Pregnancy is a taxing time for a woman. All that energy you get from food is being used to sustain the unborn life inside you. As a result, pregnant women feel tired all the time. Unfortunately, it is surprising how despite feeling this way, sleep doesn’t come easily to pregnant women.

Luckily, with a bit of understanding of the types of changes you will go through each trimester, and the reasons for these changes, it is possible to find a solution to your sleep woes. Read on to find out!

Pregnancy-Related Lethargy

First, let’s tackle why you might be feeling more tired than usual. Researchers haven’t been able to pinpoint what exactly causes pregnant women to feel this way. There might be several reasons to explain why this happens:

Hormonal Changes
An increase in progesterone levels will cause you to feel more relaxed and slow you down.

Physiological Changes
During pregnancy such as the growth of the uterus, weight gain, bloating etc. The body is being pushed harder to keep up with the increased demand for energy and blood flow by the fetus.

Emotional Changes
You might feel extra worried about the health and wellbeing of your baby. This increased level of anxiety can be energy draining.

What Causes Insomnia During Pregnancy?

The last thing you would expect to have when you are tired all the time is insomnia. Unfortunately, it is not uncommon to suffer from this when you are pregnant.

This section describes some of the reasons for your insomnia by stage of pregnancy:

During First Trimester

The first stage of pregnancy is a period of rapid changes in your body.  A variety of physiological and hormonal alterations are taking place. You may begin to notice the following symptoms and feel more drained due to poorer sleep quality.

Frequent Urination
Since you are in your first trimester, your baby is still very small. However, your uterus is growing to accommodate the developing fetus. This increase in the size of your uterus puts pressure on the bladder.

Moreover, throughout pregnancy, blood volume keeps increasing until it is 50% greater than usual. This massive increase means that the kidneys process more body fluids. Hence, more urine is produced.

Unfortunately, the combined effect of these changes leads to frequent urination which can ruin a good night’s sleep.

Morning Sickness
Another reason for insomnia might be due to sudden attacks from morning sickness. Researchers are unsure why pregnant women suffer from this condition. A popular theory states that it may be a reaction to increased levels of hCG hormone in the body.

Breast Sensitivity
Women find that breasts are more sensitive during pregnancy. Unfortunately, it can be painful to sleep in your favorite positions such as lying on your stomach or sides if you have breast tenderness.

The culprits behind this are the hormones estrogen and progesterone. This hormone duo causes breasts to begin growing larger. To facilitate growth, fat deposition, and blood flow to the area increases which results in increased sensitivity.

Higher Body Temperature
Metabolic rate increases to provide the body’s greater need for energy during pregnancy. Unfortunately, this means you will begin to feel warmer than usual.

To combat a high body temperature, try using a ceiling fan in your room. It will keep you cool as well as drown out any background noises that disturb sleep.

Pregnant women might realize that they have suddenly begun to snore. This is because pregnancy hormones cause mucous membranes to swell resulting in nasal congestion. This is exacerbated by lying down. If you are an obese or overweight woman, the extra tissues in your head and neck can worsen snoring.

During the Second Trimester

Unlike the first trimester where your body undergoes rapid change, the situation is very different during the second trimester. This is the period in your pregnancy when you will be most well rested.

The reason for this is that your body isn’t changing quite as fast. Unfortunately, there are still some interruptions.

Restless legs
During the second trimester, you might experience a sensation that feels like tiny insects crawling inside your leg. The only relief is moving your legs until this feeling goes away. This condition is called restless leg syndrome.

It begins during the evening hours of the second trimester but gradually worsens as you approach the third trimester. The exact cause of restless leg syndrome in pregnancy is unknown, but imbalances in brain dopamine, deficiencies of folate or iron, and rising estrogen levels have all been suggested as causes.

Gastroesophageal Reflux Disease
As your pregnancy progresses, your uterus grows bigger and heavier. When lying down at night, the heavy uterus puts pressure on the stomach forcing food up the esophagus. There is a valve in your esophagus that prevents digested food from coming back up.

Progesterone causes this valve to relax. Hence, food mixed with stomach acid travels up the esophagus and causes a painful burning sensation. This is called gastroesophageal reflux disease.

Sleep on your left side with your knees bent reduces the risk of a heartburn attack at night. Alternatively, you can sleep in a sitting up position with your back propped up by a stack of pillows for support.

Vivid Dreams
Pregnancy is an emotional rollercoaster ride for women. You might spend most of it constantly worrying about the health of your baby. This anxiety can translate into your sleep and lead to bizarre dreams.

