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:


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


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.

FERTILITY, PREGNANCY AND MISCARRIAGE a simplified approach to a complex problem

Too often people take for granted how special each conception and birth is when it occurs naturally. There are so many events that need to occur and so many factors at play that the opportunities for failure and misadventures are vast. As a specialist whose main job it is to help people overcome infertility or prevent yet another pregnancy loss, we need to create a unique plan for each patient/couple. In order to do so, we must take a few steps to better understand and organize their journey. I begin by categorizing the key factors into one of the four “P’s”: the patient, the partner, the passenger and the placenta.

  • The Patient–this special designation refers to each woman that decides to become pregnant. Her role is paramount in the success of the process. She not only contributes the egg but also 280 days of around-the-clock care. During pregnancy, a woman provides her developing baby with each calorie, every breath of oxygen, and countless nutrients while maintaining a protective, safe environment. Think about THAT that next time that you celebrate Mother’s Day. During a fertility evaluation or an assessment for Recurrent Pregnancy Loss (RPL) we focus on the patient’s overall health/wellness. We assess her ability to produce an egg. And we evaluate her anatomy–uterus and tubes–for their ability to provide a safe haven
  • The Partner–refers to male’s ability to fertilize an egg. This is why the male fertility evaluation is so simplified in comparison. Although we hope and expect for the partner’s full participation in raising the child; until birth their physiologic role is quite limited. This is the reason that male fertility evaluation centers on the semen analysis. More recent studies are now validating that simply observing sperm under a microscope does not rule out male contributing factors to infertility or miscarriage. But this simple test does identify most male factor problems.
  • The Passenger–is a unique designation for each individual embryo that successfully implants and grows to become a fetus. Given that each egg and sperm represents a distinctive shuffling of the DNA of the person that they came from–their union represents another opportunity for individuality. Unfortunately, many of these unions are flawed from the beginning. Depending upon the severity of that flaw, they may fail to grow beyond a specific point in development. As a general rule, the earlier that failure occurs; the most severe the genetic anomaly. Studies have shown that typically, failed pregnancies come from flaws in the egg but sometimes it can either be from the sperm or an event that occurs shortly after conception. With today’s technology we cannot correct any of these genetic abnormalities but we can often identify them when they occur. One proven strategy has been to select embryos that are free of major additions or deletions of DNA prior to placing them into a woman’s uterus.
  • The Placenta–is the connection that a developing fetus has with the woman carrying the pregnancy. It is through this vascular organ that a fetus receives all of its calories, oxygen and nutrients. It is also through this structure that all waste products are removed as well. But the placenta is not a just filter; it is a vital organ that also regulates a woman’s physiology throughout her pregnancy. It performs this function by producing most of the hormones that control a pregnant woman’s physiology. The placenta also regulates her immune system. Aiding a placenta to meet the needs of an ongoing pregnancy is something that steer the course of pregnancy; but only if the Passenger and Patient are healthy.

In closing, the process of becoming pregnant and delivering a baby is extremely complicated.  There is rarely a single explanation for why any individual/couple is not achieving success. The best path for a successful outcome is to fully evaluate the situation in an organized fashion. Creating an organized plan helps assure that details were not overlooked. Through greater understanding, it is possible to create greater success as well as realistic expectations.


Successful Fertility Treatment; it’s about much more than what happens in the office

Whenever someone asks me “what else can we do to boost our chances?” it represents one of the most exciting and challenging moments of our interaction. It’s exciting because it shows a willingness to make changes in their current diet and/or lifestyle. It’s challenging because there are no simple answers and most of the data is rather loosely supportive of the recommendations. Fortunately better studies are coming out all the time.

The January 2015 Issue of the journal Fertility & Sterility put this topic front and center. The journal opened with a commentary  that pointed out the fact that each egg–even those from fertile egg donors–has no more than a 40% chance of becoming a successful pregnancy. Therefore, we need to look beyond what we do with the sperm and eggs and also direct our attention toward what else can impact their quality. A “global medicine approach” proposes  that we look at the nutritional status, environment and lifestyle for additional answers and better outcomes. The journal went on to present three papers to bring us closer to that goal.

The first study  looked at infant birthweight and the risk–several decades later–of male factor infertility. Specifically, they were looking at the theory that some male infertility begins in the womb prior to birth. Other studies have found results suggesting this happens for women; that low birthweight may increase the risk of longer time to conception and a higher risk of diminished ovarian reserve. That prompted this research to determine if the same might be true in men. It was. They found that men that were born with a birthweight less than 2,500 gm (normal is 2,500 to 3,500 gm at term) were at a higher risk of having a low sperm count and their sperm was more likely to have damaged DNA. They also tended to be overweight or obese which is also associated with male factor infertility. So nutrition during pregnancy can have lasting implications for the children that are born.

