Sharon Perkins

Article / Updated 09-14-2023

Here’s a collection of seven traits that are often found in amazing dads — qualities that each and every guy can develop on his journey to becoming a father: Confidence: It takes time to feel truly confident about handling a newborn, but you gain confidence by doing things and getting your hands dirty (literally in some cases), even if at first things don’t go right. Looking after a newborn, baby, or toddler can seem daunting at times but isn’t actually that hard. It just comes down to being attentive to the needs of your little one, making an effort, and learning a few tricks. No matter how hard things get — you’re stressed out at work and the baby’s waking up every three hours at night, your partner’s sick, and you’re doing all the housework — you’ll get through it and you’ll be a more confident dad (and person) as a result. So don’t be afraid to wade in because it will give you a great sense of achievement, lift your spirits, and build your self-esteem when you don’t have to rely on mom for anything to do with the baby (other than breastfeeding). Creativity: Sometimes you truly have to think outside the box when you’re looking after babies or spending time with children. Children have no trouble with pretend play and let their fantasies run wild, so just go with it. Sometimes you’ll also have to find creative solutions to some basic problems, such as when you’ve run out of diapers. An old dish towel may have to do while you take baby to the store to get disposables. Endurance: Sometimes the only way to cope with a situation is to endure it. When your baby is colicky and wakes every few hours at night, or is teething and cries constantly, you may be at the end of your rope trying to work out how to put a stop to that noise. Often there’s no solution; there’s nothing you can fix or do to make a difference. It’s just the way it is, and you’re going to have to suck it up. But understanding that everything in parenting comes and goes — that one day, your little one will sleep through the night, one day, your child will have all his teeth, and one day, he will grow out of colic — will help you endure the bad times while they last. Like patience, endurance can be hard to muster when you’re tired, you’ve had little sleep, and you see no end in sight. The early weeks of a baby’s life are a little like an endurance sport — just surviving the sleep deprivation, the crying that grips your brain and shakes it about, and the never-ending rounds of feeding, burping, changing, and settling can seem impossible. But even marathons end sooner or later, so take every day as it comes and before you know it you’ll be celebrating your little one’s first birthday. If you’re having a hard time coping with a crying child and feel like lashing out — stop right now. Put your baby in a safe place, such as her crib, and take a breather. Count to ten. Even better, go outside for a minute or two, take some deep breaths, and calm down. When you go back, comfort your baby and call your healthcare provider or someone who can come and take over for a while, while you take a break. Optimism: Your life as a dad will be much easier if you try to see the funny side of things and take the “glass is half full” position. At times you may be overwhelmed, stressed, or totally exhausted, and then it’s easy to slip into thinking nature’s way of organizing procreation totally sucks. When you get annoyed and you’re feeling negative, your child is likely to pick up on it, and he might actively participate in making the situation even more difficult to handle. So shake yourself up and snap out of negativity. Try a different approach or do something to get in a better frame of mind. Chances are you’ll get a more positive response from your child if you’re more positive. Passion: Immerse yourself in all the tasks that need doing around your baby, toddler, or child. By doing that, you’ll develop a passion for being a dad, and you’ll love being a dad with all your heart. Your child picks up on your passion and will be inspired to learn, develop, and grow with you at an amazing pace. Patience: Patience is a virtue — especially for dads! Patience is your friend and makes things a lot easier when you’ve got kids around. Without patience, you would just pop with anger and there’d be tears all around, even for you. Most of the learning in the early years (and perhaps even throughout life) is achieved through constant and frequent repetition. As a father, you’re in the business of facilitating that learning, which means repeating yourself a lot, such as reading Where the Wild Things Are for the 53rd time, or telling your toddler not to pour his milk in the fish tank for the 17th time. Adults often not great at dealing with constant repetition because it’s deemed boring or frustrating. By fostering your own patience, you’ll be able to elegantly deal with constant repetition and keep your calm. As a result your child will get the support and encouragement he needs to learn. By being patient you avoid putting unnecessary pressure on your child to achieve something, which helps reduce frustration or feelings of inadequacy on his part. Presence: Taking time to be with your child and partner in a family is important. How you spend that time with your family is also important. Children have a finely tuned awareness of your attention. They can tell right away whether you’re actually engaging with them or merely present physically, with your mind miles away. Being present means you devote 100 percent of your attention to your child and you focus on what he’s doing. You don’t watch TV, read the newspaper, or get a bit of work done at the same time as playing with your child. If you’re hanging out with your child, be fully present and in the moment.

