embryo.

  • And so that's called an employee, 67% of first trimester of pregnancy losses are due to chromosomal issues within the embryo itself.

  • Other reasons would be if the thyroid was not functioning well if vitamin D.

  • Is low if there's a fibroid in the uterus if you have a uterus and you've had two or more pregnancy losses.

  • You should be evaluated for many decades.

  • We always expected that it would be the individual with the womb and the eggs to be the one that gets evaluated for pregnancy loss.

  • Now the tide is shifting and individuals who contribute the sperm are also being evaluated when there's a pregnancy loss in the couple.

  • There's emerging data that things like DNA fragmentation where the DNA that are normally supposed to be very tightly wrapped up in the sperm are somehow unraveled and might have little breaks in the DNA strands.

  • And those brakes can contribute to the pregnancy loss, freezing your eggs guarantees that you can have kids later myth.

  • And the myth is in the word guarantee.

  • If you freeze your eggs you can stop the clock.

  • And so you're basically freezing the youngest version of yourself at that point, however, there's no guarantee that eggs, even when frozen, will thaw and yield a light board baby.

  • So it's really a conversation that needs to happen with your specialist based on your age, based on your egg number, not every egg that's thought after freezing will survive the thought.

  • Not every egg that is injected with sperm will actually yield and embryo, not every embryo that's created, meaning not every fertilized egg will ultimately form a pregnancy.

  • But on top of that affordability is an issue of access to clinics that have great protocols and great success rates with their eggs cause you really need a clinic that has a good track record of successfully find eggs and having pregnancies from thought eggs peeing or showering after having sex will lower your chance of pregnancy by the time you even get up off the bed and make your way to the bathroom, sperm have made their way up the uterus and are on their way to an egg.

  • And so that should not be a form of contraception.

  • Now, what can decrease your chance of pregnancy is if you're someone who douches after sex.

  • And so we strongly recommend against douche in general.

  • It doesn't work for your vaginal microbiome.

  • It doesn't work for your general health myths.

  • We hear the most sperm quality doesn't decline with age.

  • We have this term that we use a lot in medicine called advanced maternal age.

  • So there was not this term advanced paternal age, but that is starting to emerge.

  • And there's a lot of data now that is showing that individuals with sperm that is older, say in the 5th, 6th, 7th decades of life and beyond is more at risk of forming embryos that have chromosome abnormalities, getting exercise, eating well are things that can improve the general biology of an individual.

  • Certainly if it's good for the heart and it's good for the brain, then it's probably good for the penis and the scrotum and the testicles as well.

  • We talked about egg freezing, but sperm freezing has its role, particularly for individuals who may not be in a relationship or may not be thinking of a family at this time.

  • But later on down the road they might want to produce a family.

  • It's impossible to get pregnant after 35.

  • It is possible to get pregnant after 35.

  • The truth is though, that the chance of pregnancy progressively declines as the age of the egg increases.

  • And so you might find greater and greater need for fertility treatments.

  • But when you're born, if you're someone born with ovaries you'd have somewhere between one million to two million eggs.

  • And those ovaries, usually by age 30 70% of those eggs are gone and by age 40 97% of those eggs are blonde at the same time, those eggs are also aging.

  • And so what we see is that the chance of pregnancy declines very quickly and then for some people it declines even faster.

  • So if you have endometriosis, if you're someone who's maybe have surgeries on the ovaries are needed to be on medications, chemotherapy radiation, all of those things can also further the decline in the egg number.

  • So my recommendation is, if you have ovaries at age 30 you should at least be asking your doctor to do a check of your egg number or what's called your ovarian reserve.

  • The best way to get pregnant is to have sex every day.

  • It comes down to the ambulatory cycles and making sure that you're sort of timing things and tracking things, particularly if you're trying to conceive deliberately, we always get this question and I want to know what your thoughts are.

  • Should the couple be trying to conceive every other day during ovulation or every day during ovulation?

  • I say every other day.

  • And it's because one we need to give the sperm and semen enough time to sort of re accumulate.

  • So we can get those millions of sperm um in the ejaculate.

