Hello, everybody, we are live with Mikayla Dalton, one of the Premom virtual consultants. We're super excited to have you with us today, Mikayla. We're going be talking about trying to conceive and trying to avoid, but most of your questions are about trying to conceive, so we will be focusing on that. But first, can you tell us about yourself?
Thanks, Teri. Okay. First of all to explain my accent, I'm from Australia. But I've been living here in Boston, Massachusetts for 11 years now. I have also been working in fertility awareness for about 9, almost 10 years now. . . . That's a long time! So, my time in the USA and my time in the reproductive area of work have come together, so the two are inevitably linked for me now.
Nice! And who do you tend to work with? What do you specialize in?
I actually have a lot of postpartum clients. It's one area where a lot of people feel the need for some expert guidance. So, I'm actually do end up with a lot of postpartum, breastfeeding mamas who are looking for some help in figuring out where their fertility is. But it runs the gamut; I see people who are coming off birth control and wanting to move to a natural option. I see people who are trying to conceive; I work with people who are engaged and planning for the future. Already, I work in all sorts of areas. It's really diverse and really fun.
That's really neat. Why did you decide to work with Premom?
Well, I had been looking for a solution to keeping track of my test sticks. The fertility awareness based method that I actually teach incorporates the use of various hormonal at home urine tests. And I was looking for a solution to keeping track of them that didn't entail taping them onto pieces of paper. And Premom has that wonderful app where you can take pictures of the test and they're aligned in a neat row and they're dated. And you can get the test to control line ratio, or your Premom has its own really cool tests where they'll actually give you a numerical figure. And that was just game changing for me, so then I hopped on board and bought the smart thermometer as well. So, I sync that every morning. I've really jumped into that.
Wonderful. I was poking around in your info a bit and saw that you call yourself a "Femtech geek." Did I get that right?
Yeah, I am very into Femtech. It's a little confusing out there. There are so many options. It can be hard to choose what's right for somebody. But I'm very into modernizing the approach to suit people's lifestyles now.
Yeah, the industry has come a long way recently.
Yeah, it sure has. My husband sometimes looks at me a little oddly when I come with all of my gadgets. He's supportive, but he's like: "I'm not sure. Is this normal?"
Yeah, I saw your Borg reference. I loved that. Anybody who likes Star Trek . . . check out her Instagram!
I would love for you to talk a little bit about trying to conceive versus trying to avoid, particularly with tracking. I think trying to avoid is a little bit longer, a little bit more complicated. So I'd love to hear your perspective on that.
It is. It's funny because sometimes you see people who've used fertility awareness to conceive successfully. And the idea is that you track your body's biomarkers, whichever ones you're using. So, you have the hormone tests like looking for the LH surge. You have cervical mucus, cervical fluid, if you prefer. You have basal body temperature; those are the three main ones -- there are some extras. And then you target the most fertile days to try for a baby. And so the fertile window technically is about six days. So you probably have like six, five to eight days where you're focusing your attention on making the baby.
But when you're avoiding pregnancy, it's funny, it doesn't just work to flip it. So, achieving pregnancy, you're trying to target the very best days, and you have a fairly well defined fertile window for the best days to get pregnant. But in avoiding pregnancy, every method is different. They'll all have different rules about what tools you're using, and what approach you take for determining what days are potentially fertile. But you're looking for all potentially fertile days, not just the very best, most fertile days. Depending on the method, some methods might say that the days of bleeding at the start of your cycle aren't available, in the sense they are potentially fertile. So, if you want to avoid pregnancy, you would not consider those days safe. Because if you're relying on a biomarker like cervical mucus and bleeding as obscuring your observations, then you have to assume potential fertility. So you find that window of days that are considered potentially fertile is different between trying to conceive and trying to avoid pregnancy. Because if you're trying to conceive, you're probably not trying on the second day of your cycle. But if you're trying to avoid, you might be like: "Well, this could be potentially fertile." So we should be aware of that. It's a really different mindset, a different approach to fertility awareness, and a different mindset and different challenges. Both can be challenging in their own ways. And it's funny, because you're using the same set of tools, but for different outcomes. And so it comes with a different set of challenges, and a set of approaches.
