Whenever I speak to groups or patients in my counselling practice, I get more questions about vitamins and minerals than almost any other topic.

Typical questions include “what should I take”, “how much should I take”, “is there any harm in taking them” and of course “food vs supplements.”

So, as we close out nutrition month, I thought I would once again address this popular topic.

Vitamins and minerals are components in food that are essential for our well being. There are many, as most people know, and they all have very specific properties. Most importantly they are all found naturally in a variety of different foods. There are guidelines for how much of each one you need and also — how much is too much.

In general, it’s pretty difficult to overdo it with foods but with supplements there are instances where too much can be a problem.

In a perfect world, under perfect circumstances, diet would give you everything you need and there would be no need for supplements. But, there are times when it’s not possible to get all you need and supplements can help. These times include:

– Women who are pregnant are advised to take a multivitamin with adequate iron to support the demands of pregnancy.

– A multi-supplement with 400 mcg of folic acid is recommended for all women who could become pregnant or who are pregnant or breastfeeding.

– For many menstruating women, getting the required 18 mg of iron can be challenging, even more so if she is on a very low-calorie diet or a strict vegetarian. In these cases, a supplement may be necessary.

– Vegetarians require almost twice as much iron as non-vegetarians and may have difficulty meeting this need with diet alone.

It is recommended that adults over the age of 50 take a supplement of vitamin D as a single supplement or as a component of a multivitamin. And, vitamin D of 600 to 1000 IU or more is being recommended by many health organizations to all Canadians since it is so difficult to get enough in food alone.

Adults over 50 may not be absorbing enough vitamin B12 from foods and are advised to get it from supplements or fortified foods.

People with many food allergies or intolerances, on very restricted diets or those on very low calorie diets may benefit from a multivitamin.

Can you overdo it with supplements? Yes, in some instances you can. Here are a few of those instances:

High doses of vitamin A can be associated with increased risk of fractures and other health issues.

While folate is important, especially to women of childbearing years, too much is not wise. The safe upper limit is 1000 mcg/day. Higher amounts of synthetic folic acid can increase cancer risk in predisposed individuals over time. If you are taking both a multivitamin and a B complex, chances are you are getting too much.

A multivitamin can be a safety net if you feel you are not always eating well. If you are taking a variety of different supplements (for example, vitamin C and B vitamins separately in addition to a multivitamin), it’s a good idea to sit down with your pharmacist or dietitian to evaluate your intake. And, of course, supplements will never take the place of a healthy diet nor will they make up for a diet that’s loaded with unhealthy foods. I’ll write more on this subject in future columns.

Should I take vitamin supplements to prevent illness? Do I need them if I eat a balanced diet? What is the best dosage of vitamin D or C?

I often receive questions about vitamin therapy. So are vitamins worth it, or a waste of money? Scottish heritage forbids me to spend money foolishly. Neither should you.

When patients question the value of vitamins, I always ask them, “What do you eat for breakfast?” The reply is often, “I skip breakfast as I’m rushing to the office.” Or “I get a muffin (fat-laden) and coffee on my way to work.” So they start their day with one nutritional strike against them. Their breakfast lacks fibre, vitamins and minerals such as magnesium. This routine is also a great way to develop constipation and irritable bowel syndrome.

The second strike comes when they grab a hamburger for lunch. And later in the day they strike out for the third time when it’s too convenient to pick up a packaged dinner loaded with calories, sugar and salt. Reheating also destroys many of the vitamins that are present.

Some of my friends are strict vegetarians. But in their enthusiasm for avoiding animal products, they may not be getting enough vitamin B12, zinc or calcium.

Readers of this column know I enjoy an alcoholic drink before dinner. I’ve always believed Sir William Osler was right when he said, “Alcohol is for the elderly what milk is for the young.” But only in moderation, as those who imbibe too much are usually vitamin deficient.

As our bodies age, they undergo change. For instance, the stomach produces less acid, making it more difficult to absorb vitamin B12. I recall a patient who was believed to be in the early stages of Alzheimer’s disease who slowly regained normal mental function after receiving this vitamin.

But vitamins are not just for the elderly. There are more than 70 million North American women in their reproductive years. They should all be taking folic acid every day, not just after they become pregnant. Rather, it’s vital to be on this vitamin before they become pregnant to prevent a defect in their baby’s spinal cord. This message is still not being heard by enough women.