  • So that's the first thing.

  • The other is sperm healthy sperm actually survive in the female genital tract for up to five days.

  • So once the egg is released from the ovary, think of the fallopian tube as an arm with a catcher's mint at the end the catcher's mitt captures the egg, pulls it into the arm and then the egg sits around there for 12 to 20 hours waiting for sperm.

  • And then if you have intercourse anywhere within the next 24 hours, sperm will also get to the eggs.

  • So that's why we say every other day around population.

  • So what that means is if you're someone who articulates on day 14, you should really be trying to have a starting date 12 and a 14, day 16.

  • I usually say go out to day 18.

  • There is this movement now, particularly on the internet discussing what's called abstinence from pornography, masturbation and orgasm or PMO.

  • It's also a movement called no fat.

  • And those individuals say to have the best reserve of sperm or the best sort of power with erections or orgasm that they should conserve for days, weeks, months at a time.

  • This stuff is not Scientific at all.

  • And in fact after a week of storing up the sperm may not necessarily be healthy.

  • You are most fertile 14 days after your period starts.

  • That is only true if someone has a 28 day cycle, if your cycle is 35 days, you're actually going to articulate on day 21.

  • If your cycle is 25 days, you're actually going to ovulate on day 11 after your period.

  • For some people, they ovulate on day nine after their period.

  • If they have like a 22 23 day cycle.

  • So it really takes getting to know your body, know your cycle, track your cycle.

  • So you can truly understand your frequency for your cycle.

  • You can never have Children after a vasectomy.

  • It is in fact possible.

  • There are a number of ways to conceive a pregnancy after a vasectomy.

  • The simplest way to think about it is to get a vasectomy reversal.

  • There are ways of getting pregnant after a vasectomy that don't involve reversing the vasectomy.

  • One of those ways is to go looking for sperm in the testicles Or in the epidermis, which is the storage organ behind the testicles that holds the sperm that can be as simple as a 10-15 minute procedure that's done in the office.

  • But that sperm will then have to be used with in vitro fertilization, eating pineapple can increase fertility.

  • That's a good one.

  • Pineapple by itself.

  • If you have infertility is unlikely to reverse your infertility.

  • We know that pineapples have watermelon inside of them, which is a compound that is known to be a blood thinner to a certain degree, but it's very, very weak and you'd have to eat so much pineapple to even have enough talent to have a little effect.

  • But if you're looking to add it as an adjunct to your meals etcetera, go for it, you should be having a meal balanced in protein complex, carbohydrates and fiber.

  • So getting your usual multivitamins and full it into your diet because full it is really important for once you're pregnant.

  • But technically no pineapple and by itself does not boost fertility.

  • You can't have Children.

  • If you're unable to ejaculate, you can have Children uh from your own biological material.

  • If you cannot ejaculate if the inability to ejaculate is a medical condition because of prior surgery or because of a medication one is taking or if they were born with that condition, there may be ways of reversing that condition.

  • There are individuals who come to me who the problem is not so much ejaculation, but the problem is erectile dysfunction for those individuals we can use medications.

  • There's injections.

  • There's hormone treatments, There's a variety of things that can be done to sort of treat or cure the erectile dysfunction more common in my practice is premature ejaculation and there are different kinds of therapy, different kinds of medication that we can try to prolong the ejaculate Torrey.

  • Um latency time, You can't get pregnant right after stopping birth control.

  • That is a yes and no.

  • It depends on the type of birth control.

  • So when we use the term birth control were referring to tablets were referring to injections were referring to I.

  • U.

  • D.

  • S.

  • Once we remove the I.

  • D.

  • You can start working on getting pregnant the following month.

  • If you're someone who was doing the shot, like the depo Provera shot, it can take up to a year for your ovaries to wake up and start ovulating.

  • Again, if you're someone who was on a progesterone only pill, you're usually able to coagulate again within a month to two months of discontinuing.

  • If you were on birth control for an extended period of time or what we call the combined oral contraceptive pills.

  • It could take up to a year myths.

  • Parents used globally.

  • If you've already had Children, then you'll always be fertile.

  • That is a myth.