Preparing for Pregnancy with Dr. Stephen B. Mooney

Podcast Transcript

Intro:
There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough, intimate health questions so you get the answers you need. This is The Health Essentials Podcast, brought to you by Cleveland Clinic and Cleveland Clinic Children’s. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:
Hi, and thank you so much for joining us for this episode of The Health Essentials Podcast. I'm Kate Kaput, and I'll be your host today. We're talking to reproductive endocrinologist, Dr. Stephen B. Mooney, about how to prepare your body for pregnancy. We've all heard about the many things that pregnant people should and shouldn't do, from reducing caffeine intake, to avoiding soft cheeses, to not handling kitty litter. But what should you do or not do if you're trying to get pregnant? Dr. Mooney is here to talk to us about the ways that you can best ready your body for conception and pregnancy. Dr. Mooney, thank you so much for being here with us today.

Dr. Stephen B. Mooney:
Thank you. Thank you for the invitation to speak and answer questions on such an important topic.

Kate Kaput:
Absolutely. So I'd like to start by asking you to tell us about your work here at Cleveland Clinic. What kind of work do you do and what kind of patients do you typically see?

Dr. Stephen B. Mooney:
Yeah, perfect. I'd be glad to. I am one of a team of seven reproductive endocrinology and infertility physicians here at Cleveland Clinic in Northeast, Ohio. And as such, we each provide services for patients seeking care for infertility, recurrent miscarriage, anatomic and surgical issues of the reproductive tract, hormone imbalance, genetic disorders, and we provide consultations, surgical care, as well as second opinion.

Kate Kaput:
Great. So it sounds like you're just the guy to talk to us today. So first things first, if someone knows that they want to try to get pregnant, is there any certain time when they should start taking steps to ready their body for that process? When is the right time to start preparing your body for pregnancy?

Dr. Stephen B. Mooney:
Great question. So in a perfect world, we would all be taking care of our bodies and our minds all along, but of course we live in a busy world and a stressful world and sometimes we put our own health at the back burner or on the side. And so if someone is really being conscious about preparing their body and preparing their mind for pregnancy, it would be nice if they could start as much as a year or six months out from that. But in reality, if we could even get three months or 90 days of preparation, that goes a long way. And like everything else in life, it's never too late.

Kate Kaput:
So what are some of the conditions that people might have, health conditions that could make conception difficult? And if you're a person who has a known medical condition, when is the right time to start talking to your doctor about how it might impact your ability to get pregnant or how it might impact your pregnancy itself?

Dr. Stephen B. Mooney:
Yeah. The list of conditions is numerous, but to pick a few conditions, such as ovulation disorders, endometriosis, fibroid tumors of the uterus, as well as chronic medical conditions such as diabetes, high blood pressure, thyroid disease, these are all things that can impact a person's ability to become pregnant. And essentially, the sooner that dialogue starts to take place with the healthcare provider or physician, the better we are to be able to handle all the issues that come along with that condition.

Kate Kaput:
That makes a lot of sense. So what can you tell us about how age impacts pregnancy? I know that the term geriatric pregnancy refers to pregnancies in people who are 35 and older. Is there an ideal time or age to try to get pregnant?

Dr. Stephen B. Mooney:
Yeah, this is a really tough and bewildering question. Unfortunately, as mammals, which of course we are as humans, the perfect time to become pregnant is when you're a teenager. Socially, that's not a great time for us to become pregnant for any number of reasons. And so within reason, the sooner that an individual or individuals are prepared, whatever that means to them to be prepared, to become parents and become pregnant, the better. Because age does have an impact on fertility.

So for example, the impact is most widely seen in women because women are born essentially with all of the eggs that they're ever going to have during their entire reproductive lifetime. And just like any other biological entity, these eggs will decline in quality over the course of time. So imagine a woman who starts to try for pregnancy at the age of 35 or 40 or 42, for example, essentially those eggs have been housed in the ovaries for three or four decades.