Article / Updated 06-05-2023

An unfortunate consequence of separation and divorce is that a large number of fathers are separated from their children. Separation should be no barrier to continuing to be a great dad and role model for your child or children. There’s very little difference between the responsibilities of a nonresident father and a living-at-home father. You don’t have to be going through separation to be regarded as a remote father. Fathers who are away overseas on military service, fathers who are in prison, and dads who are very busy or travel often can also be considered remote fathers. Here are some tips for continuing to be a great dad, even though you can’t be there for every bedtime: Be punctual. If you’re expected at noon, be there at 12 p.m. sharp. Waiting around for you can be very hard on a young child, especially one who doesn’t understand why you don’t live at home anymore. Don’t slack off on all those fatherly duties you may have had when you were still living with your kids, such as discipline and encouraging their development. Be consistent with your rules and boundaries. As difficult as it may be, you also need to work hard to agree to some basic principles for disciplining your children with your ex. And of course, keep going with the principles of parenting — provide your child with love and warmth, a secure and safe environment, and lots of time spent listening to and talking with him. Foster a good working relationship with your child’s mother. Your child will pick up on when things aren’t going well between you two, so work hard at putting the anger, bitterness, or frustrations behind you. Keep your promises. If you told your child that you’d be there on Thursday to pick him up after school, then do it. Take care of yourself, mentally and physically. Being positive and happy is rough after separation and divorce, but it makes you a positive role model for your kids. Neglecting your basic needs (eating decent food, showering every day, getting some exercise, and keeping your place tidy) or turning your place into a new bachelor pad is not a great situation for your children to spend time with you. Try to avoid falling into the trap of buying your kids special presents or taking them on special outings all the time in an attempt to be the favorite parent or to ensure they love you. They love you unconditionally, and the best things you can give them are your time, respect, and unconditional love. When you drop off your child at his mother’s house, try not to draw out the goodbyes like you’re about to go to the moon for a month. Normalize the situation by telling him good night, that you love him, and that you’ll see him very soon. Your child may be feeling abandoned, resentful that you’ve left, or just plain confused about when he’ll see you again. Being on time and a man of your word means your little one can trust in you and believe in what you say. Remind him that even though you don’t live at his home anymore, you’ll always be there for him.

