Depression in Dads


The stress related to a diagnosis of infertility parallels what is experienced with a cancer diagnosis or grief of the loss of a loved one. We all recognize that stress has a negative impact on our health and can impact fertility. However, most of what we know has been from studies based on the female partner.  New research demonstrates that the stress of infertility on male partners should be considered as well.


Nearly 50% of men seeking IVF reported symptoms of depression. 50%! This study found that although major depression is more common in female partners than in male partners, it can still have a significant impact on fertility success. Couples in which the male partner had major depression were 60% less likely to conceive and have a live birth than those in which the male partner did not have depression.


Although this study shows an association between male depression and decreased likelihood of success with fertility treatments, it leaves many questions about whether one causes the other unanswered. What this study does a great job at, however, is demonstrating the need for us to focus on the health of all our families prior to conception.


Take Home Points:

  • Infertility and the associated treatments are a major life stressor.
  • Depression during fertility treatments can be common, in both female and male partners
  • Untreated depression in men may decrease fertility
  • Talk to your REI and primary care doctor if you think depression is impacting your life

You CAN improve your swimmers

Nearly 40-50% of couples who are having trouble getting pregnant have a male factor impacting their ability to conceive. Part of the evaluation includes performing a semen analysis, which measures how much sperm is produced. These results can help us learn if there is a male factor contributing to your infertility.

The majority of preconception counseling involves preparing a woman for a healthy pregnancy. I go even further and encourage your entire family to make positive changes to their nutrition when trying to conceive. Not only will you all become healthier, which will enhance your fertility as a couple,  but you will also keep one another motivated because it’s hard work!

We have previously reviewed what guys can do to boost their fertility and improve their numbers on this test.  A recent study adds to this: what you eat impacts your semen analysis results and, ultimately, how easy it is for a couple to conceive. Men who stick to a healthy diet were found to have more sperm and a greater number of swimming sperm. This suggests that men with poor sperm counts could potentially improve their numbers with their nutrition when trying to conceive.

So keep up the good work and continue to motivate one another to be the healthiest you can be when trying to conceive. Fertility and enhancing fertility is a team effort.

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:


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.

Sleep Can Affect Male Fertility

The impact of lifestyle upon male fertility is very difficult to study and therefore rarely gets much scrutiny. In previous posts, I have referenced studies on how healthy sleep and melatonin levels impact egg quality. Now we have a new study that found that men that sleep less than 6 hours per night or more than 9 hours per night seem less fertile than those within the 6 to 9 hour time range. Although further research would be needed to confirm the validity of this study, it could be that sleep is impacting your ability to conceive with your partner.

Male Fertility and Diet |

Too often the entire focus of fertility recommendations are directed towards women. It is true that egg quality is the single most important factor in determining conception. That said, a healthy egg cannot overcome sperm with damaged DNA. So, let’s provide some guidance for what men should be doing with their food choices to improve the chance of a successful conception.

State of the A.R.T (Advanced Reproductive Techniques) 2015

It feels great to be blogging again. I figured the best was to re-start this blog was to provide an update and summary on how these remarkable techniques have grown and developed as well as summarizing their current success and limitations. The technique of In Vitro Fertilization (IVF) has become the gold-standard of fertility treatment both for its diagnostic value as well as its high success rates compared to other treatment options. It is currently estimated that over 5,000,000 people have been born using IVF since the first reported success in 1978. In 2012 about 1% of all births in the USA —a total of 65,160 babies—were conceived and born through IVF. So let’s first consider the safety of this technology.

A recent report  summarized the safety of Assisted Reproductive Technology in the US by reviewing all of the available data from 2000 to 2011. This analysis included 1.14 million IVF cycles in order to determine the incidence of medical complications within 12 weeks of the procedure. They were looking for complications like infection, bleeding, adverse reaction to medications, anesthetic complications and Ovarian Hyperstimulation Syndrome (OHSS). OHSS was the most common complication and occurred in about 1.54% (154 times in 10,000 cycles). Even this It was rare for any complications to require hospitalization which occurred in 0.35% (35 times in 10,000 cycles). Best of all, the incidence of complications—including adverse medical reactions—declined throughout the time period analyzed.

Importantly, as the pregnancy rates have increased; ART treatment is also resulting in the birth of healthier babies. For instance a 20 year review  of cycles performed in the Scandinavian countries of Norway, Sweden, Finland and Denmark demonstrated a remarkable decline in the incidence of preterm birth or with low birth rate. They also found a similar reduction in still birth and infant mortality. The most important contributing factor to this remarkable success is that these countries have a national policy of transferring only one embryo at a time. The practice of elective single embryo transfer (ESET) is rapidly becoming the norm in the US as well. Another reassuring finding  was that the risk of Autism Spectrum Disorder (ASD) was not increased in children born through IVF; a fear that many had theorized before the data was available to review.

Finally, a recent report  on the increased use of Intracytoplasmic Sperm Injection (ICSI) as a technique to fertilize eggs was recently misinterpreted—in my opinion—rather cynically by the popular critics. ICSI was a treatment first used in 1992 to overcome severe male factor infertility. This report revealed that the use of ICSI has doubled during the last two decades even though the incidence of male factor infertility has remained steady.  Their reports suggested it was being used unnecessarily. As a clinician however I know that many couples have multiple factors contributing to their infertility challenge. Even with a normal sperm count, the sperm may not be able to penetrate the egg; either because the sperm is too weak or because the egg shell (zona) is too tough. Either way, this technique overcomes either challenge. In fact, this recent study found that the rate of “failed fertilization” was markedly reduced by the wider use of ICSI. Another important benefit of using ICSI routinely is that it makes it possible to minimize the risk of a good egg being fertilized by an abnormal sperm. The end result is that ART becomes increasingly safer and more effective and ICSI is one aspect that has contributed to that success.