And probably if we think about any other biological entity, non-machinery sort of entity, we wouldn't expect those biological things to still be as good as they were 40 years later as they were when they first started. The impact does occur in men as well. However, it's not as great and it seems to be later on, maybe around the age of 45 to 55 or so.

Kate Kaput:
Are there any special precautions that a person needs to take or special things that you need to do if you are 35 or older and trying to get pregnant?

Dr. Stephen B. Mooney:
Probably start having the dialogue with your partner and start having the dialogue with your provider sooner than later. So you may know that infertility is defined as one year or 12 months of unprotected intercourse without achieving pregnancy. But in women age 35 and older, we like to shorten that duration to maybe six months or so, just so that those individuals can feel more comfortable and feel more assertive in getting in and starting to get the care that they require.

Kate Kaput:
So what about family hereditary concerns? Is there anything sort of genetic that could impact a person's ability to get pregnant that they should consider?

Dr. Stephen B. Mooney:
Yes. Certainly hereditary cancers, such as breast cancer, ovarian cancer, cervical cancer, or uterine cancer can have a tremendous impact on future fertility. And so if one knows that they have a family history in their mother, in their sister, in their aunt, in their grandmother, this information is first and foremost critical to share with the physician of record.

And it may not turn out to be germane or important in that individual's care, but just the knowledge of screening tests, procedures, and other modalities are important. Also, there can be heritable conditions in the family, such as predisposition for diabetes, hypertension, blood clot formation, and other issues that may be of critical importance and if caught early, dealt with early can help mitigate or minimize complications in the pregnancy and the process in achieving pregnancy.

Kate Kaput:
So what about ovulation tracking? Can you tell us a little bit about what it is and kind of what it means, how you do it, and when a person should start doing it if they're trying to get pregnant?

Dr. Stephen B. Mooney:
Absolutely. So ovulation can be tracked in several methods. Some women will use an app, which can be found on their phone or their computer, and they'll just simply track days. And that app will help try to predict when their next ovulation would be. This is probably and honestly more accurate than just guessing, but probably not as accurate as some of the other methods.

There's also BBT or basal body temperature charting. And this is when a specialized thermometer, which is graded in half degree increments, is used prior to the individual rising from the bed in the morning to monitor the temperature. And the idea is that after ovulation occurs, the temperature should start to rise. So basically that methodology just confirms ovulation occurred, but it's honestly a retrospective or an after-the-fact sort of thing. So one wouldn't necessarily use it when trying to achieve pregnancy, unless they just want to confirm ovulation.

Then there's this so-called OPK or ovulation Predictor KIT or Ovulation Predictor Strip. And these are found by many manufacturers. And the idea here is that one can contest their morning urine around the time of ovulation or their suspected time of ovulation, trying to detect a surge in the hormone known as LH or luteinizing hormone. One other manufacturer has a test that looks at confirming ovulation through analyzing in the urine at home metabolites of progesterone, which of course is the hormone that rises, as previously mentioned, after ovulation takes place.

Kate Kaput:
Got it. And so those over-the-counter ovulation strips, are they fairly reliable? I think that's one of those tools or resources that a lot of folks have heard about but kind of don't know if they really do work or if they're reliable indicators of ovulation and fertility.

Dr. Stephen B. Mooney:
Yeah. Very, very common question in the office. And some people are so frustrated by those tests. Over the past 20 years of my career, I've sort of learned that for maybe eight or nine out of every 10 women who are using these tests, the tests show up, the test has the line or the smiley face or the egg symbol or whatever it is they're measuring and it works just like it should. And for maybe one or two out of 10, it just becomes a frustrating endeavor that doesn't seem to work. I encourage them that it's probably more related to their body chemistry, their hormone chemistry, and the test itself. Because let's face it, it's a simple test. You can't urinate incorrectly. So if it's not showing up, it's either a bad test or it just doesn't jive with your body chemistry.