And I know you talked about how you love myth busting. So it's pretty neat. That's a myth right there. Right? The difference in trying to conceive and trying to avoid when you're checking. It's not the same.
Yeah, I see it a lot there. I've seen several people become unexpectedly pregnant because they tried to flip what they were doing for trying to conceive -- and were now trying to avoid -- and had intercourse on those same days to give a good chance of having a baby. But now they're trying to avoid pregnancy and just avoiding having intercourse on those same days. But they weren't aware that you can't just flip it and expect a level of effectiveness. And so there are some people who end up with a surprise baby. When they're like: "Oh, why didn't this work?" And just because they didn't realize that there is a difference.
Fantastic. Let's dig into some of these questions. The first question is about LH surges. Why is my LH never showing surges? But I have regular cycles?
Potentially, more than one answer. So one reason could be the time of day that you're testing. For some women, their LH surge is fairly short. So if you're testing just once a day, you may be missing it. Statistically, the best time to pick up that surge is somewhere between 10am and 4pm. Usually people say 10 to 2 or 12 to 2 or 10 to 4 to give a bit of a wider window. Statistically, that's where the surge is most often detected in the urine. That's about 80% of women. However, you may not be in that percentage, so you might not see the surge in your urine until later in the day. For example, I know for myself, there was at least one cycle where my true positive OPK, my true peak was like one o'clock in the morning. Now, I'm a night owl. So, my biorhythms may be a little different. So, one thing you could try doing is testing at different times of the day; you may want to do multiple tests to see if you can pick it up. Do be wary of doing a first morning test, though. Sometimes first morning urine can be a little too concentrated and give you misleadingly strong results. So that's one possible reason.
Another possible reason could be that perhaps you're not ovulating regularly. So, you may be having bleeds on a fairly regular basis. But they may not be actually a menstrual period. In order to be a menstrual period, you do need to ovulate, and your uterus has to undergo these changes that occurred during due to the hormones specific to the luteal phase between ovulation and your next period. There are actually biological changes that happen there due to the hormones, and that bleed is a menstrual period. But you can have other bleeds, like hormonal breakthrough or withdrawal bleeds. So, an estrogen breakthrough or estrogen withdrawal bleed, and sometimes women can confuse those for menstrual periods, when they're not actually a real period. So, that's another possibility that may be happening. If you can't find the LH surge, and you've been testing it many different times, it might be worth seeing your physician just for a bit of a checkup.
Wow, I feel like that was a great answer right there we can finish the interview! I'm really glad you addressed that because that does come up. Sometimes women will get --like you said -- a good result at a different time than that recommended 10 to 4 window, and then we say to go with what's working because not everybody is the same. So, that was a really helpful description.
Someone asked what to do or eat during the two week window and what to avoid.
In the approach that I teach, we take the basic approach that what's good for a healthy pregnancy is good for a woman in general. So, the thing to do is try to maintain a healthy lifestyle, so you want to eat your fruits and vegetables and get a decent amount of protein and healthy fats. There are a couple of things you may want to avoid during the two week wait or the two week window. One of those is nonsteroidal anti-inflammatory drugs, like a common one is ibuprofen, but there are a range of them. The use of these in recent research has been associated with more difficulties with implantation or early miscarriage. So, you may want to avoid those nonsteroidal anti-inflammatories. If you need some over-the-counter pain relief, there are other options like aspirin, for example, that may be suitable for you. Definitely check with your pharmacist or your doctor about your best options for your body and your health history. But that's something to be aware of, because nonsteroidal anti-inflammatory drugs are very common, commonly used over the counter.