Current evidence shows folic acid, vitamins B6 and B12 help to decrease the risk of heart disease by decreasing the blood level of homocysteine, a by-product of protein metabolism. But I believe vitamin C plays an even greater role in preventing heart disease. In fact, studies by Dr. Sydney Bush, an English researcher, prove that high doses of C, plus the amino acid lysine, can open up blocked coronary arteries.

I believe there are now several reasons why it’s prudent to consider vitamin therapy. We must first rid ourselves of the misconception that the majority of North Americans eat a balanced diet. A significant portion of this diet is junk food that does not contain sufficient amounts of fruit, vegetables, fibre, minerals and other vital ingredients.

As a prudent Scot I first try to eat a balanced diet. I also take a variety of vitamins and minerals every day. This routine is not cheap, but relative to the high cost of ill health, I look on these purchases as an inexpensive insurance policy.

A recent report contained disturbing news. Some North American pharmaceutical companies are importing billions of dollars of drugs and ingredients from foreign countries. A report from the University of California says, “Your vitamin pill may as well be labelled Vitamin China.”

It’s ironic that although manufacturers must state where your socks or TV sets were made, this is not true of vitamins. And studies have shown that just as household appliances can differ in quality, so can vitamin products. So it’s important to be careful where you purchase vitamins.

Unfortunately, the 700 words of this column do not allow me to tell you in detail what vitamins and minerals I take every day and why I choose them. But you can obtain this information on my website www.docgiff.com. For comments info@docgiff.com.

Bisphenol A (BPA) is a controversial industrial chemical used to make hundreds of plastic household items including water bottles and food containers, as well as the protective lining in metal cans.

BPA is believed to interfere with the body’s hormone functions, and has been linked to everything from infertility and sexual dysfunction to certain cancers and cardiovascular disease. Many experts say it causes abnormal or premature sexual development in girls. A recent study out of Simon Fraser University found that exposure to BPA in the womb may also be associated with behavioural problems in girls.

Statistics Canada data released in 2010 found that 91% of Canadians had the chemical in their bodies. That year, Canada became the first country in the world to declare BPA toxic and ban its use in baby bottles. The European Union soon followed.

Because of the many millions purchased each year, soup cans have been of particular concern to scientists.

A 2011 study from the Harvard School of Public Health showed people who ate canned soup each day for five days had a more than 1,200% increase in urinary bisphenol A compared with those who consumed fresh soup daily for the same period.

“We’ve known for a while that drinking beverages that have been stored in certain hard plastics can increase the amount of BPA in your body. This study suggests that canned foods may be an even greater concern, especially given their wide use,” Jenny Carwile, the lead author of the study, said in a statement.

Campbell’s Soup said Monday it will stop using the chemical in the lining of its cans, the Milwaukee Journal Sentinel reported. The company has been working on alternatives for years, and will make the move as soon as is feasible, the report said, though Campbell’s stopped short of providing a specific timeline for the phase-out.

The announcement comes just ahead of a U.S. Food and Drug Administration ruling, expected by the end of the month, on whether to ban BPA from food and beverage packaging.

The company’s Canadian operations are a major manufacturer and represent one of its largest businesses outside the U.S.

As if pregnant women haven’t already enough to worry about with morning sickness, swollen ankles and aching backs. Now, there’s one more annoyance — a wonky thyroid!

Pregnant women are susceptible to thyroid disease, says the Thyroid Foundation of Canada which is urging women contemplating pregnancy to visit their doctors to ask for a thyroid test.

Thyroid disease is five times more common in women than it is in men, says Dr. Wendy Rosenthall, a Mississauga, Ont. endocrinologist. “One in 100 women of childbearing age would have an underactive thyroid gland,” she says.

A recent study of 500,000 pregnant women, published by the Journal of Clinical Endocrinology and Metabolism, found 15% had an underactive thyroid.

Despite that, a survey done for the Thyroid Foundation of Canada indicates 79% of Canadian women were not told by their doctors about the importance of thyroid health when they were pregnant. And only 15% had their thyroid levels checked with a simple blood test when they were pregnant.

A current debate among health professionals concerns whether a thyroid test should be mandatory for women in their first trimester. Experts certainly agree that women who’ve had a family history of thyroid disease, or experienced previous thyroid problems, should get tested. The American Thyroid Association last year went further and advised all pregnant women age 30 and older should be tested, as should women with enlarged thyroids, women who are obese, and women with previous pregnancy issues.