Kate Kaput:
Okay. So maybe yes, maybe no. Obviously, if you're going to start tracking ovulation, you have to be off of birth control. So let's talk about stopping birth control. What are the considerations related to going off oral contraception, IUD implants, patches, all of it? How does a birth control method impact plans to get pregnant? And when should you stop your birth control if you want to try to get pregnant?

Dr. Stephen B. Mooney:
Yeah. I think there's a common misconception that one should be off birth control, such as oral contraception, for some prolonged duration to "get your cycles back" or something along these lines. But in reality, unless being on an oral contraceptive or using an IUD or an implantable contraceptive advice, unless it's masking an underlying ovulation disorder, really when you want to achieve pregnancy, that's the time to come off the contraceptive because for most people, they'll start having a regular ovulatory cycle within one to three months. And many people are quite surprised that when they go off the contraceptive, they can achieve pregnancy relatively quickly.

Kate Kaput:
I definitely know people that's happened to, where you're like, "Oh, I think I'm going to try to get pregnant in the next six months or so." And then you go off your birth control and boom, you're pregnant a month from now.

Dr. Stephen B. Mooney:
Surprise. They probably thought they were going to have plenty of romantic nights and it turned out really quickly.

Kate Kaput:
So I want to talk about some of the things that can impact our body itself and our ability to get pregnant, things that will sort of prepare the body for pregnancy. So a topic that's relevant to so many of us is stress and anxiety. Can you talk about some of the ways that stress and anxiety can impact a person's ability to get pregnant?

Dr. Stephen B. Mooney:
Yes. And as you can imagine, stress and anxiety comes in a number of forms and it impacts individuals in very different ways. And so what's interesting about the medical literature and the scientific literature out there regarding stress and anxiety related to infertility is that even stress relief programs that are tried and true do indeed reduce stress may not improve pregnancy rates.

And so that seems somewhat bewildering and the opposite of what one's common thinking might be. However, those programs are promoted because it's important to reduce stress from the standpoint of being able to think clearly, make life decisions clearly, being able to weigh options clearly, and diminish stress in your relationships at work, relationships at home in your marriage, relationships with maybe children or people in your family who keep pressing you about, when are you going to have a baby? And so all of those endeavors to relieve stress are important, even if the stress relief modality doesn't seem to directly increase the pregnancy rate.

Kate Kaput:
And stress can have a direct impact on your cycle too. Is that right? I know that stress can sometimes either make you stop having a period or make you have your period too often. Is that right?

Dr. Stephen B. Mooney:
Sure. For some women, that's the case. No doubt. So if you think about the endocrinology and the physiology of the way the cycle happens briefly, there's a part of our brain, the non-thinking part of our brain known as the hypothalamus. And the hypothalamus takes in signals from all sorts of things, light and dark during the day, circadian rhythms, psychological stress, physical stress, a number of inputs.

And those neurologic inputs are filtered down into the pituitary gland right below it. And then that sends out hormone signals through the bloodstream, to the ovaries, or in men, to the testicles. And that's how the cycle is regulated as far as ovulation and release of the egg.

But it's interesting because if you think about all women, worldwide, some women let's say in third world countries, for example, must be under tremendous stress going through daily life, trying to maybe not knowing where the next food is coming from or not knowing how the shelter's going to hold or not knowing where the money's going to come from and doesn't seem to affect some people's ovulation or fertility rates whatsoever. So it's a highly, highly individual circumstance as to whether it's going to impact the cycle or ovulation or not.

Kate Kaput:
Okay. So in terms of stress management, a lot of people turn to exercise as a means of easing their stress and anxiety, which is of course also good for the physical body. What can you tell us about the role that exercise and weight management play when a person is trying to conceive?

Dr. Stephen B. Mooney:
Absolutely. So exercise, of course, is promoted for all individuals, all humans, whether they're attempting to conceive or are currently pregnant. And so it's thought that exercise, of course, is known to improve cardiovascular health, to help with weight management and diminish the opportunity for obesity or increasing obesity and relieve stress. And so it's interesting that the pre-pregnancy and the early pregnancy exercise recommendations for most individuals who don't have health problems that would be contraindications to exercise, it's kind of the same.

