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

Daylight Savings Time May Lower Chances of IVF Success for Some: Study

At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts.  https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html

More Reason to Eliminate Phthalates from your home: impaired sperm function

We’ve already provided pretty compelling reasons why it is worthwhile to avoid these chemicals with a funny name but now there is even more evidence. A new study has now found that these chemicals can reduce the chance that a man’s sperm will make a healthy embryo. Bottom line is that paying careful attention to your potential exposure risk with both your chances of having a healthy pregnancy and a healthy home to raise your child.

Here are some easy steps that you can take to begin reducing your phthalate level today:

  • Only use nail polishes that are phthalate free—most add a phthalate called DBP to reduce chipping
  • Don’t microwave or cook your food in plastic containers or use plastic utensils to eat hot foods—heat leaches this chemical out of the plastics and into food—the easiest pathway into your body
  • Avoid plastic bottles—seek out glass or metal instead. When you must use plastic seek out bottles with the #2, #4 and #5 in the recycle triangle
  • Avoid perfumes and scented products—phthalates (DEP) are used to prolong fragrances
  • Don’t use air fresheners—most contain phthalates
  • Avoid vinyl containing products—many products like lawn furniture, rain coats or shower curtains can not only release phthalates that can be inhaled but they can also be absorbed through the skin as well.

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.

Is YOUR Makeup Speeding Our Journey Toward Menopause? The Scary Association That You Need to Know About

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One of the first research projects I did on the impact that lifestyle can have on fertility showed that women exposed to a handful of common chemicals classified as EDCs (endocrine disrupting chemicals) go through menopause earlier than women who have less exposure. It gained a lot of media attention because several of the toxic chemicals I found in my study are common in makeup products. A more recent study highlighted the continued importance of addressing this issue in women’s health and prompted this post.

This group evaluated the top beauty brands for each type of makeup and found 1322 ingredients. They then went on to summarize the evidence suggesting the association between each of these chemicals and menopause. Most of the chemicals they found are absorbed through the skin, meaning that all these chemicals are entering our bodies each day. Although the group admits there aren’t enough studies to show a direct link between cosmetics use and menopause, I think it’s enough to have me question what I’m being exposed to on a daily basis and how it’s going to impact my health.

Even though you may be far from menopause, I think it is still important for you to consider how chemicals that you’re exposed to can be impacting your ovaries. Women who go through menopause early are likely to have a shorter fertility window, meaning that they may use up their eggs at a faster rate than someone else their age. In the fertility world, this can translate to women who respond less to medications or are less successful with their use of assisted reproductive technology compared to others their age.

As a woman, as a mother, and as a fertility specialist, my first response to learning how many chemicals we are exposed to daily was disbelief: Why aren’t we protected as consumers from these potentially toxic chemicals? Why are they still exposing people to these toxic chemicals? Although the Food and Drug Administration monitors the chemicals that go into food and drugs, cosmetics are not subjected to the same regulation. Here are a few things that we can do to protect ourselves by limiting the numbers of chemicals we are exposed to daily.

 

Take home points:

  • Women are exposed to 1000s of toxic environmental chemicals each day.
  • Some of the chemicals found in makeup have been linked to health problems, including earlier menopause
  • Physicians and patients need to do a better job learning about the risks to their health so that they can make more informed choices in selecting their personal care products
  • What you can do:
    • Limit the number of personal care products you use. For example, try to limit to one type of shampoo to minimize the exposure to multiple chemicals.
    • Avoid any personal care items that have fragrances or scents.
    • Read labels and support companies that disclose what their ingredients are and support their efforts to remove those that are not necessary or are suspected to be unsafe.
    • Be an informed consumer: know what you are being exposed to. Here is a list of great resources.