Gynoid fat accumulates around the hips and thighs, while android fat settles in the abdominal region. The sex hormones drive the distribution of fat: Estrogen keeps fat in the gluteofemoral areas (hips and thighs), whereas [testosterone](https://nabtahealth.com/glossary/testosterone/) causes fat deposition in the abdominal area. Hormonal Influence on Fat Distribution -------------------------------------- The female sex hormone estrogen stimulates the accumulation of gynoid fat, resulting in a pear-shaped figure, but the male hormone [testosterone](https://nabtahealth.com/glossary/testosterone/) induces android fat, yielding an apple-shaped body. Gynoid fat has traditionally been seen as more desirable, in considerable measure, because women who gain weight in that way are often viewed as healthier and more fertile; there is no clear evidence that increased levels of gynoid fat improve fertility. Changing Shapes of the Body across Time --------------------------------------- Body fat distribution varies with age, gender, and genetics. In childhood, the general pattern of body shape is similar between boys and girls; at [puberty](https://nabtahealth.com/glossary/puberty/), however, sex hormones come into play and influence body fat distribution for the rest of the reproductive years. Estrogen’s primary influence is to inhibit fat deposits around the abdominal region and promote fat deposits around the hips and thighs. On the other hand, [testosterone](https://nabtahealth.com/glossary/testosterone/) promotes abdominal fat storage and blocks fat from forming in the gluteofemoral region. In women, disorders like [PCOS](https://nabtahealth.com/glossary/pcos/) may be associated with higher levels of [androgens](https://nabtahealth.com/glossary/androgen/) including [testosterone](https://nabtahealth.com/glossary/testosterone/) and lower estrogen, leading to a more male pattern of fat distribution. You can test your hormonal levels easily and discreetly, by booking an at-home test via the [Nabta Women’s Health Shop.](https://shop.nabtahealth.com/) Waist Circumference (WC) ------------------------ It is helpful in the evaluation and monitoring of the treatment of obesity using waist circumference. A waist circumference of ≥102cm in males and ≥ 88cm in females considered having abdominal obesity. Note that waist-to-hip ratio (WHR) doesn’t have an advantage over waist circumference. After [menopause](https://nabtahealth.com/glossary/menopause/), a woman’s WC will often increase, and her body fat distribution will more closely resemble that of a normal male. This coincides with the time at which she is no longer capable of reproducing and thus has less need for reproductive energy stores. Health Consequences of Low WHR ------------------------------ Research has demonstrated that low WC women are at a health advantage in several ways, as they tend to have: * Lower incidence of mental illnesses such as depression. * Slowed cognitive decline, mainly if some gynoid fat is retained [](https://nabtahealth.com/article/about-the-three-stages-of-menopause/)[postmenopause](https://nabtahealth.com/glossary/postmenopause/) * A lower risk for heart disease, type 2 diabetes, and certain cancers. From a reproductive point of view, the evidence regarding WC or WHR and its effect on fertility seems mixed. Some studies suggest that low WC or WHR is indeed associated with a regular menstrual cycle and appropriate amounts of estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) during [ovulation](https://nabtahealth.com/glossary/ovulation/), which may suggest better fecundity. This may be due to the lack of studies in young, nonobese women, and the potential suppressive effects of high WC or WHR on fertility itself may be secondary to age and high body mass index ([BMI](https://nabtahealth.com/glossary/bmi/)). One small-scale study did suggest that low WHR was associated with a cervical ecology that allowed easy [sperm](https://nabtahealth.com/glossary/sperm/) penetration, but that would be very hard to verify. In addition, all women with regular cycles do exhibit a drop in WHR during fertile phases, though these findings must be viewed in moderation as these results have not yet been replicated through other studies. Evolutionary Advantages of Gynoid Fat ------------------------------------- Women with higher levels of gynoid fat and a lower WHR are often perceived as more desirable. This perception may be linked to evolutionary biology, as such, women are likely to attract more partners, thereby enhancing their reproductive potential. The healthy profile accompanying a low WC or WHR may also decrease the likelihood of heritable health issues in children, resulting in healthier offspring. Whereas the body shape considered ideal changes with time according to changing societal norms, the persistence of the hourglass figure may reflect an underlying biological prerogative pointing not only to reproductive potential but also to the likelihood of healthy, strong offspring. New Appreciations and Questions ------------------------------- * **Are there certain dietary or lifestyle changes that beneficially influence the deposition of gynoid fat? ** Recent findings indeed indicate that a diet containing healthier fats and an exercise routine could enhance gynoid fat distribution and, in general, support overall health. * **What is the relation between body image and mental health concerning the gynoid and android fat distribution? ** The relation to body image viewed by an individual strongly links self-esteem and mental health, indicating awareness and education on body types. * **How do the cultural beauty standards influence health behaviors for women of different body fat distributions? ** Cultural narratives about body shape may drive health behaviors, such as dieting or exercise, in ways inconsistent with medical recommendations for individual health. **References** 1.Shin, H., & Park, J. (2024). Hormonal Influences on Body Fat Distribution: A Review. Endocrine Reviews, 45(2), 123-135. 2.Roberts, J. S., & Meade, C. (2023). The Effects of WHR on Health Outcomes in Women: A Systematic Review. Obesity Reviews, 24(4), e13456. 3.Chen, M. J., & Li, Y. (2023). Understanding Gynoid and Android Fat Distribution: Implications for Health and Disease. Journal of Women’s Health, 32(3), 456-467. 4.Hayashi, T., et al. (2023). Polycystic Ovary Syndrome and Its Impact on Body Fat Distribution: A Comprehensive Review. Frontiers in Endocrinology, 14, 234-241. 5.O’Connor, R., & Murphy, E. (2023). Sex Hormones and Fat Distribution in Women: An Updated Review. [Metabolism](https://nabtahealth.com/glossary/metabolism/) Clinical and Experimental, 143, 155-162. 6.Thomson, R., & Baker, M. (2024). Body Image, Self-Esteem, and Mental Health: The Role of Fat Distribution. Health Psychology Review, 18(1), 45-60. 7.Verma, P., & Gupta, A. (2023). Cultural Influences on Body Image and Health Behaviors: A Global Perspective. International Journal of Environmental Research and Public Health ([MDPI](https://www.mdpi.com/journal/ijerph)), 20(5), 3021.
Autoimmune diseases cause the body’s own immune system to generate auto-antibodies that attack and destroy healthy body tissue by mistake. The most common autoimmune diseases include rheumatoid arthritis, thyroid disease and [lupus](https://nabtahealth.com/glossary/lupus/). Many are associated with increased risk of miscarriages and [infertility](https://nabtahealth.com/glossary/infertility/). The reasons for this are not fully understood and differ between diseases, but are thought to be due to the altered immune response causing [inflammation](https://nabtahealth.com/glossary/inflammation/) of the [uterus](https://nabtahealth.com/glossary/uterus/) and [placenta](https://nabtahealth.com/glossary/placenta/). Medications commonly prescribed for autoimmune diseases can also affect reproductive function. Conditions that are known to impact fertility, such as premature ovarian insufficiency ([POI](https://nabtahealth.com/glossary/poi/)), [](https://nabtahealth.com/what-is-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [polycystic ovary syndrome](https://nabtahealth.com/what-is-pcos/) ([PCOS](https://nabtahealth.com/glossary/pcos/)) are thought to have an autoimmune component. An underlying autoimmune disease (most commonly of the thyroid and adrenal glands) has been identified in approximately 20% of patients with [POI](https://nabtahealth.com/glossary/poi/) and autoimmune thyroiditis has been reported in 18-40% of [PCOS](https://nabtahealth.com/glossary/pcos/) women, although this varies by ethnicity. Furthermore, it is hypothesised that in the 20% or more cases of idiopathic [infertility](https://nabtahealth.com/glossary/infertility/), where no direct cause can be identified, inflammatory processes may play a role. #### Thyroid Disease Autoimmune thyroid disease is a common condition in women of childbearing age affecting 5-15% and can [lead](https://nabtahealth.com/glossary/lead/) to either an overactive (Graves’ disease, [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/)) or underactive (Hashimoto’s thyroiditis, [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/)) thyroid. Women with thyroid disease often experience menstrual cycle irregularities, so may struggle to conceive. #### [Lupus](https://nabtahealth.com/glossary/lupus/) Systemic [Lupus](https://nabtahealth.com/glossary/lupus/) Erythematosus (SLE) is a long-term autoimmune disease causing [inflammation](https://nabtahealth.com/glossary/inflammation/) of the joints, skin and other organs. SLE affects approximately 1 in 2000 women of childbearing age and diagnosis of the condition seems to correlate with a reduction in pregnancy rates. Women with SLE frequently exhibit [irregular periods](https://nabtahealth.com/why-are-my-periods-irregular/). This might be due to their medication, but there is also evidence of disease-specific effects. Women with SLE are immunocompromised and therefore at increased risk of [infection-induced](https://nabtahealth.com/causes-of-female-infertility-infection) [infertility](https://nabtahealth.com/glossary/infertility/). There is a psychosocial element, as women who are diagnosed with SLE are at increased risk of stress, depression and reduced libido, all of which can make falling pregnant more difficult. One of the most established links between SLE and [infertility](https://nabtahealth.com/glossary/infertility/) relates to the [cytotoxic](https://nabtahealth.com/glossary/cytotoxic/) drugs used to treat the condition, for example, cyclophosphamide. Taken for prolonged periods, these drugs can cause ovarian failure. #### [Celiac Disease](https://nabtahealth.com/glossary/celiac-disease/) Around 1% of women in developed countries have the autoimmune condition [celiac disease](https://nabtahealth.com/glossary/celiac-disease/), where the ingestion of gluten leads to damage in the small intestine. They are at increased risk of [infertility](https://nabtahealth.com/glossary/infertility/) and recurrent [miscarriages](https://nabtahealth.com/pregnancy-after-miscarriage/). This is likely to be due to nutritional deficiencies in their diet. Thus, women with the condition may want to consult a nutritionist prior to attempting to start a family. #### Auto-antibodies The production of [autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) is central to autoimmune disease. One in five infertile couples are diagnosed with unexplained [infertility](https://nabtahealth.com/glossary/infertility/) (UI) in which they are unable to conceive with no obvious cause. [Autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) have been found to account for some cases of UI, examples include: * Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies ([ASAs](https://nabtahealth.com/glossary/asas/)) * Antibodies against the [thyroid gland](https://nabtahealth.com/glossary/thyroid-gland/), or cellular components such as the nuclear membrane or the cell membrane (phospholipid) * Antiovarian antibodies. Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies ([ASAs](https://nabtahealth.com/glossary/asas/)) have been detected in the [cervical discharge](https://nabtahealth.com/cervical-discharge-through-the-menstrual-cycle/) of infertile women, as well as in the seminal fluid of their male partner. [ASAs](https://nabtahealth.com/glossary/asas/) bind to [](https://nabtahealth.com/everything-you-need-to-know-about-sperm/)[sperm](https://nabtahealth.com/glossary/sperm/) cells, causing them to stick together (agglutinate) resulting in [reduced movement](https://nabtahealth.com/low-sperm-motility-asthenozoospermia/) and, in many cases, reduced cervical penetration and inhibition of [implantation](https://nabtahealth.com/glossary/implantation/). However, further research is required on determining exactly how [ASAs](https://nabtahealth.com/glossary/asas/) affect fertility, as [ASAs](https://nabtahealth.com/glossary/asas/) have also been found in the cervical secretions of fertile women. The majority of studies assessing the relationship between [ASAs](https://nabtahealth.com/glossary/asas/) and [infertility](https://nabtahealth.com/glossary/infertility/) are old and have used outdated technologies which may result in false-positive results due to cross reactivity with other antibodies. The evidence of the effects of antibodies against thyroid, or cellular components such as the nuclear membrane or phospholipid and antiovarian antibodies on fertility, like [ASAs](https://nabtahealth.com/glossary/asas/) is conflicted and requires further research. Furthermore, how antibodies can cause [infertility](https://nabtahealth.com/glossary/infertility/) is not fully understood, and all studies suggesting a link are more about association with [autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) rather than a cause. Anti-[oocyte](https://nabtahealth.com/glossary/oocyte/) antibodies also exist, but these seem to be a lot less common.Anti-ovarian antibodies have been detected in women with [](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate)[POI](https://nabtahealth.com/glossary/poi/). They are associated with anti-follicle-stimulating hormone ([FSH](https://nabtahealth.com/glossary/fsh/)) antibodies. [FSH](https://nabtahealth.com/glossary/fsh/) is involved in regulating ovarian function. [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-infection) [Infertility](https://nabtahealth.com/glossary/infertility/) – Infection ([PID](https://nabtahealth.com/glossary/pid/) and [HPV](https://nabtahealth.com/glossary/hpv/)) [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-environmental-lifestyle-factors) [Infertility](https://nabtahealth.com/glossary/infertility/) – Environmental/Lifestyle Factors Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#671e060b0b062709060513060f02060b130f4904080a) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Brazdova, A, et al. “Immune Aspects of Female [Infertility](https://nabtahealth.com/glossary/infertility/).” International Journal of Fertility & Sterility , vol. 10, no. 1, 2016, pp. 1–10. * Domniz, N and Meirow, D, “Premature ovarian insufficiency and autoimmune diseases” Best Practice & Research Clinical Obstetrics & Gynaecology, vol 60, Oct 2019, pp 42-55. doi.org/10.1016/j.bpobgyn.2019.07.008. * Hickman, R A, and C Gordon. “Causes and Management of [Infertility](https://nabtahealth.com/glossary/infertility/) in Systemic [Lupus](https://nabtahealth.com/glossary/lupus/) Erythematosus .” Rheumatology, vol. 50, no. 9, Sept. 2011, pp. 1551–1558., doi:10.1093/rheumatology/ker105. * Khizroeva, J et al, “[Infertility](https://nabtahealth.com/glossary/infertility/) in women with systemic autoimmune diseases” Best Practice & Research Clinical Endocrinology & [Metabolism](https://nabtahealth.com/glossary/metabolism/), vol 33, Dec 2019, doi.org/10.1016/j.beem.2019.101369. * Kim, N Y et al. “Thyroid autoimmunity and its association with cellular and humoral immunity in women with reproductive failures.” American Journal of reproductive immunology, vol. 65, no. 1, Jan. 2011, pp. 78-87. doi: 10.1111/j.1600-0897.2010.00911.x. * Lebovic and Naz, “Premature ovarian failure: Think ‘autoimmune disorder’”, Sexuality, Reproduction & [Menopause](https://nabtahealth.com/glossary/menopause/), vol. 2, no. 4, Dec 2004, pp.230-233. https://doi.org/10.1016/j.sram.2004.11.010. * McCulloch, F. “Natural Treatments for Autoimmune [Infertility](https://nabtahealth.com/glossary/infertility/) Concerns.” American College for Advancement in Medicine, 29 Jan. 2014, [www.acam.org/blogpost/1092863/179527/Natural-Treatments-for-Autoimmune-](http://www.acam.org/blogpost/1092863/179527/Natural-Treatments-for-Autoimmune-Infertility-Concerns)[Infertility](https://nabtahealth.com/glossary/infertility/)\-Concerns. * Romitti, M et al. “Association between [PCOS](https://nabtahealth.com/glossary/pcos/) and autoimmune thyroid disease: a systematic review and meta-analysis.” Endocrine connections, vol 7, no. 11, Oct 2018, pp 1158-1167. doi: 10.1530/EC-18-0309. * Shigesi, N et al, “The association between [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and autoimmune diseases: a systematic review and meta-analysis.” Human Reproduction Update, vol. 25, no. 4, Jul 2019, pp 486-503. doi: 10.1093/humupd/dmz014. * “What Are Some Possible Causes of Female [Infertility](https://nabtahealth.com/glossary/infertility/)? .” National Institutes of Health, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female)[infertility](https://nabtahealth.com/glossary/infertility/)/conditioninfo/causes/causes-female.
* Charting your basal body temperature (BBT) is a way to understand where you are in your menstrual cycle, helping you to predict the exact point of [ovulation](https://nabtahealth.com/glossary/ovulation/). * Basal body temperature is your body temperature when it is at rest and it increases by around 0.3 – 0.6°C during [ovulation](https://nabtahealth.com/glossary/ovulation/). * Measuring basal body temperature can be done orally, vaginally or rectally and is best taken each morning, after sleep. * Vaginal monitoring is the most precise method with 99% accuracy and can be done using the [OvuSense vaginal thermometer](https://nabtahealth.com/product/cycle-monitoring-with-ovusense/) alongside the [Nabta app.](https://nabtahealth.com/our-platform/nabta-app) A woman’s menstrual cycle lasts from the first day of menstruation to the day before her next period starts. For women who have a very regular 28 day cycle, [ovulation](https://nabtahealth.com/glossary/ovulation/) will usually occur around day 15, which is approximately 2 weeks before the start of the next menstrual cycle. However, a ‘normal’ menstrual cycle can vary from 21 to 40 days, so determining the exact point at which [ovulation](https://nabtahealth.com/glossary/ovulation/) occurs is not that simple. It is, however, possible to use physiological cues (the way the body functions) to determine the likely start of [ovulation](https://nabtahealth.com/glossary/ovulation/); the body produces certain physical signs in response to fluctuating hormone levels and by accurately monitoring these, you may be able to deduce when you are most fertile. Approaches such as [observing cervical mucus](../cervical-discharge-through-the-menstrual-cycle) and measuring Basal Body Temperature (BBT) are types of fertility awareness-based methods that can be used for natural family planning. #### What is Basal Body Temperature? BBT is the temperature of the person at rest. During [ovulation](https://nabtahealth.com/glossary/ovulation/), the BBT usually rises by 0.3 – 0.6°C (0.5 – 1.0°F). By accurately recording the BBT every day, a woman may be able to determine if and when [ovulation](https://nabtahealth.com/glossary/ovulation/) occurred. Typical temperature fluctuations during a normal cycle: * The follicular phase of the cycle is the time before [ovulation](https://nabtahealth.com/glossary/ovulation/). BBT is influenced by [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels are low. Normal BBT range: 36.4 – 36.8°C (97 – 98°F). * One day before [ovulation](https://nabtahealth.com/glossary/ovulation/) there is a peak in luteinising hormone. BBT reaches its lowest point, known as the nadir. * After [ovulation](https://nabtahealth.com/glossary/ovulation/), [progesterone](https://nabtahealth.com/glossary/progesterone/) levels increase up to 10-fold.Temperature increases 0.3 – 0.6°C (0.5 – 1.0°F) and typically remains above 37°C for the next 10-14 days. This is known as the luteal phase of the cycle. * If fertilisation does not occur, [progesterone](https://nabtahealth.com/glossary/progesterone/) levels and BBT both reduce 1-2 days before menstruation starts. [](https://nabtahealth.com/wp-content/uploads/2019/09/Charting-Your-Basal-Body-Temperature-300x224-1.webp) It is important to always measure BBT in the same way, orally, vaginally, or rectally, using the same thermometer. Measuring under the armpit is not considered to be accurate enough. The best time to record BBT is first thing in the morning before undertaking any physical activity. Ideally, BBT measurements should be taken after at least 3-4 hours sleep. BBT can be affected by increased stress, illness, medication use, alcohol consumption and changes in time zone/circadian rhythm. It is not recommended to take measurements if you are using hormonal contraceptives, as the synthetic hormones will disrupt the normal ovulatory cycle. #### What can you use basal body temperature for? As a means of contraception, recording BBT is not without its drawbacks. At best it predicts peak fertility, with the rise in temperature indicating that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred. To completely avoid pregnancy, a female would need to abstain from intercourse from the start of menstruation until 3-4 days after the rise in BBT. The most valuable use for BBT plotting is perhaps as a tool for determining the best time to have intercourse if trying to conceive. For those women who have regular periods, measuring BBT for 3-4 cycles can give a fairly accurate prediction of which days they are most fertile. Male [sperm](https://nabtahealth.com/glossary/sperm/) can survive for 5-7 days inside the female reproductive tract, but once [ovulation](https://nabtahealth.com/glossary/ovulation/) triggers the release of the female egg from the [ovaries](https://nabtahealth.com/glossary/ovaries/), the egg only has a 24 hour period of viability. This means that a female is fertile from 5 days before [ovulation](https://nabtahealth.com/glossary/ovulation/), to 2 days afterwards. Outside of this window, she cannot conceive. By the time the BBT spike is seen, the female is reaching the end of her fertile period for that month. #### Can measuring basal body temperature help fertility? The major benefits to using BBT to identify [ovulation](https://nabtahealth.com/glossary/ovulation/) are that it is low-cost, easily accessible (the only equipment you need are a thermometer and chart paper to plot your readings) and non-invasive. One means of improving the efficacy of BBT is to combine it with other fertility awareness-based methods, such as the cervical mucus method. This method is based on the theory that cervical secretions change throughout the menstrual cycle. Using these two approaches in combination is known as the symptothermal approach. BBT can also be tracked alongside using our [OvuSense device](https://nabtahealth.com/products/ovusense/), which is a realtime fertility monitor, aimed to predict [ovulation](https://nabtahealth.com/glossary/ovulation/) with 99% accuracy. The benefits of tracking your basal body temperature ---------------------------------------------------- Tracking your basal body temperature (BBT) is a simple and effective way to gain insights into your menstrual cycle and fertility. BBT is the lowest body temperature that you experience during a 24-hour period, and it can be measured using a basal body thermometer. By taking your temperature every morning at the same time and recording it, you can create a chart that shows any changes in your BBT throughout your menstrual cycle. **There are several benefits to tracking your BBT, including:** 1. Identifying [ovulation](https://nabtahealth.com/glossary/ovulation/): Your BBT typically rises slightly during [ovulation](https://nabtahealth.com/glossary/ovulation/), which is when an egg is released from the [ovaries](https://nabtahealth.com/glossary/ovaries/) and can be fertilized. By tracking your BBT, you can identify when you are most likely to be ovulating, which can help you plan or avoid pregnancy. 2. Monitoring your menstrual cycle: By charting your BBT over time, you can get a better understanding of your menstrual cycle and how it varies from month to month. This can be helpful for identifying any changes or irregularities in your cycle, which can be a sign of underlying health issues. 3. Assessing your fertility: Your BBT can provide valuable insights into your fertility, and tracking it over time can help you and your doctor assess your overall reproductive health. For example, if your BBT remains consistently high over several cycles, it could indicate that you are not ovulating, which can affect your ability to conceive. 4. Predicting [ovulation](https://nabtahealth.com/glossary/ovulation/): By tracking your BBT and identifying when it rises, you can predict when you are most likely to ovulate and plan accordingly. This can be helpful for those who are trying to conceive or avoid pregnancy. The [Nabta App](https://nabtahealth.com/our-platform/nabta-app/) can be used to record the Basal Body Temperature and store and plot the data. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a1d8c0cdcdc0e1cfc0c3d5c0c9c4c0cdd5c98fc2cecc) if you have any questions about this article or any aspect of women’s health. We’re here for you. Don’t forget you can register [here](https://nabtahealth.com/my-account) to become a Nabta member free of charge. **Sources:** * NHS Choices, _NHS_, [https://www.nhs.uk/conditions/contraception/natural-family-planning/](https://www.nhs.uk/conditions/contraception/natural-family-planning/). * “Fertility Awareness-Based Methods of Family Planning.” ACOG, _Women’s Health Care Physicians_, [https://www.acog.org/Patients/FAQs/Fertility-Awareness-Based-Methods-of-Family-Planning](https://www.acog.org/Patients/FAQs/Fertility-Awareness-Based-Methods-of-Family-Planning). * Pallone, S. R., and G. R. Bergus. “Fertility Awareness-Based Methods: Another Option for Family Planning.” _The Journal of the American Board of Family Medicine_, vol. 22, no. 2, 2009, pp. 147–157., doi:10.3122/jabfm.2009.02.080038. * Su, Hsiu-Wei, et al. “Detection of [Ovulation](https://nabtahealth.com/glossary/ovulation/), a Review of Currently Available Methods.” _Bioengineering & Translational Medicine_, vol. 2, no. 3, 16 May 2017, pp. 238–246., doi:10.1002/btm2.10058.