While a recent study has challenged the notion that mothers with hypothyroidism may be risking their child’s cognitive development — mild cognitive defects in the offspring of women with hypothyroidism in the first trimester are still a possibility, according to Dr. Rosenthall — thyroid disease impacts women in their childbearing years in many different ways. Low fertility may be the reason why someone can’t get pregnant or stay pregnant.

Vanessa McHugh found that out the hard way. The 30-year-old Guelph mom blamed thyroid disease for a miscarriage during the first trimester of a pregnancy which took more than a year to achieve. Thanks to fertility drugs, she’s now pregnant again, due in April, but this time her thyroid is being closely monitored.

She wants other women to know, should they have trouble conceiving, it could be a thyroid problem.

“Thyroid is a hormone that affects all body function,” Dr. Rosenthall explains. “One of those functions is ovulation. There is an exquisite balance between the higher centres of the brain and the ovaries, and if your thyroid levels are either under or over, you may not ovulate or you may ovulate but not achieve fertilization.”

The thyroid, a butterfly-shaped gland in the base of the neck, produces hormones that regulate metabolism and affect almost every tissue in the body.

“The thyroid really only makes two hormones,” says Dr. Rosenthall. “But the hormones are part of the endocrine system and travel in the bloodstream to different targets such as the bone, the gut, and the skin.”

In fact, thyroid hormones affect every organ and the cells within: “That’s what metabolism is, it’s about controlling cell function.”

Having your thyroid tested is an easy thing to do, she says. It isn’t until the fourth month that a baby has its own fully developed thyroid. “In the first three months, the fetus is dependent on the mother’s thyroid hormone. So if you have a thyroid problem, you’d want it diagnosed as soon as possible.”

Over or under?

An overactive thyroid, called hyperthyroidism, speeds up metabolism and causes weight loss, tremor, and increased heart rates. An underactive thyroid, called hypothyroidism, slows body functions and may be responsible for fatigue, constipation, dry skin, a feeling of being cold, weight gain and depression.

Critical hormones

Two hormones are produced by the thyroid gland: Thyroxine, known as T4, and triiodothyronine or T3. A simple blood test can measure thyroid hormone levels to see if there is a problem.

Butterfly basics

You can learn more about the butterfly gland at thyroid.ca or thyroid.org, or by reading The Thyroid Sourcebook, by M. Sara Rosenthal, a thyroid cancer survivor and a published expert on thyroid bioethics at the University of Kentucky.

Experimental obesity drug Qnexa won the backing of U.S. health advisors on Wednesday, raising hopes for approval of the first prescription weight-loss pill in 13 years.

Vivus Inc’s Qnexa was one of three promising obesity drugs rejected by the U.S. Food and Drug Administration in the past two years over safety concerns.

It is the first to come back up for review after more extensive clinical trials, as public health officials urge the FDA to consider a medical treatment for a condition that affects nearly one-third of Americans.

A panel of outside experts to the FDA voted 20-2 to recommend approval of Qnexa, saying they were convinced that the benefits it offers in treating obesity outweighed the potential heart risks and birth defects associated with the drug.

They did say Vivus should conduct a study on possible heart problems and supported the company’s plan to limit its use to women who are not pregnant.

During discussions, panelists seemed divided on whether the heart-focused safety study should happen before or after the drug is approved. A pre-approval study could delay the time before Qnexa is available to patients.

Shares in Vivus nearly doubled in value to $20.30 in afterhours trade, while fellow obesity drugmakers Orexigen Therapeutics gained 12 percent and Arena Pharmaceuticals rose 10 percent.

“The vote reflects the clinical community’s concern about the challenge of obesity,” said JMP Securities analyst Charles Duncan.

“I continue to believe Orexigen’s Contrave and Vivus’ Qnexa remain approvable drugs and are going to move forward,” Duncan said. “I am less positive on Arena’s Lorcaserin.”

The FDA usually follows panel recommendations, although it is not required to. It will make a final decision by April 17.

“Everyone around the room knows obesity and its substantial health risks,” said Dr. Susan Yanovski, an advisory panel member and director of the obesity and eating disorders program at the National Institutes of Health.

