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Pre-pregnancy vitamin D3 in take has a vital role in fertility. Vitamin D3 regulates the hormone production of the ovaries and is essential for a healthy reproductive system. Vitamin D3 deficiency can impair ovarian functions and reduce the chance of pregnancy.

During pregnancy, vitamin D3 is essential for the baby’s bone development. By increasing calcium and phosphate absorption, vitamin D3 helps the baby’s bones develop healthily, strengthens the immune system, can protect against infections, and can also help prevent mood disorders such as depression of the mother. Also, vitamin D3 deficiency can lower the baby’s birth weight and cause premature birth.

Pregnant women are at risk of vitamin D3 deficiency because the mother’s need for vitamin D3 increases during pregnancy. The daily requirement of vitamin D3 for pregnant women is 600-800 IU. They can get this amount through sunlight, foods, and supplements. However, pregnant women should consult their doctor before taking vitamin D3 supplements.

 

VITAMIN D3 SOURCES:

Vitamin D3 is a vitamin that can be synthesized from sunlight. It is also found naturally in some foods. These are :

• Oily fish: Oily fish such as salmon, mackerel, sardines are rich in vitamin D3.
• Liver: Especially chicken and turkey liver contains high vitamin D3. (But, it is not recommended to be consumed during pregnancy)
• Egg: Egg yolk contains vitamin D3.
• Milk and dairy products: Dairy products such as milk, yogurt and cheese may contain vitamin D3. However, milk and dairy products can also be enriched with vitamin D2.
• Mushrooms: Mushrooms are rare foods containing vitamin D3.

Dietitian, Turgut Arsan

What is HSG (Hysterosalpingography)?

Hysterosalpingography, also known as uterine film or medicated uterine film, is a diagnostic method used to examine the uterine and fallopian tubes by radiographic methods.

HSG is a technique commonly used in infertility cases as it allows the evaluation of the inner structure of the uterus and tubes and the patency of the tubes.

 

How is HSG done?

The uterus is filled with a liquid contrast material so that the uterus, cervix, and tubes are visible with X-rays. The contrast material goes from uterus to the tubes and then to the abdominal cavity from the end of the tubes. The flow and distribution of the contrast material in the uterus and tubes are observed under fluoroscopy.

Since the contrast agent is given under pressure from the cervix, in some cases it can also have a therapeutic effect by clearing mucus-like barrier structures in the tubes. Generally, there is an increase in pregnancy rates in the first 6 months after uterine film is performed.

 

In which situations is HSG (medicated uterine film) performed?

The most common reason for performing HSG is infertility.

• Adhesion in the tubes, obstruction, swelling, liquid filling, etc.
• Uterine polyps, fibroids, anomalies, tumors, etc.

may be the reason for not being able to have a baby. Your doctor may request an HSG examination to diagnose these cases and choose the appropriate treatment for you.

 

What is the ideal time for performing HSG?

HSG should be performed within the first 3 days after the end of menstruation (menstruation).

Because;

• In this period, the intrauterine tissue is thin, and the probability of pregnancy is low. Thus, possible harm to a newly formed pregnancy is prevented.
• In the following days after menstruation, the uterus will thicken, hiding possible masses in the uterus and reducing the scan’s clarity.
• The cervical canal (cervix canal) is open during and immediately after the menstrual period. Over time, the cervical canal narrows, making it difficult to place the catheter in this area and enter the contrast material from the inserted catheter.

Note: Women under menopause can perform HSG anytime they feel ready. Any time frame does not apply to them.

 

Frequently asked questions about HSG

• Can HSG be performed during menstruation?

The answer is No. Because, during this period, when contrast material is given, the particles that need to be expelled from the uterus together with the contrast material can be transported to the intra-abdominal cavity, and this may create a serious infection risk.

• What to do before HSG?

It is not necessary to use a drug for preparation before HSG. However, since this procedure is performed using sedation (anaesthesia) at our hospital, it is necessary not to drink and eat after 24.00 the night before the procedure to be prepared. (6-8 hours before HSG)

Note: Anaesthesia time takes approximately 15-20 minutes.

 

What should be considered after HSG?

• It is not recommended to do heavy work on the same day after HSG.
• The usage of a vaginal tampon is not recommended on the day HSG is performed. Pad can be used instead of a vaginal tampon.
• Any environment where infection may occur (pool, sea and sauna) should be avoided.
• If you have complaints such as severe abdominal pain, fever, excessive bleeding, it is recommended to consult your gynaecologist.

Antral follicle count (AFC)

Before going through a fertility treatments, IVF specialist will ask some fertility tests to be performed. The “antral follicle count” (AFC) is one of those key fertility tests. The antral follicle count, together with some hormone blood tests, are considered as a must for fertility testing.