A man will be diagnosed with a low [sperm](https://nabtahealth.com/glossary/sperm/) count if his semen sample contains fewer than 15 million [sperm](https://nabtahealth.com/glossary/sperm/) per milliliter. The medical term for this condition is oligozoospermia and it is one [reason for male](../causes-of-male-infertility) [infertility](https://nabtahealth.com/glossary/infertility/). Establishing the [prevalence of male](https://nabtahealth.com/articles/why-is-it-so-difficult-to-establish-the-prevalence-of-male-infertility/) [infertility](https://nabtahealth.com/glossary/infertility/) is challenging. However, abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production, including low [sperm](https://nabtahealth.com/glossary/sperm/) counts, is considered to be one of the major contributing factors. Having a low [sperm](https://nabtahealth.com/glossary/sperm/) count does reduce the odds of a couple falling pregnant. However, it can still happen; after all, it only takes a single [sperm](https://nabtahealth.com/glossary/sperm/) to fertilise an egg. A female can only fall pregnant if she ovulates, which is the process by which an egg is released from the ovary. This happens about midway through her menstrual cycle; for a woman with a 28 day cycle, [ovulation](https://nabtahealth.com/glossary/ovulation/) will occur around day 15. This is when she is at her most fertile and conception is most likely to occur. However, [sperm](https://nabtahealth.com/glossary/sperm/) can survive for approximately five days inside the female body. For those who wish to maximise their chances of conceiving, it is worth having intercourse every day. That is, from at least four days prior to the expected date of [ovulation](https://nabtahealth.com/glossary/ovulation/). The released egg is only viable for fertilisation for 12-24 hours after [ovulation](https://nabtahealth.com/glossary/ovulation/). Intercourse after this time will not result in pregnancy. ##### Methods used; There are methods available to assist a female in determining if and when she has ovulated, including commercially available kits and the charting of [basal body temperature](https://nabtahealth.com/charting-your-basal-body-temperature-bbt/) (BBT). BBT will rise 0.5°C after [ovulation](https://nabtahealth.com/glossary/ovulation/). Knowing precisely when [ovulation](https://nabtahealth.com/glossary/ovulation/) is likely and timing intercourse accordingly, will further increase the chances of successful fertilisation. If a female’s cycles are irregular this may be more challenging. Often the cause of low [sperm](https://nabtahealth.com/glossary/sperm/) count in males is unknown, with hormones, medications, genetics and childhood conditions all thought to play a role. To further increase the likelihood of pregnancy without medical intervention, men may be encouraged to make certain [lifestyle changes](../environmental-factors-that-contribute-to-male-infertility). It is important to treat underlying medical conditions. Adopting a [better diet](../do-vitamins-and-other-nutritional-products-improve-sperm-count) and avoiding alcohol and smoking can help. Seeking help for the management of medical issues, such as [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/), genital infections and hormonal irregularities. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#463f272a2a270628272432272e23272a322e6825292b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Low [Sperm](https://nabtahealth.com/glossary/sperm/) Count.” _Mayo Clinic_, 18 Sept. 2018, www.[mayoclinic](https://www.mayoclinic.org/).org/diseases-conditions/low-[sperm](https://nabtahealth.com/glossary/sperm/)\-count/diagnosis-treatment/drc-20374591. * Sengupta, P, et al. “The Disappearing Sperms: Analysis of Reports Published Between 1980 and 2015.” _American Journal of Men’s Health_, vol. 11, no. 4, July 2017, pp. 1279–1304., doi:10.1177/1557988316643383.
Diagnosed with Azoospermia will be made if no spermatozoa ([sperm](https://nabtahealth.com/glossary/sperm/) cells) are detected in two semen samples, taken 2-3 months apart. Azoospermia affects approximately 15% of infertile men and, if unexpected, can be quite an upsetting diagnosis to come to terms with. Fortunately, advances in modern medicine mean that a significant number of men who are in this position go on to successfully father children. Before determining which treatment will be most suitable, it is first important to establish whether it is a case of obstructive azoospermia (OA) or non-obstructive azoospermia (NOA). **Obstructive Azoospermia (OA)** -------------------------------- OA, affecting up to 40% of men with azoospermia, occurs when part of the reproductive tract is blocked. The testes are usually normal sized and hormone levels are in the normal range. The blockage can be acquired, for example by previous vasectomy or by surgery or trauma to that area of the body; or it can be congenital. The most well-known example of congenital [infertility](https://nabtahealth.com/glossary/infertility/) is due to [](../causes-of-male-infertility)[Cystic Fibrosis](https://nabtahealth.com/glossary/cystic-fibrosis/). Depending on the part of the reproductive tract affected, reconstructive surgery is an option. Blockages in the [epididymis](https://nabtahealth.com/glossary/epididymis/) or [vas deferens](https://nabtahealth.com/glossary/vas-deferens/) can be treated with vasoepididymostomy or vasovasostomy (also known as a reverse vasectomy). Obstruction of the ejaculatory duct can be treated with transurethral resection of the ducts, whereby a small incision is made in the ejaculatory duct, enabling [sperm](https://nabtahealth.com/glossary/sperm/) to reach the semen. In some cases, even if blockage removal appears to have been successful, additional techniques are implemented to aid fertilisation because the [sperm](https://nabtahealth.com/glossary/sperm/) is prone to poor [](../low-sperm-motility-asthenozoospermia)[motility](https://nabtahealth.com/glossary/motility/). If reconstructive techniques are not suitable or do not work, [sperm](https://nabtahealth.com/glossary/sperm/) retrieval techniques might be attempted. Examples include: – TESE: testicular [sperm](https://nabtahealth.com/glossary/sperm/) extraction – TFNA: testicular fine needle aspiration – PESA: percutaneous epididymal [sperm](https://nabtahealth.com/glossary/sperm/) aspiration – MESA: microsurgical epididymal [sperm](https://nabtahealth.com/glossary/sperm/) aspiration. The choice of technique largely depends on patient preference as well as local expertise. If initial attempts do not yield sufficient [sperm](https://nabtahealth.com/glossary/sperm/), the doctor can try to extract from an alternative location, often at the same time, meaning additional procedures are kept to a minimum. [Sperm](https://nabtahealth.com/glossary/sperm/) retrieval is successful in over 90% of OA cases. Once extracted the [sperm](https://nabtahealth.com/glossary/sperm/) can be used directly for intracytoplasmic [sperm](https://nabtahealth.com/glossary/sperm/) injection (ICSI) or cryopreserved for use at a later date. **Non-obstructive Azoospermia (NOA)** ------------------------------------- NOA usually occurs as a result of a testicular deficiency. The underlying pathologies are varied and include genetic and congenital abnormalities, [](../what-are-varicoceles)[varicoceles](https://nabtahealth.com/glossary/varicoceles/) (enlarged testicular veins), hormonal disorders, medications and toxin exposure. Often men with NOA will have abnormal testes and/or hormone levels. NOA is sometimes associated with specific microdeletions in the Y chromosome (AZFa and AZFb) that have a particularly poor prognosis in terms of [sperm](https://nabtahealth.com/glossary/sperm/) retrieval. Therefore, genetic testing for microdeletions in this region may be offered to these men to determine the likelihood of finding viable [sperm](https://nabtahealth.com/glossary/sperm/) prior to them undergoing any additional procedures. Men with NOA have fewer options available to them. Not all of the [sperm](https://nabtahealth.com/glossary/sperm/) retrieval techniques are suitable, but TESE can be used. If this is unsuccessful, microsurgical testicular [sperm](https://nabtahealth.com/glossary/sperm/) extraction (micro-TESE) can be attempted. This method requires a skilled practitioner and a general anaesthetic, but the advantages are that blood supply is preserved and the surgeon can deliberately identify and select larger [seminiferous tubules](https://nabtahealth.com/glossary/seminiferous-tubules/), i.e. those more likely to contain [sperm](https://nabtahealth.com/glossary/sperm/). [Sperm](https://nabtahealth.com/glossary/sperm/) is found in 40-50% of men with NOA, including men who are azoospermatic as a result of previous [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Those men who have been diagnosed with concurrent [varicoceles](https://nabtahealth.com/glossary/varicoceles/) might want to consider undergoing a varicoceletomy, as this has been shown to improve ejaculate [sperm](https://nabtahealth.com/glossary/sperm/) levels in 20-55% of men with NOA. Ideally, [sperm](https://nabtahealth.com/glossary/sperm/) that is extracted from a man with NOA should be used fresh, as freeze-thawing compromises its stability and viability. When compared to OA [sperm](https://nabtahealth.com/glossary/sperm/), NOA [sperm](https://nabtahealth.com/glossary/sperm/) is more susceptible to DNA damage. Men who do have a genetic condition need to consider carefully the chances of passing it on to their offspring if they do undergo additional fertility treatment using their own [sperm](https://nabtahealth.com/glossary/sperm/). **Assisted Reproductive Techniques (ARTs)** ------------------------------------------- Once [sperm](https://nabtahealth.com/glossary/sperm/) is extracted the next step is to attempt to fertilise the female’s egg. The most well-known [ART](https://nabtahealth.com/glossary/art/) is in vitro fertilisation ([IVF](https://nabtahealth.com/glossary/ivf/)). During [IVF](https://nabtahealth.com/glossary/ivf/) the female’s eggs are extracted and mixed with her partner’s [sperm](https://nabtahealth.com/glossary/sperm/) in a petri dish. Once fertilised the eggs are placed back into the female’s [uterus](https://nabtahealth.com/glossary/uterus/). ICSI is a variant of [IVF](https://nabtahealth.com/glossary/ivf/) that involves injecting a single [sperm](https://nabtahealth.com/glossary/sperm/) into an egg. This is ideal in cases where only small quantities of usable [sperm](https://nabtahealth.com/glossary/sperm/) could be harvested using the techniques described above. ICSI fertilisation rates are 45-75% for OA and 20-65% for NOA. Live birth rates following successful ICSI fertilisation are 18-55% for OA and 8-35% for NOA. Whilst these figures may still seem low it is worth considering that advances in reproductive medicine are progressing rapidly and, prior to the development of microsurgical techniques and ICSI, men with NOA would have had no chance of fathering their own children, having to rely instead on donor insemination. Whilst azoospermia can seem like a fairly intimidating diagnosis, it is important to remember that lack of [sperm](https://nabtahealth.com/glossary/sperm/) does not equal complete sterility. Many men still produce [sperm](https://nabtahealth.com/glossary/sperm/) and the techniques for harvesting it are becoming more refined and as a result more effective. Regardless, both OA and NOA may benefit from surgical procedures to correct the problem. If surgery is successful, there is a good chance that fertilisation will be able to occur through normal intercourse, avoiding the need for stressful, costly [ART](https://nabtahealth.com/glossary/art/). It is important to consider that [ART](https://nabtahealth.com/glossary/art/) can be very stressful for the female as she undergoes artificial hormonal induction to retrieve eggs. All options should be discussed with a doctor, prior to making a decision. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#b3cad2dfdfd2f3ddd2d1c7d2dbd6d2dfc7db9dd0dcde) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Esteves, S C, et al. “[Sperm](https://nabtahealth.com/glossary/sperm/) Retrieval Techniques for Assisted Reproduction.” _International Braz J Urol_, vol. 37, no. 5, 2011, pp. 570–583. * Katz, D J, et al. “Male [Infertility](https://nabtahealth.com/glossary/infertility/) – The Other Side of the Equation.” _Australian Family Physician_, vol. 46, no. 9, Sept. 2017, pp. 641–646. * Jungwirth A, et al. _European Association of Urology (EAU)_ guidelines on male [infertility](https://nabtahealth.com/glossary/infertility/). Arnhem, The Netherlands: European Association of Urology, 2015. Available at [https://uroweb.org/wp-content/uploads/17-Male-](https://uroweb.org/wp-content/uploads/17-Male-Infertility_LR1.pdf)[Infertility](https://nabtahealth.com/glossary/infertility/)\_LR1.pdf \[Accessed 31 March 2019\]. * “What Is Male [Infertility](https://nabtahealth.com/glossary/infertility/)?” _Urology Care Foundation_, [www.urologyhealth.org/urologic-conditions/male-](http://www.urologyhealth.org/urologic-conditions/male-infertility)[infertility](https://nabtahealth.com/glossary/infertility/). * Wosnitzer, M, et al. “Review of Azoospermia.” _[Spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/)_, vol. 4, no. e28218, 31 Mar. 2014, doi:10.4161/spmg.28218.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