Another thing you may want to avoid is alcohol. This can be controversial. That's a very big part of our society. And I grew up in Australia, which has traditionally had a more relaxed approach to alcohol. However, it has also been implicated in lowering the success rate of implantation or increasing the rate of chemical pregnancy. So, that might be something to kind of go light on or avoid completely at that time. But generally speaking, I think there can be a limited amount of things that we can do to control the process. So, those are two of more recent ones that you may want to be aware of avoiding. Another thing you may want to do if it ever becomes an issue with you in successfully conceiving or carrying a child is to have a look at your progesterone levels. So, if you have a history of repeated early miscarriages, you may want to look at your progesterone levels. And I know that Premom includes those tests in its app as well to make sure that your progesterone levels get high and stay high.
Also kind of related to the avoiding question: Can having oral sex or saliva near the vagina or on the penis while trying to conceive affect chances of conception?
The short answer is no. You don't have to worry about that when you're trying to conceive. Typically you're having intercourse, and the man ejaculates fairly deep inside the woman. And so you're placing those sperm right up near the cervix, giving them the best chance to get where they need to go. Saliva is not the most sperm-friendly fluid. And this is normal -- sperm need particular things that are good for them. Sperm need warmth and moisture and a certain pH level, kind of alkaline. Usually, the woman's vaginal canal is more of an acidic environment; it actually changes to become more alkaline as she becomes more fertile, which is friendly to the sperm. And the cervical mucus, cervical fluid that she's producing actually becomes nutritious for the sperm and protective. So, the woman's body is actually cooperating very actively in the conception process. Saliva isn't the best for sperm, but it's not really a factor. If it's on the surface of the vagina, on the vulva, at the entrance, it's not really going to be affecting sperm that are deposited inside the vaginal canal. So, I wouldn't worry about it.
Good to know. We have a question about the possibility of getting pregnant with ovary cysts.
Okay. Cysts on your ovaries are not that uncommon. It can happen randomly to women. There's such a thing as a leutinized unruptured follicle, for example, that aren't that uncommon. If you have a lot of cysts -- and you may have some other symptoms that might go along with a diagnosis of PCOS or polycystic ovary syndrome -- that could impact your chances of conceiving successfully. Women with PCOS can have more trouble. It's not guaranteed that they will have more trouble; plenty of them conceive with no problem. But that's definitely something -- if you've been told that you have cysts on your ovaries -- that's definitely something to ask your physician about. Go see your family doctor or your OBGYN and ask them: Are these cysts on my ovaries? Could they be a problem for conceiving? Do I have other symptoms that could indicate an issue? That's more of a medical question, and I want to stay out. That's not my area to answer. It really depends on the context. Sometimes they can go along with issues that make it difficult to conceive, but it doesn't necessarily mean that.
Okay. I love this question because again, here's the myth part you're talking about: is it truly beneficial to elevate legs after baby dancing?
It can't hurt, but it's unlikely to help much either. I was mentioning before that you're depositing this sperm, right up in the vaginal canal close to the cervix. Now, sperm are held in seminal fluid. So, when you stand up after intercourse -- this may not happen straight away -- but you will see seminal fluid come out of you, or you will feel it. There are some sperm still in that fluid; they tend to be the ones that would probably be filtered out anyway as less robust. They're not all going to disappear. They're not all going to come out with the seminal fluid because they move quickly. They're hardy little things. So if you're depositing in the vaginal canal, close to the cervix, what they start doing is they start swimming, like in this special little corkscrew fashion, just wildly swimming for their lives, you know. And they'll be trying to make their way to the cervix, which has special little crypts that harbor them basically, providing a safe place for them to rest, get some nutrition, fortify themselves for the journey. They're not going to fall out of you with the seminal fluid. There's nothing you can do to stop them. So, if you were to have intercourse, and then immediately stand up and jump up and down, trying to get it out, that doesn't work because they are tiny little things already on their way. Likewise, trying to encourage them by holding the seminal fluid in is unlikely to do anything much. You really don't have to do it. It makes some women feel better about it, like they're doing something, and it can't hurt. So, if you want to, you can lie down with your legs in the air. And if you're okay with that, by all means go for it. I wouldn't do it; I think I'd start to feel a little ridiculous if I tried. But it's not -- as best as we can tell -- it doesn't actually improve any chances statistically.