“I would say not treating obesity is not risk neutral. We have few treatments for obesity for those who don’t respond to lifestyle treatments.”

LOSING 10 PCT OF BODY WEIGHT

Obesity, a leading cause of diabetes, heart disease and other serious health problems, has reached epidemic proportions in the United States, with about a third of the population obese and more than half overweight.

The FDA has set a high approval bar for weight loss drugs because such a large portion of the general population is likely to want to take them, and has not approved a new obesity drug since 1999.

Qnexa, which combines the appetite suppressant phentermine and anti-seizure drug topiramate, helped patients lose at least 10 percent of their weight after a year of treatment, the company said.

FDA staff reviewers said patients taking the drug had more safety problems, including memory loss and higher heart rates, than those on a placebo, and some of these problems could get worse over time.

However, Vivus said the drug also reduced blood pressure, and a link between heart rates and heart health was not conclusive. Panelists called for the company to study whether a higher heart rate was tied to heart health.

“They need to step up to the plate and do the cardiovascular outcomes trial, and do it fast,” said panel member Dr. Sanjay Kaul, professor in the division of cardiology at Cedars Sinai Medical Center in Los Angeles. “I also encourage the FDA to hold their feet to the fire.”

FDA staff also noted that exposure to one of the ingredients in Qnexa has been linked to a higher rate of birth defects. A Vivus study showed topiramate caused a higher rate of oral clefts in infants of women taking the drug during pregnancy

The FDA has said the rate of potential birth defects is about two to five times higher with topiramate than with a placebo.

Vivus officials said obesity, and its common symptom diabetes, come with their own risks to pregnancy, such as stillbirth, premature birth and other complications.

A study from the University of California, San Francisco shows mothers who suffer migraines are twice as likely to have babies with colic.

The researchers wonder if colic could be an early symptom of migraines.

Colic is excessive crying in an otherwise healthy infant. Some studies have linked it to gastrointestinal problems, but after more than 50 years of research, there has been no definitive link between the two.

“We’ve known about colic for a really long time, but despite this fact, no one really knows why these babies are crying,” child neurologist Amy Gelfand said in a release about the study.

The researchers studied 154 new mothers and their babies’ crying patterns.

Moms who suffer migraines were found to be 2 1/2 times more likely to have colicky babies, the study found. Overall, 29% of infants whose mothers have migraines had colic compared to 11% of babies whose mothers don’t have migraines.

Gelfand will present the research at the American Academy of Neurology’s annual meeting in April.

A new study suggests autism may begin developing in the brain during infancy, even though children don’t usually start showing sympstoms until after their first birthday, and diagnosis can come often much later.

That’s because many of the warning signs of this developmental disease — being anti-social, having behavioural problems — can be attributed to other factors.

But a new study out of the University of North Carolina Chapel Hill shows there are clear differences in brain communication pathways as early as six months in children who are later diagnosed with autism.

“These results offer promise that we may one day be able to identify infants at risk for autism before the behavioural symptoms are present,” co-author Geri Dawson said in a press release.

Dawson said the goal of this research “is to intervene as early as possible to prevent or reduce the onset of disabling symptoms.”

The researchers studied early brain and behaviour development in 92 infants whose siblings had autism, which meant they were more likely than other kids to also develop the condition.

By six months, the babies who went on to develop autism showed different white matter development for 12 of the 15 major brain pathways than those who did not.

This could be a “brain marker” to determine which children will develop autism.

But the scientists warn these results are preliminary.

“It’s too early to tell whether the brain imaging techniques used in the study will be useful in identifying children at risk for ASD in early infancy,” co-author Joe Piven said.

“But the results could guide the development of better tools for predicting the risk that a child will develop ASD and perhaps measuring whether early intervention therapies improve underlying brain biology.”

The findings were published in the Journal of American Psychiatry.

CALGARY — Anxious children may have developed a hypersensitivity to perceived threats while in their mother’s womb, new research shows.

Gerry Giesbrecht of the University of Calgary was the lead author of the study that examined if a mother’s mood during pregnancy affect levels of cortisol, a hormone linked with stress.

While cortisol is already increased significantly during pregnancy, as it also contributes to fetus development. Giesbrecht found above and beyond the typical increase in the hormone during pregnancy, mood also affected the levels.

