Okay, a quick blog this time. I get asked frequently if I encourage a flu shot in pregnancy-of course I do!. There are two main strains of flu in the vaccination-the common strain and the H1N1.
Last year we were hit by the H1N1 and in hindsite it is apparent how bad it really was for pregnant women. This is a bad flu anyway, but it hits pregnant women harder than others. There were many deaths from this flu in otherwise healthy young women. These were terrible deaths, in the ICU, on ventilators, doing emergency c-sections to try and save the baby. Not something that you want to go through. Even here in Cache Valley we had several mothers who were incredibly sick, some even transferred to Salt Lake for further care.
The other strain is the more common strain. I head a lot of people say, "I only get the flu in the years that I get the flu shot.". This has been studies and is just not the case. I think a lot of people are confused at what the flu is. It is not jut the stomach virus that gives you vomiting and diarrhea. The flu is a virus that causes respiratory illness and body aches. It can make every hair on your body hurt. Most people-no matter how strong you are-lie around in bed wishing they were dead. It costs the US millions of dollars in lost wages from missed work. It usually lasts about 10 days and is really not something that you want. Can you image having this flu and then going into labor? I've seen it- it's not pretty. These women can hardly remember having a baby.
I think that I've seen quite a decrease of women with both of these flu-a testament in my mind that the vaccines work. There is really no down side to the vaccine except a sore arm for a couple of day. It does cross the placenta some and may be the only way to protect a newborn from the virus as well.
So the answer is yes! Get the vaccine if you are pregnant
Showing posts with label pregnancy. Show all posts
Showing posts with label pregnancy. Show all posts
Friday, January 7, 2011
Wednesday, November 3, 2010
Let's not talk about the hemorrhoids!
I asked my medical assistants what topic they think I should address and I was very surprised that they said, "Hemorrhoids". They said that questions about hemorrhoids was one of the most common phone calls that they get. I guess it is easier to talk about them over the phone than in the office!
So, while hemorrhoids are usually under the hospices of the general surgeon, here I go to review them briefly.
What is a hemorrhoid? Hemorrhoids are just varicose veins around the anus and rectum. Some are more external and some are internal. Just like other varicose veins, there are usually from a blockage and backup of blood in those veins. Most commonly in my office, the blockage comes from a pregnancy. The pressure on those veins back up the blood and the veins swell until they are easy to see and become irritated. Once the blockage is removed, the veins usually decompress pretty quickly. Like a balloon though, the first time the veins are expanded it takes some force, but once they have been stretched they can pop right back up again with minimal pressure.
Symptoms: Varicose veins, in and of themselves, are not usually a problem. You may just feel them when you wipe. Usually the external ones are soft and fleshy. When they get swollen, irritated, or if a clot forms in them they suddenly become a much bigger, "pain in the butt". They are often the cause of painless bleeding with bowel movements. (Painful, tearing bowel movements that cause bleeding is usually a fissure).
Treatment: The treatment for the swelling and irritation is usually a hemorrhoid cream that includes a steroid. Topical ointments and pads, such as tucks, are soothing but don't offer any anti-inflammatory action. Prep H., anusol etc, have some hydrocortisone (a steroid) in them which will work much more effectively in reducing the irritation. These need to be used regularly, at least 2-3 times a day and maybe even 4 times a day until things get better. There are some prescription strength creams that are effective as well.
In additional to topical medications, the pressure has to be off. This means, no heavy lifting or straining. Stools should be the texture of a ripe banana. You may have to take fiber drinks-metamucil, citracel etc. to get your stools softer. (hint. start slowly with the fiber drinks and work your way up to the dose that gets you results. Going to fast will make you very gassy and bloated). Stools softeners like colace will work for the short term but if you are prone to constipation you may need the fiber for the long term.
After a pregnancy with normal bowel function, decreased lifting, topical creams and time, the hemorrhoids should go away until your next pregnancy.
If you get a clot in one of the veins you will know it. The pain is pretty intense and instant and will probably bring you to the ER. There, they will just incise the veins and remove the clot. Relief is almost instant with this treatment.
Surgical treatment of hemorrhoids is the very last resort and some say the surgery can be worse then the hemorrhoids. It is definitely worth the slimy orange drinks and the creams to avoid needing surgery.
Prevention: Preventing hemorrhoids is difficult, particularly in a pregnancy. Not allowing for on going constipation is the best prevention. Choosing your parents wisely will help too as hemorrhoids can have a large genetic predisposition.