A second article  summarized the concept of “ecofertlility;” environmental toxins that may alter fertility. The examples that they focused on were those that were most common and most easily controlled, tobacco and marijuana since there is typically a choice to use or not use these substances. The authors reviewed a variety of studies that consistently demonstrate that women that are cigarette smokers tend to take about a year longer to conceive, have a higher rate of infertility and are more likely to have a diminished ovarian reserve than nonsmokers. Men were impacted similarly. Male smokers had a higher risk of abnormal semen analysis as well as a higher rate of erectile dysfunction. The authors also presented evidence that various substances produced by tobacco smoke appear in the fluid that surrounds the eggs and then have a very toxic impact. These substances may actually result in a higher rate of failed fertilization. This may explain why smokers have about a 40% lower pregnancy rate when undergoing IVF than nonsmokers. Even with sperm injection (ICSI) directly into the egg; the rate of “fertilization failure” is about three times higher in smokers. The impact of marijuana was more difficult to quantify. In men it has been linked to a higher risk of sperm abnormalities, as well as various hormonal dysfunctions including gynecomastia (increase in breast size), low libido and problems with erectile dysfunction. There is less data on women as exposure is difficult to accurately assess and monitor and correlate with egg function since exposure now may impact an egg many months (or even years) later.

Finally, in a third paper  they reviewed the potential impact of one of the most widely studied chemicals that we’re all exposed to called bisphenol-A (BPA). This chemical was first produced in 1891. It was identified to have estrogen-like activity as far back as 1936. Unfortunately, that did not stop its production and distribution. Today it is recognized as one of the most ubiquitous hormone disrupting chemicals. About 20% of the BPA produced—nearly 3.4 million tons per year—is used to line various food containers. From there, it has clearly been shown to leech into the food that we eat and then contribute to various health problems like diabetes, obesity, heart disease, lung problems, kidney disorders as well as various reproductive problems. The data on its toxicity has been alarming enough to prompt Canada from banning its use in baby bottles (2008). More recently the European Union went a step further and banned its use entirely in 2011. Here in the US, there is just now legislation  proposed to require clear labeling on food containers that contain BPA.  The study authors went on to provide a further note of caution by providing evidence that two chemicals that have been proposed to replace it—BPS and BPF—may have similar negative effects based upon animal data. Human studies are pending. The bottom line is that we need to pay more attention to the chemicals that we use to package our food in as they may actually taint our food supply as well as reduce our health and fertility.

As a reproductive health specialist, I don’t want to alarm my patients but I also don’t want to marginalize the potential impact of our choices upon our ability to initiate a healthy pregnancy. Although walking the line between concern and unnecessarily upsetting people may be a delicate one; I do feel compelled to empower those that are willing to listen. Success is not just about what happens in the clinic—it begins at home.

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Lead in Lipstick!?! Whose idea was that?

There have long been rumors that lipstick contains lead and but since cosmetic producers are not mandated to release the ingredients of their products, this fact remained hidden for many years. Back in 2007 the Campaign for Safe Cosmetics [r1] sent 33 brands of lipstick to an independent lab for testing and found that 61% tested positive for up to 0.65 parts per million of lead. What’s more they found top selling brands—including one that sold for $24 each—had the highest lead content! They reported their results to FDA and were promised an investigation.

It took the FDA two years and a letter from 3 US Senators to perform a follow up study. They found lead in every brand that they tested[r2] . Some of the brands had four times more lead in them then the Campaign study results. Despite these findings, the FDA did not take any action to protect consumers. More recently, an expanded analysis found lead levels as high as 7.19ppm. Even more surprising 5 of the top 10 most heavily contaminated brands were made by a one manufacturer[r3] , Loreal USA. Why aren’t consumers being made aware that something as toxic as lead is being sold to apply to their lips? That’s a hard question to answer.

The US Center for Disease Control and Prevention states that there is “No safe blood level for lead.” Lead is a neurotoxin. It accumulates in the body and it can even cross the placenta to harm a developing fetus. That’s why the only effective strategy against heavy metal poisoning is to minimize your risk of lead exposure. The effects of lead are well known and include lower IQ scores, behavioral problems, aggression and learning (especially language) disabilities.

More recently, a study demonstrated that high levels of lead can also contribute to infertility. In this study[r4] —conducted by the National Institute of Health—they found that women and men with higher levels of the heavy metals lead and cadmium experienced a nearly 30% reduction in their chance of conceiving. Although their study considered cigarettes to be the primary source of exposure to these toxic metals; their study was completed before the high lead levels in lipstick were revealed. Be a smart consumer and check out your personal care products and cosmetics before you apply: .

