Dads- pay attention too!

In my fertility clinic, much of the discussion about pre-conception counseling, or what should be done to prepare for a healthy pregnancy, focuses on the female. We discuss a woman’s diet, vitamins, immunization status, supplements, exercise habits and more. New research is suggesting that dad needs to be involved in this health optimization before starting a family.

Epigenetics is a new hot term in science. We all have DNA, which is a roadmap of genes that encode the proteins that are expressed that make our bodies work. To describe it simply, epigenetics is the field that ensures that these genes are expressed at the right time, the right place, and the right amount. My research over the past three years has focused on epigenetics.

I am passionate about learning how our environment impacts our fertility. Epigenetics is an emerging link  to learning about your environment and how it may impact your genetic health: most toxins in our environment are not strong enough to cause DNA damage and mutations, but are able to impact gene expression, and ultimately the health of an individual, by altering epigenetic profiles. Exposure to endocrine disrupting chemicals in our environment, like those commonly found in plastics, induce epigenetic changes in sperm. Worse yet, these changes can be transmitted to future generations.

Recent studies suggest that epigenetic changes may be the key mechanism by which paternal factors such as age and weight contribute to health outcomes in their kids. For example, dads who smoke have children that are more likely to be overweight. Similarly, dads that are obese are more likely to have obese children as a result of epigenetic changes.

Dads- don’t lose hope. There are early indications that some paternal lifestyle-associated effects on sperm can be reverse through exercise, diet, and/or surgical weight loss. In my practice, I like to focus on the couple becoming the healthiest they can be before conceiving. Because ultimately, our goal is similar: we don’t just want to help you get pregnant, we want to help you be a healthy and happy family for generations to come.

If you’d like to take some steps to reduce the impact of your environment on your fertility, consider the following:

 

Your standard prenatal vitamin might not be enough

 I still remember feeling completely overwhelmed the first time I shopped for prenatal vitamins when I was ready to try to conceive. I’m sure I was putting too much thought into it, but like many others, I was going to take my fertility seriously and I wanted the BEST option. So why did my drugstore have over 5 different types of prenatal vitamins, all with a different concoction of what they claimed was “best?” Some of my friends reported using “prescription prenatal vitamins” and swore they were worth the cost.

I ultimately ended up buying prenatal vitamins that contained docosahexaenoic acid (DHA) since they were advertised as “supporting neurodevelopment” and who wouldn’t want a smarter baby? DHA is an omega-3- fatty acid that is important for brain development.  It has been recommended to eat foods which are high in omega-3 fatty acids for women who want to become pregnant or when nursing.  Although vegetarian sources are now available, fish and fish oil are often utilized for DHA supplementation. For months, I endured gross fishy tastes in my mouth and a fishy odor to my breath; all in the sake of helping my baby’s brain develop. Was it worth it?

The sale of prenatal supplements with DHA continues to increase, despite limited evidence that it actually helps brain development. A recent study suggests that DHA may not be all that it was chalked up to be. This group evaluated pregnant women who took DHA supplements and compared them to women who didn’t. There was no difference in cognitive, language, or motor development in the children from moms who took DHA compared to those that didn’t at 18 months, and 7 years- DHA doesn’t seem to result in smarter kids.  This data is strong enough for me to recommend that you can skip the DHA supplement in your prenatal vitamin, especially if you are having undesirable side effects like gross fish burps.

So what does a good prenatal vitamin need, anyway?

  • Folic acid- at least 400 micrograms; some patients require higher doses of folic acid
  • Iodine

Although a prenatal vitamin will help supplement your diet with extra amounts of vitamins and minerals, your diet should be the primary source. Iron, calcium, and vitamin D are particularly important in pregnancy.

My advice to anxious patients (like myself a few years ago) is simple: eat a well-balanced diet, stay healthy, and find an inexpensive prenatal vitamin that you like so that you remember to take every day.

Atypical PCOS: new insights for patients with fertility problems that don’t have other symptoms

Women with Polycystic Ovarian Syndrome (PCOS) can have a variety of symptoms including irregular/infrequent menstrual cycles, skin problems and weight gain. This creates a diagnostic challenge as many healthcare providers rely heavily upon these symptoms to make their diagnosis. New discoveries over the last two decades have demonstrated that PCOS is not a simple cluster of findings.  Instead it is a spectrum of conditions with a variety of presentations. New information has provided greater understanding why some PCOS patients may present primarily with infertility alone and none of the other commonly associated symptoms.