Warning: Hemorrhoids that seem way out of proportion for your situation, that get worse and worse, or that bleed a lot, need to be seen. Severe hemorrhoids can be a sign of other problems such as colon cancer. Obviously rare in younger women who are having children, but not unheard of. Never be too embarrassed just to have them checked if they are not improving as expected.
Well, hopefully that answered some of your questions that maybe your were afraid to ask! Now back to the gynecology!
Wednesday, July 14, 2010
whats with the Vit D?
Vit D. deficiency is something that is fairly new. It has been surprising how many women, even in sunny areas, that are low in vit. D. Vit D. is used for calcium absorption and calcium is used for bone growth and muscle function. Being low in vit D and calcium can affect your bone density as well as your muscle function. There may be other benefits of vit D as well that are still being studied. These benefits may include decreased colon cancer risk, better prognosis with breast cancer, and decreased risk for pre-eclampsia in pregnancy.
It is thought that since we are staying out of the sun and drinking less milk-both sources of vit D-may be the cause of so many people having low levels.
So what do you do? First, get your vit D level checked-a simple blood test. If it is low then you may need supplementation. The amount you need will depend on how low your levels are. If severely low you may be put on 50,000IU's for 8 weeks. If borderline, you may just be given an over-the-counter vitamin. Pregnant women should probably be taking around 2,000IU. It is important for pregnant women to have adequate vit D for the health of your baby's bones.
There is no known "toxic level" of vit D. but megadoses are not recommended. In fact, some supplemention with vit D and calcium may cause kidney stones.
Again, I've been surprised at the number of tan, active women who have had low vit D levels. I've also been surprised that many of these women feel better when on their supplements. They feel stronger and will some increased energy.
If nothing else, enjoy a little sun (with SPF of course) and drink your milk!
It is thought that since we are staying out of the sun and drinking less milk-both sources of vit D-may be the cause of so many people having low levels.
So what do you do? First, get your vit D level checked-a simple blood test. If it is low then you may need supplementation. The amount you need will depend on how low your levels are. If severely low you may be put on 50,000IU's for 8 weeks. If borderline, you may just be given an over-the-counter vitamin. Pregnant women should probably be taking around 2,000IU. It is important for pregnant women to have adequate vit D for the health of your baby's bones.
There is no known "toxic level" of vit D. but megadoses are not recommended. In fact, some supplemention with vit D and calcium may cause kidney stones.
Again, I've been surprised at the number of tan, active women who have had low vit D levels. I've also been surprised that many of these women feel better when on their supplements. They feel stronger and will some increased energy.
If nothing else, enjoy a little sun (with SPF of course) and drink your milk!
Monday, May 24, 2010
Pregnancy, turkey and hotdogs
What can I eat when I'm pregnant?
This post has taken me awhile as I wanted to do some research first. Unfortunately, in regards to nutrition and safety in pregnancy, there is very little "proven". As you know, there are many claims of vitamins, herbal remedies, diets etc out there. Because most of this stuff is not controlled, there are very few studies that prove efficacy or safety of any of these things. I've tried to go through the scientific literature and get you the best answers I could find. I will not address herbal and natural remedies. I agree that these may work, but I can not attest to their safety. I do want to talk about obesity in pregnancy but I will do that in a later post.
So, back to diet, you're not supposed to eat tuna or hot dogs or foods that cause allergies or soft cheeses, or melons, or smoked seafood.....and you need to take your vitamin everyday or your baby will have three eyes, right? Wrong.
The thing about nutrition is that it should be commonsense. If a good balanced diet is good for mom, it is good for the baby. Nothing extreme. All things in moderation. Exercise, good diet, appropriate food handling, avoidance of drugs and alcohol; these are all recommended to all women, pregnant or not.
So lets look with a little more detail.
Listeriosis: The topic that made me even think of writing this blog is deli meats. I can't tell you the number of phone calls that I get asking if someone can have a hot dog at their family reunion. This recommendation is based on some science, though probably blown way out of proportion. Listeriosis is a bacteria that can be found in many sources, including deli meats. It is not killed by refrigeration and so can be on many preprocessed foods. It is found in dirt, on drinking fountains, in deli meats, melons, soft cheeses, hummus, corn salad, many animals, food from delicatessen counters, pasturized and unpasturized dairy products, fruits and vegetables. In otherwords, it can be found most everywhere. Two large outbreaks were from turkey meat, thus the warning against that. For some reason, when people are exposed to listeriosis, it is the immunocompromised (cancer pts, HIV) and pregnant women in the third trimester that are most succeptible to getting sick. If a third trimester patient gets listeriosis there is a risk of fetal death as well as maternal death. There is no doubt this is a terrible disease.