If you’d like to estimate your own unique chance of a achieving a successful pregnancy through IVF, check out the following link to the Society for Assisted Reproductive Technology: . There you can answer a few short questions about your current situation and you’ll be given your own personalized IVF cycle prognosis using the statistics from the SART National Database (2006-2012). The results from your center may vary but this should give you an excellent reference point to have further discussions with your reproductive healthcare provider.

[r1]Link to

[r2]Link to

[r3]Link to

[r4]Link to

Boosting Pregnancy Rates for “poor responders” to IVF—new hope by applying existing technology

One of the greatest challenges in reproductive medicine is trying to figure out ways to improve pregnancy rates for women that produce a limited number of eggs. Other posts on this blog[u1]  address various steps to try to optimize/improve egg quality[u2] . But new data suggests that the use of intracytoplasmic sperm injection (ICSI) can improve embryo formation and more importantly increase a woman’s chance of becoming pregnant. Traditionally, ICSI has been used to overcome male factor infertility. Over the last several years, some centers have included it in all of their treatment cycles as a means of maximizing fertilization. Some experts criticized this practice since it was based upon a theory rather than clinical proof of an improved outcome. In fact, the American Society for Reproductive Medicine has a Patient Fact Sheet [u3] that describes the guidelines for the use of ICSI (last revised in 2008). Recently a large study attempted to settle this debate on whether or not ICSI should be used in women considered to be “poor responders” to fertility therapy.

One of the limitations of previous studies on “diminished ovarian reserve (DOR)” was the lack of an agreed upon definition of how to diagnose this condition. In 2011 an international meeting was held to form a consensus [u4] on the identification of “poor response to ovarian stimulation.” Their goal was to improve the design of future studies and provide practical guidelines as well as assist doctors in the diagnosis of this condition. To meet diagnostic criteria it was agreed that a woman must have at least two of the following:

  • 40+ years of age or any other risk factor for poor ovarian response
  • A previous cycle producing  3 (or fewer) eggs with a conventional protocol (excludes Mini IVF)
  • An abnormal ovarian reserve test (i.e., AMH [u5] below the age- related norms)

The recent study [u6] referred to in this blog post followed over 1000 IVF patients that had failed on a previous cycle and met the new criteria for “poor responders.” These patient/couples completed nearly 3000 total cycles of IVF with ICSI. They found that including ICSI—despite a normal sperm count—improved the ongoing pregnancy rate by 40%. Another noteworthy fact is that this study was performed in Israel where IVF is a fully covered health benefit for all citizens. This made it possible for patients to continue treatment without concern of cost thereby removing a “selection bias.” The potential benefit of ICSI—in the absence of a male factor—does make sense. Some studies show that women with DOR have a thicker coating on the egg making it more difficult for a healthy sperm to enter. Selecting a sperm for use in ICSI may also reduce the possibility of an abnormal sperm fertilizing an otherwise limited number of healthy eggs. Whatever the reason, most women with a poor response to fertilization are immediately directed to use donor eggs. However, this study found that ~35% of these “poor responders” achieved a successful pregnancy within 5 to 7 IVF attempts. The bottom line is that couples that would otherwise have been discouraged from completing a second attempt went on to have a baby at least 1/3 of the time.

So discuss with your doctor whether or not you may benefit from including ICSI in your next IVF cycle. In doing so, be careful to ask if there is an additional charge for this service. At CNY Fertility[r7]  Center, we are pleased to offer this augmented fertilization technique to all of our patients as part of the standard IVF cycle (included in the standard fee). Now we have more data supporting this recommendation.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at

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

What else can He do to improve our fertility? A simple recommendation…go nuts!

When couples are having difficulty conceiving, studies show that at least 1/3 of the time, there is a contributing male factor. Yet today the bulk of our tests and treatments are directed toward women. For couples that already know that they are dealing with a sperm problem, there are very few good recommendations on what they can do at home to improve their outcome; until now.

Many studies have found that dietary fats can impact pregnancy outcome [r1] in women. More recent data has even helped differentiate that some fats can improve fertility[r2] . But very little of the nutritional intervention has been directed toward men.

Polyunsaturated fatty acids (PUFA) are critical for sperm function and production. These fats are necessary to make healthy sperm as well to optimize their ability to swim. They are called essential fatty acids because you need to consume them in the foods that you eat so that your body can use them to manufacture hormones and other substances. Unfortunately, the typical foods that most of us consume don’t contain them. Instead, many of us eat foods that contain unhealthy fats; a situation that worsens the imbalance between good fats and bad fats.

Now that we know male fertility is improved with PUFA’s, the challenge is getting men to change their diet or take a supplement. Nutritionists have been encouraging men to increase their consumption of fish, flax seed and other foods with healthy oils but only with limited success. Now a group of researchers has found a practical solution[r3] . They had a group of men begin eating 75 grams of walnuts per day. After only 12 weeks they demonstrated an improvement in sperm count, better sperm motility and increased sperm vitality. Better still, they did not experience any increase in body weight or body mass index proving that this recommendation is practical with no identifiable drawbacks. In fact, eating walnuts has also been shown to be heart healthy [r4] and may reduce the risk of prostate problems [r5] as well. So, it’s time for men to “go (Wal)nuts!”

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at

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.