 

PCOS is essentially a hormone imbalance. One of the most important hormones that is typically involved is one called Anti-Müllerian Hormone (AMH). What’s disappointing is that some physicians either don’t measure this hormone or don’t understand its implications. Many women with PCOS have very high levels of AMH. Having too much of this hormone may be their greatest obstacle to becoming pregnant.

 

A new study shows that AMH (referred to as Müllerian Inhibiting Substance or MIS in this article) can inhibit the maturation of eggs. In fact, it can be so potent that it may someday be used as a contraceptive. But most importantly, having a high AMH level can make a woman’s ovaries behave like a woman that has PCOS; even if she does not have any of the other common symptoms. Regardless of what we call this hormone imbalance; women with a high AMH often benefit from similar treatment recommendations as women with PCOS.

 

Stay informed,

~Robert

 

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Egg Quality: new insights into why human eggs don’t age well

It has long been accepted that the primary reason that human eggs don’t age well is due to a dysfunction in when and how the chromosomes separate. This reduced chance of becoming pregnant associated with aging as well as the increased miscarriage rates. A new paper has now demonstrated that it’s not just the DNA separation that declines with time but also how the chromosomes are actually sorted and divided.

Within each egg are cable-like structures called microtubules. These microtubules not only help the egg maintain its shape but also are integral in sorting/separating the DNA. They are also in charge of cell division after fertilization is complete. In fact, some of the most powerful cancer fighting drugs are used to deliberately damage microtubules in order to prevent cancers from growing. This new information provides us with further insight into another important aspect of egg quality.

Although we don’t currently have any specific recommendations on what we can do to improve microtubule function; this information does provide us with more diagnostic information for patients that are going through In Vitro Fertilization (IVF). IVF is not only the treatment that provides patients with the highest pregnancy rates but when performed in a high quality setting; it also provides important diagnostic information. There is no accurate test for egg quality except to put a healthy sperm inside and see if/how well the process of fertilization and development takes place. We routinely use this information in discussing treatment options for patients that do not successfully conceive in their first IVF cycle at our center.

Fertile thoughts,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates

Thyroid Hormone for Women Trying to Conceive; why extracts and T3 can be harmful to your developing baby

Many patients that present to fertility centers are on thyroid supplements that are extracts from pig thyroid gland. Unfortunately, they have often embraced this treatment because it is presented as more “natural” then  the synthetic thyroxine often prescribed by most healthcare providers. In reality, the human thyroid gland converts T4 (thyroxine) into T3 (the active form) very efficiently. The typical ratio of T4:T3 in humans is about 14:1. By contrast, pig thyroid extracts have a 4:1 ratio so that there is much more active T3 in the preparation. The problem with this high level of T3 is that the developing baby needs the T4 from a pregnant mom’s blood; not T3. High T3 levels during early pregnancy can impair healthy brain development. So I recommend the following: 

          –take a stable dose of thyroxine. 

          –If you still feel challenged; consider meeting with an endocrinologist to see if you might be a candidate for small supplemental dose of T3; two or three times per day. 

http://endocrinenews.endocrine.org/controversy-continues-combination-treatment-hypothyroidism/

Selective dietary supplementation in early postpartum is associated with high resilience against depressed mood

Much of modern psychiatry is about using medications to try to normalize brain chemistry as a tool to help resolve mood disorders. Having been involved in considerable research on how hormonal shifts can cause changes in brain chemistry–I am always interested in trying to help my patients understand what may occur and what they may be able to do to take preventive actions. Here is a study that suggests that using a dietary supplement containing tryptophan (2 grams) and tyrosine (10 grams) may prevent postpartum blues without changing breast milk contents. Better still, this might interrupt the spiral to postpartum depression! Check out this link and then talk with your doctor before starting any program.

http://www.pnas.org/content/114/13/3509.abstract

Tens of Millions Lack Local Assisted Reproductive Services | Medpage Today

The lack of quality treatment has been something that we have taken on aggressively this year through our tele-medicine campaign. Since the new law was enacted in Colorado-making telemedicine fully reimburseable–we have been actively building our internet based services. If you’re one of the millions lacking care in your area, consider setting up a consultation. We’d love to meet you.

http://www.medpagetoday.com/Endocrinology/Infertility/63901?xid=nl_mpt_AACE_Daily_2017-03-17&eun=g7126400d9r