Physical Health & Well-Being Articles

Article / Updated 07-28-2022

CrossFit, in its simplest definition, is a fitness routine that personal trainer Greg Glassman developed over several years in the mid- to late-1990s. CrossFit is designed to improve your overall physical abilities, including your endurance, strength, flexibility, speed, coordination, balance, and more. But CrossFit is also a few more things — it's an exercise philosophy, a competitive sport, a corporation, and a community. You can't find a CrossFit class in just any gym you step into, CrossFit is offered only by gyms that undergo special certification by CrossFit, Inc. to become CrossFit-affiliated. CrossFit workouts typically include a combination of elements from other exercise styles, including high-intensity interval training, gymnastics, weightlifting, calisthenics, powerlifting, and strongman competitions. The "CrossFit community" is a key part of the overall philosophy of CrossFit — members of the same class typically become close by sharing fitness goals with one another, pushing each other to break personal records and overcome fitness plateaus, and praising each other for reaching milestones. CrossFit is a scalable workout that's accessible to everyone. The stereotype about a CrossFit class is that it's full of the kind of chest-pounding, lifelong athletes who scale mountains or jog from St. Louis to Albuquerque just for fun. In reality, that same class may have a 60-year-old grandmother who's just completed the first pull up of her life. The intensity of each exercise can be customized to suit the lifestyle and fitness level of every class member. Many CrossFit trainers (often called coaches) see themselves as part of a new movement in fitness that rejects some longstanding and conventional fitness wisdom. For example, a regular personal trainer may have you repeat a movement with a dumbbell 10 or 15 times, but a CrossFit Coach could ask you to keep going to exhaustion — until you simply can't perform the movement again. Most CrossFit coaches also encourage their students to follow CrossFit, Inc.'s nutrition recommendations, including a Paleo diet. The structure of CrossFit To become a CrossFit affiliate, a gym's personal trainers must complete a standard two-day course and a variety of additional seminars on topics like gymnastics, Olympic weightlifting, endurance training, kettlebells, self-defense, rowing, and more. Once this training is complete, CrossFit, Inc. licenses the CrossFit name to the gym for an annual fee and certifies the trainers. Each CrossFit gym is then free to develop its own exercise classes and pricing. What a CrossFit workout looks like A typical CrossFit workout will involve various equipment from other workouts, including Barbells Dumbbells Kettlebells Gymnastic rings Jump ropes Medicine balls Resistance bands Rowing machines Squat machines Abdominal mats Pull up bars Additionally, a CrossFit class may incorporate some less conventional fitness equipment, including Ropes, for climbing Boxes, for performing jumps Tractor tires, for flipping Each class is led by a certified CrossFit instructor, called a coach, and the gym is called a Box (CrossFit has its own language). CrossFit classes usually last one hour and include a warm up, a skill session, an explanation and example of the Workout of the Day (WOD, in CrossFit lingo), and the actual workout. Some of the exercises you can expect to do in a CrossFit class include Push ups Pull ups Squats, with and without a barbell Bench press Deadlifts Farmer's carry, where you pick up some heavy object and walk with it as far as you can Box jumps, where stand in front of a secured box or platform, jump onto the box, and immediately back down to the floor Back extension Toes-to-bar, where you hang from an overhead bar (or pull up bar) and bring your toes up to touch the bar Kettlebell swing