Many of us are guilty of hoarding an extensive collection of cosmetics and skincare products; some of them are favourites that we use everyday, others barely used and relegated to the back of the cupboard. How many of us though, can honestly say we know exactly what ingredients our beauty staples contain? How many of us have stopped to consider that many of these products are full of chemicals, things added to extend the shelf-life, or keep our make-up from sliding off our face? Do we ever stop to question what these additives and preservatives might be doing elsewhere in our body? #### **What are [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/)?** [Endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) are attracting more attention globally, not least because they are found in so many products we use on a daily basis, including personal care items and cosmetics. They are environmental chemicals that mimic or block hormone action; sometimes by binding to the sites that endogenous hormones are supposed to bind to, sometimes by preventing the synthesis or [metabolism](https://nabtahealth.com/glossary/metabolism/) of these hormones. Reproduction is a process regulated by hormones and, as such, it is susceptible to the negative effects of endocrine disrupting chemicals. These can manifest as subfertility, [infertility](https://nabtahealth.com/glossary/infertility/), menstrual cycle irregularities, [anovulation](https://nabtahealth.com/glossary/anovulation/) and impaired [oocyte](https://nabtahealth.com/glossary/oocyte/) (and [sperm](https://nabtahealth.com/glossary/sperm/)) quality. The exact mechanisms by which [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) impede fertility are unclear; however, as our awareness of how widespread these chemicals are grows and as [infertility](https://nabtahealth.com/glossary/infertility/) rates continue to rise, perhaps a deeper understanding is needed. #### **Which chemicals should I look out for in my products?** One of the problems with [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) is that there are a large number of them and avoiding them altogether may prove difficult. Particularly as identifying which, in a sometimes very long and very unpronounceable list, are the questionable ingredients. Many of the [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) found in beauty products are non-persistent, meaning they are removed from the body rapidly, thus there is no build-up effect. However, repeated usage of the same products, over a prolonged time period, means exposure can be consistent and long-term. Here we present a list of some of the [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) most commonly found in cosmetics and personal hygiene products. It is fair to say that the data is minimal for the vast majority of these and definitive conclusions are lacking, but we will attempt to provide a summary of the information that is currently available. #### **Phthalates** These are found in personal care products. In the case of cosmetics, most phthalates enter the body via dermal absorption, i.e. through the skin. Animal studies have suggested that high dose phthalates lower [oestrogen](https://nabtahealth.com/glossary/oestrogen/) levels and inhibit [ovulation](https://nabtahealth.com/glossary/ovulation/), but there is no equivalent data in humans. Human studies have predominantly focused on couples undergoing [IVF](https://nabtahealth.com/glossary/ivf/), where higher phthalate exposure seems to correlate with a lower [oocyte](https://nabtahealth.com/glossary/oocyte/) yield. One study found that increased phthalates in the urine, correlated with a reduced follicle count. However, this could not be replicated in other work. Time To Pregnancy (TTP) is a marker of fecundability. When exploring the effects of phthalates, TTP has varied across different studies. There was even some evidence that certain phthalates reduced the TTP. Furthermore, effects were not always consistent between men and women, so in future studies it would be important to assess the exposure levels of both members of a couple. Overall, there is currently insufficient data on which to draw definitive conclusions. #### **Triclosan (TCS) and triclocarbon (TCC)** TCS and TCC are [antimicrobials](https://nabtahealth.com/glossary/antimicrobials/) found in soaps and personal hygiene products, such as toothpaste and deodorant. Exposure is via dermal absorption and ingestion and, growing concerns over their potential safety profile has led to their use in consumer products being regulated by the Food and Drug Administration ([FDA](https://nabtahealth.com/glossary/fda-2/)) in the USA. Animal studies have suggested that TCS may be anti-oestrogenic, that it disrupts the synthesis of [LH](https://nabtahealth.com/glossary/lh/) and [FSH](https://nabtahealth.com/glossary/fsh/) and that its presence correlates with lower ovarian and uterine weight. Studies in humans are limited, but high levels correlate with poorer [IVF](https://nabtahealth.com/glossary/ivf/) outcomes and it can affect [sperm](https://nabtahealth.com/glossary/sperm/) quality in males. There is currently no data showing any link between TCS or TCC and TTP. #### **Benzophenones** Benzophenones are added to products to extend their lifespan by providing protection from UV light. They are found in sunscreen, lipstick, hairspray and body lotions and, therefore, usually enter the body via the skin. Concerns about their effects on fertility came from _in vitro_ (cell culture) studies and animal work where they were shown to have oestrogenic-like activity and affect menstrual cycle length in rats. To date, there has been no work supporting these findings in humans and the only study looking at TTP was performed on males. Whilst the experimental data is currently lacking, the knowledge that the metabolites of these products can be stored in adipose (fat) tissue, extending the time in which they can exert a negative effect elsewhere in the body; warrants further research into their mechanism of action. #### **Parabens** Parabens are widely used in cosmetics because they act as preservatives. Often, more than one paraben will be added to a product, as they can act synergistically. They are very widely used; in fact, the National Health and Nutrition Examination Survey in 2005/2006 found that some of the most common parabens were detectable in more than 90% of participants. They were also found at much higher levels in women than in men. Animal studies have suggested that parabens have weak oestrogenic activity and are anti-androgenic, meaning they block the action of the [male sex hormones](https://nabtahealth.com/male-hormones-in-women/). Human studies have suggested an association between high paraben levels and shortened menstrual cycles and lower follicle counts. High exposure to particular paraben metabolites has been associated with a longer TTP, but the relationship is only seen with female exposure. Furthermore, this finding has not been replicated in other studies. #### **Glycol ethers** These are solvents that were traditionally used in an industrial setting, but are now increasingly added to personal care products such as perfume and liquid soap because they are considered to have low acute toxicity. There are more than 30 glycol ethers in use, all with differing properties and toxicities. Most work to date has involved occupational studies, whereby those working in the semiconductor industry reported disrupted menstrual cycles and an increased risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/). Animal studies have suggested that various glycol ethers have an adverse effect on ovarian function, but this has yet to be extrapolated to human studies. There is a possible association between high levels of exposure to certain metabolites and increased TTP, but validation of these preliminary results is necessary. #### **Conclusion** The titular question asked by this article is surprisingly difficult to answer. Could the contents of your bathroom shelf and/or make-up bag really affect your ability to conceive? Furthermore, when we are exposed to so many different chemicals in our everyday lives, is it really ever going to be possible to identify which, if any, are causing us actual, measurable harm? In researching this topic, it soon became abundantly clear that there are significant gaps in our knowledge and many unanswered questions remain: * Where multiple [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) are present in the same product, do they have a synergistic or cumulative effect? * The ability to successfully produce live offspring (fecundability) is complex and couple-dependent. Males will also be exposed to [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) in their daily lives, how much of an effect does this exposure have on a couple’s fertility? Are the chemicals typically the same, or different; and could things that are relatively harmless to females, have a more drastic effect on the male reproductive system? * The conclusions we are trying to make at this stage are largely based on animal studies. Those looking at human cases, tend to use the success and/or failure rate of [IVF](https://nabtahealth.com/glossary/ivf/) as a measure. There is a need for more studies designed to look at TTP, using environmentally-relevant doses of chemicals. So where does this leave us? Preliminary work provides few definitive conclusions, but certainly raises awareness of just how widely used some of these chemicals are. Perhaps it is time we all made a switch away from chemically-laden products with incomplete safety profiles? Whilst the data remains inconclusive from a scientifically significant perspective, the fact is that more and more people want to understand exactly what ingredients are in the products they are using. So much so, that there are a growing number of ‘clean beauty’ products available; products that promote their use of natural, chemical-free ingredients. Taking care of the skin is one of the most important part of a good and healthy lifestyle, try Nabta’s [Cystic acne pack](https://nabtahealth.com/product/cystic-acne-luxury-selfcare-pack/). **Sources:** * Cho, Yeon Jean, et al. “Nonpersistent Endocrine Disrupting Chemicals and Reproductive Health of Women.” _Obstetrics & Gynecology Science_, vol. 63, no. 1, Jan. 2020, pp. 1–12., doi:10.5468/ogs.2020.63.1.1. * Hipwell, Alison E, et al. “Exposure to Non-Persistent Chemicals in Consumer Products and Fecundability: a Systematic Review.” _Human Reproduction Update_, vol. 25, no. 1, 1 Jan. 2019, pp. 51–71., doi:10.1093/humupd/dmy032. * Rattan, Saniya, et al. “Exposure to [Endocrine Disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) during Adulthood: Consequences for Female Fertility.” _Journal of Endocrinology_, vol. 233, no. 3, June 2017, pp. R109–R129., doi:10.1530/joe-17-0023. * Smarr, Melissa M., et al. “Urinary Concentrations of Parabens and Other Antimicrobial Chemicals and Their Association with Couples’ Fecundity.” _Environmental Health Perspectives_, vol. 125, no. 4, Apr. 2017, pp. 730–736., doi:10.1289/ehp189.