Furthermore, if you wake up in the middle of a REM stage, you can vividly recall what you saw in your dreams.

During the Third Trimester

The last stage of your pregnancy is the most difficult. Sadly, you will suffer from the poorest quality of sleep because it is harder to fall asleep. You may also be awakened by numerous interruptions during this time.

Back Pain
You are heaviest during your third trimester. Throughout your pregnancy, you will gain 25-35 pounds. Your uterus will grow to almost full size by now. Thus, there is a lot of strain on the spine which has to support all this extra weight.

To make things worse, your body produces a hormone called relaxin which loosens ligaments to prepare your body for labor. This hormone loosens spinal ligaments making it more difficult for the spine to carry the burden placed on it.  This eventually culminates in back pain which might keep you up at night.

Increased Snoring
The weight gain from pregnancy worsens nasal congestion which leads to increased snoring. According to a study, mothers who snore are at high risk of developing pregnancy-related high blood pressure than mothers who do not.

Tips on How You Can Get a Decent Night’s Rest

Although your quality of sleep will suffer during pregnancy, you can reduce the frequency of interruptions and catch some z’s by following the tips below:

Schedule Your Sleep Sessions
A night full of running to the bathroom and waking up from bizarre dreams will certainly leave you exhausted by the morning. Many times through the day you may want to ditch the chores and have a lie in.

Well, seize the opportunity for a little nap whenever you want! Take as many naps as you need especially when you are running low on energy.

Experts advise avoiding the use of sleeping pills including ones which contain melatonin, during pregnancy.

Don’t Drink Fluids Right Before Bedtime
Stay hydrated during pregnancy to keep constipation and bloating at bay. However, you may want to reduce water consumption from the evenings up until bedtime. And, lay off caffeine which worsens insomnia.

Keep a Packet of Saltines or Dry Cereal on Hand
Keeping a packet of saltine or dry cereal on your nightstand will help you fight against morning sickness. Simply, pop in a cracker whenever you begin feeling queasy to ease nausea.

Use Pregnancy Pillows
When pregnant, you may have had to forsake your favorite sleep position to reduce any discomfort due to your changing body. Fortunately, pregnancy pillows come in a variety of shapes for all your support needs.

These pillows support the head, chest, back, and knees to help ease body pains and allow you to assume any sleep position you want.

Eat Healthily
If you suffer from heartburn, fatty food should be completely off limits. Consuming fat and oil-rich food causes the stomach to produce more acids and aggravates the digestive system. Eat a balanced diet that is rich in fruit and vegetables.

Moreover, eating a healthy diet during pregnancy is vital to having a healthy baby. Maternal nutrition influences the nutritional habits of the fetus for the rest of its life.

Furthermore, the baby’s predisposition to certain illnesses and its birth weight and development depend on the kind of nutrition it receives from its mother.

Exercise in the Mornings
Exercising during pregnancy improves your moods, increases your stamina for labor, reduces backaches and makes you more energetic. When you exercise in the mornings, it stimulates your body to produce melatonin earlier in the evening which positively affects sleep and improves your sleep rhythm.

Related article: Exercise and sleep quality

Related article: Three best pregnancy workouts

Make Your Bedroom More Comfortable
Use night lights to provide illumination whenever you need to go to the bathroom at night without turning the lights on and ruining your chances of getting any sleep. Keep your room dark and cool to make it an optimum environment to sleep in.

Practice Self-Soothing
If you have trouble falling asleep, don’t just lie in bed fretting. Get up, read a book or do something else. Distracting yourself will ease any tensions. You can also try meditating or relaxation exercises to soothe yourself.

The bottom line

As a pregnant woman, you may feel exhausted and have trouble sleeping a lot of the time. Although poor sleep quality is one of the side effects of pregnancy, you don’t have to spend the entirety of your pregnancy being chronically tired.

Following the above advice will help you stay well rested during pregnancy. However, if lethargy persists or worsens, consult a doctor.

Fertility problems are more common than you might think. About 10 percent of American women ages 15-44 will experience fertility problems. For women who don’t have their own viable eggs, donor eggs are often the only option for a natural pregnancy. Fertility specialists rely on healthy donors to supply these eggs.

What do you need to know before becoming an egg donor?

1. The screening process is intense

A lot of women choose to donate their eggs because of the excellent compensation that is offered. But, the screening process to become an egg donor is intense. You will be required to complete both physical and psychological screenings to be eligible to donate.