Article / Updated 05-03-2023

You have either been granted a parenting order by the courts or negotiated with your former partner to be the primary caregiver. It’s more unusual for dads to be primary caregivers than it is for moms, so take pride that you’re blazing a trail for dads everywhere! As the primary caregiver, you’re in charge of your kids. Whenever you have to make a decision about your family, keep in mind that the kids come first. Coming to terms with being a primary caregiver Having day-to-day care of your children on your own can be both exciting and terrifying. Being primary caregiver is a huge responsibility, and you need to take a lot into consideration: How do you look after yourself in all this? How will you handle contact arrangements with your former partner? How often will your children see your former partner’s family? Where will you find the money for mortgage payments or rent, food, clothes and school uniforms, school fees, doctor’s visits, transport, school supplies, extracurricular activities, and sports fees? Will you work, or receive welfare or child support payments? How much time will you have for paid employment? How will you juggle your children’s school and sports schedules? How are you going to sort out life with your children if you have a new partner? At times it may seem daunting to be a single dad, but plenty of single moms are out there looking after children and doing a bang-up job. A dad can do just as good a job as a mom! It helps to have a routine and make sure your kids know what’s happening. Enlisting family to give you some space or help with pick-ups or babysitting from time to time also helps. Supporting your children’s mother Even though you’re not partners in a romantic sense, you and your children’s mother are still partners in a parenting sense. Whatever happened during the marriage or partnership that caused the breakdown and separation, it’s time to let go of the negative feelings — the hurt, the resentment, the anger — and get on with raising your children as best as you can. Your children need their mother around. Although she doesn’t live with your children anymore, she can see them all the time and have a close, loving bond with them. What can you do to support the relationship between your kids and their mom? Here are some ideas: Just like bedtime and dinnertime, you might like to make mom time a daily ritual. Mom could call at the same time each night to say good night or read a bedtime story on the phone. If she lives nearby, she could come over for half an hour at the same time each night to tuck the children in. Keep your children’s mother up to date with your children’s progress at school, any special events that are coming up, or parent–teacher evenings she should attend. Keep your negative comments about your kids’ mom to yourself — bad-mouthing her to your children is not okay. They love their mother and have trust in her, and eroding those feelings helps no one. Realize your former partner may be feeling inadequate or irresponsible as a mother. Appreciate that this arrangement is probably quite tough for her. Share pictures, stories, artwork, and school successes with your former partner so she still feels a part of what the children are up to when she’s not there. Try not to be too rigid with contact arrangements. Go easy on your ex-partner if she’s a little late. At the beginning she may be a bit nervous or unsure of how her relationship with her kids is going to work out. Make sure the kids are ready to go when she arrives and pack their bags so she’s not caught out without diapers or sippy cups. Seeking help and assistance As the primary caregiver of the children, you may require some (or loads) of help and assistance. You shouldn’t hold back from making use of what is available. Parenting courses In some cases, courts can require you to complete online parenting courses during the divorce process. Websites such as positiveparenting.com can provide you with a list of acceptable courses. Fatherhood.gov can help you find local programs in your state as well as provide other sources of information that can help you be the best parent possible. Financial help Contact the appropriate government department to see whether you’re eligible for any benefits or tax credits. The IRS website can give you information on whether or not you qualify, based on your income and other factors. Getting out and about Just knowing you’re part of a wider network of dads raising their kids alone and well is invaluable. It’s also really healthy for your kids to know they’re not the only ones dealing with mom and dad being apart. If parents’ groups or dads’ groups are close to where you are, join in so you can network with other parents. Personal help The end of a relationship can bring up some personal issues. You may realize you need help with anger management, self-esteem, or managing stress. Don’t procrastinate — if you feel you could benefit from a coach, therapist, or other specialist, pick up the phone or search the Internet. Your kids need you to be the best dad you can be, so if that means getting a bit of help, just do it. Having fun Despite everything that has happened, spending time with your children is still generally great fun. But you may encounter some times when it isn’t so much fun. When you’ve had a rough day in the office and come home to bills in the mail and children who turn up their noses at their dinner, just stop for a moment and clear your head. Take a look at your children’s faces. Remember how much you love them and how they make you smile and laugh. Your children are worth every bit of extra effort in the end. Your children will bring you more joy than frustration if you’re open to it. Play and interact with your children as much as you can. Read books together, give them lots of hugs, and let yourself be a bit silly with them. Children can learn so much from an involved and caring father. If you’re an older dad, constant playing can take a toll on you, so get other family members involved, set up play dates, and share the fun, while you spend time with adults watching the children have fun. Actually, this is highly recommended for parents of all ages!