_Medical experts have discredited misleading claims circulating on social media falsely linking the mRNA Covid-19 vaccines with [infertility](https://nabtahealth.com/glossary/infertility/) in women_ In December 2020 two doctors, [Dr Michael Yeadon and Dr Wolfgang Wodarg](https://www.scribd.com/document/487135032/Wodarg-Yeadon-EMA-Petition-Pfizer-Trial-FINAL-01DEC2020-en-Unsigned-With-Exhibits?mc_cid=639a39a608&mc_eid=38e9f8ee6f#from_embed), wrote to the [European Medicines Agency](https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/vaccines-covid-19/covid-19-vaccines-authorised), responsible for the safety of vaccines. They called for clinical trials of the [Pfizer](https://www.pfizer.com/)/[BioNTech](https://biontech.de/) mRNA Covid-19 vaccine to be stopped, citing concerns about the vaccine’s impact on female fertility. They were apprehensive the vaccine might prevent the safe development of placentas during pregnancy and linked this with potential [infertility](https://nabtahealth.com/glossary/infertility/) in vaccinated women. Their argument was that the mRNA vaccines used against Covid-19 target a protein called syncytin-1. Syncytin-1 plays a critical role in human reproduction. The claims have been widely discredited by independent medical experts who confirm that the mRNA vaccines for Covid-19 do not target the syncytin-1 protein vital to successful pregnancies. Pfizer has said, [“there is no data to suggest the Pfizer BioNTech vaccine candidate causes](https://factcheck.afp.com/covid-19-vaccine-not-shown-cause-female-sterilization) [infertility](https://nabtahealth.com/glossary/infertility/).” Reuters Fact Check states, [“no available mRNA vaccines target a protein called syncytin-1.”](https://www.reuters.com/article/uk-factcheck-syncytin-idUSKBN2A42S7) And according to Mayo Clinic, [“there is currently no evidence that Covid vaccines cause fertility problems.”](https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vaccine/art-20484859#fertility-menstruation) #### _How do mRNA vaccines work?_ Let’s understand how mRNA vaccines work. The vaccines most of us will be familiar with are the Pfizer/BioNTech and [Moderna](https://www.modernatx.com/) Covid-19 vaccines. mRNA stands for ‘messenger’ RNA. The vaccines work by teaching our cells to make a protein like the spike protein found on the SARS-CoV-2 virus which causes Covid-19. The protein triggers an immune response in our bodies. And the immune response produces antibodies which protects us against getting the real virus if it enters our bodies. #### _So why the confusion around pregnant women, fertility and mRNA vaccines?_ The false claims about syncytin-1 stem from confusion around a short amino acid sequence: “It has been incorrectly suggested that Covid-19 vaccines will cause [infertility](https://nabtahealth.com/glossary/infertility/) because of a very short amino acid sequence in the spike protein of SARS-CoV-2 virus that is shared with the placental protein, syncytin-1,” said [Dervila Keane of Pfizer](https://factcheck.afp.com/covid-19-vaccine-not-shown-cause-female-sterilization). “The sequence, however, is too short – 4 shared amino acids – to plausibly give rise to autoimmunity. Additionally, a cohort comparing the outcomes of pregnancies with and without intercurrent SARS-CoV-2 infection shows no difference in outcomes.” #### _Advice for pregnant or breastfeeding women_ While [there is no evidence that mRNA vaccines for Covid-19 have a negative effect on female fertility,](https://www.reuters.com/article/uk-factcheck-syncytin-idUSKBN2A42S7) some of the information and guidance around pregnancy and breastfeeding and the Covid vaccines is being mixed up with fertility misinformation. The latest advice, [supported by medical bodies around the world](https://mediaoffice.ae/en/news/2021/June/29-06/DHA-starts-to-vaccine-pregnancies), is to offer Covid-19 vaccines to women at any stage of pregnancy or breastfeeding to protect them from a higher risk of severe disease if they contract the virus. For women who are trying to become pregnant or who become pregnant soon after their vaccine, there are no safety concerns. If you are unsure or have any health conditions, consider consulting a doctor for more information. You can book an [at-home doctor visit](https://nabtahealth.com/product/family-doctor-gp-home-visit/) on the Nabta Women’s Health Shop to chat about any concerns you may have if you are pregnant or breastfeeding. **Sources** Wodarg Yeadon EMA Petition Pfizer Trial FINAL, 1 Dec 2020 (function() { var scribd = document.createElement("script"); scribd.type = "text/javascript"; scribd.async = true; scribd.src = "https://www.scribd.com/javascripts/embed\_code/inject.js"; var s = document.getElementsByTagName("script")\[0\]; s.parentNode.insertBefore(scribd, s); })() Covid-19 vaccine not shown to cause female sterilization, AFP, 9 Dec 2020 [https://factcheck.afp.com/covid-19-vaccine-not-shown-cause-female-sterilization](https://factcheck.afp.com/covid-19-vaccine-not-shown-cause-female-sterilization) COVID-19 vaccines: Get the facts, Mayo Clinic [https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vaccine/](https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-vaccine/art-20484859#fertility-menstruation)[art](https://nabtahealth.com/glossary/art/)\-20484859#fertility-menstruation [https://biontech.de/](https://biontech.de/) [https://www.pfizer.com/](https://www.pfizer.com/) [https://www.modernatx.com/](https://www.modernatx.com/) DHA begins vaccinating pregnant women against COVID-19 [https://mediaoffice.ae/en/news/2021/June/29-06/DHA-starts-to-vaccine-pregnancies](https://mediaoffice.ae/en/news/2021/June/29-06/DHA-starts-to-vaccine-pregnancies)
There are a number of lifestyle and environmental factors that can influence [infertility](https://nabtahealth.com/glossary/infertility/). Lifestyle factors are, by their nature, generally modifiable. This means that for women who are struggling to conceive, making simple lifestyle adjustments could improve their likelihood of falling pregnant. Some of the most well known lifestyle factors include: #### Age Many couples are choosing to delay having children, for personal, social or economic reasons. Fertility peaks and then declines over time, so a couple needs to carefully consider when the best time to start a family is. A woman is born with all the eggs she will ever have (over 1 million), but the number of viable eggs decreases during her lifespan, and only 400–500 are actually released from the [ovaries](https://nabtahealth.com/glossary/ovaries/) during [ovulation](https://nabtahealth.com/glossary/ovulation/). With increasing age, there is a reduction in both the number and quality of eggs in the [ovaries](https://nabtahealth.com/glossary/ovaries/). The reduction in the number of eggs leads to changes in hormone levels, which further reduces a woman’s fertility. Increasing age also increases the time it takes for a woman to fall pregnant. In a European study with 782 couples, [infertility](https://nabtahealth.com/glossary/infertility/) was estimated at 8% for women aged 19-26 years, 13-14% for women aged 27-34 years and 18% for women aged 35-39 years. However, sometimes time and patience are key, and the authors concluded that many infertile couples would conceive if they tried for an additional year. #### Nutrition An improved diet can help improve fertility . Eating a [](https://nabtahealth.com/eating-to-conceive/)[folate](https://nabtahealth.com/glossary/folate/)\-rich diet of dark, leafy greens, such as spinach is a good natural way to boost fertility. In fact, the NHS in the UK recommends that women who are trying to conceive take folic acid supplements (usually 0.4 mg daily) and continue with this throughout the first 12 weeks of pregnancy, as it can be difficult to get sufficient quantities from the diet alone. Avoiding too many [trans fatty acids](https://nabtahealth.com/the-good-dietary-fat/) (TFA), will not only improve overall health and reduce the risk of heart disease; but also, improve the likelihood of falling pregnant. TFAs can adversely affect the shape and size of the [sperm](https://nabtahealth.com/glossary/sperm/) and the quality of the female [oocyte](https://nabtahealth.com/glossary/oocyte/). #### Weight Women who have a [Body Mass Index](https://nabtahealth.com/what-is-body-mass-index-bmi/) ([BMI](https://nabtahealth.com/glossary/bmi/)) over 25 are classed as obese; obese women have a greater risk of experiencing recurrent early miscarriages. Women with a high [BMI](https://nabtahealth.com/glossary/bmi/) are also at greater risk of developing type 2 diabetes and [](https://nabtahealth.com/factors-that-contribute-to-transient-pcos-like-symptoms/)[PCOS](https://nabtahealth.com/glossary/pcos/)\-like symptoms, which can also [lead](https://nabtahealth.com/glossary/lead/) to [infertility](https://nabtahealth.com/glossary/infertility/). Losing weight has been shown to improve fertility. On the other end of the spectrum, having a low [BMI](https://nabtahealth.com/glossary/bmi/) (<18.5) can also [lead](https://nabtahealth.com/glossary/lead/) to problems conceiving. Low body fat increases the risk of ovarian dysfunction and women with a history of eating disorders are more likely to experience fertility issues. #### Exercise Moderate exercise is good for you and partaking in regular physical activity has been shown to improve fertility when coupled with weight loss in obese women. However, those who exercise excessively may be reducing their chances of conceiving. Specifically, when energy demand exceeds dietary energy intake, it can result in dysfunction of the hypothalamic axis and subsequent [menstrual irregularities](https://nabtahealth.com/why-are-my-periods-irregular/). Up to 56% of exercising women experience menstrual disturbances due to low energy availability. There is evidence that female athletes are more likely to suffer from [iron](https://nabtahealth.com/glossary/iron/)\-deficient [anaemia](https://nabtahealth.com/glossary/anaemia/), which can also affect menstruation and fertility. [Iron](https://nabtahealth.com/glossary/iron/) is required for follicular development as well as endometrial thickening and a shortage can [lead](https://nabtahealth.com/glossary/lead/) to difficulty in conceiving. Ensuring that, during training, the body has time to recover and the nutrients that are lost during strenuous exercise are replaced, will alleviate some of these risk factors. #### Stress Stress can be physical or psychological, and both types may negatively impact fertility. Unfortunately, up to 30% of women who visit a fertility clinic are likely to exhibit symptoms of psychological stress, such as depression or anxiety; for some women these manifestations are directly related to their struggles to conceive, for other women they occur as a result of underlying mental health issues. Regardless of the root cause, it is probable that their inability to conceive will exacerbate the situation further. A positive mood has been shown to correlate with increased live birth rates and, conversely, rates of [oocyte](https://nabtahealth.com/glossary/oocyte/) fertilisation are reduced when stress levels are increased. The reasons why stress reduces fertility are not well understood, although the stress hormone alpha amylase has been implicated, possibly reducing blood flow to the Fallopian tube. #### Smoking According to the [World Health Organisation](https://www.who.int/tobacco/en/atlas6.pdf) (WHO), 250 million women smoke worldwide. Average rates are far higher in developed countries (22%) compared to developing countries (9%). Smoking is unhealthy on many levels, but in terms of fertility it disrupts ovarian function and reduces the ovarian reserve. Typically women that smoke go through the [](https://nabtahealth.com/about-the-three-stages-of-menopause/)[menopause](https://nabtahealth.com/glossary/menopause/) between one and four years earlier than non-smokers. Women who smoke more than 20 cigarettes a day, have [lower](https://nabtahealth.com/what-happens-if-my-progesterone-levels-are-too-low/) [progesterone](https://nabtahealth.com/glossary/progesterone/) levels during the luteal phase of their menstrual cycle, which can serve as a marker of [anovulation](https://nabtahealth.com/glossary/anovulation/). Without [ovulation](https://nabtahealth.com/glossary/ovulation/), fertilisation is not possible. Women who stop smoking double their chances of getting pregnant. The chemicals found in cigarette smoke can also compromise the uterine environment, making it inhospitable for embryo [implantation](https://nabtahealth.com/glossary/implantation/) and growth. Tobacco smoke also contains carcinogens, or cancer-causing substances. Carcinogens cause damage to DNA, which is the basic building material found in all cells of the human body, including the [germ cells](https://nabtahealth.com/glossary/germ-cells/), which give rise to male [sperm](https://nabtahealth.com/glossary/sperm/) cells and female egg cells. Thus smoking can have a direct effect on the health of the reproductive sex cells. It is also important to consider the impact of passive smoking. In addition to contributing to [male fertility issues](https://nabtahealth.com/environmental-factors-that-contribute-to-male-infertility/), having a partner who smokes heavily can have reproductive consequences for the female who is regularly exposed to secondhand smoke, even if she does not smoke herself. Passive smoke exposure can be almost as detrimental as direct smoke inhalation and increases the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), [premature labour](https://nabtahealth.com/glossary/premature-labour/) and birth defects. #### Recreational and prescription drugs Scientific studies are rare for ethical reasons and, certainly in the case of illicit drugs, under-reporting. However, the evidence does suggest that marijuana, for example, contains cannabinoids, which bind to reproductive structures and alter hormonal regulation. Prescription medications, such as those used to control [autoimmune disease](https://nabtahealth.com/causes-of-female-infertility-autoimmune-and-immune-mediated-disorders) or those used in [cancer therapy](https://nabtahealth.com/causes-of-female-infertility-cancer), may affect fertility. Consult your doctor if you are on any medication prior to starting a family. Your healthcare professional can ensure the drugs you are prescribed are safe for use during conception and pregnancy. #### Alcohol and caffeine **Alcohol** is one of the most widely used recreational substances worldwide and is associated with multiple reproductive risks. Perhaps the most well studied and widely understood of these risks are those related to foetal development. Alcohol readily crosses the [placenta](https://nabtahealth.com/glossary/placenta/) and therefore any alcohol consumed by the mother passes directly to her unborn child. High alcohol exposure can cause Foetal Alcohol Spectrum Disorders, which [lead](https://nabtahealth.com/glossary/lead/) to behavioural and cognitive deficits and growth retardation. However, there are other issues that women who drink alcohol should consider if they are planning to start a family. Chronic, prolonged alcohol use can [lead](https://nabtahealth.com/glossary/lead/) to menstrual cycle disturbances and a reduced ovarian reserve. There is a proven link between alcoholism and early [menopause](https://nabtahealth.com/glossary/menopause/). Even moderate alcohol use reduces the success rates of [infertility](https://nabtahealth.com/glossary/infertility/) treatment, possibly due to an alteration in endogenous hormone levels and reduced endometrial receptivity. There is a suggested link between alcohol consumption and [miscarriage](https://nabtahealth.com/glossary/miscarriage/), and, although studies performed to date have given conflicting results, the best advice is for pregnant women to completely abstain from alcohol and for all women to limit their intake whilst trying to conceive. **Caffeine** is found in coffee, tea, carbonated drinks, energy drinks and chocolate. It is the most widely consumed [psychostimulant](https://nabtahealth.com/glossary/psychostimulant/) worldwide; and drinking coffee is considered a cultural tradition in many countries of the Middle East. Pregnant women are advised to limit their caffeine consumption to between 200mg (European Food Safety Authority) and 300mg (WHO) a day, which equates to two to three cups of coffee. This is because of an increased risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) in those who regularly consume high quantities of caffeine. It is not fully understood why caffeine increases the rate of [miscarriage](https://nabtahealth.com/glossary/miscarriage/), but suggested mechanisms are altered levels of endogenous hormones and disrupted placental blood flow. Caffeine also crosses the [placenta](https://nabtahealth.com/glossary/placenta/), so can have direct effects on the developing foetus. Women who regularly consume more than 300mg of caffeine a day might notice that they have shorter than average menstrual cycles, however, there is no clear data on the effect of high caffeine intake on other areas of reproductive capability. A final point to bear in mind is that caffeine is not the only bioactive substance in coffee. It is possible that the different ingredients may have a cocktail or synergistic effect, and more work is required to look at circulating caffeine levels as well as comparing the effects of decaffeinated drinks with their caffeine-filled equivalents. #### Environmental exposures/toxins These are amongst the most difficult factors to avoid, as they surround us in our day-to-day lives. Heavy metals, such as [lead](https://nabtahealth.com/glossary/lead/), [mercury](https://nabtahealth.com/glossary/mercury/) and [boron](https://nabtahealth.com/glossary/boron/) can affect both male and female fertility. [Lead](https://nabtahealth.com/glossary/lead/) is found in batteries, metal products, paints and pipes; it interrupts the hypothalamic-pituitary axis and alters hormone levels. It also reduces [sperm](https://nabtahealth.com/glossary/sperm/) quality and can cause [menstrual cycle irregularities](https://nabtahealth.com/why-are-my-periods-irregular/) in females. [Boron](https://nabtahealth.com/glossary/boron/), used to manufacture glass, ceramic and leather, has similar effects on the hypothalamic-pituitary axis. [Mercury](https://nabtahealth.com/glossary/mercury/) is found in thermometers, batteries and industrial emissions. It enters the food chain via tainted seafood and [bioaccumulates](https://nabtahealth.com/glossary/bioaccumulates/) in humans, negatively affecting fertility; disrupting [spermatogenesis](https://nabtahealth.com/glossary/spermatogenesis/) and potentially causing foetal abnormalities. Air pollution comes from particulate matter and ground-level ozone being released into the atmosphere. Gases such as carbon monoxide, sulphur dioxide and nitrogen dioxide all contribute to the problem. These air pollutants come from, amongst other sources, vehicle emissions, the burning of fuels and industrial emissions. Air pollution has a significant impact on a number of physiological functions, including reproduction. It is very difficult to isolate specific pollutants, as usually people are simultaneously exposed to a number at the same time. It has also proved challenging to identify the specific mechanisms through which these particles impact fertility. They seem to interfere with the development of the male and female sex cells. Excessive exposure to air pollutants also has an association with increased [miscarriage](https://nabtahealth.com/glossary/miscarriage/) rates and [foetal malformations](https://nabtahealth.com/glossary/foetal-malformations/), for reasons yet to be fully elucidated. Whilst absolute avoidance of air pollution is not possible, the message must be to raise awareness and, on a global scale, attempt to limit the release of harmful, ozone-damaging materials into the environment. #### [Endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) [Endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) affect [male](https://nabtahealth.com/environmental-factors-that-contribute-to-male-infertility/) and female fertility. They mimic natural hormones, impeding normal hormone activity and altering the function of the endocrine system. They are widespread and found virtually everywhere, from manufacturing processes, to personal care products, medical applications, to cleaning products. Some of the most widely used, repeatedly shown to affect female fertility are: * **BPA (Bisphenol A)**. Used in the manufacture of plastics. Found in microwaveable containers and water bottles; as well as paints and adhesives. Associated with recurrent miscarriages and embryonic chromosomal abnormalities. * **Phthalates**. Used to soften plastics. Found in cosmetics, perfumes, toys, pharmaceuticals and medical devices. Cause ovulatory irregularities, reduced fertility and a longer time to pregnancy. Also linked to [early](https://nabtahealth.com/possible-reasons-for-early-puberty-in-girls/) [puberty](https://nabtahealth.com/glossary/puberty/). * **Solvents**. Found in plastics, resins, glues, paints, dyes, detergents, pesticides, nail varnish, insulation, food containers, cleaning products, amongst other things. [Lead](https://nabtahealth.com/glossary/lead/) to hormonal changes and reduced fertility. It is quite obvious from the list above that [endocrine disruptors](https://nabtahealth.com/glossary/endocrine-disruptors/) are prolific, and have unfortunately become a central part of modern life. Therefore,avoiding all exposure to potential endocrine disrupting chemicals is not feasible. However, minimising exposure to some known toxins, may help couples who are struggling to conceive. [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-autoimmune-and-immune-mediated-disorders) [Infertility](https://nabtahealth.com/glossary/infertility/) - Autoimmune and Immune-Mediated Disorders [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-cancer) [Infertility](https://nabtahealth.com/glossary/infertility/) - Cancer Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#fb829a97979abb959a998f9a939e9a978f93d5989496) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Carré, J, et al. “Does Air Pollution Play a Role in [Infertility](https://nabtahealth.com/glossary/infertility/)?: a Systematic Review.” Environmental Health, vol. 16, no. 1, 28 July 2017, p. 82., doi:10.1186/s12940-017-0291-8. * Chalupka, S, and A N Chalupka. “The Impact of Environmental and Occupational Exposures on Reproductive Health.” Journal of Obstetric, Gynecologic and [Neonatal](https://nabtahealth.com/glossary/neonatal/) Nursing, vol. 39, no. 1, 2010, pp. 84–102., doi:10.1111/j.1552-6909.2009.01091.x. * “Female Smoking.” World Health Organisation, [www.who.int/tobacco/en/atlas6.pdf](http://www.who.int/tobacco/en/atlas6.pdf) * “How Stopping Smoking Boosts Your Fertility Naturally.” Cleveland Clinic, 16 Apr. 2019, [health.clevelandclinic.org/how-stopping-smoking-boosts-your-fertility-naturally/](http://health.clevelandclinic.org/how-stopping-smoking-boosts-your-fertility-naturally/). * Lyngsø, J, et al. “Association between Coffee or Caffeine Consumption and Fecundity and Fertility: a Systematic Review and Dose-Response Meta-Analysis.” Clinical Epidemiology, vol. 9, 15 Dec. 2017, pp. 699–719., doi:10.2147/CLEP.S146496. * Palomba, S, et al. “Lifestyle and Fertility: the Influence of Stress and Quality of Life on Female Fertility.” Reproductive Biology and Endocrinology, vol. 16, no. 1, 2 Dec. 2018, p. 113., doi:10.1186/s12958-018-0434-y. * Petkus, D L, et al. “The Unexplored Crossroads of the Female Athlete Triad and [Iron](https://nabtahealth.com/glossary/iron/) Deficiency: A Narrative Review.” Sports Medicine, vol. 47, no. 9, Sept. 2017, pp. 1721–1737., doi:10.1007/s40279-017-0706-2. * Practice Committee of American Society for Reproductive Medicine. “Smoking and [Infertility](https://nabtahealth.com/glossary/infertility/).” Fertility and Sterility, vol. 90, no. 5 (Suppl), Nov. 2008, pp. S254–S259., doi:10.1016/j.fertnstert.2008.08.035. * Sharma, R, et al. “Lifestyle Factors and Reproductive Health: Taking Control of Your Fertility.” Reproductive Biology and Endocrinology, vol. 11, no. 66, 16 July 2013, doi:10.1186/1477-7827-11-66. * Van Heertum, K, and B Rossi. “Alcohol and Fertility: How Much Is Too Much?” Fertility Research and Practice, vol. 3, 10 July 2017, p. 10., doi:10.1186/s40738-017-0037-x. * “What Are Some Possible Causes of Female [Infertility](https://nabtahealth.com/glossary/infertility/)? .” National Institutes of Health, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female)[infertility](https://nabtahealth.com/glossary/infertility/)/conditioninfo/causes/causes-female. * “What Lifestyle and Environmental Factors May Be Involved with [Infertility](https://nabtahealth.com/glossary/infertility/) in Females and Males? .” National Institutes of Health, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/lifestyle)[infertility](https://nabtahealth.com/glossary/infertility/)/conditioninfo/causes/lifestyle.
