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.

An apple a day … keeps the REI away?

 

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The Mediterranean diet has long been promoted as a heart-healthy eating plan. This diet incorporates healthy eating like fruits, vegetables, whole grains, and limits unhealthy fats like animal fats. A recent study, however, suggests that the benefits of the Mediterranean diet may be further reaching.

A group in Greece evaluated men attending a fertility clinic and determined their adherence to a Mediterranean Diet. They then compared their semen analysis results. What they found was incredibly interesting: men who deviated the most from the Mediterranean diet were 2.6 times more likely to have lower sperm counts and decreased motility in their compared to men who followed the Mediterranean diet closely. These results suggest that greater adherence with this diet may help improve semen quality.

This study doesn’t directly answer all the questions we need answered like whether changing your diet will improve your semen parameters or whether you will be more likely to get pregnant on your own with this diet. So unfortunately, the answer is “no”: an apple a day may not keep you out of the fertility clinic. We still think it’s worth a try!

New Year’s Resolutions: why men should consider them too!

Happy 2017! Like many others, I use the new year as a time to reflect on what I can continue to improve on. The global obesity crisis is real and it is common for weight loss to be a new year’s resolution. Although the risks of infertility and pregnancy complications is understood with female obesity, men have largely been left out of these discussions until now.

 

A new study released by the NIH suggests that dad’s weight also has a significant influence on child development. Children of obese parents may be at risk for developmental delays. The study found that children of obese fathers were more likely to fail developmental tests, like measures of social competence or problem solving ability.

 

It is not known why parental obesity might increase children’s risk for developmental delay. But if you or your partner are obese, now is the time to re-consider what you can do to become healthier.

 

Wishing you all a healthy and fertile 2017!

Are Low-Calorie Sweeteners Making You Fat?

There is a global obesity epidemic. More than one BILLION adults are projected to be obese by 2025. Obesity is a major risk factor for the development of medical conditions such as diabetes and cardiovascular disease, as well as numerous types of cancers. Obesity, in either male or female partners, is associated with a decrease in the ability to become pregnant. Obese women are not only at an increased risk of having trouble conceiving, they are also at risk of: needing medications to conceive, being less responsive to fertility treatments, losing pregnancies to miscarriage, having children with birth defects, as well as having complications during pregnancy such as high blood pressure and diabetes.

 

Many people use artificial sweeteners or “diet” drinks as a substitute for whole ingredients with the hope of cutting calories. A recent study suggests that this may be a bad idea. This group followed people for 10+ years and found that people that used low-calorie sweeteners had a higher body mass index (BMI), larger waist circumference, and were more likely to be obese. This paper suggests that using low-calorie sweeteners may not be effective means of weight control, and might even lead to harm.

 

When I review studies like this, I think it’s important to note that these studies are NOT designed to prove that artificial sweeteners CAUSE obesity; rather, they show an ASSOCIATION at a population level. For me, as a physician and mom, this association is reason enough to be cautious about the use of artificial sweeteners. For others, especially die-hard Diet Coke drinkers, they might want more proof before changing their diet habits.

 

There is no easy solution for weight loss; diet drinks probably aren’t going to help. If you are overweight or obese, don’t lose hope. Even a modest weight loss (10-15% body weight) can enhance your natural fertility. It will take hard work through diet and lifestyle changes. Avoid sugary snacks and drinks in general. Consider using natural sweeteners like stevia (Dr. Greene’s favorite!) or honey (my favorite!) instead of artificial ingredients. Your selection in which sweetener you use, is likely going to depend on what is most important to you including considerations like why you are using a sweetener, why you are looking for artificial sweeteners (cutting calories), and taste. Please be an informed consumer and make sure that you know why you are making the choices that you make. Taking care of yourselves will help prepare you for a healthy pregnancy and prepare you to be healthy parents.

What’s really in those supplements?

As a fertility specialist, many of my patients come to me already taking multiple herbal supplements or have questions about a specific “cocktail” that will enhance their fertility. My blanket statement to patients and friends, is to use extreme caution.

Nearly 2/3rds of American adults take dietary supplements. I am a big believer in optimizing your fertility naturally (hence a dedicated blogger!), but I think that ensuring your safety is even more important.

Before you take a supplement, make sure you understand why you are taking it and what you hope it will achieve. Consider talking to your healthcare provider about potential interactions between any supplements and your existing prescription medications. Next, speak up if you are start noticing any side effects.

If a supplements makes claims that sound too good to be true; they usually are. In a recently published analysis, nearly 80% of the supplements tested did not contain the primary ingredient listed on the label.  As a mother and physician, it’s so disappointing to read how much the supplement industry can take advantage of vulnerable populations. I recommend that you consider using supplements that are sponsored by USP. Supplements that have a USP logo on them are subjected to higher quality control.  Another great resource is ConsumerLab.com; the routinely test products that they purchase from store shelves and reveal who passed and who failed.

I plan to evaluate the evidence behind commonly recommended supplements often encouraged to boost fertility in future posts. In the meantime, stay healthy and be safe!

Safe Makeup DOES Exist! Become an Informed Consumer

I want to thank everyone for the overwhelming support for my first blog post. Several of you have contacted me for more details about safe cosmetics. I obtained my information from the Campaign for Safe Cosmetics. I strongly encourage you to use this website- it’s a great resource to be an informed consumer and an advocate for safer products!

What I love about their website is that they list safer alternatives to choose based on the beauty product that you may need. I haven’t had the opportunity to try all the companies listed, but I plan to use this website from now on to help me find safer products moving forward. Many of the companies are smaller companies and I think it’s a great to support their dedication to keeping their consumers healthy.

I urge you to look at the Campaign for Safe Cosmetics website for full information, but here is a quick summary of safer cosmetic product choices to make at the time of this posting. I love that these companies are transparent in what is and isn’t in their products since current regulations do not require them to do so. I am not sponsored by any of these companies and have no financial interest in their success. I’m just a fan that recommends them to my patients:

You don’t need to throw out all your makeup and personal care products at home today. But I do urge you to start questioning what IS in the things that you expose yourself to every day through makeup. Specifically, look for chemicals listed in each of the Red Lists, and try to avoid them whenever possible.

Things that you can do:

  1. Simplify your routine. Use fewer products. Choose products with simpler ingredient lists. Avoid fragrances.
  2. Consider making some personal care products yourself so you know exactly what is and isn’t in them. Disclaimer: I’ve never done this myself but would love to learn if you have some experience with this!
  3. Research the products yourself. The beauty industry is mostly unregulated. It’s up to you to keep your body safe. Consider trying an app like:

These will help you shop clean.