Article / Updated 07-28-2022

The ketogenic diet (or keto diet for short) is an exceptionally well-researched and proven method to start working with your body, rather than against it, to improve your health. Following the basic rules of the keto lifestyle can help you Feel more energized. Lose weight faster. Improve the health of your heart. Sharpen your mental focus. In addition to these benefits, there are a host of other long-term benefits that will leave you jumping for joy. Though it’s become popular recently, the keto diet has been used for almost a hundred years to heal and prevent disease — that’s a long track record of benefits. In a nutshell, the keto diet is High fat Moderate protein Very low carbohydrate Having grains and carbohydrates form the basis of every meal may seem like contemporary wisdom, but for most of human history, this wasn’t the case. Processed and easily digested carbohydrates fuel weight gain and unhealthy spikes in blood sugar with each bite; over the course of a lifetime, this destroys your health. The keto diet puts your body into ketosis, a process where you use fats, rather than sugars from carbohydrates, to fuel your body. On the keto diet, you’ll learn to turn to nutritional powerhouses — fats — into the basis of your meals. The truth is that fat really isn’t to blame for the increasingly common problems of obesity and being overweight that we always hear about. Fat is actually very good for you, keeps you feeling fuller longer, helps you lose weight, and improves your health over the long term. There are a lot of misconceptions about nutrition in general, and the keto diet in particular. The keto lifestyle is much more than the “bacon wrapped in cheese” memes will have you believe — although you can eat cheese and bacon. It won’t wreak havoc on your heart or blood vessels, nor will it increase your cholesterol levels if you follow a whole-food-based keto lifestyle. Despite what many of us have been told for decades, we don’t need to eat many carbohydrates as part of a healthy lifestyle. Instead, eating a range of whole keto foods can be the key to healthy living. Keto is a flexible and adventurous lifestyle that isn’t a one-size-fits-all plan; there are several different varieties to fit with your lifestyle and goals. Standard ketogenic diet The standard ketogenic diet is the basic version of the keto diet. It’s been around the longest and has the most evidence and research behind it. If you’re thinking about keto, you need to be very familiar with the standard ketogenic diet. It clearly breaks down the sources of your daily calorie intake, as follows: Fat: 70 percent Protein: 25 percent Carbohydrates: 5 percent Historically, on this diet, you’ll generally eat about 25 grams of carbohydrates per day. However, we live in more flexible times, and some people eat as much as 50 grams per day. That’s okay, because most people stay in ketosis on 50 grams of carbs a day, so they don’t need to limit their carbs anymore. Over time, you’ll figure out what works best for you. The amount of daily carbs is, at most, only a fifth of what many Americans eat. On the standard American diet, you get about 30 percent of calories from fat, 20 percent from protein, and 50 percent (or more) from carbohydrates. That means most Americans are eating about 250 grams of carbs or more per day. As you can imagine, making such a radical change from a carb-based diet to a fat-based one will have a massive impact on your health and energy levels. On the standard ketogenic diet, the ratio is 70:25:5 in terms of calories coming from fat, protein, and carbs. You should aim for 30 grams of carbs or fewer in a day. Targeted ketogenic diet The targeted ketogenic diet is geared toward athletes. It’s a slightly more flexible version of the keto diet because it allows you to eat more carbs around the time of your intense workouts. When you’re burning a lot of calories, the carbs you eat are consumed as fuel immediately, so your body doesn’t get “kicked out” of ketosis in the long term. As soon as you use up all the carbs during your workout, your body goes back to fat burning because there aren’t carbs left around when you’re more sedentary. This choice is good for very active people who are exercising at high levels regularly (for hours, not minutes) or training for an intense athletic challenge that requires a lot of energy, like a marathon. Regardless, this is not a free pass to eat as many carbohydrates as you would on a high-carb diet. You should consume about 20 or 25 grams of easily digestible carbs approximately 30 to 45 minutes before you exercise. After exercising, you’ll go back to the regular keto diet. Keep in mind the total number of calories (including your pre-workout carbs) when coming up with your daily energy intake. It’s critical that you only eat enough carbs to fuel your workout, so your body goes back to burning fats when you’re done exercising. Generally, you should be well adjusted to the standard ketogenic diet for a couple months at least before you switch to this targeted version. Cyclical ketogenic diet The cyclical