Anxiety is a very common problem that many women suffer from. Besides my own personal experience with anxiety, my patient population is exceedingly anxious. As some of you already know, I help couples get pregnant and stay pregnant. When I say couples, I really mean women. Even though 40 percent of fertility problems are male factor, only about five to 10 percent of my patients are men. I am sure this is not news to anyone, but when it comes to healthcare, we men are stereotypically stubborn and very reluctant to seek help.

My patients are almost entirely woman trying to get or stay pregnant. They are typically in their late 30s to early/mid 40s. They are usually smart, capable successful career women who cannot only afford to see me, but are able to pay for very expensive ART treatments as well.

These are women that are used to success. They are used to making a plan, implementing it and having that plan manifest as reality. They are stereotypically A-type personalities. They do not like dealing with things that do not follow set plans or schedules. Any irregularity in their schedule is annoying. An irregularity in their menstrual cycle is unsettling for them, to say the least. Again, as those of you who treat menstrual cycles know already, especially those in women in their late 30s to mid-40s, their cycles are typically not regular. For these women, their periods have probably changed from what they were in their late 20s early 30s. They are probably less regular, the amount of blood flow is probably less, they have more clots and they probably have less fertile quality cervical fluid present as well. This drives my patients nuts! Piled on top of the fact that they are diagnosed as infertile, they feel broken, and try as hard as they can to fix it. When it doesn't work they feel irritated and anxious.

They feel their time slipping away. The baby clock is ticking loudly. They are acutely aware that each menstrual cycle that comes means they are not pregnant. Many feel like a failure, and it brings them closer to not having any eggs left and being irrevocably infertile.

Each period is not only a reminder that they are not pregnant, but also a reminder that they are getting older and closer to menopause. My patients typically obsess over every detail of their cycle. Generally under acupuncture and herbal treatment you do see an improvement in a woman's menstrual cycle. Their cycles become more regular, less clotty dark blood, there is less PMS and cramps/pain. But the human body is not a machine and while steady improvement can be seen at times, it does not always happen that way. Some cycles are worse or there is no improvement.

Most of the time, the first cycle a woman has after starting acupuncture is dark, heavier, clottier and sometimes more painful. Besides this, my patients' lives are not regular, they go on vacation, eat and drink too much over holidays, go on business trips, have stressful things happen in their work and family lives. All of these things have an impact on your menstrual cycle. They also have an impact on your sleep. However having a bad night's sleep because you drank or ate too much makes it much easier to see the causal relationship from act to consequence, and you only have to wait until that next night to see change or improvement. To see change or improvement in a menstrual cycle you have to wait a whole month. The link between cause and effect (lifestyle/diet changes) is too long to easily make a direct link in your patient's mind. Again that is 30ish days to worry about and overanalyze every little detail, which leads to increasing anxiety.

What exactly is anxiety? According to the Free Dictionary's medical section: "Anxiety is a multisystem response to a perceived threat or danger." In other words the root of anxiety is fear, a fear that you will not be able to protect yourself. In the case of my patients, their fear is multi-faceted.

One big fear is that they have made a mistake and put off having a child and now it's too late. The generation of women now in their late 30s early 40s were raised on the empowering messages of feminism and equality. They rightly believe that they can do anything they set their mind to. They can be CEOs, astronauts, screenwriters and carpenters. They hopefully believe, that if they want to do something, that if they work hard enough they can do it. It is the American dream.

With this relatively newfound freedom woman have flocked to the workforce. They have dedicated themselves to building their careers. They are fulfilling their own considerable personal and individual potential. But like every choice in life, there are always consequences. The consequences these woman are facing is that their reproductive systems don't function as well as they did 10 years before, and their eggs are aging along with them. This is another way of saying it is now harder for them to give birth to a healthy child.

Some of you might read into my words as a subtle message that I believe women should not be in the work force and should be at home pregnant and in the kitchen. While it is true that I found my wife very sexy while she was pregnant, that is not the point. I feel for my patients. I see their struggles and I want to help them. I see some of them openly confronting the myth that you can have it all, whenever you want it. The consequences of that ideal, is a slightly darker side of the American dream. We run smack into the cult of "me," that just because you want it, you have a right to it.

My patients have been slapped in the face by the reality that it is harder for woman to give birth to healthy babies as they age past 30. This is a chilling dunk into an icy unpalatable reality, because for some it is too late to do anything about it. Because of their choice to put off having children some women will not have children. Noone wants to say that out loud, but there it is. We do not help 100 percent of our patients. Even if we did, what about all those women that do not come to see us or can not afford to see us? I have long pondered the reasons behind this.

I think part of the problem is that our sex education classes in high school at the time were all focused on how to avoid getting venereal diseases, plus emphasized how easy it was to get pregnant. I even remember an urban myth going around my high school that a woman could get pregnant from sitting on a toilet seat. Of course that is ludicrous, but the hidden message to 15 year olds that the urban myth is inculcating into their impressionable minds is that it is very easy to get pregnant. I cannot tell you how many times my patients have told me they never thought it would be this difficult to get pregnant.

I have patients that come to me after three months of baby making sex. If that woman is 43 then, that might be a rational decision, but the few patients I am thinking of now were in their early 30s. Those of you not in the fertility business, I am sure, are taking a breath and thinking, "wow, are these woman ever anxious and impatient!" - they are.

They are anxious that they have not been able to execute their plan yet, they are acting on the subconscious belief that is should be easy to get pregnant once you have unprotected sex, and sadly it may be the first time that they have really stopped to look at their menstrual cycles. I watch a lot of my patients struggle with the limitation of their being stuck in human bodies for the first time. They are frustrated; even feel lied to that it is actually more difficult to get pregnant than they thought. Not only is it difficult, like I wrote earlier, for many of them it will not happen.

Back to anxiety. I secretly worry about the genetic consequences of us waiting until we are older to have children as a society. Because of aging eggs and testicles, are we introducing significantly more genetic defects into our population? Will infertility, mental illness and other diseases increase significantly through the generations? How much does all the pollution we breathe, eat and drink affect our fertility? How much is our own greed and push to have more material goods dooming our species to an infertile future?

We have yet to find out. Stay tuned.