It's 30 minutes a day, five times a week, 150 minutes a week, or if that's just not feasible in 30-minute blocks, then it's thought that we could break it up into 10 -minute blocks of so many times a day, so many times a week for whatever fits our schedule. And that's very, very similar to the recommendation for those who, quite frankly, aren't pregnant or aren't pursuing pregnancy, because it's known that exercise is that important and that helpful for the mind and body.

Kate Kaput:
Okay. So a long story short, exercise is good for everyone, pregnant or not pregnant, no matter what. Can you tell us how can being overweight or underweight affect a person's ability to get pregnant?

Dr. Stephen B. Mooney:
Yeah. So let's start with underweight. Underweight is, believe it or not, the less common of the two. And it's a situation where some individuals who are underweight can have effect on the menstrual cycle and an ovulation, especially those with eating disorders, such as anorexia, or bulimia, or other types of eating disorders. And even those without eating disorders who are underweight can have issues that relate to ovulation, cycle management, implantation of pregnancy, preterm delivery once the pregnancy is in place and moving forward.

And so those individuals, of course, would be encouraged to see a dietician and be taught about healthy caloric intake. If they're underweight because they are maybe over exercising, then maybe moderation and exercise. Those sorts of treatment plans would be put in place with those individuals. The individuals who are experiencing overweight status or obesity status, that's a much more common occurrence and it has maybe more far-reaching impact. Obesity has an impact on all sorts of issues related to pregnancy.

Obesity can affect the menstrual cycle. It can affect ovulation. It can affect the quality of the eggs produced, believe it or not. It can affect whether or not an individual later in pregnancy has to have a C-section, preeclampsia, chronic hypertension, gestational diabetes. I mean, it's almost an innumerable list that is present in the situation of obesity. And so certainly trying to...

I always encourage my patients to first try to just maintain their weight if they're struggling with obesity. And then also let's try to get a plan in place to begin to lose weight. And I'm always encouraging those individuals that sometimes these goals don't have to be huge and monstrous and things that just don't even seem achievable. Sometimes these goals should be possibly let's first try to lose five pounds or seven. And if we get to that, let's try 10 or 12. And if we get to that, maybe we'll suddenly be at 20 at some point in time. And really you'd be surprised the physiologic impact that that can have even if a person is substantially overweight.

Kate Kaput:
So I want to move on to another topic, sort of an umbrella topic that has a lot of other questions beneath it. And that's the things we consume and how they can impact our bodies before conception. So let's start with prenatal vitamins. How important are they? When should you start taking them? And what exactly do they do? What makes prenatal vitamins different from everyday vitamins?

Dr. Stephen B. Mooney:
Yeah. That's a great question, too. These are all great questions. Thank you. So from the standpoint of prenatal vitamins, probably, believe it or not, the most important ingredient in prenatal vitamins is the folate or the folic acid. You may know that folic acid, or also known as folate, is integral in helping the human spinal column close properly, preventing a condition called spina bifida.

So it's one of the amazing, preventable human conditions that can just be basically eradicated or wiped away with the use of folic acid. Of course, because a woman who is now pregnant has a new growing human inside of them, nutrients are taken away from that mother. Prenatal vitamins beyond folic acid are also important because nutrients are shifted from the mother and to the fetus and it's important to have a continuous supply of important nutrients for fetal growth.

So many times there's a misconception that there's a best prenatal vitamin or a certain brand of prenatal vitamin that's the best. And that may be. For an individual, there may be something that they believe to be the best. But I think more importantly than trying to spend time and effort and delay in trying to figure out what's the best, it's more important just to get started, just to get on a prenatal vitamin, whether that prenatal vitamin is from the local grocery store brand, or whether that is from a very famous brand that's advertised and has a beautifully colored marketing box and is very enticing for the eye.