ketogenic diet is another more flexible keto option for highly trained athletes. We’re upping the playing field here — this is the ultramarathon runner or the professional athlete, not the weekend warrior. These athletes may increase their carb intake for a short time to “fuel” themselves for the high level of performance they’re about to commit to. The increase may be for a couple of days before a major training event — and the amount of carbs they consume is in line with the amount of physical activity they’re facing. Then they go back to the standard ketogenic diet after the major event is over. Although they may be out of ketosis during these “cheat days,” their high level of performance ensures that they’re still in the low-carb range because they’re burning so many more calories than usual. Another group of people who follow the cyclical ketogenic diet are those who have a hard time sticking to the standard ketogenic diet and choose to have cheat days once in a while. This may involve going keto five days a week, with the weekends reserved for “cheat days.” For those who eat carbs on the weekend, or can’t stick to the standard ketogenic diet because of social pressures, it’s important not to go on carb-binging cycles. It’s quite a shift for the body to go from ketosis to high-carb so rapidly. Instead, increase your carbs to a “low-carb diet,” in the range of 150 to 200 grams on your cheat days. You won’t be in ketosis on those days — and it may take a while for your body to go back to ketosis even on your regular standard ketogenic diet days — but at least you’ll still have the benefits of cutting back on carbs. The cyclical ketogenic diet may be helpful for athletes and those who find it difficult to commit to the keto lifestyle. Keto is very flexible and can work with any lifestyle, as long as you make a commitment to health. High-protein ketogenic diet In the high-protein ketogenic diet, you increase the percent of calories from protein. Commonly, this breaks down as follows: Fat: 60 percent Protein: 35 percent Carbohydrate: 5 percent This option is best for people who are concerned about losing muscle or even want to bulk up, like bodybuilders or individuals who have very low lean body muscle mass. Generally, keto is a muscle neutral diet (you don’t gain or lose it), so adding protein is a great choice for those who want to gain muscle. In this diet, you’re still in ketosis, but you don’t necessarily have as high a level of ketones as someone on the standard ketogenic diet. It’s hard, but possible, to get kicked out of ketosis if you go higher than the recommended 35 percent of calories from protein. It’s also important on this type of keto diet to remember to eat a range of protein foods that are healthy and nutritious. Burning fat: Ketosis Ketosis is the process your body uses to breaks down ketone bodies for most of its energy needs. Ketones come from fatty acids regardless of whether you eat them or get them from your fat cells. Your body prefers to use glucose for energy (see the preceding section), so ketosis only occurs when you don’t have enough glucose coming in from your diet. On a keto diet, your body switches from glycolysis to ketosis as the primary energy generator. Fat, like carbohydrates, is also a source of calories, but it provides a whopping nine calories per gram, compared to the measly four calories you get from carbs and protein. This means, head to head, fat is always a more efficient source of energy than carbohydrates. On the keto diet, instead of using glycolysis for energy, fatty acids are broken down into three types of ketones that provide energy to all your body’s cells: Acetoacetate: The main ketone made by your liver. β-hydroxybutyric acid: The main ketone in your bloodstream and the source of ketones’ anti-inflammatory benefits. Acetone: The least common ketone; it doesn’t provide energy, but it is responsible for carrying waste out of the body. It’s responsible for keto breath (the fruity or moldy breath that some people have when in ketosis) because it’s ridding the body of excess acetone through the lungs. Importantly, fatty acids not only make ketones but also are able to produce glucose if you aren’t getting it from your diet. That’s why, even on the keto diet, your blood sugar levels don’t drop precipitously. They also don’t rise astronomically, as they do on a carb-rich diet, every time you take a bite of food. The liver, the workhorse of metabolism, can’t use ketones as its energy source, so it’s crucial that fat can be turned into glucose to support the liver during ketosis. Like glucose, ketones are also a source of energy for the brain and provide its fuel during ketosis. Ketones may be better brain fuel than carbohydrates because they’ve been shown to improve the health of our brain cells and may be helpful in preventing neurodegenerative diseases like Alzheimer’s. The words ketosis, ketogenesis, and ketogenic are all derived from a similar root, meaning to produce and utilize ketone bodies as the primary form of energy. That’s where the names ketogenic diet and keto diet come from!