The physical screening is relatively straightforward. You’ll have an ultrasound to inspect the health of your ovaries and determine if you’re a good candidate for donation. The doctor will also draw blood and go over your medical history.

Any inheritable genetic disorders will automatically disqualify you from donating. You also need to be within a healthy BMI range to qualify. The exact BMI requirements will vary from clinic to clinic.

The psychological screening helps the doctor determine your state of mind, which is essential before you’re allowed to donate. You’ll also go over your personal history with any mental illnesses, abuse or drug problems. You may even be asked to take a personality test to help match you with potential recipients.

The screening process is so intense because it’s designed to weed out anyone who wouldn’t be a good fit for an egg donation. This includes anyone with a physical or mental illness that could be inherited by the child. It also often excludes anyone who’s just in it for the money.

2. The process takes a couple of weeks

Donating eggs for women is nothing like donating sperm for men. For a man, all they need to do is walk in, do their thing and walk out again. For women, the process is quite like the IVF procedure but ends with egg retrieval.

Egg donation starts with a series of nightly injections. These hormone injections trigger your ovaries to start producing a lot of eggs — anywhere from 10 to 30 or more per cycle. Once the doses are complete, a process that usually takes two to three weeks, you will receive a trigger shot that tells your ovaries to release the eggs. They will be aspirated and provided to the recipients.

During the cycle, you will probably feel bloated and uncomfortable, but for most donors, the discomfort fades quickly after the process is completed.

3. It’s about more than money

Egg donors are well compensated for their donations. The compensation depends on a few things:

  • What type of donation you want to make
  • The state in which you live
  • The clinic you’re using

You could be paid anywhere from $6,000 to $50,000 just for donating your eggs. For many people, receiving that amount of money is life-changing.

But donating eggs should not be just about the money. In fact, many donation clinics will turn you away if your sole reason for donating is to cash in on those eggs that you’re not using anyway.

If you do donate, keep in mind that the money you make from your donation is considered taxable income. It will be taxed as miscellaneous income — the same category as lottery winnings — which varies depending on the rest of your income and the state you live in.

Depending on how much you make annually, you may need to put away as much as 40 percent if the compensation you receive to pay your taxes at the end of the year.

Related Article:  Why Infertility Treatment Should be a Covered Benefit

4. There are risks

As with any medical procedure, there are risks to consider before you sign on the dotted line. You will be jump-starting your body’s egg production, meaning you’re incredibly fertile after a donation cycle and have a higher chance of becoming pregnant. The aspiration procedure is done under conscious sedation, which has its own set of risks.

Donating your eggs also carries the risk of developing ovarian hyperstimulation syndrome (OHSS). The ovaries are overstimulated by the hormone shots you take before the eggs are aspirated. They can become swollen and painful.

In extreme cases, the fluid produced in the ovaries can leak into surrounding tissue. While this is rare, affecting between 3 and 6 percent of women who take fertility drugs through intramuscular injection, it is a risk you should keep in mind.

There have also been some cases where women have experienced adverse side effects months or years after their donation. Be sure you discuss all the risks with your doctor before you agree to donate your eggs.

5. It can be life changing

Donating your eggs can be a life-changing experience. You’re certainly going to change the life of the couple that receives your eggs. You are giving them a chance to have children they wouldn’t have had otherwise.

When it comes to you as the donor, the jury is still out as to whether the experience is a good one or a bad one.

Some women are happy to donate their eggs. They feel a sort of empathy that leads them to connect with others. Others, including women who donated their eggs for the money, have regretted it later.

Issues range from health complications like OHSS to the idea of there being a biologically related child they have no contact with.

If you’re considering donating your eggs, make sure you’re doing it for the right reasons. Discuss all the risks and concerns with your doctor ahead of time.

It is true that egg donation can be a life-changing experience, but it isn’t the right choice for everyone.

The bottom line

Make sure you understand all the ins and outs of egg donation. This will keep you from making a decision you could later regret.

The fertility industry wouldn’t work as well without egg donors. What donors do is noble. But not everyone is cut out for it.

It’s not about the money. It is about making a selfless decision to change someone’s life for the better and give them a family they might not have otherwise.

More by this author: Health Conditions That Can Lead to a Hysterectomy

Infertility is a sensitive issue. Most people believe it affects only a minor part of the population. However, multiple studies have shown that between 15 and 20 percent of people in the reproductive age suffer from some degree of infertility. If we dissect the statistics further, it comes to light that female factor infertility is the culprit in only 40 percent of the cases. The surprise here is that male factor infertility is to blame in roughly 30 to 40 percent cases.

