All I Want for Christmas

She came in for a rash, but the visit turned out to be about so much more. Ella was a thirty six year old female presenting with a rash around her neck. “They told me that it was shingles,” she said. The rash was small and mildly red, present around her neck. It was itchy, not painful. Urticaria. She admitted that she had been under a tremendous amount of stress from work and it was actually her boss that suggested she see the doctor. Ella appeared to be on the verge of tears during the interview. When I asked her if she was feeling okay, she said that the stress was starting to get the best of her. She found out that she was possibly going to be fired from her job, she was in the process of moving, and her husband and her had been trying to have a baby for the past six months with no success and it was putting a strain on them. On top of that, the holidays were starting to also get the best of her. “All I want for Christmas is for something to go right,” she said.

Ella had an episode of what I like to call complaint-vomit, where all the pent up stress and anxiety exploded into an epic rant. The rash was the least of her worries, but it’s what took her over the top. Ella asked if she could be checked for why she couldn’t get pregnant. Getting pregnant is a funny thing. It seems to happen unintentionally for people that aren’t trying to get pregnant, but seems impossible for people that are. There are a few things to consider when it comes to the subject.

Infertility is defined as an inability to conceive over the course of a twelve month period. It is typically at this point that speaking to a doctor becomes necessary as medical issues may be the problem. It goes without saying, but I will say it anyway: you need to be actively trying to conceive. This means no birth control. This means being sexually active. Regularly. It also means that the couple are in general good health, meaning to say that they have no underlying medical conditions that are being left untreated like diabetes.

For men, infertility can be related to abnormal sperm, relating to low numbers or motility issues. A number of physical conditions can contribute to abnormal sperm counts, like overheated testicles or anatomical issues like hypospadias, where the urethral opening is under the penis. Certain drugs, like steroids, chemotherapuetic agents, and testosterone may also affect the problem.

For women, infertility can be related to hormonal imbalance. This can be related to medical conditions like endometriosis and PCOS. In addition, dietary and exercise habits can also affect fertility, where too much or too little can affect body composition. A prior history of sexually transmitted infections may also be a risk. In both cases of men and women, smoking can have a significant impact along with advancing age.

In terms of optimizing the chances, it’s important to maintain a healthy body weight. Exercise in moderation and maintain a healthy diet that’s balanced. And don’t forget the prenatal vitamins if the plan is pregnancy. Above all, the best piece of advice I can give to any couple trying to conceive is to relax. The psychological stress and anxiety of trying to start a family can be detrimental not only to the chances of conception, but also to the relationship itself.

Ultimately, Ella didn’t just have a rash, but she was also carrying the weight of her world on her shoulders. Because of her age, I ended up referring her for fertility testing. Ella wanted nothing more than to be a mother for Christmas, but the joys of motherhood are a different monster all together. Just a reminder for Ella, there are some presents that you can’t return.

By: Dr. Juan Borja
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