Step by Step / Updated 07-28-2022

When eaten on a regular basis, foods with anti-inflammatory properties can help reduce inflammation in the body, helping to prevent the long-term health consequences associated with it — but only if you also eliminate the foods that cause inflammation. When inflammation is under control, not only will you have more energy and feel better overall, but you’ll also find that weight loss and reduction of belly fat both become easier! Try adding anti-inflammatory foods into your meal plan on a daily basis. The more often you eat these foods, the less inflammation that will be present in your body. The following foods and nutrients can fight inflammation.

Article / Updated 07-28-2022

Keto flu is one of the most frequently experienced consequences of implementing a keto diet plan, but it can be overcome quite easily if you’re prepared with a few tricks up your sleeve. Symptoms of keto flu You’ll know you are going through the keto flu if you have Muscle aches and weakness Brain fog and difficulty concentrating Headaches Intense fatigue Insomnia Gut issues like indigestion, constipation, and even diarrhea Your body is making a significant change in its basic mode of operation, and the keto flu and other symptoms are just signs that the kinks are getting worked out. As your glucose stores drop and your body turns to fat as the primary source of energy, the many genes, enzymes, and proteins needed to accomplish this goal must come out of hibernation and ramp up to do the job. Your body has to go through the transition period of getting used to these new processes before it can become efficient at using fat as fuel. When does keto flu hit? The keto flu is a common speedbump that, if it happens, will begin a few days into starting the keto journey. The first thing you’ll need is patience. Your body is doing its best to keep up with your good intentions — give it time and remember to be gentle with yourself and your body. Make sure that you won’t be preparing for a major exam, gearing up for an intense work deadline, or having a slew of social activities around the time of your keto transition. If you have a break from work or school, use that time to start the keto diet. Or, if you can’t afford that luxury, at least make sure it’s at a time of relative calm in your life. You need to remove as many obstacles as you can to ensure you stay on keto; trying to completely change your eating style while going through other life transitions or periods of stress can be overwhelming. If you don’t have any downtime to transition, or you’re trying to go keto a second or third time because of roadblocks in the past, a good suggestion is to slowly decrease your carb intake instead of jumping headfirst into a diet where you’re suddenly restricted to 25 grams of carbs per day. You’ll still get to ketosis if your journey takes a little longer. If you’re on the standard American diet, you’re likely consuming 150 to 200 grams of carbs per day; over a few weeks, slowly drop down to less than 50 grams of carbs per day. This will help decrease your risk of going through severe keto flu. The authors keto flu experience When we first started the keto journey, we were ready to go all in. We fasted for two days, drinking water often and walking around a local park for an hour and a half each day to burn up our excess glycogen stores. We thought, “Faster is always better, right?” Not so fast. When day three hit, just as we began to get excited about digging into our avocado and coconut oil stores, the keto flu hit — and it hit hard. To say we felt like we had been run over by a truck was an understatement. We found it difficult to get out of bed, not only from fatigue, but also because as soon as we tried, the room immediately would go in and out of focus. Nausea hit like a ton of bricks, and we spent a lot of time in the bathroom. Both blood and urine tests showed that we were fully in ketosis, but being chained to the toilet put a damper on our celebration. Remedies for the keto flu If you do end up experiencing symptoms of keto flu, you can decrease the severity — or eliminate it altogether — by following a few simple steps. In no particular order, here are five remedies to get you through the keto flu: Take an Epsom salt bath. Epsom salts are magnesium sulfate crystals, and they’re great for relaxing sore muscles and decreasing pain. We recommend putting 1 or 2 cups of Epsom salts in a warm (not scalding) bath and soaking for at least 20 minutes. For an added benefit, choose a lavender and Epsom salt combo or add a few drops of lavender oil to your bath. Lavender is also known for its ability to relieve tight muscles and will add a relaxing and soothing quality to your experience. Eat (and drink) your minerals (salt, potassium, and magnesium). You can quickly lose salt and potassium on the ketogenic diet, so it’s vital that you replace them. Losing these essential minerals can cause the symptoms of keto flu, so if you replace them before they get too low, you may save yourself a challenging few days. Additionally, magnesium helps mitigate symptoms like constipation and muscle aches. To replenish these lost minerals, drink electrolyte water or bone or vegetable broth, and eat potassium-rich foods like avocado. Another good option is to take a potassium and magnesium supplement during your transition and get friendly with the salt shaker. Stay hydrated. You should be drinking half your body weight in ounces of water per day. For example, if you weigh 200 pounds, you should be drinking 100 ounces of water, but that’s just a baseline. Ditch the coffee and alcohol. If you’re addicted to your morning latte, then at least try to decrease your intake. Both caffeine and alcohol are diuretics, meaning they make you urinate more and can worsen the dehydration that often occurs as you transition to keto (as glucose and glycogen leave your body, they carry three to four times their weight in water with it). Try reducing your intake of both beverages as you’ll be chasing after your own tail — and getting nowhere fast — if you continue with the double espressos or after-dinner cocktails during your transition. Don’t be afraid to take a rain check. If you have the keto flu, you’re probably not going to feel like going anywhere. Don’t be afraid to let friends and family know that you’ll have to reschedule something for another time. Relaxation and rest are very important — don’t underestimate them! While going full bore will get you to ketosis faster, it isn’t necessarily the healthiest — or most sustainable — way to go. If you’re planning on kicking off ketosis with an intermittent fast and you’re physically prepared and able, then go for it. But stay well hydrated and add some electrolyte water or even a bit of bone broth to your hydration regimen. If you start noticing symptoms or begin feeling unwell, make sure to have your favorite electrolyte replacement within easy reach. If you get a nasty case of keto flu, you’ll be happy that you took some time to prepare for the worst-case scenario.

Step by Step / Updated 07-28-2022

Medicinal herbs really are nature’s gift. They work wonders at alleviating and preventing many ailments, and herbs are an effective, inexpensive, and convenient way to manage your health. Herbs can help many conditions. If you suspect vitamin or mineral deficiencies, lack proper rest, are under chronic stress, or get numerous colds or infections, you probably have a lowered immune system and medicinal herbs may help. If you’re considering herbs to boost your immune system, discuss your particular needs with a health practitioner who understands your individual situation. Some herbs for the immune system may enhance or interact with the action of synthetic medications and should be monitored by an herbalist or a doctor who understands how herbs interact with other treatments.