The important thing to note, though, is that it is a very rare disease. The risk of getting it is 3 people per 1 million (all-comers, not just pregnant women). On the other hand, there is a 4100 women/million ( pregnant women) chance of getting hospitalized for a trauma-most are car accidents. There are some areas where the biggest risk to a pregnant women is homicide. From what I can indirectly calculate, you are approximately 1000 times more likely to be murdered in your pregnancy then you are to get listeriosis. That being said, cautious intake of cold, preprocessed foods is probably wise.
The FDA provides a website www.fda.gov/food/resourcesforyou/healtheducators/ucm082539.htm for more information.
Just keep things in perspective.
Macronutrients: There are many sites that talk about protein, fat and caloric intake. I think it is safe to say, again, that a balanced diet is best. You only need about 300 more calories a day when you are pregnant if you start at a healthy weight. Obviously if you are underweight or overweight you may need to eat more or less. I'll address this more next time with a chat about obesity.
Fish/fat and IQ: Fat is a necessary evil. Low cholesterol and saturated fat is going to be best. There is some strong evidence that long chain fatty acids found in fish is very good for brain development. Several studies show that there is a significant increase in IQ of young children born to women that eat fish or take fish oil. The warning about this is mercury. We also know that mercury can cause brain damage. So do you eat fish or not?
The best advice I can give is to avoid big fish that contain more mercury-swordfish, fresh tuna and shark for example. A can or two of tuna per week has been deemed safe by the fda. I would encourage you to eat other fish though, such as salmon, trout, talapia, cod. In this area (UT) the river fish are safe. Some areas of the country the rivers are polluted with mercury and so you should check with the local health depts. One to two servings a week would be good. Of all the vitamins and nutrients out this, this is one of the most studied and most convincing.
Micronutrients: The other most studies nutrient is folate. It is clear that folic acid helps to prevent spina bifida. I've also been to conferences where they have reported some decrease in heart defects and abdominal well defects. This has not been published yet that I've seen. Regardless, we know it is a good thing. Our flours and cereals are now fortified with folate so we are getting more than ever now. The key point of this is: the folate needed for spine and heart formation is what is in your body when you concieve--NOT what you take afterwards. If you are planning on concieving, that is when you should be taking vitamins.
All the other vitamins have not necessarily been proven to give better outcomes for the pregnancy, the baby or the mother. My advice it that if you feel better on a prenatal vitamin then continue to take it. If it makes no difference, or if it makes you sick and you can otherwise eat a normal diet, then dump the prenatal vitamin for a healthy diet.
If you are undernourished for whatever reason, (heavy smoker, vegetarian, lactose deficiency, carrying twins) vitamins have been shown to grow a little larger baby.
Iron has only been shown to be helpful if you are already anemic. This is usually tested in your first prenatal labs.
Caffeine:
There is no good data on caffeine. One study I read only found a correlation with bad outcomes when consuming 6 cups of coffee a day. It has been linked with miscarriage and so you may not what to drink large amounts in early pregnancy. (more than 200mg) One can of coke has 46 mg. 1.5 oz of Hersheys had 10mg. 8 oz of brewed coffee has 135mg. to give you an idea.
Artificial sweeteners have not been linked with any ill outcomes though these are still being studies.
Flouride: Supplementation with flouride has not been seen to make any difference in your baby's teeth and is not recommended. Topical flouride-with washes etc-has been the only source shown to make a difference.
In summary the motto of nutrition in pregnancy is balance and moderation. What is good for you is good for your baby.
This post has taken me awhile as I wanted to do some research first. Unfortunately, in regards to nutrition and safety in pregnancy, there is very little "proven". As you know, there are many claims of vitamins, herbal remedies, diets etc out there. Because most of this stuff is not controlled, there are very few studies that prove efficacy or safety of any of these things. I've tried to go through the scientific literature and get you the best answers I could find. I will not address herbal and natural remedies. I agree that these may work, but I can not attest to their safety. I do want to talk about obesity in pregnancy but I will do that in a later post.
So, back to diet, you're not supposed to eat tuna or hot dogs or foods that cause allergies or soft cheeses, or melons, or smoked seafood.....and you need to take your vitamin everyday or your baby will have three eyes, right? Wrong.