Article / Updated 04-17-2023

Pregnancy looks easy when it’s happening to someone else. As a man, you don’t have to endure what’s going on in a pregnant woman’s body 24/7 — and there’s a lot going on. Helping in any way you can is greatly appreciated. Take care of your partner Growing a baby is hard work and takes quite a physical toll on a woman’s body. Sure, some women climb mountains and run marathons up to the day they give birth, but those are exceptions rather than your average woman’s pregnancy experience. For starters, morning sickness can be debilitating, and for some women the morning sickness never eases until the pregnancy is over. The tiredness and carrying around all that blood, fluid, and an extra person puts all sorts of strains on the female body. Look after your partner 24/7 if need be, especially if she’s having a difficult pregnancy, and do all you can to make life easier for her. It may mean looking after the household for nine months all by yourself, and for sure you’ll get sick of it. But let’s face it — would you prefer to squeeze a baby out of your body? So, man up and do whatever needs doing in the house. Get on the wagon Your partner has to stay off alcohol, drugs, cigarettes, blue cheese, seafood, and a whole lot of other stuff to keep that baby in there safe and sound. Seeing you downing a pint of beer and enough salami to sink a small ship could be enough to send her over the edge. Staying off alcohol and cigarettes, not to mention anything heavier you may be into, and eating what she can eat is not only better for you, but it sets up a precedent for how you intend to live as a father. Give your partner some “me” time every now and then The prospect of becoming a mother, while really exciting for your partner, is also a daunting one, both mentally and physically. For most mothers, the first few months after birth end up being a 24-hour, seven-days-a-week job. Even though they traded in their old life of meetings, schedules, work commitments, and deadlines that they may have no sentimental attachment to, for the care of a tiny, helpless baby whom they love, the role can be overwhelming. Over the next few years — perhaps until your child has left home — your partner’s always going to have one eye on what she’s doing and one eye on your child. So in the months before this all kicks off, let her have some time that’s just for her. Be there for the medical stuff Go along to all the medical appointments, scans, and meetings with your midwife or obstetrician. Your partner will want you to be there to share in it. The first time you hear your baby’s heartbeat through the Doppler or see the faint shadows of your baby moving and bouncing around in your partner’s belly during an ultrasound scan, you’ll be glad you came along. Although you’re not carrying the baby right now, that tiny growing thing in there is your child too. Your place is to know about how well he’s developing, any potential health issues, and what options you as a couple have for welcoming your child into the world. Get with the program Start getting some hands-on practice with essential baby knowledge and skills. Moms-to-be love to see their partners getting excited about their new life as parents, and what better way to show it than to throw yourself into the preparations? There’s so much to learn about looking after a newborn baby and the months after that, so why not find out all you can about it? Ask your midwife or obstetrician about prenatal classes in your area and discuss which one you think would suit you and your partner best. Make it a priority to never miss a class, even if there’s work to be done at the office or you’ve been invited to drinks after work. Let’s face it; the office and your work will be there for a long time. Preparing for your first child happens only once in your life. Go on a babymoon As a couple, now is the perfect time to take a relaxing and indulgent holiday somewhere. Don’t choose a 10-mile hike in the mountains. Someplace where lounge chairs and swimming pools are more common than office buildings, with great restaurants and shops to browse. Somewhere the two of you can just hang out, sleep late, read books, and do whatever you want when you want. Check with your healthcare provider before heading off to parts unknown. She may suggest not traveling for a certain number of weeks before your partner’s due date or to certain parts of the world. Be excited about becoming a dad Finding out you’re going to be a dad is a little scary. You may have some reservations because of your own childhood, your financial situation, or the responsibility you’re going to have. Your partner may also share some of those worries and concerns, but burying your head in the sand and pretending the baby’s not going to arrive won’t help. Even if the impending change of lifestyle takes a while to sink in, you can definitely make the pregnancy experience more enjoyable for your partner if you show a bit of excitement about becoming a dad. Showing your partner that you’re excited will get her excited and happy about becoming a mom. You want her to be happy and excited. Celebrate! In a few months when the baby is born, you’ll be celebrating a new person’s presence in your life. Not just any new person, but the person who is on this Earth because of you. That’s pretty special! But it does come with a price — temporary sleep deprivation and a restricted social life. So make the most of your quiet nights and unlimited access to the outside world now! Take your partner out for a posh dinner somewhere fancy, visit a special place together — do whatever spins your wheels as a couple. Record that beautiful belly In our great-grandmothers’ and grandmothers’ days, having a whole litter of children was common, and the pregnant belly was hidden away as if it were some kind of obscenity. These days, though, it’s rare to have more than five or six children, and more usual for a woman to have one to three children in her lifetime. Celebrating the physical changes that take place during pregnancy, such as the voluptuous new shape of a pregnant belly and those plus-sized breasts that you gotta love, is now more usual. Most pregnant women, while despising the weight they put on, love their bellies, so get out your camera from week one and get snapping. Keep telling your partner how beautiful she is For many women, the hardest part of pregnancy is near the due date. Your partner may be having a difficult time getting comfortable at night and suffering from heartburn, hemorrhoids, and various aches and pains. She may have stretch marks, and her legs and feet may be sausage-shaped. Your partner’s tired all the time but can’t sleep. She wants her body back but is frightened about how she’s going to handle giving birth. You, as your partner’s great ally, her support, and her rock, will earn mega brownie points and endear yourself to her always if you keep telling her how beautiful she is. She wants to know that you still find her attractive — not just because of the way she looks, but because of who she is and the fact that she’s going to make a wonderful mother.

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.

Cheat Sheet / Updated 03-23-2022

Becoming a dad is both an exhilarating and a terrifying experience. Planning ahead and being prepared are the best ways to handle what’s coming up in the next nine months and beyond. Doing what you can ahead of time, such baby-proofing your house and packing your hospital bag, will save precious time later on and help you feel like you’re in control (at least a little bit). After the baby arrives, all bets are off as far as feeling in control, but you can still be prepared to take an active role in caring for your newborn and supporting your partner during the postpartum period.