Article / Updated 07-19-2022

All eight disease-modifying medications that are approved by the U.S. Food and Drug Administration (FDA) to treat MS have been shown to be effective for people who experience relapses. So, as long as you continue to have relapses, you’re still a good candidate for most, if not all, of these medications. However, the evidence is pretty strong that these medications have their greatest impact early in the disease, primarily by reducing inflammation in the central nervous system (CNS) and reducing the number and severity of relapses. If you don’t have relapses — that is, if you have primary-progressive MS (and have never had relapses) or secondary-progressive MS (and used to have relapses but no longer do) — your options are much more limited. Some of the drugs for multiple sclerosis (MS) currently under study will no doubt turn out to be safe and effective options. Meanwhile, Novantrone (mitoxantrone) is the only one of the eight medications that has been approved for people with secondary-progressive MS whether or not they continue to have relapses. And to date, no medication has been found to be effective for primary-progressive MS. That doesn’t mean that those of you with progressive disease are out in the cold, however. If your MS appears to be progressing significantly in spite of whatever treatments have already been tried, your neurologist may recommend a chemotherapy drug, such as Imuran (azathioprine), CellCept (mycophenolate mofetil), Cytoxan (cyclophosphamide), or methotrexate. Even though none of these medications has been specifically approved for use in MS, they appear to slow the disease course for some people. These medications — like Novantrone — are immunosuppressants that are also used to treat various forms of cancer or to prevent transplant rejection. Because these meds work by suppressing the entire immune system (rather than selected parts of the immune system as occurs with the other MS medications), they all carry specific types of risks. These risks include infection, impaired fertility, and an increased risk of certain types of cancer. More treatment options for progressive MS are being evaluated in clinical trials. If you’re interested in participating in a treatment trial, ask your neurologist if you would be a good candidate for any trials going on in your area. And check out the National MS Society website for more information about trials for progressive MS. You may also hear or read about bone marrow transplantation (also called autologous stem cell transplantation because the treatment involves stem cells from your own body), which is sometimes used in an effort to control very active, progressive MS. This is a procedure in which your immune system — including the immune cells that are thought to be causing damage in your central nervous system — is destroyed by chemotherapy or whole body radiation and is then replaced using immune stem cells from your bone marrow. This highly invasive treatment has been studied in small numbers of people with some success. Because this procedure poses significant risks and is still experimental, it may not be reimbursable by most insurance policies. The fact that the available medications aren’t particularly helpful for progressive MS doesn’t mean that you have no other options. On the contrary, this is the time to call in the troops. A healthcare team — particularly one at an MS care center that’s staffed by specialists — has a great deal to offer people who have more advanced disease.

Article / Updated 06-01-2022

Infertility has long been a silent struggle for some people trying to start a family. But this June, Infertility Awareness Month seeks to help those suffering learn more about conception and become more vocal about their journey. The prevalence of infertility Infertility is usually defined as not being able to get pregnant after one year of trying. It also refers to women who are able to become pregnant, but struggle to carry their pregnancy to term. Six million women are diagnosed with fertility troubles each year in the U.S., which equates to roughly 10 percent of women ages 15 to 44. Moreover, around 1 in 8 couples deal with infertility on their way to becoming a family. It’s a common problem, but it’s often kept quiet, as many couples feel shame, fear, or judgment around the issue. Overall, Western culture is becoming more open to discussing infertility. Maybe you’ve seen it addressed on TV shows like This is Us, Parenthood, or Friends. Maybe you’ve heard about the infertility journeys of celebrities like Kim Kardashian, Emma Thompson, and Gabrielle Union. Or, maybe you saw a friend post “I am 1 in 8” on social media. Though it’s not as taboo as it once was, it still can be difficult to know how to discuss such a personal issue. Infertility Awareness Month is meant to help others see the wide reach of this disease and to give those struggling with it a way to start conversations with friends, family, and other loved ones. Not just a woman's issue Though people tend to think of infertility as a woman’s struggle, its causes are split equally between women and men. A third of infertility cases are caused by female reproductive issues, another third by male reproductive issues, and the remaining third by a combination of male and female or unknown issues. Male infertility issues tend to be a bit more straightforward; they’re usually caused by low sperm production, slow sperm movement, or variant sperm shape. Female infertility problems, on the other hand, can be very complex. Because many different organs and systems need to work together to produce a viable pregnancy, just one irregularity may prevent fertility. Checking out the organs Doctors will often check a woman’s uterus and fallopian tubes first to see if any tumors, polyps, or scars are present. The fallopian tubes can also be damaged in some way. The roles they play in fertilization are vital: Think of them not only as the intersection where the sperm and egg have their “meet-cute,” but also the romantic bistro where the relationship incubates and, finally, the minivan that carries the fertilized egg to its new home: 1000 Uterus Place. Unfortunately, fallopian tubes can swell, dilate, or even burst. If there’s anything wrong with them, it’s likely the woman will need to look into in-vitro fertilization (IVF) to get pregnant. Parsing PCOS Another common cause of infertility in females is polycystic ovary syndrome (PCOS). It’s unknown what causes this mysterious syndrome, but it’s quite prevalent, affecting 1 in 10 women of childbearing age. PCOS can manifest in myriad ways. Women with PCOS may experience irregular periods, excessive hair growth on their face, chest, or thighs, or male-pattern baldness on their head. Often, women with PCOS will develop multiple cysts on their ovaries (sometimes referred to as a pearl necklace — because of the appearance of the “chain” of circular cysts on ultrasounds). However, the presence of cysts isn’t necessary for a PCOS diagnosis. Doctors may also measure hormone levels, such as insulin, androgens, and progesterone. Since PCOS interferes with ovulation (that interference is what can cause irregular periods), women with PCOS may have trouble growing the follicles that produce an egg to full maturity, and thus, have issues becoming pregnant. Thankfully, there are fertility medications that can aid ovulation, such as Clomid and Letrozole. If all else fails, IVF is another option for women with PCOS. 'Outside' fertilization (aka in vitro) You’ve probably heard of in vitro fertilization (IVF) before, but what does it actually mean? In vitro is a Latin term that literally translates to "in glass." This refers to a glass test tube or petri dish where a doctor or scientist observes or performs an experiment. In contrast, in vivo is a Latin term that translates to "in the living." So, when something happens in vitro, it happens outside of a living organism. But to get to that “outside” fertilization, a lot of stuff needs to happen inside first. An IVF treatment cycle involves different courses of drugs and hormones meant to stimulate egg production and egg maturation. If the drugs work as planned, an egg collection and sperm collection are scheduled, and an embryologist will put the egg together with the sperm (this is the in vitro part). If this is successful, the egg fertilizes, and an embryo begins to form. A few days later, this embryo is placed in the uterus, and a pregnancy test is performed after a few weeks to see if the implantation worked. Sadly, it often takes many cycles of treatment for IVF to be successful, and each procedure can be very expensive, time-consuming, and stressful. However, there are things people wanting to start a family can do to help. Explore this IVF cheat sheet to discover ways to improve chances at IVF success, learn common abbreviations and procedure names, and view ways to keep high spirits on this journey. Infertility support Whether those struggling with infertility are in and out of doctors’ offices, calculating an ovulation window, or trying to discreetly inject themselves with hormones in public, it’s easy to feel alone when undergoing infertility treatments. But there are organizations that exist to help women and families on this journey: RESOLVE: The National Infertility Association exists to help all people on a family-building journey find knowledge, community, advocacy, and eventually, resolution. In addition to providing important facts about infertility, RESOLVE also helps connect people with medical professionals and support groups. Fertility Out Loud helps people struggling with infertility to understand cryptic insurance policies, learn how to reply to insensitive comments (like “Your clock is ticking! Better hurry up!”), and connect and share stories on social media platforms. Rescripted is an online community for those trying to conceive (TTC) founded by two women who underwent their own IVF journeys. Aside from articles and support stories, this site also has videos on how to perform common hormonal injections and a digital pharmacy where users can search for inexpensive fertility medications. For general information about how to assess fertility and nurture pregnancy, check out Getting Pregnant for Dummies.