People find that surprising because the problem of infertility or childlessness is traditionally laid at the door of the female partner in a couple. However, among couples that come in for IVF or surrogacy treatment in my practice, the male partner is as likely to suffer from infertility and be responsible for a couple’s childlessness as the female.

At the same time, diagnosing male factor infertility is a lot harder than diagnosing female infertility as the latter offers more observable and visible set of symptoms compared to the former because of its impact on menstruation. Conditions like polycystic ovary syndrome (PCOS) or endometriosis play havoc with their ovulation cycle. A disturbance of the ovulation cycle is instantly recognizable as it causes noticeable changes in a woman’s menstruation cycle. The symptoms for males as such are a lot less visible and therefore, rarely draw discussion when a couple is not able to conceive a child through regular sexual intercourse. There are, however, some signs that may suggest male infertility is the problem.


Five possible signs of male infertility

1. Trouble with ejaculation and orgasms

The medical term for this is “ejaculation disorder.” It is an important sign that a male infertility factor could be lurking somewhere. The base issue is that ejaculation is not normal, for example, the volume of the ejaculate is too low, it takes place only rarely, or is hampered by erectile dysfunction.

Disorders related to ejaculation are many different causes. For one, there is the phenomenon of retrograde ejaculation in which the semen actually retreats into the bladder instead of being ejaculated. Other causes include certain types of medications such as antipsychotics, neurologic conditions, and problems related to the spinal cord. If you suffer from any of these conditions and are not able to conceive a child with your partner, you should get checked by your physician or a fertility specialist.

2. Varicocele of the testes

A varicocele is when the veins in your testicle swell which obstructs necessary drainage and lowers your sperm count. The condition affects around 10-15% of reproductive age men.  Although it’s exact cause is a matter of debate, signs of a varicocele include swelling of the testicle(s), a dull pain, lumps, and observably large inflamed veins.The bad news is that a varicocele can seriously affect your capability to impregnate your partner. The good news is it can be corrected easily with surgery in most cases. Routinely check your testicles for any kind of swelling or lumps. If you find anything out of the normal, get it checked out by a medical professional.

3. Low sperm count

Lack of enough sperm to travel up the vagina and fertilize eggs is one of the more common causes of male infertility. Scientifically known as oligospermia, it denotes a male whose sperm count falls below 15 million sperm per milliliter of semen. Now that may sound a lot but remember that in a normal healthy and fertile male, the sperm count is between 20 million to 150 million sperm per milliliter of semen.

Related story: Sperm Counts in the Privacy of Your Home

A low sperm count is also one of those infertility causes that has no visible symptoms. It can only be confirmed by a diagnostic test where your sperm is sent to the lab for a complete semen analysis. Some of the common causes of a low sperm count include infections in the testes, environmental exposure to toxic materials, an imbalance in the hormone levels, stress, obesity, excessive smoking and alcohol consumption, and STDs.

4. Smaller than normal testicles

Males born with Klinefelter’s Syndrome (KS) is also called 47,XXY or XXY because they have one or more additional X chromosomes. The primary result of KS is smaller than normal testicles, which limits their ability to produce enough testosterone levels for puberty to begin. Other signs of Klinefelter’s syndrome include negligible facial hair, excess fat in the area around the breast and thin or disproportionate bodies.

5. Decreased libido & other hormonal problems

In popular culture, men are portrayed as more desirous of sex than women. While that depiction is certainly overblown, there is also the fact that men produce a greater amount of testosterone, the hormone most closely related to the libido or sex drive. That is why if you or your partner perceives a change in your sexual drive that is unrelated to external events (like excess stress resulting from increased work hours or a tragic episode in your life), it should warrant greater scrutiny. For one, it hints at the possibility of lower than normal levels of testosterone being secreted in the man’s body, which is a possible cause of an underlying infertility problem.

The inability to maintain an erection for the duration of the sexual intercourse (erectile dysfunction), having problems ejaculating (premature or delayed ejaculation) or ejaculating only small amounts of fluid are also signs of a larger infertility problem.

Abnormalities related to the other hormonal systems like the pituitary, hypothalamus, adrenal and thyroid glands also have the ability to influence male fertility. Some symptoms of these types of problems include unexplained weight gain, a decreased amount of facial and body hair, and gynecomastia (abnormal breast growth in males).


For the sake of fertility, do not ignore these sign

Although a stereotype, there is no denying that men usually do not acknowledge issues about their fertility. That may lead to ignoring signs and symptoms like the ones described above. Issues may not be attended to until and unless there is some sort of pain or discomfort. That makes all the more important why sexual problems, no matter how supposedly small or irrelevant, should be addressed as soon as they manifest.