The thing about nutrition is that it should be commonsense. If a good balanced diet is good for mom, it is good for the baby. Nothing extreme. All things in moderation. Exercise, good diet, appropriate food handling, avoidance of drugs and alcohol; these are all recommended to all women, pregnant or not.
So lets look with a little more detail.
Listeriosis: The topic that made me even think of writing this blog is deli meats. I can't tell you the number of phone calls that I get asking if someone can have a hot dog at their family reunion. This recommendation is based on some science, though probably blown way out of proportion. Listeriosis is a bacteria that can be found in many sources, including deli meats. It is not killed by refrigeration and so can be on many preprocessed foods. It is found in dirt, on drinking fountains, in deli meats, melons, soft cheeses, hummus, corn salad, many animals, food from delicatessen counters, pasturized and unpasturized dairy products, fruits and vegetables. In otherwords, it can be found most everywhere. Two large outbreaks were from turkey meat, thus the warning against that. For some reason, when people are exposed to listeriosis, it is the immunocompromised (cancer pts, HIV) and pregnant women in the third trimester that are most succeptible to getting sick. If a third trimester patient gets listeriosis there is a risk of fetal death as well as maternal death. There is no doubt this is a terrible disease.
The important thing to note, though, is that it is a very rare disease. The risk of getting it is 3 people per 1 million (all-comers, not just pregnant women). On the other hand, there is a 4100 women/million ( pregnant women) chance of getting hospitalized for a trauma-most are car accidents. There are some areas where the biggest risk to a pregnant women is homicide. From what I can indirectly calculate, you are approximately 1000 times more likely to be murdered in your pregnancy then you are to get listeriosis. That being said, cautious intake of cold, preprocessed foods is probably wise.
The FDA provides a website www.fda.gov/food/resourcesforyou/healtheducators/ucm082539.htm for more information.
Just keep things in perspective.
Macronutrients: There are many sites that talk about protein, fat and caloric intake. I think it is safe to say, again, that a balanced diet is best. You only need about 300 more calories a day when you are pregnant if you start at a healthy weight. Obviously if you are underweight or overweight you may need to eat more or less. I'll address this more next time with a chat about obesity.
Fish/fat and IQ: Fat is a necessary evil. Low cholesterol and saturated fat is going to be best. There is some strong evidence that long chain fatty acids found in fish is very good for brain development. Several studies show that there is a significant increase in IQ of young children born to women that eat fish or take fish oil. The warning about this is mercury. We also know that mercury can cause brain damage. So do you eat fish or not?
The best advice I can give is to avoid big fish that contain more mercury-swordfish, fresh tuna and shark for example. A can or two of tuna per week has been deemed safe by the fda. I would encourage you to eat other fish though, such as salmon, trout, talapia, cod. In this area (UT) the river fish are safe. Some areas of the country the rivers are polluted with mercury and so you should check with the local health depts. One to two servings a week would be good. Of all the vitamins and nutrients out this, this is one of the most studied and most convincing.
Micronutrients: The other most studies nutrient is folate. It is clear that folic acid helps to prevent spina bifida. I've also been to conferences where they have reported some decrease in heart defects and abdominal well defects. This has not been published yet that I've seen. Regardless, we know it is a good thing. Our flours and cereals are now fortified with folate so we are getting more than ever now. The key point of this is: the folate needed for spine and heart formation is what is in your body when you concieve--NOT what you take afterwards. If you are planning on concieving, that is when you should be taking vitamins.
All the other vitamins have not necessarily been proven to give better outcomes for the pregnancy, the baby or the mother. My advice it that if you feel better on a prenatal vitamin then continue to take it. If it makes no difference, or if it makes you sick and you can otherwise eat a normal diet, then dump the prenatal vitamin for a healthy diet.
If you are undernourished for whatever reason, (heavy smoker, vegetarian, lactose deficiency, carrying twins) vitamins have been shown to grow a little larger baby.
Iron has only been shown to be helpful if you are already anemic. This is usually tested in your first prenatal labs.
Caffeine:
There is no good data on caffeine. One study I read only found a correlation with bad outcomes when consuming 6 cups of coffee a day. It has been linked with miscarriage and so you may not what to drink large amounts in early pregnancy. (more than 200mg) One can of coke has 46 mg. 1.5 oz of Hersheys had 10mg. 8 oz of brewed coffee has 135mg. to give you an idea.
Artificial sweeteners have not been linked with any ill outcomes though these are still being studies.