Article / Updated 05-11-2022

Women’s infertility issues can be very complex because so many different systems can be at fault. Is the problem uterine, tubal, hormonal, age-related, or ovarian? Any one of these problems can cause enough trouble to prevent you from becoming and staying pregnant. A healthy uterus Maybe you had an HSG to evaluate your fallopian tubes and uterus, or maybe you had a hysteroscopic surgery for an even closer look into the uterus. Looking at the uterus is an integral part of any fertility workup because the uterus nourishes and holds a baby for nine months. Finding fibroids in the uterus Fibroids, or benign tumors, are commonly found inside or on the outside of the uterus. They’re extremely common, with 40 percent of women between the ages of 35 and 55 having at least one. Fibroids are even more common in African-American women, with 50 percent having at least one. Fibroids can cause bowel or bladder problems, very heavy bleeding, or pain. Fibroids can be either inside or outside the uterine cavity; their location determines whether they cause a problem with your ability to get or stay pregnant. Fibroids completely outside the uterus, such as pedunculated fibroids, which are attached to the uterus by a stem, don’t usually cause a problem with fertility. Submucosal fibroids grow through the lining of uterine wall and can cause a miscarriage. Fibroids can be surgically removed through a process called a myomectomy. A small fibroid inside the uterus can usually be removed by hysteroscopy, a procedure in which a thin telescope is inserted into the uterus through the vagina. This is outpatient surgery and is relatively atraumatic. In contrast, large intramural fibroids require an abdominal incision and a hospital stay. You generally need to deliver by cesarean section after an abdominal myomectomy. Removing polyps in uterus Polyps are small fleshy benign growths found on the surface of the endometrium. Very small polyps usually cause no problem with getting pregnant, but larger polyps or multiple polyps can interfere with conception. Polyps can cause irregular bleeding; they can be diagnosed via sonohysterogram or hysteroscopy and can be scraped off the endometrium. Polyp removal is called polypectomy. Clearing out the fallopian tubes Most women have two fallopian tubes, one on each side of the uterus, next to the ovaries. Because these tubes are the transport path from the ovary to the uterus, a problem with one or both tubes can have a big impact on your baby-making ability. How fallopian tubes should work and what can go wrong Fallopian tubes are not just tubes. If they were, then repair would be much simpler and far more successful. Tubes actually have jobs to do: specifically, to transport and culture. The tube is where the sperm and eggs meet, and fertilization takes place. So, the tube must allow sperm to migrate through the uterus and into the tube. The tube also must pick the oocyte from the surface of the ovary when it is ovulated and move it nearer the uterus. Finally, once the fertilized egg, now called an embryo, has developed for two to three days, the tube must move the embryo into the uterus. The inside of the tube is lined with cells that have hair-like projections that move in a wave-like fashion to transport the embryo. (Think beach ball at a football game moving around the crowd.) Infections can damage these hair-like projections and decrease or destroy the tube’s ability to perform the transport function. This is a microscopic function and therefore cannot be diagnosed. Also, the tube acts as an incubator for the early development of the embryo. The environment in the tube, designed specifically for the embryo, is unlike anywhere else in the body. This function also cannot be seen or diagnosed. Sometimes a tube is surgically removed after an ectopic pregnancy, a pregnancy that starts to grow in the tube rather than in the uterus. If this pregnancy is found early enough, it may be possible to dissolve the pregnancy with a chemotherapy agent called methotrexate. However, if the fetus grows large enough undetected in the tube, the tube can burst, causing life-threatening bleeding. The only way to stop the bleeding is to remove the tube. You can get pregnant with only one tube but having one ectopic pregnancy leaves you at a higher risk to have another. Frequently, when a tube is removed, the surgeon will look at the other tube and find that it looks okay. For a person with an ectopic and one remaining tube, the pregnancy rate is estimated to be about 70 percent, of which 10 percent are another ectopic. So why don’t the other 30 percent conceive? Probably because the tube may appear normal and be open, but damage on the interior of the tube has caused it to malfunction and not be able to perform the job it needs to do. When women become pregnant after an ectopic has been removed, they usually do so within the first year. Beyond that pregnancies can occur but they are rare, and the couple may want to pursue IVF. Damaged tubes Women who have only the left ovary and the right fallopian tube can get pregnant because the egg can “float” to the