Okay. How about CrossFit? Does CrossFit HIIT exercise affect implantation or trying to conceive?
Similarly to how I was just talking about if you're trying to avoid pregnancy, jumping up and down immediately after sex to get the sperm out isn't going to work. It's similar to that for implantation. I mean, this is happening at a cellular level; you can't dislodge the cells by intensive exercise; you know, there's no amount of burpees that you can do that is going to affect implantation.
So, feel free to do your exercise. However, if you're doing very intensive exercise, like high intensity interval training, CrossFit. That can have an effect on your fertility in general -- so maybe not implantation specific, like you were asking -- but in general, very intensive exercise -- this happens with professional athletes, people training for marathons -- it can cause menstrual cycle irregularities. It can stop you ovulating. So, if you go from a sedentary lifestyle, and then suddenly start a really intensive exercise, it can throw your body into a sort of shock. And that might mess with your cycles. But also, if you're consistently exercising to a very high level, your body may be doing a version of conserving energy, where it's like: "This is not a good time to get pregnant" -- because this person either has a very low body fat percentage or is stressing their body in a certain way. And it could be healthy in one sense, but it could be unhealthy reproductively. So, that's something to be aware of. If you're trying to conceive, and you feel like your cycles are a bit messy, and you may not be ovulating, you may want to ease back on the exercise a little.
We had a question about about having a regular period, getting positive opks, they have egg white cervical mucus -- so they're doing all the tracking -- but they're still not pregnant after a miscarriage at the beginning of the year. Any thoughts on that?
I'm so sorry. You're checking with the LH tests, and you're following your cervical mucus, and you're tracking your cycles. It's important to know what is the normal range of conceiving. For people who are charting fertility, who have healthy fertility, these are the trying to conceive success rates over the cycles:
In the first cycle of trying -- in one study that was published in 2003 -- the success rate was 42%. In the second cycle of trying, that success rate went up to 50%. It was up to 75% in the third cycle, and then in cycle six that went up to 88%, had succeeded. And this is in a group of women. well, couples, with healthy fertility. That 88% by the conclusion of six cycles is roughly equivalent to the success rates that people who are not charting at all and timing intercourse achieve after a year of trying.
So, if you have been charting for more than those six cycles -- and I'll avoid January February, because coming after a miscarriage, your hormonal profile may not be ideal -- but if it's been more than six cycles without success, at that point, I would recommend for my own clients that they seek medical advice. Because if they've been charting and timing intercourse, and six regular cycles have gone by without success, they're in the same position that another couple who are not charting and timing intercourse would be after a year. So, it sounds like it may have been more than six cycles for this person. I don't know the reason why she may not be conceiving -- and there are a whole swath of reasons -- it could be her, it could be her partner, it could be a hormonal issue, it could be anything else. But it sounds like she's been diligently tracking. And if it's been six cycles with that with no success, then she knows she's in the 12% who haven't. And at that point, it's worth taking a look and seeing if something's going on.
And then we have a question about molar pregnancy. What are some things to help get pregnant after a partial molar pregnancy? There's a termination at 20 weeks, also a chemical last month. . . working with letrozole. . . Any thoughts?
That's really tough. And I'm so sorry for this question. That's a very sad situation to be in. For anyone who's joining us or are watching afterwards and who doesn't know what a molar pregnancy is, it's been described as a genetic accident, which is not a term that I like. But it gets to the idea that with a molar pregnancy, there are two types: complete and partial. And with a complete molar pregnancy, what happens is you have an egg and sperm that meet, and somehow, though, the woman usually provides her chromosomes -- 23 chromosomes in her egg -- and then the man provides 23 chromosomes with his sperm. And they join together and make a new person with their own genetic makeup and 46 chromosomes. But what happens in a complete molar pregnancy is the woman's chromosomes are missing, somehow, and the egg gets two sets of the father's chromosomes. And this affects the placental cells; they don't develop properly into a properly functioning placenta, and the baby will never develop at all. There's no baby there because it doesn't have the mother's chromosomes that it needs.