While this article has discussed some of the more prominent signs of male factor infertility, there may be others that negatively impact your ability to reproduce. That said, a visit to a fertility specialist not only helps you learn what the exact problem is but also puts you on the right treatment protocol.

It was a bathmat that did it.

Leaning over my tiny daughter as I bathed her one night, I stared at the broken-in vinyl mat she was sitting on in the tub. For the first time, I wondered if it could be leaching into every night’s bathwater. And into her. When even Google couldn’t give me a clear answer, I knew I had work to do.

Turns out, there’s no clear, credible and concise site for consumers, no place where they can get actionable guidance about how to reduce their exposure to everyday toxic chemicals. Meanwhile, there’s a silent epidemic: A tidal wave of toxicity surrounding us. Most of us remain completely unaware of it – especially pregnant women who are responsible not only for their own health but also for the health of the whole next generation.

I started SafetyNEST to solve this problem.

We are surrounded by toxins

According to the EPA, there are more than 85,000 synthetic chemicals that surround us in everything from our living room couch to our cleaning products.1 Another way to slice it: 30,000 pounds of industrial chemicals are being produced for every single person in the United States, every year.2 Lead, mercury, phthalates, Bisphenol A, flame retardants, Teflon, and pesticides are among the chemicals of concern. Increasing evidence shows widespread exposure and adverse health outcomes as a result.

Here’s the glitch.

Most of us think that if it’s sold in the store, someone must have tested it for toxicity and safety…right?

Not so. Unlike pharmaceuticals, consumer product companies can constantly introduce chemicals into the environment with little to no proof of safety, due to a flawed approval system.3

These chemicals get into us through the air we breath, the food we eat, the water we drink and a host of products we routinely, blithely, benightedly use in our home and workplace. Us, by the way, includes pregnant women. Virtually every pregnant woman in the US, according to a UCSF study, has at least 43 toxic chemicals in her body. 4 These chemicals are also found in the breast milk of nursing mothers and the umbilical cord blood of newborns.

Toxins and pregnancy

We know for sure that exposure to toxic chemicals, even at very low levels, during vulnerable windows of development such as pregnancy and infancy can disrupt the delicate growth process, causing a lifetime of health havoc, even death.5 Prenatal exposure to toxic chemicals is linked to preterm birth, birth defects, childhood cancer, obesity, diabetes, asthma, and lasting harm to the brain.6

Toxic chemicals affect us all. But many toxic chemicals disproportionately impact vulnerable populations, leaving underserved women more susceptible to adverse impacts. These can be exacerbated by other factors, including stress, nutritional status, housing quality, and poverty. It’s notable that immigrant populations often work in occupations associated with hazardous workplace environments.

Related content: Fetal syndromes: Diagnosis, Treatment, and Outcomes

Research continues to prove that we are ignoring this issue – but shouldn’t be. In August 2017, UCSF released a study titled “Higher Exposure to Flame Retardants in Pregnant Women Leads to Lower IQ in Children.” The facts:

For every 10-fold increase in a mom’s levels of PBDE – the compounds used as flame retardants, which are found in couches, electronics, plastics and more – there’s a drop of 3.7 IQ points in her child.

The price tag for all this? In 2008, the price tag was $76 billion every year in the United States. This is for poor childhood health caused by environmental factors, such as air pollution and exposure to toxic chemicals.7 The Lancet published a 2016 study showing exposure to chemicals in pesticides, toys, makeup, food packaging and detergents costs the U.S. more than $340 billion annually, in health care costs and lost wages.8

How can this be something we are willing to ignore?

How can this be something we are willing to ignore? Maybe we’re not. Since SafetyNest started in 2016, a lot has happened:

  • There’s been an acknowledgment of the problem

In the US: The American College of Obstetricians and Gynecologists (ACOG) released a Committee Opinion in 2013 stating:

“The evidence that links exposure to toxic environmental agents and adverse reproductive and developmental health outcomes is sufficiently robust….Harmful chemicals can cross the placenta…ACOG and the American Society for Reproductive Medicine join leading scientists and other clinical practitioners in calling for timely action to identify and reduce toxic environmental agents while addressing the consequences of such exposure.” 9

There has been a call to action

FIGO, the International Federation of Gynecology and Obstetrics, released a call to action in 2015 that stated, categorically, that exposure to toxins before and after birth is a serious threat and

“Preventing exposure to environmental chemicals is a priority for reproductive health professionals everywhere.” 10

  • There has been legal reform

After 40 years of waiting, the Toxic Substances Control Act (TSCA) – our nation’s badly broken chemical safety law – was reformed in June 2016. It still leaves the majority of chemicals untested and only a very small fraction of new chemicals added to the list for assessment.11 But it is a step in the right direction.