Cheat Sheet / Updated 03-15-2022

Polycystic ovary syndrome (PCOS) often appears to be a collection of unrelated symptoms affecting your menstrual cycle, fertility, appearance, and weight. But when you put the puzzle pieces together, you can see not only how the symptoms relate to one another but also how simple lifestyle changes can have a positive impact on them. Unlike many disorders, PCOS can improve if you take steps to manage the causes. Recognizing the symptoms of PCOS early and working on improving insulin resistance through diet and exercise can help prevent complications of PCOS, including infertility.

Cheat Sheet / Updated 09-15-2021

Vaccinations are a hot topic today. While vaccines can have some side effects, the benefits outweigh any possible risks. Vaccines have saved untold numbers of lives. Many previously feared childhood and adult diseases have been eliminated. Take a look at the entire vaccination process.

Article / Updated 09-02-2021

How exactly do genes work, and why are they important if you are trying to have a baby? Nothing is more popular around the dinner table than crediting or blaming your family for who you are. You are so good at math — just like your dad. You sing like a dream — just like your mom. Always late like your Aunt Ellen! Grandma’s eyes, Grandpa’s hair, Aunt Susie’s wit, Uncle Bert’s moods . . . and your sister’s funny little toe can all be found in you, and it must be because of your genes. Grasping genetics basics Genetics has become a very popular word. With that popularity has come myth and misunderstanding. But the concept of the field of genetics is really quite simple. Genetics deals with the instruction manual on how to build a human. To be exact, a Google search gave the definition of genetics as “the study of heredity and the variation of inherited characteristics.” One analogy is to view the instructions on how to build a human as a book, passed on from generation to generation, which is called inherited. The book is divided into chapters called chromosomes. The chapters have paragraphs called genes, and the words are made from a very simple alphabet. And just in case you are feeling special, the majority of the book, (99 percent) has the same chapters as the manual for building a chimpanzee. Also, the person you think is, well, “different,” actually has the same 99.9 percent of your genetic code. Reassuringly, given the size of the genetic code, that is still over three million differences. The estimate is that the human genetic code has over 3 billion units, which is huge, but the lowly Amoeba dubia has over 670 billion units. So, it really is not how you say it but what you say that matters. What are genes and chromosomes? Genes are a long string of four chemicals called nucleotides and lettered as A (adenine), C (cytosine), G (guanine), and T (thymine). Words in the code are made from just these four chemicals, and the alphabet has only four letters. That’s really a small alphabet to create a person. The English alphabet has 26 letters, and if you limit the number of syllables a word could have to 14, over 2.75963 x 107 words are possible. Fortunately for those spelling whizzes, the English language has only a little over 200,000 words. The genetic code has only four letters, and the words (codons) can be only three letters long, so at most 64 possible combinations are used for the genetic code. The directions for building a human, the genetic code, is a string of three-letter words. However, the string is not one continuous string but rather 23 strings of code. These 23 separated strings are called chromosomes. Each time a cell wants to divide, it must accurately create two copies of the genetic code, and it does this one word (codon) at a time. To complicate this even further, a person inherits one set of chromosomes from each parent so that each cell has two copies of each chromosome. Thus, inheritance is a demanding task of accurately repeating the copying of the code over and over to create the 37 trillion or so cells that make a human. What do genes do? Genes are used to direct a cell to make proteins. Proteins are strings of molecules called amino acids, and there are 20 that are used to make proteins. Proteins are the workhorse of constructing a human. The DNA uses a different type of genetic material called RNA to assemble proteins from the amino acids. Each gene determines which amino acids are to be used and in what sequence. The way in which the amino acids are strung together determines the three-dimensional structure of the protein. The structure of protein is critical for