In a partial molar pregnancy -- which is what is this question I had -- the mother's chromosomes are there, but she gets two sets of the father's chromosomes, typically, because two sperm managed to get in there, instead of just the one. This again causes problems with the placental cells' development and the development of the baby itself. It's very chromosomally abnormal, and it doesn't usually survive.
So this happening, seems at this point to be relatively random. Molar pregnancies are more common in very young women, like in their early teens, and in women over the age of 40. Molar pregnancies that are complete are about one in 1000. And it's even more rare for partial molar pregnancies. So, I don't know that there's anything you can do to prevent that from happening. Because it's just a deviation from the normal conception process that happens when the sperm is meeting the egg. You can't really control that.
Chemical pregnancies -- there can be a variety of reasons for that -- a chemical pregnancy is when sperm and the egg meet. And they implant, so they join and then you have implantation. And it may be just enough for a pregnancy test to pick up as positive, but it's a transient positive -- miscarriage happens very soon after. In most cases, if women aren't tracking, it just will seem like a regular period. They're very very, very short lived pregnancies. We think that most of the time with chemical pregnancies, again, that it's a genetic or chromosomal issue; although, there are many reasons for early miscarriage.
One thing you could try doing is there are various diets out there that are supposed to be help you nurture your eggs. All of the eggs in your ovaries are in a kind of primordial state. You have all the eggs in your ovaries -- like in your ovaries -- when you are in your mother's womb. They are there already, but they can't be fertilized. They have to go through a maturation process before they can be released and fertilized. And this process actually takes a long time -- it actually takes months, interestingly enough -- it's a very slow process. So, there are some diets out there that are aimed towards helping developing a healthy egg batch that you could look at. You could look at other reasons for early miscarriage. If you have repeated early miscarriages, it's worth seeing your doctor. Again, there's a progesterone issue that could be there. But there's a whole range of other things, like mild inflammation in the uterus. Some people look at MTHFR mutations . . . a whole range of things that the medical profession will know about. So, you can look at that. But unfortunately, with molar pregnancies, there's very little that we can do. The reproduction is still -- we know a lot more about it than we used to -- but it's still very much a mystery in some senses. And when things go wrong, we don't always know why.
Someone is wondering about her chances when her AMH is only 2.7 and she's 40. She's thinking about IVF.
AMH is just one indicator. That's what I want to say: it's just one indicator. There are some questions about how useful of an indicator it is in chances of conceiving. The age that women go into menopause varies a lot. So anything between -- something like, off the top of my head, I think it was 35 to 60 . . . but usually, the average age hovers around about 51. And usually by 55 women are no longer fertile, like the vast majority of women. I know that fertility does decline, and a lot of people say 35. But it does not drop off a cliff at the age of 35. A lot of women are panicking unnecessarily when they hit 35. But it doesn't drop off a cliff. There's a slower decrease. Very slow. Once you get over the age of 40, that decrease is much more noticeable.
So if you wanted to try for a baby, then seize the day. I can't speak to IVF, that is outside my purview. I know that IVF success statistics, especially for older women over the age of 40 are not great. So, it would be a consideration as to whether you wanted to pursue that route or whether you wanted to pursue a more natural route, like as intensively as possible. There are functional medicine doctors, there are reproductive endocrinologists, there are the napro physicians . . . there are a whole heap of people that would be thrilled to try to help with the natural conception -- and depending on your circumstances, that can be as effective or more effective than IVF. So, it's definitely something to investigate. But you'll need to really receive personalized advice on where your body is at.
Fantastic, and I think that was about it! Thank you everybody for all of your questions. Amazing! And thank you for your very thorough answers, Mikayla.
You're very welcome. This was a great selection of questions. It really kept me on my toes.
And you did great. And if you would like to meet personally with Mikayla to go over your charts, any further or personalized questions you have, you can find her right in the Premom app. If you go into the "More section" and "Schedule a Consultation", you can find her under fertility awareness method professionals. And go from there. So thank you again Mikayla.
You are welcome Teri. My pleasure.