Flouride: Supplementation with flouride has not been seen to make any difference in your baby's teeth and is not recommended. Topical flouride-with washes etc-has been the only source shown to make a difference.
In summary the motto of nutrition in pregnancy is balance and moderation. What is good for you is good for your baby.
Tuesday, February 23, 2010
Why can't I get pregnant?
I know it's taken a year to finally start writing but my plan is to pick a topic each month or so and give you some advice, and maybe a little science about these things. Some of the topics will be my "most asked questions"(how can I lose weight?), some will be an opportunity for me to vent about misconceptions out there (if I raise my arms above my head will the cord wrap around my baby's neck?) , some may even be for fun (what's the worst phone call I've received on call). I'm not going to pretend that I know everything. And while I will do some research on these topics I'm not going to present a review of the literature on each topic either. I want this to be practical and easy to understand. Something you can take away and use. So here goes....
My first topic is about trying to get pregnant. This is one of the most trying times in many couples lives. We're already going to assume that you are in agreement with your spouse about even getting pregnant. There are some many pschological complexities about conception but I'm not really going to talk about those here.
There are three things you need to get pregnant: an egg, sperm, and a happy meeting place. Let's start with the egg. If you are having regular cycles (every 25-35 days) you are probably ovulating. Ovulation should occur around 14 days from the start of your period. Some women will feel the ovulation as a pain on one side, most women will get a watery, clear discharge with ovulation. Some women will even spot a little with ovulation. If you still aren't sure, you can do a temperature chart (BBT chart) by taking your temperature every morning before you do anything else. After ovulation your temperature should rise by a 10th of a point or so. These charts can be difficult to read but if you drop one by I can look at it for you. Lastly, you can use an ovulation predictor kit that you buy over the counter. These are actually pretty good at identifying ovulation. You must have a negative reading before you have a positive reading for it to be accurate. If you test is "alway positive" you are not ovulating. Occassionally you think you are ovulating around day 14 and so you always have intercourse then, and after doing some testing you find you ovulate day 17 and you've been missing the timing all along!
So let's say you can't identify any ovulation. You're periods come every 3 months, or maybe even every 2 weeks. If you are not ovulating you will not get pregnant. Occassionally someone will only ovulate every 3 months or so. These are women who may take years to concieve and then suddenly it happens. Regardless, if you can't identify ovulation that is when you come in and talk about ovulation induction. This involved medication that will encourage your ovaries to prepare and ovulate a follicle. There are risks to this-including twins/triplets, but it tends to work fairly well. The details of ovulation induction will have to be given at another time.
Sperm. Lots of sperm. While it only takes on to fertilize an egg, it takes millions to get the one to the right spot. 40% of infertiliy is male (40% is female and 10% have both). So, if you are ovulating regularly and having timed intercourse and you are still not pregnant in 9-12 months, a semen analysis should be done. This is a simple test and fairly inexpensive. A sample is given to the lab ( I have a specific person who does them in my office) and they will look at the sperm counts, as well as seeing if there are abnormalities (sperm with two heads etc). If the counts are good you husband is off the hook. If they are low he will need to see a urologist to see if there are ways to increase it. As a man makes sperm all the time many things can temporarily influence his count. If he is an avid biker, if he wears tight pants, if he sits in hot tubs all the time, even a cold or flu can affect counts for awhile. He may also have a hydrocele or vericocele in the testicle that can influence counts. If he has borderline low counts we can often try intrauterine insemination (IUI) here. If the counts are low the only way to concieve is through a process called ICSI done along with IVF in Salt Lake.
Happy meeting place. The uterus is the meeting place and has to be of normal shape and size. There are some developmental abnormalities that may cause the uterus to have a septum or for half of the uterus to be missing and these can cause infertility or miscarriages. The tubes have to be open. Tubes can be blocked from various reasons-usually an infection but sometimes just developmentally as well. The cervix has to be accepting of the sperm. There can't be any antibodies or other things that may kill sperm as they try to swim up. There are many theories about cervical problems. Most are unproven and few have any treatment except doing IUI. Lastly, there can't be any outside influences, specifically endometriosis. Endometriosis is when the normal lining of the uterus grows outside of the uterus. We are not sure how this causes infertility but it is believed that it "poisons" the embryo in a way. It is usually symptomatic beforehand by causing crampy, painful periods, painful intercourse, bowel symptoms with your periods etc. The only way to diagnose endometriosis is through laparoscopy (surgery) but it can be suspected just by symptoms and your exam.
