Fertility: Ask The Experts
News What factors affect fertility and how can you ensure a comfortable pregnancy? Dr. Margaretha Rebel MD, FRCPS, MEd, Interim Medical Director, The Fertility Clinic, LHSC, provides some insight.
Mediaplanet: How should someone choose a fertility specialist/clinic?
Margaretha Rebel: The most important factor is to choose a physician that you trust. The key to good clinical outcomes and satisfaction is a positive physician and patient relationship. There needs to be mutual trust, respect, and the ability to have good communication. Choosing a clinic/physician near your place of residence is helpful as it facilitates care, but it is not as important as the relationship with the physician. Another important factor is that you choose a clinic/physician who has the reputation for providing evidence-based, compassionate and ethical care.
MP: Does stress cause infertility?
MR: There is little scientific evidence that stress is a major, direct cause of infertility, but stress can have important indirect effects if it leads to smoking, increased alcohol use, or overeating and weight gain. As fertility specialists, we are also aware that infertility itself can cause stress. We encourage patients to find ways to manage stress through exercise, yoga, meditation, or other stress-relieving activities. Good stress management is important when coping with physically and emotionally difficult interventions and therapies.
MP: What effect does the environment have on fertility?
MR: There is a good scientific link between known environmental toxins causing damage to both men and women’s gametes (eggs and sperm). Exposure to large amounts of environmental toxins, such as pesticides and herbicides, are well-established to cause fertility problems.
What is not as well understood is other environmental factors such as steroids in the food chain, low level toxins in fish and wild game, and the link to fertility issues. Another significant environmental factor is our changing societal norms that have delayed child bearing into the third decade of life — this coincides with a woman’s declining fertility.
MP: What are complications associated with a multiple pregnancy?
MR: There are many complications associated with a multiple pregnancy. In the first trimester there is an increased chance of bleeding, threatened miscarriage, and miscarriage. In the late second trimester and third trimester there are complications with discordant fetal growth, with twin-to-twin transfusion, and preterm delivery. For the mother there is an increased risk of gestational diabetes, high blood pressure, and pre-eclampsia.
The birth of multiple pregnancies is associated with a higher incidence of induction, operative delivery, and post-partum hemorrhage. The incidence of congenital abnormalities is nearly double in multiple pregnancies compared to singletons. Lastly, establishing breast feeding for multiples is more time consuming and more difficult.