From the point of view of other sorts of things like organic, non-GMO, that's all in the patient preference. What I really care about and what I think the patient should care about is a prenatal vitamin that she can take every day, something that she can tolerate that doesn't cause GI distress. And maybe get that prenatal vitamin started even while she's in the pre-planning phase and if not, certainly when she finds out she's pregnant.

Kate Kaput:
Okay. So basically it sounds like if you think you want to get pregnant, it can't hurt to start on a vitamin now?

Dr. Stephen B. Mooney:
Absolutely.

Kate Kaput:
So are there any kind of foods in particular that people should stay away from when they are hoping to get pregnant or conversely, anything that they should eat more of when you are hoping to conceive?

Dr. Stephen B. Mooney:
Yeah. So I believe in 2007, a book was authored called The Fertility Diet. It was a very interesting book and essentially it detailed maybe the most important nutrients and dietary intake factors for women who are pursuing pregnancy or women are currently pregnant. And it's a very interesting book because really what it boils down to is maybe trending toward lower carbohydrate intake, increased protein and fat intake. Not necessarily a keto diet per se or an Atkins diet per se, but some combination of low carb/the Mediterranean diet type motif, with lots of green leafy vegetables. And essentially, if one can think of the fruit and vegetable spectrum, anything that's brightly colored probably has a lot of good nutrients in it. And maybe that's something to select when you're shopping at the grocery.

Kate Kaput:
That sounds like a good rule for life, right? They say eat the rainbow. So are there any foods that you should stay away from if you're trying to conceive?

Dr. Stephen B. Mooney:
So you mentioned previously, I believe, sometimes soft cheeses, sometimes certain fishes, especially raw fishes. And the concern even with cooked fishes, such as the predator fishes, like tuna, is that they in their lifetime will use the smaller fishes as their food source and heavy metals from the ocean that accumulate in the ocean accumulate in the large fish as you go up the food chain, such that if we were to have some type of diet that was primarily tuna or primarily some other sort of predator fish, we may be exposed to greater levels of heavy metals, such as mercury and cadmium, than would be healthy for us and our fetus.

Kate Kaput:
Got it. So take it easy on the tuna. Again, probably a good rule for diets in general. So in the vein of what we consume, let's talk about substance use, including smoking, drinking, and drug use. What can you tell us about how substances impact our body when we're trying to conceive and the importance of quitting before conception?

Dr. Stephen B. Mooney:
Yeah. So interestingly enough, because for example, cigarette or marijuana smoking, which are very similar from the standpoint of the weight affects the body, when one takes in all of those factors that come through cigarettes through the lungs and into the bloodstream, our lung cells are separated from our blood vessels in the lungs by just one cell layer. And so anything we take in such as cigarettes or marijuana basically are directly placed into the bloodstream and transit throughout the body.

And so in women, all of the compounds that are in cigarette smoke end up deposited all over through the body. And the ovaries are primary place for those factors to be deposited. And so cigarette smoking can have a profound, detrimental impact on ovarian function, egg quality, egg number. And so of course, quitting or not starting as soon as possible would be to the benefit of those individuals. From the standpoint of alcohol use, illicit drug use, clearly, no scientists, no physician is going to advocate those things. But the sooner that someone can recognize the issue, stop the issue and essentially clean out their system, the better.

Kate Kaput:
So if you're just a casual drinker, maybe you're used to having a mimosa brunch with friends or a happy hour cocktail. If you're trying to conceive, should you cut out alcohol entirely or is that sort of every once in a while drinks still okay in the lead up to conception? I know we talked about quitting smoking and quitting recreational drug use, or never starting prior to conception, but what about sort of light social alcohol use?