Remember though, only about 20% of couples concieve each month. You are not considered infertil until after 1 year of trying. If you have a clear problem, like no periods on your own, seek help earlier, otherwise try and document ovulation and do worry too much. Sometimes it happens when you least expect it. Take your prenatal vitamins or folate if you are trying to concieve. If you are on medications or have medical problems your should probably be seen before you get pregnant. Stay healthy and happy trying!
My first topic is about trying to get pregnant. This is one of the most trying times in many couples lives. We're already going to assume that you are in agreement with your spouse about even getting pregnant. There are some many pschological complexities about conception but I'm not really going to talk about those here.
There are three things you need to get pregnant: an egg, sperm, and a happy meeting place. Let's start with the egg. If you are having regular cycles (every 25-35 days) you are probably ovulating. Ovulation should occur around 14 days from the start of your period. Some women will feel the ovulation as a pain on one side, most women will get a watery, clear discharge with ovulation. Some women will even spot a little with ovulation. If you still aren't sure, you can do a temperature chart (BBT chart) by taking your temperature every morning before you do anything else. After ovulation your temperature should rise by a 10th of a point or so. These charts can be difficult to read but if you drop one by I can look at it for you. Lastly, you can use an ovulation predictor kit that you buy over the counter. These are actually pretty good at identifying ovulation. You must have a negative reading before you have a positive reading for it to be accurate. If you test is "alway positive" you are not ovulating. Occassionally you think you are ovulating around day 14 and so you always have intercourse then, and after doing some testing you find you ovulate day 17 and you've been missing the timing all along!
So let's say you can't identify any ovulation. You're periods come every 3 months, or maybe even every 2 weeks. If you are not ovulating you will not get pregnant. Occassionally someone will only ovulate every 3 months or so. These are women who may take years to concieve and then suddenly it happens. Regardless, if you can't identify ovulation that is when you come in and talk about ovulation induction. This involved medication that will encourage your ovaries to prepare and ovulate a follicle. There are risks to this-including twins/triplets, but it tends to work fairly well. The details of ovulation induction will have to be given at another time.
Sperm. Lots of sperm. While it only takes on to fertilize an egg, it takes millions to get the one to the right spot. 40% of infertiliy is male (40% is female and 10% have both). So, if you are ovulating regularly and having timed intercourse and you are still not pregnant in 9-12 months, a semen analysis should be done. This is a simple test and fairly inexpensive. A sample is given to the lab ( I have a specific person who does them in my office) and they will look at the sperm counts, as well as seeing if there are abnormalities (sperm with two heads etc). If the counts are good you husband is off the hook. If they are low he will need to see a urologist to see if there are ways to increase it. As a man makes sperm all the time many things can temporarily influence his count. If he is an avid biker, if he wears tight pants, if he sits in hot tubs all the time, even a cold or flu can affect counts for awhile. He may also have a hydrocele or vericocele in the testicle that can influence counts. If he has borderline low counts we can often try intrauterine insemination (IUI) here. If the counts are low the only way to concieve is through a process called ICSI done along with IVF in Salt Lake.
Happy meeting place. The uterus is the meeting place and has to be of normal shape and size. There are some developmental abnormalities that may cause the uterus to have a septum or for half of the uterus to be missing and these can cause infertility or miscarriages. The tubes have to be open. Tubes can be blocked from various reasons-usually an infection but sometimes just developmentally as well. The cervix has to be accepting of the sperm. There can't be any antibodies or other things that may kill sperm as they try to swim up. There are many theories about cervical problems. Most are unproven and few have any treatment except doing IUI. Lastly, there can't be any outside influences, specifically endometriosis. Endometriosis is when the normal lining of the uterus grows outside of the uterus. We are not sure how this causes infertility but it is believed that it "poisons" the embryo in a way. It is usually symptomatic beforehand by causing crampy, painful periods, painful intercourse, bowel symptoms with your periods etc. The only way to diagnose endometriosis is through laparoscopy (surgery) but it can be suspected just by symptoms and your exam.
Remember though, only about 20% of couples concieve each month. You are not considered infertil until after 1 year of trying. If you have a clear problem, like no periods on your own, seek help earlier, otherwise try and document ovulation and do worry too much. Sometimes it happens when you least expect it. Take your prenatal vitamins or folate if you are trying to concieve. If you are on medications or have medical problems your should probably be seen before you get pregnant. Stay healthy and happy trying!
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