Iodine Supplements Before, During, and After Pregnancy; critical problem with a simple solution

The problem of iodine insufficiency during pregnancy has troubled me for years. So much so that I spoke at length about this in pregnancy book that I wrote as well as the fertility book. Now there is a very brief video made by Dr. Michael Greger that explains this problem more articulately than I ever did with simple recommendations—check your prenatal vitamin! Only about half contain this nutrient that is so important for your baby to build a healthy brain.     http://nutritionfacts.org/video/iodine-supplements-before-during-and-after-pregnancy/?utm_source=NutritionFacts.org&utm_campaign=94b0f568b9-RSS_VIDEO_WEEKLY&utm_medium=email&utm_term=0_40f9e497d1-94b0f568b9-23307533

How Many EGGS do you think you have left?

You were born with every egg that you’ll ever have. Although studies suggest that there may be a process where we can create eggs; such technology is far into the future. More importantly, you’re losing eggs at a rate that far exceeds what you would guess. Current research suggests that most women will lose about 500 to 1000 eggs per month through a process of attrition called apoptosis—yet only one or two eggs each month will be capable of fertilization. A recent summary of all of the available research has shown that most women will only have about 3% of their eggs remaining by age 40.

Ovarian Reserve Curve from Conception to Menopause.png

Estimated number of remaining follicles (from birth)

Although the slope of that curve appears intimidating, the goal of this blog post is to increase your awareness and to empower you to take action. Some women are born with more eggs than others. Some women will lose their eggs at a faster rate. Most importantly, the eggs that remain in your ovaries at any given moment represent your ovarian reserve. Therefore, it is very relevant for you to consider how many eggs you have now and then plan how many (more) children you think you might someday wish to have.

This diagram shows the various stages of egg development summarized in a single ovary.

Ovary demonstrating egg development.png

It takes an egg several months to develop from its status as a primordial follicle to that of a mature fertilizable oocyte. It is only when they reach that stage that the ovary releases the egg through a process called ovulation. Fewer than 300 of your eggs are likely to ever complete this journey. In other posts on this blog, we focus on various steps you can take to optimize the health of your developing eggs; but for now let’s focus on the future of your fertility in the months and years to come.

At least 99% of your remaining eggs are dormant—alive but not metabolically active. They have been in this resting state since you were a newborn. The eggs that are in these intermediate stages of development—which represents your fertility—can be estimated by a simple well timed blood test. Consider having your ovarian reserve tested today. Then think about how many children you envision yourself having. Consider when you will be ready to start or expand your family. By doing so, you can better estimate whether or not egg freezing or embryo banking (creating and storing embryos for future use) are steps you should be considering to assist you in creating your future family.

Seafood Allergy and HSG Contrast?—no problem. Another myth dispelled.

In medicine, well intended advice often proves wrong. Sometimes, such recommendations are repeated for years until we lose sight of the where/how the ideas originated. It then takes well documented research to retract the outdated ideas—even then correction is often resisted. An example is the frequently repeated advice that women allergic to seafood should not undergo a hysterosalpingogram (HSG). This rationalization is due to the fear that the iodine-containing contrast that is used to perform the test may provoke a reaction in sensitized patients[r1] .

Food allergies occur in about 4% of the population[r2] . Seafood is among the most common of the foods that people are allergic to. Shellfish and seaweed are the most common foods that contain high levels of iodine. That fact aside, it is difficult to establish how the concern between seafood allergy and iodine first originated. True allergies result when your immune cells react to a protein—not a mineral like iodine—by producing antibodies. These antibodies can then create a reaction upon repeat exposures to the allergen (protein that the person is allergic to). A true seafood allergy is typically a response to a protein called tropomyosin. There is no tropomyosin in the HSG contrast.  Therefore, a classical allergic effect isn’t possible.

A recent review [r3] of the medical literature confirmed that the actual risk of a reaction to the contrast is rare. In fact, the odds of a severe reaction were far less than 1% (0.02-0.5%). So given the importance of the information obtained by performing an HSG, most patients benefit from this part of the infertility evaluation.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

 


The Right To Know: use of laparoscopy to help diagnose unexplained infertility

One of the most challenging aspects of infertility care is helping couples understand why they have not yet become pregnant. About 20-30% of couples will have no definitive diagnosis after completing a standard infertility evaluation[r1] .  In today’s fast-paced treatment paradigm, some patients prefer to move forward with treatment without further clarification. Although oftentimes appropriate, this strategy should not be applied to every patient/couple. Laparoscopy and hysteroscopy are minimally invasive, out-patient surgeries [r2] that can provide a diagnosis and sometimes even offer improved pregnancy rates if scar tissue or endometriosis is found and treated at the time of surgery.

Women with infertility are about eight times more likely to have endometriosis than women that have been pregnant. Treatment of endometriosis can not only reduce pain but also improve pregnancy rates as well. In fact, a large, randomized meta-analysis[r3]  of the available research found that treating endometriosis was associated with about a 60% increase in the chance for a successful pregnancy. Additionally, if there is scar tissue preventing the egg from reaching the fallopian tubes this can also be identified and treated. So consideration of diagnostic surgical procedures can be beneficial. The challenge is in deciding which patients should pursue this option further.