remaining tube. Of course, this also applies to women who have the left tube and the right ovary. (One study estimated that the egg gets picked up by the opposite tube about 30 percent of the time.) Sometimes fallopian tubes are seen to be enlarged on ultrasound or during an HSG. If the tubes are very swollen and dye doesn’t flow through them, you may have a hydrosalpinx, the medical term for a tube filled with fluid. If both tubes are dilated, the condition is known as hydrosalpinges. A hydrosalpinx interferes with pregnancy in two ways: The egg cannot be picked up by the dilated tube, whose fimbriae (the end) is blocked by scarring. The tube has an environment that damages the development of the embryo. The treatment for a hydrosalpinx is surgical. In mild cases, the end of the tube can be opened and the ends peeled back like a flower. Surgical repair of damaged tubes has a low chance of success primarily because surgical repair does not address the damage on the interior of the tube. However, in severe cases, the tube will not work even if it is opened. In these cases, the tube or tubes must be removed, and you need to have IVF. This diagnosis is a hard thing for many women to accept because it definitely ends any chance that they’ll be able to get pregnant on their own. However, well-done studies have demonstrated that pregnancy rates are lower for women with bilateral hydrosalpinges. Having one hydrosalpinx and one open tube still reduces the chance for a successful IVF cycle. The reason why the hydrosalpinx reduces the pregnancy rate is unknown, but theories propose that the fluid in the tube can leak into the uterus prevent implantation. In very rare cases, women can be born without any fallopian tubes; often the tubes are missing as part of a syndrome in which the external sex organs look normal, but the vagina, uterus, and fallopian tubes are missing. Of course, if you’ve had two ectopic pregnancies, you may have had both tubes surgically removed also. Sometimes fallopian tubes look fine on an X-ray but may be surrounded by adhesions (scarring) that prevent them from picking up the egg. Endometriosis, tissue growths found anywhere in the pelvis, can grow in or around the fallopian tubes and is a common cause of adhesions around tubes. Normal tubes can’t be visualized by ultrasound. Because the fallopian tubes play such a large role in getting pregnant, you’ll probably need intervention, such as IVF, to get pregnant if a problem is discovered with them. Removal or absence of the tubes, or a blockage that can’t be removed, makes IVF inevitable if you’re trying to get pregnant. Addressing scar tissue For doctors who perform surgeries in this area, it's typical to see scar tissue, or adhesions (as shown), in your reproductive system. Many women having a second or third cesarean section delivery or other surgery had scar tissue throughout the pelvis that needed to be cut away before the delivery team could get to the uterus. Adhesions form when blood and plasma from trauma, such as surgery (like an appendectomy, tubal removal of an ectopic pregnancy or fibroid), form fibrin deposits, which are threadlike strands that can bind one organ to another. They can be removed, but surgery to correct adhesions may result in — you guessed it — more adhesions. The amount of scarring depends upon the surgical procedure done but can occasionally be extensive. Adhesions can cause pelvic pain; cesarean sections can cause adhesions, but they tend to be anterior (or in front of) the uterus, and thus may cause difficulty during a subsequent C-section. However, C-sections don’t usually cause problems with tubes (which tend to be behind the uterus), and thus don’t usually cause infertility. Your chances of getting pregnant after adhesion removal are highest in the first six months after surgery, before extensive adhesions form again. Some adhesions can’t be removed without damaging the tubes or ovaries, and you may need IVF to get pregnant. Since the advent of IVF, surgical repair for pelvic adhesions is uncommon. If you have adhesions in the uterus itself, you may be diagnosed with Asherman’s syndrome, also called uterine synechiae. Asherman’s can follow a dilation and curettage (D&C), an abortion, or a uterine infection. It can be diagnosed during an HSG but is best diagnosed with a hysteroscopy, where the inside of the uterus can be visualized. Asherman’s is also suspected if you have scant or no menstrual flow or recurrent miscarriages following uterine trauma. There are varying amounts of scarring in Asherman’s syndrome. Some people have very few adhesions, and these are filmy and easy to remove. That person has a very good chance to conceive. If the mild to moderate adhesions are removed surgically, you have a good chance, probably 75 percent or better, of becoming pregnant and carrying to term. Severe adhesions may destroy nearly all the normal uterine lining, and pregnancy may not be possible. Less frequently, a person will have extensive intrauterine scarring and that person will have a very poor chance for achieving a pregnancy. A gestational surrogate may be needed in these cases.