Dr. Stephen B. Mooney:
Yeah. There's honestly no scientific evidence that suggests that one has to completely stop alcohol intake. It's thought that one drink on a daily basis or a couple of drinks on a weekly basis do not have any impact on fertility or fetal development. Clearly, heavier drinking, especially in the first trimester during fetal development and organogenesis, where the organs are forming inside the fetus, can have profound impact, such as fetal alcohol syndrome. But those are drinkers who are not those individuals who are having the brunch time mimosa or the beer on the back patio when the family comes over. Those are a much different type of drinkers.

Kate Kaput:
Got it. So I want to talk about another substance that a lot of us consume every day without really ever thinking about it as a substance, and that's caffeine. How can cutting back on caffeine intake help you ready your body for pregnancy?

Dr. Stephen B. Mooney:
This one is more scientific. So it's known that 500 milligrams of caffeine or greater, which would be let's say equivalent to maybe five or six cups of coffee in a day, this has been shown to have an impact on fertility and miscarriage. And so the rule of thumb is to try to limit it oneself to maybe two caffeinated beverages on a given day. And so, as you can understand, that could be two cups of coffee, a coffee and a tea, a soda and a tea, some combination. And I try to encourage patients that I see to remember that these are averages. And so if one day is particularly tough to get going and they end up with three cups of tea, I don't think the world's going to end. We're just trying to strive toward not overusing caffeine such that it becomes detrimental to the reproductive process.

Kate Kaput:
I think that's another answer that's probably pretty reassuring to a lot of people who are hoping not to have to give up their morning coffee just to get pregnant. So what about prescription medications? I know that there are a range of medications that can affect the fetus if you're hoping to get pregnant. What course of action should you take in terms of prescription medication use and what should you talk to your doctor about?

Dr. Stephen B. Mooney:
At every visit, or even if you don't have a visit, if you're on prescription medications and you and your partner have made a decision to try for pregnancy, it's never a bad idea to review medications with your physician, whomever that physician is, your internist, your family medicine physician, your specialty physician, even if they're not OB-GYN. Because it's a simple question and answer session. I'm on such and such medication. Does that have any impact on pregnancy? And most physicians know the answer.

And if it's newer medication or a medication that a different physician put them the patient on, most physicians will simply say, "I'm not sure. You should check with so and so." And so it's just such a simple conversation and easy to have, there's really no reason not to have it up front. Some examples of medication that can affect one's fetal development. There are some seizure medications for epilepsy, for example.

There are some specialty high blood pressure or cardiac medications. There are some blood thinning medications, coumadin, eliquis, these types of medications that can also cause birth defects. And so physicians know those, pharmacists know those. And so it's easy just to ask the question, get the answer and try to find an equivalent or similar medication to switch to so that's safety for all.

Kate Kaput:
So that was going to be my next question. Typically, I'm thinking that people probably get nervous, that, "Oh, if I get pregnant, I'm going to have to stop taking medication for this condition that's really important to me." But your doctor can typically help you swap to something safer, is that correct?

Dr. Stephen B. Mooney:
Absolutely. And in some cases, unfortunately, there's not a safer alternative and we just have to live with the potential consequences. And even though we say such and such is associated with birth defects or such and such may be associated with birth defects, there's very few medications where it's a 100% circumstance that this is going to cause a congenital anomaly or birth defect.

But as you can imagine, in a pregnancy and the field development, we don't to take any chances. And so if we have an opportunity to swap the medication, we do. But in those cases where, say, for example, there's an individual who has to take an epilepsy medication, or she's not allowed to operate a motor vehicle and there's no alternative, then that patient should be counseled through toxicology or genetics counseling, what are the risks of being pregnant and having to use this medication because it's your only choice? And then allowing that couple to make the decision, do we go ahead and become pregnant or is this just too much risk for us to take on for us to think about this?

Kate Kaput:
What about medications for mood disorders, anti-depressants, anti-anxiety medication? Are there versions of those that women can still be on when they're trying to get pregnant? Because I think that, again, that's something that a lot of people worry about, that if I get pregnant, I'm not going to be able to take my antidepressant anymore. Is that the kind of thing where there are swaps to be made?