SafetyNEST – a trusted source for pregnant women

We can’t just kick back and wait for strong policy to be enacted in the United States. We have to get smart, ourselves. This is why SafetyNEST’s mission is to become the most trusted source for every pregnant woman and her reproductive health provider to safeguard our babies’ health against toxic chemicals.

SafetyNEST transforms prenatal care by equipping both reproductive health providers and the pregnant women they serve with the most accurate, evidence-based, and personalized information about the effects of toxic chemicals on prenatal and early childhood health. Our goal is to reduce the incidence of preventable diseases linked to toxic chemical exposure.

Our priority is developing an engaging, digital health platform to educate women about how to reduce their exposure to toxic chemicals in their daily lives, particularly in their homes. Partners include UCSF Program on Reproductive Health and the Environment, Icahn School of Medicine at Mount Sinai and the American Medical Women’s Association.

Together we’re working to make sure no more mothers have that moment of panic I did, all those years ago, at bath time – or worse. It’s our job, and our mission, to give the next generation the best possible start.


1. Children and Environmental Toxins: What Everyone Needs to Know, Philip J. Landrigan and Mary M. Landrigan, Oxford University Press, 2018.
2. We’re Surrounded by Way More Chemicals Than We Thought, Mother Jones, October 2015.
3. Why the Toxic Substance Control Act Needs an Overhaul, and How to Strengthen Oversight of Chemicals in the Interim, SA Vogel and JA Roberts, Health Affairs, 30:898-905, 2011.
4. UCSF Study Identifies Chemicals in Pregnant Women, January 14, 2011.
5. Environmental Chemicals in Pregnant Women in the United States, Tracey Woodruff et al, Program on Reproductive Health and the Environment, Environmental Health Perspectives, June 2011.
6. The Role of Environmental Toxicants in Preterm Birth, National Academy of Sciences, 2007.
7. Environmental Illness In Children Costs $76.6 Billion Annually, Health Affairs, May 20111.
8. Exposure to Endocrine-Disrupting Chemicals in the USA: A Population-Based Disease Burden and Cost Analysis, The Lancet Diabetes and Endocrinology Journal, October 2016.
9. Committee Opinion Number 575, Exposure to Toxic Environmental Agents, ACOG Committee on Health Care for Underserved Women; American Society for Reproductive Medicine Practice Committee; UCSF Program on Reproductive Health and the Environment, October 2013.
10. Opinion on reproductive health impacts of exposure to toxic environmental chemicals, Di Renzo GC, et al, International Federation of Gynecology and Obstetrics, 2015.
11. Assessing and Managing Chemicals Under TSCA: The Frank R. Lautenberg Chemical Safety for the 21st Century Act, United States Environmental Protection Agency, June 2016.

Have you ever felt trapped in a predicament in which you thought there was no possible good outcome? I have. I was a successful psychiatrist, married for 18 years with two young daughters, but tormented with a decision about coming out as gay. The more I struggled with the decision, the more anxious I became. Although I never considered suicide, other mature adults—and there are many—confronting the decision to come out attempt suicide at about three times the rate of the general population, sometimes making multiple attempts. My predicament lasted a relatively short time, and once I made the decision to come out, my anxiety disappeared.


The transgender suicide predicament

The dominant psychiatric belief has always been that suicide is the result of a mental disorder, and recent adverse life events are known to increase the risk and perhaps form the trigger for suicide. Dr. Saxby Pridmore, an Australian psychiatrist, described “predicament suicide,” which occurs when an individual without a mental disorder completes suicide to escape intolerable circumstances. To some extent, all suicides are a response to a predicament, but the idea of predicament suicide still has some currency when applied in a limited sense to cases where there is no mental disorder.

People who are transgender have a much harder struggle than I did. Many trans children become aware of their predicament long before they understand the concept of gender or are aware that their opposite-sex interests will result in significant disapproval. It doesn’t take long for them to begin to experience strong opposition and violence. Often, a trans individual experiences multiple, daily acts of intolerance or violence, beginning as early as preschool and continuing across a lifetime.