it to do its job properly. Any error in the sequence of the amino acids may reduce the efficiency of how the protein works or make it completely nonfunctional. Inheriting infertility—really? The construction of a human is immensely complicated. For proper functioning, all of the various parts need to work together. Any part that does not do its job properly can throw the person out of balance and thus create disease. So normal human functioning means that the systems are in equilibrium and working properly together. Any part not functioning in equilibrium causes the disease. The genetic code determines the basis for the equilibrium; any error in the code can cause the person’s equilibrium to be disturbed, and disease follows. For people having problems conceiving, a question that needs to be answered is whether errors in the genetic code are causing the problem of getting pregnant. Infertility and sterility are not the same. Infertility implies that pregnancy is not occurring in the normal time frame. Sterility means that the person will never have her own genetic child. So, when a group of people are diagnosed with infertility, there are actually two groups: one group is sterile, and the other group is subfertile and may achieve a pregnancy on their own or may need help with infertility treatments. There are a number of different types of genetic errors. Sometimes entire chromosomes may be missing or duplicated. There may be deletions of parts of the chromosome or parts that are misplaced or turned around. There can be errors in the letters of the code, thus causing the wrong amino acid to be used. These errors are called single-nucleotide polymorphisms (SNPs). SNPs are the most common form of variation amongst people. The error is the use of the wrong letter such that an A (adenine) is switched to a T(thymine). Most of these will not alter the functioning of the person, but some can cause severe disease such a sickle cell anemia. There are many types of sickle cell disease depending upon the gene mutation, but one form is caused when the sequence GAG is changed to GTG—one single letter can cause the destructive disease. The two most common chromosomal problems causing sterility in females are 47 XXX and 45 X0 (Turner’s syndrome). The 47 XXX syndrome occurs in 1 in 1,000 female births and causes premature ovarian deficiency. Turner’s syndrome occurs in 1 in 2,000 female births. Turner’s syndrome is a disease caused by an entire chromosome being absent. Turner’s syndrome results when a person has only one sex chromosome — an X chromosome. This person develops as a female with characteristics such as short stature, a web neck, and a low hairline, and about one-third will have heart defects. These people do not make eggs, so they are menopausal from birth and thus are sterile. However, some people with this problem have a mixture of cells with some having only one but some having two X chromosomes. This condition is called mosaicism. Depending upon how many cells are normal, this person may display the signs of a person with Turner’s but actually have some eggs. She may be able to have a child, which is rare. Or she may have early normal egg development but run out of eggs very early in life and, thus, lose the ability to have her own child. If this condition is established early, it is possible to harvest some of the eggs and freeze them for later use. A second example of a chromosomal cause of sterility occurs in males. Being a male is determined by the Y-chromosome. A gene on the Y-chromosome directs a man to make sperm. The gene is called the sex-determining region (SRY) and is located on the long arm of the Y chromosome. It is passed unmodified from father to son, and thus any abnormality of the gene will be transmitted to a son. One region of the SRY gene is called the azospermic factor (AZF), and this has three sections termed the a, b, and c regions. Some men with very low sperm counts or with no sperm in the ejaculate have deletions in this region. If a man had a deletion in the “a” region, he will not have sperm and has what is termed Sertoli-only syndrome. That man will not be able to have children that are genetically his. Thus, this type of mutation cannot be inherited. However, if the man has deletions in the “b” or “c” regions, his count may be low or zero but there may be regions of the testes that do make sperm. This man can undergo a testicular biopsy where a very small amount of testicular tissue is removed and tested to see whether sperm are present. If they are, then these can be used in IVF and the man has the possibility for