Dr. Stephen B. Mooney:
Yeah, very commonly, there are. Those types of medications, one of the most common categories of those types of medications for anxiety and depression are known as the SSRIs or the serotonin reuptake inhibitors. And those are used widely throughout the world and they're known to be safe and effective in pregnancy. And so many times a person doesn't even have to swap.

Now, there are some other mental health medications that may be from a different category that may need to be swapped or switched out. And also, again, if a patient is being treated by a physician with one of the very concerning medications, then sometimes it's a step back in the thinking process, does this patient absolutely have to have this medication during this important time of fetal development or pregnancy, or is it possible that the patient could just go without it and still do very well with whatever the circumstance is?

Where oftentimes, not all the time, but oftentimes there are mental health circumstances which are situational. Maybe someone's stuck in a very difficult job or maybe some family member is ill or their parent unfortunately just passed away. And sometimes there's a circumstance where the situational medication can just be stopped and not have to go forward.

Kate Kaput:
That makes a lot of sense. So if you're actively trying to conceive or considering trying in the near future, when should you see your doctor and what kind of doctor should you start with?

Dr. Stephen B. Mooney:
From the standpoint of over-the-counter supplements or medications, I think that most of the over-the-counter medications would be considered safe in pregnancy. Although there's a short list that most OB-GYN offices will have for patients who are pursuing pregnancy or currently pregnant. So for example, in the wintertime, if someone has like the common cold, you'll see a list that involves sudafed or the sudafed-like derivatives, or you'll see one that involves acetaminophen or the Tylenol derivative, or you'll see a list that says you can use Benadryl.

So the very common medications that many, many people use throughout the world are usually on that safe and pregnancy list. The ones that I become most concerned about is you know when you go to the grocery store or the pharmacy and there's that whole wall of supplements, and even as a physician, some of these supplements I don't even know what they are, or it says proprietary blend. I worry about the proprietary blend supplements that say it's good for your fetus or good for you or good for this because quite frankly, I don't even know what's in it.

And so how can I counsel you or how can I help you understand the impact it might have for you or for the baby if I, myself, as a physician don't even know what's in the supplement. And so those sorts of things I would suggest we stay away from. I just don't know that they're important if everything is so secretive in the supplement.

Kate Kaput:
That makes sense. So sort of stick to the basics, the things that have been sort of well-researched, well-documented. Yeah, that makes a lot of sense. So if you're actively trying to conceive or considering trying in the near future, when should you see your doctor and what kind of doctor should you start with? Is it best to start with your sort of GP? Should you go right to an OB? What can you tell us about the process of talking to a doctor about trying to conceive?

Dr. Stephen B. Mooney:
So in women's healthcare, we are taught that when we have a visit with a reproductive aged woman or a couple of reproductive age, no matter what they're present for, it could be their well-woman pap test exam, it could be their coming in to see if they have a sinus infection, it could be for anything, a blood pressure check, that is a prime opportunity where the patient is in front of us and she's of reproductive age for us to ask one important question: are you thinking about achieving pregnancy in the next year?

It just opens the door to a lot of discussion. And for some people it's, "No, thank you." For other people it's, "Yes. We've been starting to talk about it, but we're not quite there." And for other people it's like a weight lifted from their shoulders, that they don't have to carry that burden and start that conversation. Because for physicians and nurses and individuals who work in the field, that's an easy conversation. But for some people, it's an embarrassing conversation or it's a hard conversation.

Kate Kaput:
Is there any kind of testing that you should have done ahead of trying to get pregnant or anything in particular that you should ask your doctor about getting tested for or going a little bit deeper on before trying to conceive?

Dr. Stephen B. Mooney:
Sometimes it would make sense just to stop contraception and just to try, just to keep it low key, just to keep it low stress, and just to give it a try. However, I do understand that there are many people who like to be in control of their destiny and that like to be organized and like to be proactive. And I would say if someone was wanting to test something that would be useful and easy, that you could ask your physician to test, for example, your AMH hormone level. That's anti-mullerian hormone.