* Uterine [polyps](https://nabtahealth.com/glossary/polyps/) can arise in the neck of the [uterus](https://nabtahealth.com/glossary/uterus/), the [cervix](https://nabtahealth.com/glossary/cervix/) (cervical [polyps](https://nabtahealth.com/glossary/polyps/)) or the lining of the uterine cavity (endometrial [polyps](https://nabtahealth.com/glossary/polyps/)). * Relatively common, [polyps](https://nabtahealth.com/glossary/polyps/) are usually [benign](https://nabtahealth.com/glossary/benign/), often [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/) and don’t need to be removed. * Two key symptoms of [polyps](https://nabtahealth.com/glossary/polyps/) are unusual bleeding (irregular periods, heavy periods, bleeding between periods) and [](https://nabtahealth.com/what-is-infertility/)[infertility](https://nabtahealth.com/glossary/infertility/). * Older women are more likely to develop [polyps](https://nabtahealth.com/glossary/polyps/). #### **What are [polyps](https://nabtahealth.com/glossary/polyps/)?** [Polyps](https://nabtahealth.com/glossary/polyps/) are the most frequently observed structural abnormality of the female reproductive tract, affecting up to 10% of the female population. They can range in size from a few millimeters to filling the entire uterine cavity, and will either lie flat against the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) (sessile [polyps](https://nabtahealth.com/glossary/polyps/)), or project from the endometrium via a stalk (pedunculated [polyps](https://nabtahealth.com/glossary/polyps/)). The growth rate of [polyps](https://nabtahealth.com/glossary/polyps/) can also be highly variable; some will grow steadily over time, others will actually regress. [Polyps](https://nabtahealth.com/glossary/polyps/) are usually diagnosed using [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) or [hysteroscopy](../what-is-a-hysteroscopy), with the latter technique considered to be the more accurate. An endometrial [biopsy](https://nabtahealth.com/glossary/biopsy/) will usually be performed to assess whether the [polyps](https://nabtahealth.com/glossary/polyps/) are [benign](https://nabtahealth.com/glossary/benign/). With few clinical symptoms, [polyps](https://nabtahealth.com/glossary/polyps/) are often only uncovered following investigative procedures for unexplained [infertility](https://nabtahealth.com/glossary/infertility/). In fact, the two main symptoms of [polyps](https://nabtahealth.com/glossary/polyps/) are: * [Abnormal uterine bleeding](../what-is-abnormal-uterine-bleeding) (irregular periods, heavy periods, spotting between periods) * [Infertility](https://nabtahealth.com/glossary/infertility/). [Polyps](https://nabtahealth.com/glossary/polyps/) have been implicated in up to 50% of cases of abnormal bleeding and [35% of](https://nabtahealth.com/causes-of-female-infertility-an-overview/) [infertility](https://nabtahealth.com/glossary/infertility/) cases. Premenopausal women are less likely to experience abnormal bleeding that is related to [polyps](https://nabtahealth.com/glossary/polyps/) than older women. #### **Risk factors and Causes of Uterine [Polyps](https://nabtahealth.com/glossary/polyps/)** It is not always known what causes [polyps](https://nabtahealth.com/glossary/polyps/) to develop. * **Age** is a major factor and [polyps](https://nabtahealth.com/glossary/polyps/) are rarely found in women below 30. Recent work suggests that [polyps](https://nabtahealth.com/glossary/polyps/) might exist in a latent state in younger women, with those that do form being more prone to regression as the cells of the endometrium undergo continual cycling. * **Medication**. Whilst the exact mechanisms that [lead](https://nabtahealth.com/glossary/lead/) to the formation of uterine [polyps](https://nabtahealth.com/glossary/polyps/) is unclear, there is a strong association between their development and [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Women who are prescribed Tamoxifen or Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) are at increased risk of polyp formation. Tamoxifen is a partial [oestrogen](https://nabtahealth.com/glossary/oestrogen/) agonist used in the treatment of breast cancer. The incidence of endometrial [polyps](https://nabtahealth.com/glossary/polyps/) in women who have been prescribed tamoxifen is thought to be between 5 and 35%. [HRT](https://nabtahealth.com/glossary/hrt/) is frequently prescribed for menopausal women to alleviate some of the most uncomfortable symptoms. The oestrogenic effects exerted by tamoxifen on the [uterus](https://nabtahealth.com/glossary/uterus/), and the continuous, unopposed stimulation of the endometrium that occurs with [HRT](https://nabtahealth.com/glossary/hrt/), can both give rise to [oestrogen](https://nabtahealth.com/glossary/oestrogen/)\-dependent [polyps](https://nabtahealth.com/glossary/polyps/). Upon removal, these [polyps](https://nabtahealth.com/glossary/polyps/) have been found to contain increased numbers of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptors. * **Obesity** is an additional risk factor for polyp development because adipose tissue contains high levels of an [enzyme](https://nabtahealth.com/glossary/enzyme/) called aromatase, which converts circulating [androgens](https://nabtahealth.com/glossary/androgen/) into oestrogens. * **Genetics**. Not all [polyps](https://nabtahealth.com/glossary/polyps/) are hormonally-driven. Apoptosis, or the process of controlled cell death, has been proposed as one of the regulatory mechanisms responsible for ensuring the endometrium is shed with each menstrual cycle. There is evidence that apoptotic activity is reduced in polyp tissue, which could explain why these growths are not shed with the rest of the endometrial lining during menstruation. Furthermore, chromosomal abnormalities and differing genetic activity have been found in some women with [polyps](https://nabtahealth.com/glossary/polyps/); particularly affected are those genes that regulate cell growth. Further work on the involvement of genes in polyp formation is required, to discern whether there is a familial, heritable component to the condition. * **[Inflammation](https://nabtahealth.com/glossary/inflammation/)** has also been proposed as a potential risk factor, with the suggestion that [polyps](https://nabtahealth.com/glossary/polyps/) occur as a result of localised tissue [inflammation](https://nabtahealth.com/glossary/inflammation/). #### **Polyp Removal** The [gold](https://nabtahealth.com/glossary/gold/) standard treatment approach for those [polyps](https://nabtahealth.com/glossary/polyps/) that are causing physical discomfort or contributing to difficulties in conceiving is for patients to undergo a hysteroscopic polypectomy. This is a relatively simple technique that involves removal of the polyp tissue. Cervical [polyps](https://nabtahealth.com/glossary/polyps/) can often be removed using forceps; larger endometrial [polyps](https://nabtahealth.com/glossary/polyps/) may require cauterisation. Once removed, the recurrence rate is relatively low and complications are rare. [](../what-is-a-dilation-and-curettage-and-why-is-it-done)[Dilation](https://nabtahealth.com/glossary/dilation/) and curettage (D&C) is an alternative technique sometimes used for the treatment of uterine pathologies. It is not the preferred approach for [polyps](https://nabtahealth.com/glossary/polyps/) removal due to the high possibility of missing [polyps](https://nabtahealth.com/glossary/polyps/) during the procedure. Women with [polyps](https://nabtahealth.com/glossary/polyps/) that are <10 mm in size are more likely to see natural regression over time and those who are [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/) may prefer to avoid surgical management altogether. However, in approximately 1% of cases, [polyps](https://nabtahealth.com/glossary/polyps/) can become cancerous, and therefore, women who opt not to have them removed, should undergo regular monitoring and screening to ensure that they remain [benign](https://nabtahealth.com/glossary/benign/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#5920383535381937383b2d38313c38352d31773a3634) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Ben-Arie, Alon, et al. “The Malignant Potential of Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/).” _European Journal of Obstetrics & Gynecology and Reproductive Biology_, vol. 115, no. 2, 10 Aug. 2004, pp. 206–210., doi:10.1016/j.ejogrb.2004.02.002. * Chan, Ssc, et al. “A Randomised Controlled Trial of [Prophylactic](https://nabtahealth.com/glossary/prophylactic/) Levonorgestrel Intrauterine System in Tamoxifen-Treated Women.” _BJOG: An International Journal of Obstetrics & Gynaecology_, vol. 114, no. 12, Dec. 2007, pp. 1510–1515., doi:10.1111/j.1471-0528.2007.01545.x. * Kanthi, Janu Mangala, et al. “Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp.” _Journal Of Clinical And Diagnostic Research_, vol. 10, no. 6, June 2016, pp. QC01–4., doi:10.7860/jcdr/2016/18173.7983. * Nijkang, Njume Peter, et al. “Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/): Pathogenesis, Sequelae and Treatment.” _SAGE Open Medicine_, vol. 7, 2 May 2019, doi:10.1177/2050312119848247. * Wong, M., et al. “The Natural History of Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/).” _Human Reproduction_, vol. 32, no. 2, Feb. 2017, pp. 340–345., doi:10.1093/humrep/dew307.