A more recent study [r4] investigated the usefulness of these diagnostic surgical procedures from a financial perspective. They found that laparoscopy was cost-effective in improving pregnancy rates/outcomes based upon many factors including the potential impact of endometriosis. Finally, they also found that undergoing diagnostic surgery was associated with a lower rate of patients “dropping out” of fertility treatment before becoming pregnant. This suggests that having all of the information available prior to treatment is preferred by some couples experiencing infertility. In summary, if you are having trouble conceiving and want more information, minimally invasive surgery may be your best next step.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

Are environmental toxins hampering your chances of becoming pregnant? Here’s what you need to know.**

**About a week ago, I submitted this post to Conceive Magazine Online [r1] for publication. The very next day, another study [r2] came out finding an increase in sperm DNA abnormalities in men exposed to higher amounts of PCB’s. Although I mention other studies below with similar findings, I wanted t include this recent and compelling data.

According to the U.S. Government Accountability Office, there are 80,000 industrial chemicals currently in use, with another 700 added each year. Oftentimes it takes years or even decades to discover if or how these products influence our health. Worse still, many of these chemicals are classified as “hormone-disrupting agents,” meaning that they can trigger a hormone imbalance if you’re exposed to them. The hormonal chaos that results can cause infertility, miscarriages, birth defects and may even contribute to certain types of cancer.

You can take an active role in reducing your exposure to these potentially toxic agents by actively taking steps toward achieving hormone balance. Get informed and create a diet and lifestyle that can reduce your exposure to specific chemicals that have been linked to problems. A great place to start: Consider what you can do to reduce your contact with polychlorinated biphenyls; commonly known as PCBs.

PCBs were banned from use in the United States in 1979 due to their toxicity. Even though three decades have passed since they were widely used in construction and insulation, these hormone-disrupting chemicals persist in our environment. Today our primary exposure to PCBs is through contaminated water, polluted air, and the consumption of high-fat foods made from fish or animal products.

Since PCBs are stored in fat cells, switching to a low-fat diet can dramatically reduce your risk. For example, endometriosis is a problem commonly associated with infertility. Several studies have demonstrated that women with high levels of PCBs are three to four times more likely to develop endometriosis. One interventional study indicated that women with endometriosis can reduce their risk of reocurrence by 40 percent or more simply by reducing their consumption of beef and ham and replacing these calories with fresh fruit and vegetables.

Making these healthy choices can also improve male fertility: A 2009 study found that men exposed to water pollutants (including PCBs) were at higher risk of infertility. These toxins can disrupt male hormones as well as interfere with sperm production. Rather than worry about the impact that water may be having on you, check out the database created by the Environmental Working Group. Not only do they report on pollutants that may be present in your tap water, they also provide links to simple water filtration systems that you can use to improve your health and that of your family.

If you needed even further proof that PCBs may be affecting your chances of becoming pregnant, a study published in 2010 found significant levels of this toxin in the fluid surrounding eggs that is collected during IVF cycles. More recently, U.S. research found that not only did a woman’s PCB level impact her chance of becoming pregnant, but it also may increase her risk of having a miscarriage. So clearly it is in your best interest to minimize your exposure to PCBs. Here are some simple steps that you should consider:

  • Eat low fat—in particular reduce your consumption of beef and ham while boosting your intake of fresh fruits and vegetables.
  • Avoid farm-raised salmon and catfish since these have been shown to be prime sources of PCB exposure.
  • Drink filtered tap water instead of bottled water, which can often contain a variety of hormone-disrupting chemicals.
  • If you live in an older home with hard-wood finished floors, consider having them professionally treated with safer products.

AMH: an accurate, reproducible test for ovarian reserve

Unlike men—who continue to produce sperm throughout their lives—women are born with every egg that they’re ever going to have. As a result, women do experience a decrease in their fertility over time. Some women start with more eggs (called oocytes) then others. Additionally, some women have a more rapid decline in their fertility then others. That’s why age alone is only a rough estimate for a woman’s fertility.

Over the years, there have been various tests proposed to estimate a woman’s ovarian reserve. Some were better estimates than others but they all had their limitations. Over the last several years however there has been one test that has emerged as the most consistent and predictive of a woman’s fertility; a test called AntiMüllerian Hormone or AMH. Until recently, this test has been widely used around the world, it has had more limited exposure within the USA.

AMH is a hormone that is directly released by immature eggs into a woman’s bloodstream. Better still, it remains stable from day-to-day with minimal fluctuation over subsequent months. That means that the test can be performed on any day in a woman’s monthly fertility cycle and the results are considered to be predictive for months to follow. Other tests proposed to measure ovarian reserve actually tend to be more representative of the specific month that they were performed. AMH is also predictive of how a woman will respond to fertility treatment and can be helpful in diagnosing problems like polycystic ovarian syndrome as well.  It is reasonably priced and now easily accessible.

I have been recommending the AMH test to women for several years. Oftentimes, the response that I hear back is that “my doctor isn’t familiar with this test” or worse “my doctor doesn’t believe in this test.” Enough research has now been completed and this test is widely available so those complaints should no longer be acceptable. If you’d like to download a recent article written about this test to initiate a discussion with your doctor then please check out the September 2009 issue of Contemporary OB/GYN.