The Ugly Side of Beauty Products: many are loaded with toxic chemicals

Everyone likes to look and smell their best. But what is the real cost of that silky smooth skin and shiny hair? Cosmetics and personal care products contain various combinations of nearly 11,000 chemicals; only 11% of which have been evaluated for their safety. Maybe more concerning is that the Food and Drug Administration (FDA) [r1] has not set any premarketing standards for testing these products or disclosing the results when problems are detected. With the exception of California—which passed the California Safe Cosmetics Act of 2005 (Senate Bill 484)—the production of cosmetics is a self-regulated industry that generates over $50 billion annually. One easy (but inaccurate) way of trying to put consumer’s minds at ease by these companies is by promoting the notion that beauty products are applied externally and therefore have minimal opportunity to impact internal physiology.

Even though personal care products are applied topically; they are absorbed. How much they are absorbed depends upon several factors like, are they are applied near an opening (lipstick and eyeliner for instance gain entry easily); are they applied to a part of the body that is shaved (making for easier absorption); is it a moist or covered area (boosting the amount that penetrates the skin) and how often does is it applied or how long does it linger after application (dose). Another important aspect of a cosmetic’s ability to penetrate has to do with fragrance; the simple rule is if you can smell it, it is getting into your body and often into the bloodstream.

Let’s consider the example phthalates. These chemicals are plasticizing agents that add flexibility and a moisturizing sheen to products like nail polishes/nail hardeners, fragrances, mascara, lotions, shampoos/conditioners and sunscreens. If they appear on labels—not all cosmetics reveal ingredients—they are named for their specific chemical like DEP—most commonly used; DBP—used widely in nail polish; DMP—becoming more popular amongst manufacturers. They are well known for their ability to cause hormonal imbalance in both people and animals. They have been linked to early onset of puberty in girls[r2] , genital malformations in boys[r3]  born to women exposed during pregnancy and now there have been several studies linking them to an elevated risk of obesity[u4] . Most troubling of all, they aren’t even a necessary ingredient.

Nail products tend to be one of the greatest sources of exposure for women. Although one would not think a product could be absorbed through the nail, DBP is water soluble so slight amounts leach out each time the nail is wet. As a result, it can be absorbed by the skin or taken in orally if the leaching takes place during food preparation. In fact, the reason that nail polish becomes brittle and chips over time are due to the loss of DBP which is used to keep polishes flexible. Rest assured, there are phthalate-free products available now, and consumers have the right to be educated on why avoiding such hormone disruptors is important to their reproductive health.

The simplest way to reduce exposure to phthalates is to buy products that don’t contain them. By doing so, you’re also supporting manufacturers that are making more responsible decisions. If you’d like to check out your favorite brands as well as get some leads on healthy alternatives, go the Environmental Working Group’s Skin Deep Cosmetics Database[u5] . They have the lowdown on over 69,000 products.

The Newly Discovered Fat Hormones*

*The following is an excerpt from my book PERFECT HORMONE BALANCE FOR FERTILITY[u1] . If you’re working to lose weight or wondering if/how this may improve your chance for conception then read on…

Fat cells are not passive calorie warehouses, but rather mini endocrine factories that produce at least 20 different hormones, collectively called adipokines. These hormones direct your metabolism and help your brain keep track of your energy stores to control appetite and budget how your body uses this energy. Adipokines also help your brain determine if you have enough fat stores to sustain pregnancy. Your brain also takes into account how effectively you can share your energy with your baby—if you’re insulin-resistant, your body doesn’t channel energy to the fetus as effectively. As you modify your diet, fat cells adjust their adipokine secretions to bring them more into balance, improving your fertility profile. Here are some of the key adipokines and how they affect your weight.

  • Leptin tracks how many calories you have stored as fat—the more fat you have, the more leptin in your blood. When leptin levels are high, your brain suppresses your appetite and revs your metabolism to help you burn calories. But when leptin is chronically elevated, at it is in obesity, your brain tunes out the appetite-suppressing effect. Low leptin, on the other hand, signals low fat stores—a red flag that your brain should halt ovulation.
  • Adiponectin helps your body use fat as fuel. As you gain weight, though, you produce less adiponectin, and low levels are associated with fertility problems. As you lose weight, fat cells release more adiponectin, increasing your chance of conception.
  • Resistin is released by fat cells, resisting insulin’s ability to help store glucose. If you’re overweight, resistin rises, leading to insulin resistance and reduced fertility.