I recently interviewed a middle-aged trans female just beginning her transitioning from male to female. She always wanted to be female. At age four, her alcoholic father caught her dressing in girls’ clothing and in a fit of drunken rage, he threw her against the wall, causing injuries that required her prolonged hospitalization. Because of that violence, she lived a secret life. As an adult, she had a successful career, married, and had children, burying her interest in being a woman except when secrecy could be assured. Her predicament frequently led to thoughts of suicide.

Acts of violence are not single incidents. Mental health issues and experiences of harassment, discrimination, violence, and rejection may interact to produce a marked vulnerability to suicidal behavior in transgender and gender non-conforming individuals.

I work as a psychiatric consultant in a clinic that does gender-reassignment treatments, and stories like this trans woman’s are common. I am often asked to give a psychiatric opinion of whether a person is psychiatrically stable so that gender-reassignment surgery can proceed. In most cases, I find no evidence of a psychiatric disorder or only symptoms related to a lifetime of abuse.

Although at higher risk for anxiety, depression, and suicide, many of these transgender men and women show a remarkable resilience to having been rejected by family and peers, harassed, traumatized, and abused. Many of their psychiatric symptoms disappear once they have accepted that “I am what I am; I don’t care what anyone thinks.” Shame cannot survive in the presence of people who accept these individuals. One person who had lived as a woman for a year after having undergone hormonal treatment requested surgery and said,

“I have no illusions that I will be a beautiful woman. I just want my outsides to match my insides.”

Findings published in a report called “Suicide Attempts among Transgender and Gender Non-Conforming Adults,” indicate that 46% of trans men and 42% of trans women have attempted suicide, a public health crisis for the estimated 150,000 trans teens and 1.4 million trans adults. The prevalence of transgender suicide is highest among the young, the economically disadvantaged, and the less educated and ethnic minorities. It is also higher for those who are thought by others to be gender non-conforming, even if they are not told. For those who have an underlying mental condition, suicide prevalence is even higher.

Related Content: Suicide in America: Understanding the What and Why

Politics and religion

As a candidate for president, Donald Trump said that transgender people should use the bathroom they were more comfortable with. He appeared to support the Obama administration’s decision to inform schools receiving Title IX federal funds that they must allow students to use restrooms and changing rooms consistent with the gender with which they identified. He claimed to be sympathetic to the LGBTQ community and made a commitment to protect us from violence.

President Trump lost credibility when he reversed his position and in a brief letter announced that he was rescinding President Obama’s directives to protect transgender schoolchildren. The decision was couched in terms of deference to the primary role of states and local schools to establish educational policy. An editorial in the Los Angeles Times suggested, however, that Trump’s decision was influenced largely by religious conservatives who provided significant support to Trump and long have stirred up hysteria over the imaginary danger to children posed by policies that allow transgender children to use facilities of the gender they identify with, even if it doesn’t match the one on their birth certificates.

A recent article on the Gospel Coalition website states, “The sexual revolution has so subverted public opinion and Christian-influenced morality that teachings about sex that were previously considered immoral or even unthinkable eventually found their way into the classroom as school policy. But a quicker and more effective route to societal change is to simply reverse the process: force an issue to become school policy and eventually opposition to it will become unthinkable. That is the shift that is being attempted today on the issue of transgenderism in schools.”

This article goes on to say that people might choose “their own sex” to benefit themselves. “But as history has shown, people respond to incentives. If men can gain an advantage by saying they are women, many will do so. To claim otherwise is to be completely unaware of humanity’s sinful nature.”

Although we don’t really know why some people are transgender, the explanations for this complex issue are often found in a combination of genetic, psychological and cultural factors. The statements by the Gospel Coalition ignore the pain that goes into the decision to transition and the violence to which these people are exposed, treating the matter as if transitioning will help gain one admission to a favored college or a peek over the top of a bathroom stall.

The LGBTQ community is in for a bumpy ride. Trump supports the First Amendment Defense Act, which is quite like a law passed by Vice President Mike Pence in 2015 when he was the governor of Indiana. It would allow business owners to deny services to LGBTQ customers based on their belief that marriage is solely between one man and one woman.

That legislation was cosponsored by then Alabama senator and now attorney general Jeff Sessions, who has consistently opposed pro-LGBTQ legislation throughout his twenty years in Congress. He voted in support of a constitutional ban on same-sex marriage, against providing workplace discrimination protections for LGBTQ people, against repealing the military’s “don’t ask, don’t tell” policy, and twice against expanding the definition of hate crimes to include attacks on people because of their sexual orientation and gender identity. He has supported a law that would allow state laws to override federal laws about same-sex marriage. The Human Rights Campaign, in its annual scorecard of how lawmakers fare on LGBTQ issues, year after year has rated Sessions at zero.