having genetically his own children. If he has a male child, the child will inherit the same deletion as the father, and thus this type of infertility can be inherited. Males can also have impaired fertility or even be sterile if they have too many Y chromosomes. The person is then XYY and has what is called Klinefelter’s syndrome. Some men with this problem do have sperm in the ejaculate and others have sperm which must be extracted from the testes. Unfortunately, some will have no sperm and are thus sterile. Inheriting diseases that may impact fertility—different story! There are genetic causes of infertility that can be passed down from generation to generation, but these usually involve much less of the genetic code. Some are single gene mutations, and some are structural problems with a part of a chromosome being rearranged but not entire chromosome changes. For males, myotonic dystrophy is an inherited disease that is called an autosomal dominant. This means that if the person has the mutation in just one of the chromosomes, he will have the disease. Thus 50 percent of his offspring will also have the disease. The problem is caused by areas of the gene, which produces a protein required for normal functioning, have unwanted repeated sequences of the letters. The general term for this type of problem is nucleotide repeat diseases, and women can have a similar problem causing the fragile X syndrome. Some of these men have sperm and thus can have children, but some will have no sperm and be sterile. Males can inherit genetic diseases affecting fertility that are single gene defect problems. For these, a mutation of many mutations within a gene causes the gene to malfunction. An example of this is cystic fibrosis. A man with cystic fibrosis will have no sperm in the ejaculate because the tubes that transport the sperm from the testicle to the penis (the vas deferens) do not develop. This is called congenital bilateral absences of the vas deferens and can be treated using sperm extraction from the testis and IVF/ICIS. One problem for females that has some genetic basis is polycystic ovary syndrome. No single gene has been identified that causes PCOS. Rather, there are a number of genetic mutations that can cause PCOS. Also, patients with PCOS have DNA that has been modified so that the directions for constructing the human are not read correctly — these modifications are called epigenetic factors. Epigenetic modification of DNA helps explain how the environment can alter the way the genetic code is read, and it plays a major role in a number of diseases. Another type of problem can occur when there are too many copies of a three-letter word, for example egg (a genetic sequence). Fragile X syndrome is an example of this type of genetic error. Fragile X syndrome results when a region of a gene called the FMR1 gene has too many repeated sequences of the genetic word cgg. The FMR1 gene produces a protein that regulates other proteins to make normal nerve connections. The mutation can result in individuals with severe mental compromise. A family with members with severe mental compromise may benefit from genetic testing to determine whether the family has the abnormal FMR1 gene. A normal number of repeats is 5 to 50. If the sequence has more than 200 repeats, then the result is developmental abnormalities in varying degrees. However, where there are 50–200 repeated sequences, the person may have some developmental problems, or a female may have early ovarian failure. So experts often test a woman with premature ovarian failure to determine whether she has too many repeat sequences. There are a number of single gene defects that affect the fertility of a person. These are being diagnosed more and more so the list is becoming quite long. It is beyond the scope of this article to fully explore these diseases. Shaking the family tree for information The fact that genetics is playing a larger role in the cause and potential treatment of all diseases makes knowledge about families important. Doctors are now taking a more extensive family history, and if it seems warranted, they construct a genetic diagram (family tree). Many people have at least one disease-causing genetic mutation if it occurs on both chromosomes. Fortunately, people have two chromosomes, so the mutation does not cause a clinical problem. But if two people have children and they both have the same mutation, then one out of four children may have the disease. A family tree may show relatives that had symptoms of the diseases which would put the couple on alert to test for the mutation.