This kind of gives us a rough egg count, if you will, of the number of eggs compared to your calendar age. And also your FSH. This is sort of the menopause hormone, if you will. And certainly most people aren't going to be in menopause. But it would just give us a quick answer as to whether or not there was any concern about that individuals ovarian function. We talked about ovulation prediction. So if someone wanted to do those sorts of simple tests at home, they could.

And even semen analysis or sperm count is a quick way to involve the male partner and just make sure everything's okay on that side of the fence so that we're not trying for a year or trying for two years and then finding out that there's a problem. It's really interesting, when I started my career, the only way you could get these sort of tests done was to see a physician and to go into the office and have this conversation. Now there are all sorts of startup companies where you can test these things at home. I was astounded the first time I had a patient come in and say we checked my husband's sperm count at home. Everything's okay.

I was like, "Okay. Tell me about it." And they told me where they bought the test from the local pharmacy and they did it. And of course, it doesn't give a super accurate number. It doesn't give a super accurate result. But just for someone who is trying to get themselves in the ballpark and find out, are we even close to normal here or are there big problems? Why not if you don't want to go and see your physician right away? If you're willing to see your physician, then just see your physician and get those simple things ordered, FSH, AMH, ovulation testing, maybe a sperm count.

Kate Kaput:
That's super helpful. So if you've been trying to conceive and it just hasn't been happening, when is the right time to seek help for possible infertility issues?

Dr. Stephen B. Mooney:
Well, we were mentioning earlier in the discussion that for women under the age of 35, if they've gone one year or 12 months without contraception and not achieved pregnancy, that's the definition of infertility. And that'll end up being about 15% of reproductive age couples will fall into that category. So that certainly would be the medical definition of time to seek fertility services.

And for women who are aged 35 and older, we shorten that duration to six months, just because we know for many women over the age of 35, it becomes more difficult to achieve pregnancy and miscarriage rates go up. But in the end, in my practice, and I think in the practice of my colleagues, we'll really have a consultation or give an opinion to anybody who's been trying of any amount of time.

I certainly have seen people, not a lot of them, but I certainly have seen people over the years who've tried three or four months and are just so anxious, they can't even sleep, wondering what's going on. And I simply tell those individuals, you don't really meet the definition. But if it would help you move forward, live your life, have less anxiety, we can do a little bit of testing and a little bit of this just to try to relieve some anxiety and just try to normalize this process. Because some people just end up paralyzed by the anxiety related to even the thought that they might not be able to have a family.

Kate Kaput:
Dr. Mooney, I hope that this conversation has been reassuring for some of the folks out there who are either trying to conceive or thinking about trying to conceive in the near future. Is there anything on this topic that we haven't talked about that you think is important for our listeners to know, anything else that potential parents might want to know about in terms of reading themselves for hopeful future pregnancy?

Dr. Stephen B. Mooney:
Yeah. I think the biggest thing I could say is I would want these people, these couples, these individuals to understand that they're not alone. Many people feel isolated, bewildered, frustrated, anxious, depressed. I joke about it sometimes, even though it's not a joking matter. Sometimes I say in my world, when you mix up the ingredients that I get to work with every day in no specific order, hormones, sex, money, relationships, pregnancy, miscarriage, all of these things and more, depression, anxiety, bewilderment. You mix all these things up for the recipe and you never know what you're going to end up with. Every couple's individual, every couple's not alone. There are resources for help. There are physicians and nurses to talk to. And we're here and ready to help.

Kate Kaput:
Thank you so much, Dr. Mooney, for being here with us today and speaking with us on this important topic. To find an OB-GYN or to schedule an appointment with Cleveland Clinic's women's health, please visit clevelandclinic.org/women, or to discuss fertility concerns with our fertility center specialists, please visit clevelandclinic.org/fertility. You can reach both departments by calling 216-444-6601. Thank you so much for joining us today.

Outro:
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