You’re ready to start a family and you want to know what helps you get pregnant fast. Conceiving can take time, and fertility is different for every woman and couple. If you are trying for a baby, there are natural ways to increase your chances of getting pregnant. #### _Getting your body ready for pregnancy_ You can start by taking some lifestyle steps to prepare your body for conception. Your health before pregnancy can improve your chances of conceiving. And preconception wellbeing contributes to a healthy pregnancy. So, in the 3 to 4 months before trying for a baby: – Take **prenatal vitamins**: Start taking prenatal vitamins with [folic acid](https://nabtahealth.com/product/folic-acid-test/) before and during pregnancy to ensure your body is nutritionally strong, with all the [minerals and vitamins required for healthy fetal developmen](https://nabtahealth.com/articles/4-supplements-to-take-when-trying-to-conceive/)t. – Get a **well-woman health check**: Get a full preconception medical to flag any potential health issues that could affect you getting pregnant naturally or could affect your pregnancy. Use this check-up to make sure your vaccinations are up to date. – **Stop smoking, vaping,** and **drugs**. Limit **alcohol** intake and cut back on **caffeine**. – Eat a [**balanced diet**](https://nabtahealth.com/articles/eating-to-conceive/): Boost your health with a varied diet covering all five food groups. – Keep a **healthy weight**: Being underweight, obese or overweight can affect your fertility. – **Exercise** regularly: Exercise that builds strength, endurance and muscle tone will help your body stay healthy and strong during pregnancy and labour. – Get lots of sleep: Sleep patterns affect hormones. Stick to a regular 7-8 hours sleep routine as you prepare your body to conceive. – **Reduce stress**: High stress levels are linked with difficulties getting pregnant. – **Come off hormonal contraception**: If you’re on hormonal contraception (the pill, [IUD](https://nabtahealth.com/glossary/iud/), patch, ring implant) your body needs time to readjust and for cycles to return to your personal normal. #### _Know your fertile window_ Timing is everything when you want to conceive. You need to time sex with [ovulation](https://nabtahealth.com/glossary/ovulation/). The man’s [sperm](https://nabtahealth.com/glossary/sperm/) must meet and fertilise the woman’s egg at the right time. Knowing your fertile window and timing sexual intercourse with [ovulation](https://nabtahealth.com/glossary/ovulation/) is key to increasing your chances of getting pregnant. Women typically ovulate around 12 to 14 days before their next period. If your periods are regular (the average menstrual cycle is 28 days but it’s normal for women’s cycles to be anywhere from 21 to 40 days) you count back from the first day of when you would expect your next period. #### _Trying to get pregnant_ Have sex at least every 2 to 3 days in the [lead](https://nabtahealth.com/glossary/lead/)\-up to [ovulation](https://nabtahealth.com/glossary/ovulation/). [Sperm](https://nabtahealth.com/glossary/sperm/) can survive for several days in the female reproductive tract and once you’ve ovulated your egg has a 12-to-24-hour window for fertilisation, so for the best chances of conception have regular sex in the [lead](https://nabtahealth.com/glossary/lead/) up to that brief window. #### _What are the signs of [ovulation](https://nabtahealth.com/glossary/ovulation/)?_ Use fertility awareness methods to predict when you are most likely to conceive. If you have irregular cycles, combine these non-invasive physiological cues with tracking your menstrual cycle length to determine when you are most fertile: – Check [**cervical mucous**](https://www.mayoclinic.org/tests-procedures/cervical-mucus-method/about/pac-20393452): As you near [ovulation](https://nabtahealth.com/glossary/ovulation/) you’ll notice your discharge becomes clear, stretchy, and wet, with the consistency of raw egg whites. This means you are at your most fertile. – Chart your [**basal body temperature (BBT)**](https://my.clevelandclinic.org/health/treatments/21065-basal-body-temperature): There’s a small rise in body temperature after [ovulation](https://nabtahealth.com/glossary/ovulation/). Measuring BBT over 3-4 cycles will give a fairly accurate prediction of the exact point of [ovulation](https://nabtahealth.com/glossary/ovulation/). Other methods for tracking [ovulation](https://nabtahealth.com/glossary/ovulation/) include: – **Calendar method**: This works by recording menstrual cycles on a calendar for 6-12 months and calculating fertile periods. It’s most effective as a fertility predictor when combined with cervical mucous and BBT methods. – [](https://nabtahealth.com/articles/how-do-ovulation-predictor-kits-work/)**[Ovulation](https://nabtahealth.com/glossary/ovulation/) predictor kits**: Over the counter [ovulation](https://nabtahealth.com/glossary/ovulation/) kits work in a similar way to at-home pregnancy tests. You pee on a stick measuring luteinizing hormone and a surge in this hormone indicates [ovulation](https://nabtahealth.com/glossary/ovulation/). Unfortunately, this doesn’t prove an egg has been released and a woman can have the hormone surge but fail to ovulate. – **Period tracker apps**: Smartphone [ovulation](https://nabtahealth.com/glossary/ovulation/) tracker apps, like [OvuSense](https://nabtahealth.com/product/fertility-cycle-monitoring-with-ovusense/), monitor menstrual cycles and predict fertility. Fertility awareness, knowing and understanding your body and its menstrual cycles, and lots of patience, helps lots of couples to conceive. But getting pregnant isn’t always as straightforward as knowing your body and having lots of sex. If it’s taking longer than expected to fall pregnant, make an appointment with your healthcare team. If you are under 35 see a doctor after 12 months of trying for a baby. If you are over 35 seek advice after 6 months of trying to get pregnant. [Nabta Health](https://nabtahealth.com/) provides personalised and evidence-based support and resources for women, wherever they are on their fertility journey.
If you’re trying to get pregnant, the wait from possible conception to seeing those longed-for two blue lines is a time of nervous anticipation, impatience, and anxiety. Early signs of pregnancy differ from woman to woman. And every pregnant woman experiences her pregnancy symptoms at different times. Some women feel intuitively that their body is changing before they realise they are pregnant. Other women won’t know until they miss their period or do a pregnancy test. #### _What are the pregnancy signs in the first week?_ So, I think I might be pregnant. What should I look out for? After [conception, fertilisation](https://myexpertmidwife.com/blogs/my-expert-midwife/0-4-weeks-from-period-to-pregnant) and [implantation](https://nabtahealth.com/glossary/implantation/) [things start to happen quickly in your body](https://nabtahealth.com/articles/your-pregnancy-weeks-1-2/). Some [pregnancy tests](https://nabtahealth.com/articles/how-do-pregnancy-tests-work/) can detect hCG (human chorionic gonadotropin) hormone levels as early as one or two weeks after conception. And your body could show first signs and symptoms of pregnancy at around the same time. 1\. Spotting: Some women notice very light ‘[implantation](https://nabtahealth.com/glossary/implantation/) bleeding’. This might be as little as a spot or two of blood, or some pinkish discharge over a few days. 2\. Mild cramping: Women may experience minor cramps or discomfort in the lower abdomen, back or pelvis area when the embryo attaches to the [uterus](https://nabtahealth.com/glossary/uterus/) lining. 3\. [Tender breasts](https://nabtahealth.com/articles/your-pregnancy-week-5/): Breasts sometimes feel swollen or sore to the touch due to hormonal changes. They may also tingle, or veins may be more visible through the skin. 4\. [Missed period](https://myexpertmidwife.com/blogs/my-expert-midwife/4-8-weeks-pregnancy-hormones-and-symptoms-to-babys-early-developments): If your periods are regular and you skip a period, or your period is a week or more late, you should do a pregnancy test. 5\. Nausea: Morning sickness with nausea, and sometimes vomiting, is a common pregnancy symptom during the first trimester. Feeling nauseous can start as early as a few weeks after conception for some women. 6\. Headaches: Mild headaches, sometimes accompanied by dizziness, are due to hormonal changes and the increase in blood pumping around your body. 7\. Raised basal body temperature (BBT): A consistently high BBT for 18 days or more may be an early sign of pregnancy. 8\. Heightened sense of smell (hyperosmia): Sensitivity to smells and strong odours is one of the first indicators of pregnancy in many women. 9\. Metallic taste in mouth: Some women experience a strange metallic taste in the mouth (as if you have licked a pocketful of coins!) in early pregnancy. This seems to disappear after the first trimester. 10. [Intense fatigue](https://nabtahealth.com/articles/your-pregnancy-week-5/): Higher levels of [progesterone](https://nabtahealth.com/glossary/progesterone/) can mean extreme tiredness and exhaustion. This is a common sign of pregnancy during the early months. 11. Frequent urge to pee: If you find you need to rush to the bathroom more often, and you have other pregnancy symptoms, it may be time to take a pregnancy test. 12. Bloated feeling: Some people have a feeling of fullness, or bloating, like having a gassy stomach, in the first weeks after conception. 13. Food cravings: An unexplained need for salt and vinegar crisps with caramel ice cream? Bizarre food cravings are a pregnancy symptom hallmark. #### _How do I know for sure that I’m pregnant?_ You may experience all, or some, or just one of these early pregnancy symptoms (most likely the missed period!) but this doesn’t mean a more, or less, healthy pregnancy. Just remember not to compare your own experience to anyone else’s early pregnancy journey. A positive pregnancy test, [taken at least one week after your period is due](https://myexpertmidwife.com/blogs/my-expert-midwife/0-4-weeks-from-period-to-pregnant), and those two all-important blue lines, is the only way to know for sure that you are pregnant. #### _I have a positive pregnancy test… Now what?_ If you have missed your period and your [at-home pregnancy test](https://nabtahealth.com/articles/how-do-pregnancy-tests-work/) is positive, the next step is to make an appointment to see your doctor. If you aren’t yet taking [folic acid](https://nabtahealth.com/product/folic-acid-test/), start taking antenatal vitamins now. These early months will see vital developments for you and your baby. Rest, when possible, eat a well-balanced diet, drink plenty of fluids, say goodbye to alcohol and smoking, and let the news sink in…