 

What is an Antral follicle?

Women are born with all the eggs they will ever have. The number of eggs decrease constantly until menopause. “Ovarian reserve” refers to the reserve of the ovaries in other words “remaining egg supply” to be able to have babies.

Antral follicle is a small follicle (fluid-filled sac) in the ovaries that contains a immature egg that can potentially develop and ovulate in the future. A mature follicle (about to ovulate) measures between 18 – 25 mm.

 

What does AFC stand for?

The “antral follicle count” (AFC) means the sum of those follicles on both ovaries that can be detected by transvaginal ultrasound. Together with AMH test results and the age of a woman, the number of antral follicles, stand for the most accurate indicators of ovarian reserve that links with reproductive potential of woman. In other words, AFC indicates, how many eggs are left in your ovaries and the total number of mature eggs you might retrieve from a stimulation cycle.

Antral follicule numbers also good indicators for;

Ovarian response to stimulating medications used in IVF (How many eggs might be retrieved from a stimulation cycle)

• Chances for a succesful IVF
• Risk for a cycle cancellation

 

How does AFC change according to the age?

As the age icreases, women have less eggs remaining and fewer antral follicles. The number of follicles declines at a faster rate after age 35. Although these figures vary from woman to woman there are general benchmarks based on the studies.*

 

 

Age                             Average AFC            Lowest AFC              Highest AFC

25 to 34                                 15                               3                                 30

35 to 40                                 9                                 1                                 25

41 to 46                                 4                                 1                                 17

 

*Source: https://academic.oup.com/humrep/article/18/4/700/596535

 

Does a low AFC mean that you are unable to have a baby?

Although antral follicle count is a valuable indicator of fertility, a low number does not necessarily mean you will be unable to have a baby since for getting pregnant one good quality egg to be ovulated might be sufficient.

Please feel free to consult us to find out the best fertility treatment option for you.

AMH, also known as anti-Müllerian hormone, is a protein hormone created by unique cells inside ovarian follicles. Both male and female reproductive tissues produce AMH. Your age and gender will determine how AMH functions and whether your levels are normal.

AMH influences an unborn child’s development of sex organs. A baby will begin growing reproductive organs in the first few weeks of pregnancy. The baby will already have the genes to become either a male (XY genes) or a female (XX genes).

What is the AMH test?
An AMH test is often used to check a woman’s ability to produce eggs that can be fertilized for pregnancy. The number of eggs that a woman’s ovaries can produce declines as the woman gets older. AMH levels help show how many potential egg cells a woman has left. This is known as the ovarian reserve. If a woman’s ovarian reserve is high, she may have a better chance of getting pregnant.

Doctors can estimate a woman’s egg count by looking at her blood levels of AMH, which can also help them determine how many follicles are present in her ovaries. AMH levels for a fertile woman are between 1.0 to 4.0 ng/ml; under 1.0 ng/ml is considered low and indicative of a diminished ovarian reserve.

Age	AMH Level (ng/ml)
25	5.4
30	3.5
35	2.3
40	1.3
>43	.07

Sources:
https://medlineplus.gov/lab…/anti-mullerian-hormone-test/

https://pubmed.ncbi.nlm.nih.gov/20970126/ Fertil Steril, 2011. Age-related distribution of basal serum AMH level in women of reproductive age and a presumably healthy cohort.

https://extendfertility.com/…/fertility-statistics-by-age/

Basic Nutritional Treatment Principles in Polycystic Ovary Syndrome:

• Daily energy needs are determined according to individual characteristics. While providing bodyweight loss, it is aimed to lose 5-10% of the current weight in the first 6 months.

• Foods with a low glycemic index, high fiber content, low fat, and high protein content are preferred.

• Adequate consumption of oily fish (fish of unknown origin should not be consumed as it may contain heavy metals) is beneficial in terms of intake of omega-3 fatty acids. Appropriate Omega-3 supplementation is important in nutritional therapy.

• Fresh vegetables and fruits, which fight against inflammation with the vitamins, minerals, and antioxidants they contain, should be consumed sufficiently in the diet. In addition, packaged foods and allergic foods should be restricted to reduce inflammation in the body.

• Saturated fat intake should be limited and healthy fats (such as olive oil, almond, avocado) should be preferred.

• Particular attention should be paid to adequate vitamin D and calcium consumption.

• The consumption of refined carbohydrates, processed foods, and alcohol should be avoided.

• Daily caffeine intake should be limited and a sufficient amount of water should be consumed.

Rabia Yalinca, Dietician