“We now know that cortisol is at least one of the ways that moms signal to their babies the kinds of preparations they should make for post-natal life,” said Giesbrecht of the study, which followed 83 women who were between six and 37 weeks gestation by measuring cortisol levels in their saliva and collecting corresponding mood reports.

“If mom’s experiencing lots of stress and her cortisol levels are high, you’re going to conclude, as a fetus, ‘This is a challenging, stressful environment. I should design physiological systems that are really good at dealing with stressful environments,’” said Giesbrecht.

“That means being extremely alert, being very sensitive to potential dangers in the environment.”

It’s a trait that is believed to carry on into childhood, often unnecessarily, he added.

“They developed these hyper-responsive stress systems and any sort of change in the environment is then picked up and translated into a danger signal for them and they react very strongly,” he said.

Mom Fiona McCord participated in the study when she was pregnant with her son, Brik McCord Cooper, now 22 months old.

She said information like this will be useful for future moms-to-be, as it’s a stressful time to begin with, so understanding why managing that stress is important should help.

“As a pregnant woman you’re going to worry in general, you worry about the health of your baby, the health of yourself and all the things that are going to happen after the baby is born,” she said.

“I hope that it does create that road map, the road map to a healthy and happy baby so that people can be more proactive about it, about making their choices instead of having reactive measures taken after the baby is born.”

Years ago, a friend of mine, repeatedly frustrated by failing to get her 4-year-old out of diapers, was told by him that he just wasn’t interested and that he “would never go to the potty.” That kid today is a professor at an Ivy League college.

His example may not reassure parents who struggle with what seems like such a straight-forward task: Helping a child to become more independent while saying goodbye to wet, poopy, smelly diapers.

Toilet training is anything but a no-brainer and bookstores and the Internet are full of guides and kits promising to graduate children from wet diapers to washrooms. While these vary in their training methods, they all attempt one thing: To calm a parent’s fear of their child being in diapers until his first date.

Questions about toilet training are among the most common questions asked of pediatricians, says Dr. Darcie Kiddoo, a pediatric urologist from Edmonton who last fall wrote an article on the subject for the Canadian Medical Association Journal.

“Toilet training is felt to be a natural process that occurs with development,” she says, “but very little published science is available for doctors who care for children.”

Toilet training is quite complex, Kiddoo told me. “Most people think of the bladder as a simple storage organ and so they assume toilet training is easy, but it is highly complicated.”

So many different factors play a role in toilet training readiness: There’s the basic physiological development of the bladder, but there’s also a neurological dimension. All these coming together at the right time equals toilet-readiness.

In her research and literature review, Kiddoo found there was no evidence to show that one method worked better than another. But she says that for toilet training to have a chance, both parents and children have to be in sync.

“If you have an interested child but a parent who can’t take him to the bathroom on a regular basis, then it’s not going to succeed. On the other hand, where there’s a motivated family but a child with no interest, toilet training will be tricky.”

Training methods have swung like a pendulum since 1900, alternating between strict control (putting an infant on a toilet after every meal) to punishment-oriented (introducing timeouts or withholding treats) to permissiveness (at age 4, my friend’s son decided he was ready).

Today’s working parents may have an imposed timeline in that some childcare centres don’t accept children in diapers. Whenever you choose to begin the process, the Canadian Pediatric Society recommends a child-oriented approach, says Kiddoo.

“While there is no perfect time, they advise starting when a child is 18 months of age and that the child must be interested in the process.”

Training a very young child (usually by placing them hourly on the toilet, or after they eat) is not widely endorsed today.

“I would rather they focus on the baby’s development, making sure they reach all their milestones,” Kiddoo says. “Having a child is difficult enough. A very young child is not really toilet trained. It is the parents who are.”

Check out toilet readiness and best how-to method at cps.ca.

What works for you?

· Child-oriented, relaxed: Both child and parent are interested and committed

· Parent-oriented, structured: Increased fluid intake, scheduled toileting, positive reinforcement and overcorrection of accidents

· Infant toilet-training: Infant placed on toilet after a meal

· Operant conditioning: Dryness rewarded with affection, toys or candy; accidents are dealt with through punishment or lack of positive attention

Harmful habits

Kids who hold their urine can get infections, says Kiddoo, whose patients are older children who were toilet trained but get infections and have accidents. Generally speaking, these are kids whose parents forgot to follow through after they seemed trained. “I would much prefer parents be more aware of what happens after they toilet train than worrying about a specific age or method for toilet training.”