Article / Updated 05-11-2022

If a couple tries to conceive but can’t seem to do it, one of the first things that doctors look for is a problem with the man’s sperm. Sperm compose about 5 to 10 percent of semen, and are the only part of the semen that can cause pregnancy. If a man is infertile, there is a problem with his sperm — often a low sperm count or low motility. Sometimes, male infertility can be treated. Just because testicles look normal doesn’t mean that they are fully functioning. The most common problems of male infertility are: Low sperm count, which means that the man isn’t producing enough sperm Low motility, where the sperm he is producing lack sufficient ability to swim to the egg The basis for the problems may be abnormal sperm production, which can be difficult to treat, or that the testicles are too warm. Heat is known to decrease sperm count, so the solution could be as simple as changing the style of underwear from tighty-whities (briefs) to boxers. Another cause can be a blockage somewhere along the line, which may be corrected through surgery. Interestingly enough, most semen analysis is done by gynecologists, specialists in the female reproductive system. A gynecologist is usually the first person a woman consults when she has problems getting pregnant. Commonly, the gynecologist asks that the man’s sperm be analyzed. If the tests reveal a problem with the sperm, the man is sent to a urologist for further evaluation.

Article / Updated 05-06-2022

Like walking, running provides a fitness workout that you can take with you anywhere. You can work up a great sweat, burn lots of calories, and your muscles feel invigorated after you finish. You don’t need a rack on your car or a suitcase full of equipment; you just open the door and go. No single type of exercise is better than all the rest. It’s merely a question of what’s best for you. Many runners develop frequent, chronic injuries. Many people have joints that simply will not tolerate all that pounding. If you’re not built to run, don’t argue with your body. You can get in great condition in other ways. And if you’re a beginner, hold off on running until you’ve built up stamina and strength. Running the right way Runners have a habit of looking directly at the ground, almost as if they can’t bear to see what’s coming next. Keeping your head down throws your upper-body posture off-kilter and can lead to upper-back and neck pain. Lift your head and focus your eyes straight ahead. Relax your shoulders, keep your chest lifted, and pull your abdominal muscles in tightly. Don’t overarch your back and stick your butt out; that’s one of the main reasons runners get back and hip pain. Keep your arms close to your body, and swing them forward and back rather than across your body. Don’t clench your fists. Pretend you’re holding a butterfly in each hand; you don’t want your butterflies to escape, but you don’t want to crush them, either. Lift your front knee and extend your back leg. Don’t shuffle along like you’re wearing cement boots. Land heel first and roll through the entire length of your foot. Push off from the balls of your feet instead of running flat-footed and pounding off your heels. Otherwise, your feet and legs are going to cry uncle long before your cardiovascular system does. If you experience pain in your ankles, knees, or lower back, stop running for a while. If you don’t, you could end up having to sit on the sidelines for months. Running tips for rookies These tips help you get fit and avoid injury. Start by alternating periods of walking with periods of running. For example, try two minutes of walking and one minute of running. Gradually decrease your walking intervals until you can run continuously for 20 minutes. If you have the inclination, you can build from there. Of course, sticking with a walk-run routine is fine; you’re less likely to injure yourself that way. Vary your pace. Different paces work your heart, lungs, and legs in different ways. Always run against traffic when running on the shoulder of a road. This allows you to see oncoming cars and dive for the side of the road, if necessary. If you’re running on steeply banked (angled away from the center line) country roads and the road is flat, you can run in the middle of the road to save wear and tear on your legs. But as you head up or down hills, get as far over on the shoulder (that is, away from the road) as possible to avoid speeding cars mowing you down. Consider carrying a lightweight cell phone for emergencies. Don’t increase your mileage by more than 10 percent a week. If you run 5 miles a week and want to increase, aim to do 5 1/2 miles the following week. Jumping from 5 miles to 6 miles doesn’t sound like a big deal, but studies show that if you increase your mileage more than 10 percent, you set yourself up for injury.