Article / Updated 09-02-2021

When some fertility test results come back, you may be even more confused than you were before. If your partner’s semen analysis comes back with some results askew, he may be too embarrassed to ask what the results mean. Semen samples can vary from month to month, or even day to day. That’s because it takes about 72 days for sperm to develop. Unlike eggs, which are present from your embryonic days, sperm are replenished all the time. Because men are constantly producing new sperm, one “bad” semen analysis should be followed up with another in a month or so to see if the problem was a temporary one. An illness, injury, or medication or drug used a few months before may make one sample not so superior, but checking again a month later may show an improvement. Making too few sperm Sometimes a semen analysis shows a very low number of sperm, less than 15 million/ml, a condition called oligospermia. While 15 million sperm may sound excessive — why isn’t one or two million enough? — large numbers of sperm are needed in the ejaculate because many sperm are abnormal even in a good sperm sample, and it’s a long way to the ovulated egg, so many don’t make it all the way. There are many causes of oligospermia, ranging from varicoceles to lifestyle issues. Other causes may be Hormone imbalances, which can be checked by a simple blood test Chromosomal abnormalities such as a congenital deletion of part of the Y chromosome History of lymphoma or testicular cancer or chemotherapy Diabetes Sickle cell disease Kidney disease Liver disease You can get pregnant without fertility treatments if your partner has oligospermia, but your chances of pregnancy are higher if you do one of the following: Intrauterine insemination (IUI): The sperm are concentrated and “washed” so that the best sperm are used for insemination. In vitro fertilization (IVF): This treatment allows fertilization to take place in the lab, where a high concentration of sperm can be put in with the egg. If the sperm are especially abnormal, the lab may need to utilize intracytoplasmic sperm injection (ICSI), the insertion of a sperm directly into an egg. The procedure is done by an embryologist under a high-powered microscope. When there’s no sperm in sight If no sperm are seen, it’s called azoospermia. About 1 percent of males have azoospermia. If your partner has azoospermia, you won’t be able to get pregnant conventionally. Different factors can cause azoospermia; either the production of the sperm or the delivery of the sperm can be at fault. Sperm production problems can be caused by the following: Sertoli cell only syndrome: In this condition, the germ cells that produce sperm in the testes are absent. There is no way for a person with this syndrome to father a child. Anabolic steroids: Their use may cause irreversible shutdown of the sperm production. Abnormal hormone levels: Low levels of LH, FSH, or testosterone can cause low sperm production. This problem can be treated with hormone injections, pills, or transdermal patches. If the problem is obstruction, in general, the sperm production is normal, and the sperm simply can’t get to the ejaculatory duct. In these cases, your partner will need a surgical procedure to extract the sperm from the testicle (discussed in the nearby sidebar “If you need a sperm aspiration”). This procedure must be done in conjunction with IVF because the sperm need to be injected directly into the egg. Obstructive problems include the following: Absence of the vas deferens, the tube that delivers sperm to the ejaculatory duct and the prostate Previous vasectomy Previous infection that causes scarring and obstruction of the epididymis Obstruction from prior surgery Mechanical problems with getting the sperm where they need to be include the following: Retrograde ejaculation, in which the majority of the sperm go into the bladder Spinal cord injury that prevents ejaculation Previous injury from trauma Previous injury from surgery, such as hernia surgery A disease such as diabetes Considering the sperm’s shape and movement After checking how many sperm are available, the andrologist will look at what shape the sperm are in and how they are moving — kind of like a test to see if they are “in condition” for conception. The terms you’ll see on the report are the morphology (shape) and the motility (how they swim). Morphology There are hundreds of papers written about the shape of sperm. The concern has to do with the ability of sperm to navigate the female reproductive tract to get to the egg in the fallopian tube at the correct time. There are many barriers to this; the cervix with its protective mucus is the primary obstacle. Putting sperm beyond the cervix through the use of intrauterine insemination is based upon the fact that the cervix keeps many sperm from entering the uterus. So while the cervix can act as a storage place for sperm, it can also prevent sperm from moving forward. The theory is that sperm need a specific shape to get through the cervical mucus (see the following figure). Sperm with an abnormal shape may be filtered and not able to move forward. Both IUI and ICSI correct for this problem. But sperm have another issue. Once they reach the egg, they need to penetrate the shell of the egg. Sperm penetrate the shell by binding to the shell and releasing proteins that digest a pathway through the shell. If the sperm do not have these proteins, you could place a bazillion near the egg and they could not penetrate the shell. In the early days of IVF, before ICSI, sperm and eggs were simply placed in a dish. Fertilization had to be done by normally functioning sperm and eggs. It became apparent that some men had sperm that were incapable of fertilizing an egg, but there was no highly reliable test to determine this before the IVF procedure. That meant that couples could go through IVF only to find out that they had no embryos. One school of thought suggested that the shape of the sperm may give an indication about the ability of the sperm to fertilize an egg. To that end, they developed a very detailed process for determining if a sperm had a shape that suggested that the sperm could fertilize the egg. Originally called the Kruger method, the term strict scrutiny is now used to identify that this detailed methodology is being used to determine the percentage of sperm with the desired shape. Labs vary in what they consider normal, but in general anything < 5 percent is abnormal, from > 4 percent to 14 percent may be an indication of a reduced fertility potential, and above 14 percent is normal. Motility In the sperm world, it’s swim or die. Sperm must traverse the female reproductive tract to get to the egg. Any reduction in motility reduces the number of sperm that even have a chance to get to the egg. Like morphology, a reduced motility may sometimes also indicate that the sperm lack the ability to penetrate the shell of the egg. Normal percentages for motility are > 40 percent motile and 32 percent forwardly motile. Sperm lose their motility if they remain in semen too long, and this is why andrology labs needs the specimen within an hour of collection. Also, cold conditions, such as a cold car seat in the winter, can artificially lower the motility. Another condition that can result in lower motility is the thickness of the semen (viscosity). After ejaculation, semen coagulates just as blood does. Over the next 30–45 minutes, it liquefies. Some men have conditions that create either super thick semen (increased viscosity) or failure to liquefy. Both of these may reduce the fertility potential for the man.