Did you know: Training basics

Take a child-centred approach for long-standing success. Look for signs your child is ready: Does he have an interest in the toilet, can he stay dry for two hours at a time, is he interested in underwear, can he follow simple instructions, is he interested in doing things himself, can he walk to the toilet.

NEW YORK – Almost half of women who said they’d been struggling to get pregnant for at least a year ended up having a baby despite not getting fertility treatment, in a new study from Australia.

That success rate was only slightly lower than in women who also reported trouble conceiving and opted for treatment with fertility hormones or in vitro fertilization (IVF).

“Many women aged up to 36 years with a history of infertility can achieve spontaneous conception and live birth without using fertility treatment indicating (they) are sub-fertile rather than infertile,” study researcher Danielle Herbert of the University of Queensland School of Population Health in Brisbane told Reuters Health in an email.

That means that if nothing is clearly wrong — men make enough sperm, and women are ovulating regularly — couples who have had trouble conceiving should still be optimistic they can get pregnant on their own, researchers said.

“I’m not surprised that women who were not treated still get pregnant — we know that,” said Dr. Courtney Lynch, head of reproductive epidemiology at The Ohio State University in Columbus, who wasn’t involved in the new research.

“We know we can get women pregnant quicker if we have them go into IVF, but if we give women time, (many of them) can still get pregnant,” she told Reuters Health.

The research is part of a long-term study of more than 7,000 women living in Australia. Starting in 1996, participants filled out health surveys every few years, which included questions on pregnancy and childbirth.

The current data is from about 1,400 women age 28 to 36 who reported on the most recent questionnaires that they’d tried unsuccessfully to get pregnant for at least a year at a time.

Close to 600 of those women said they’d received infertility treatment using IVF or fertility hormones, including Clomid.

Through the latest survey in 2009, 53% of those women said they had a baby following fertility treatment, compared to 44% of women who’d had trouble conceiving but didn’t seek treatment, the researchers reported in the journal Fertility and Sterility.

For women who did have a baby, there was no difference in pregnancy complications — including stillbirths or premature births — between those who did and didn’t get fertility treatment.

AFTER A YEAR, GET CHECKED OUT

Herbert and her colleagues pointed out some limitations of the report, including that they didn’t know if women changed male partners at any point during the study period, which could have affected their chances of becoming pregnant.

And one fertility researcher not involved in the new study said it’s impossible to know whether women who didn’t get treatment lost or gained weight, or changed their diet and lifestyle to improve their chances of becoming pregnant.

Alice Domar, of Boston IVF, said that the number of women who got pregnant without treatment after a year of infertility is higher than previous studies have suggested.

“What a lot of physicians feel is if you’re not pregnant within a year, it usually means there’s something going on,” she told Reuters Health.

Domar said that she’d still recommend a woman who’s been trying to get pregnant for that long get checked out to see if there’s anything preventing her from conceiving. If not, she can keep trying. But if, for example, her tubes are blocked, any extra waiting is “time out the window,” she said.

Lynch said that about 15% of women won’t get pregnant after a year of trying, but only three to five percent of them are truly infertile. The rest will likely conceive on their own after another year or two.

“There are a lot of patients that don’t want to wait another year, especially if you’re an older patient,” Lynch said — and they might want fertility treatment, even if pregnancy without it may be possible.

“But if you’re 28, I think waiting another year makes sense potentially before going on a treatment.”

According to Domar, most women who can’t get pregnant will only need treatment with fertility hormones, which cost about a dollar a day, to get ovulation back to normal. IVF, on the other hand, runs for about $15,000 a cycle, and may or may not be covered by insurance.

‘WOMEN SHOULD STILL BE HOPEFUL’

The findings can be seen as encouraging for some women, Domar said.

“It means if you’ve been trying for a year and you’re young and you have unexplained infertility, according to this data you have a decent chance of spontaneously conceiving,” Domar said.

Dr. Sacha Krieg, an ob-gyn who studies recurrent pregnancy loss at the University of Kansas Medical Center in Kansas City, agreed.

“Women should still be hopeful that they’re going to get pregnant, even if they’ve been trying for an entire year,” she said.

Still, Krieg told Reuters Health, “I wouldn’t want this to (dissuade) women from seeing a fertility specialist and being evaluated.”