Education Secretary Betsy DeVos, a conservative Christian, originally supported President Obama’s policy of protection for trans teens but, apparently, under pressure from the new administration, has reversed her position and now says it is an issue for states and local schools to decide.

On March 28, the Supreme Court will hear oral arguments in a lawsuit filed by Gavin Grimm, a transgender high school student, a boy seeking to use the boys’ restroom at his Virginia high school. In ruling for Grimm, a federal appeals court had relied on the Obama administration’s interpretation of Title IX. With the Trump administration’s change of policy, the justices might send the case back to the appeals court.


The bottom line

What some have seen as an epidemic of people seeking to transition from one gender to another is not a real change in incidence but a change in visibility of a hidden population. If recent policy changes by the Trump administration are activated, trans children and adults will be driven back into hiding, where they will once again be faced with a huge predicament. It appears that this is only the beginning for the entire LGBTQ community.

Related content: Older Gay Men and the Risk of Suicide

Approximately 11 million U.S. couples try to conceive every year, but 15% of them will experience infertility, defined as being unable to conceive following at least a year of unprotected intercourse. According to Dr. Brian Levine, New York practice director for the Colorado Center for Reproductive Medicine, a multistate fertility practice,

“Nearly half of fertility problems originate with the male partner, however, couples have had few options for tackling the male half of the conception equation.”

Failure to identify low sperm counts as a contributing factor to infertility can “hinder timely treatment and ultimately slow the conception process,” according to Ken Mosesian Executive Director of Path2Parenthood, a nonprofit organization committed to helping parents find a streamlined path to having a child.

Sperm counts have fallen significantly over the last several decades due to a variety of factors. For example, one study documented that obese men had a 19 times higher odds of having a low total sperm count (95% CI 2.2–177.3) compared with men with a normal BMI. Another showed that sleep disturbances were associated with reduced semen quality in a cross-sectional study of 953 healthy young Danish men. Tobacco smoking, as well as stress, has also been shown to reduce semen quality. Even hot tub exposure has been reported to be a potentially reversible cause of low semen quality in infertile men. In an anecdotal N of 1 experiment (and brilliant marketing move), Sandstone’s founder, Greg Sommers, used the social media platform Medium to publish his personal account of doubling his sperm count by losing 15 pounds.

Until now, the diagnosis of low sperm count has required a visit to a urologist or fertility specialist for collection and analysis of a semen sample. But, men may delay getting the test done because they are embarrassed by the process of producing a semen sample outside of the privacy of their home. The Trak offers couples a do-it-yourself alternative to both screen and monitor key male fertility parameters at home as opposed to having to go to a doctor’s office for a semen analysis.

Related Content: 5 Signs That Male Infertility Could Be The Problem

The Trak male fertility testing system

The Trak consists of a battery powered mini-centrifuge, a collection cup, a dropper, and disposable, single-use test cartridges. The man collects the sample in the cup and then uses the dropper to load it into the cartridge. The cartridge is then placed in the centrifuge which begins to spin for a pre-determined amount of time when the lid is closed (if the lid is accidentally opened too soon, an error occurs and the process must be repeated). By spinning the sample, sperm cells (which are the most dense components of semen) sediment out of the sample and collect in the outer region of the test cartridge. The size of the sperm cell pellet correlates with the concentration of cells.

Here is how it works:

The Trak is available at for $199.99. A 2-test refill pack is available for $49.99.


But is it reliable?

Here is what we know from the published literature:

A three-site clinical trial comparing 239 untrained users self-reported results with reference results obtained by computer-aided semen analysis (CASA) concluded that “The Trak System is an accurate tool for semiquantitatively measuring sperm concentration in the home.”


The Trak is more than just a test kit

Trak’s mobile app helps men monitor their key fertility stats over time and correlate changes in sperm count to certain lifestyle changes known to impact sperm (diet, hot tubbing, exercise). Men can, then, take steps to improve their health and chances of conception. As Greg told me when I interviewed him in 2015:

“Trak is more than just a test kit…it’s a comprehensive solution to help you conceive.”

Here is a video that explains the functionality of the app:

To learn more about male fertility and take an interactive “risk assessment” quiz, check out their companion website, “Don’t Cook Your Balls.” The quiz takes about 10 minutes to complete and, per Greg, “provides comprehensive feedback on areas of a man’s life that may contribute to fertility issues.”