My neighborhood pools opened this week for summer and my family couldn’t be more excited. Unfortunately, mosquitos are popping up again and reminding me of the importance of discussing insect repellants with my friends, families, and patients.
Many women who never wear insect repellants have recently become interested in these products because of the news coverage of the Zika virus. The Zika virus was introduced to the world during the most recent Olympic games in Brazil. Mosquito bites were linked to severe birth defects and the Zika virus was identified.
The number of pregnant women with laboratory evidence of possible recent Zika virus infection and the number of fetuses/infants with Zika virus–associated birth defects continues to increase in the United States. About 1000 pregnant women in the US were diagnosed with Zika virus infection last year. Of these pregnancies, birth defects were reported in 15%. Congenital microcephaly, or severely small head in the affected child, has been a hallmark of intrauterine infection with Zika virus. However, the full clinical spectrum and severity of Zika remains unknown. Others have recently reported much lower rates of confirmed Zika virus in other parts of the US and no confirmed fetal or neonatal infections, which puts some doubt on the true prevalence of this widely publicized virus. The field of perinatal Zika virus infection is evolving and we continue to learn more about the virus as well as the risk of disease.
Insect repellants can be a good option for reducing your exposure to mosquitos and tics. The EWG has published excellent resources for consumers to learn about what is in their bug repellent.
My family uses DEET. It protects you against tics and mosquitos. DEET is the only insect repellant that has been tested on pregnancy women. The children of mothers who used DEET in their second and third trimesters showed no birth defects, changes in body size or developmental problems. No studies have examined the children of women who applied DEET during their first trimester. However, at toxic doses, DEET has been associated with seizures and neurological damage. Although this risk is scary, The EPA reports that this risk is very low- 1 per every 100 million persons. As with medications, I tend to recommend limiting the use of multiple products in order to limit exposure to multiple chemicals. Choose one insect repellant and stick with it.
A more natural alternative is also available as oil of lemon eucalyptus. The tree extract is refined to intensify the concentration of the naturally occurring substance para-menthane-3,8-diol (PMD) from 1 to 65 percent. The resulting oil is very different from unprocessed tree oil. Some testing shows that concentrations of 20 to 26 percent PMD may perform as well as 15 to 20 percent DEET against both mosquitoes and ticks (Barnard 2004, Consumer Reports 2010). I think it is important for us to recognize the limited safety data available on essential oils in pregnancy and in children. Refined oil of lemon is classified as a possible biochemical pesticide. Oil of lemon eucalyptus and essential oils have disadvantages but is a good choice for people who want a botanically based bug repellant. EWG recommends that consumers who are in high-risk areas for bug-borne disease or need long-lasting, effective bug protection avoid botanically-based bug repellents, aside from Oil of Lemon Eucalyptus. In other cases, you may find it worth your while to try botanical repellents to identify one that works well for you.
What you can do:
- Avoid exposure to mosquitos: use insect repellants with <50% DEET when trying to conceive and during pregnancy. More is not better. My family uses 30%.
- Wash your hands well after applying insect repellant. Wash repellant-coated skin at the end of each day.
- You and your partner should avoid travel to areas with Zika virus when trying to conceive and during pregnancy. Discuss your travel plans with a physician if there is any question about the safety of travel. Talk to your physician if you or your partner are concerned that you have been exposed to the Zika virus.
For more information:
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
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.
Here’s another fascinating study for women with PCOS; 1500 mg of the potent antioxidant from red wine can reduce testosterone levels by nearly 25%. This can not only improve egg quality and pregnancy rates but also reduce other symptoms of PCOS as well!
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 email@example.com
Call our toll-free number at 800.539.9870 or request a consult here.
May 1, 2010 Blog Post
Do you have endometriosis or problems related to painful menstrual cycles? There is a supplement that could relieve your symptoms and improve your fertility.
Many women with endometriosis continue to have pelvic pain even after surgical removal of all their lesions. In order to provide relief, many healthcare providers have used hormone suppressing agents (BioLimited hormones or BioAntagonists) like Lupron or Zoladex. However these treatments have not been shown to improve pregnancy rates and can delay your ability to become pregnant. Recently, a third option has been investigated: pine bark extract.
A certain type of pine tree is known to have bark that contains a potent antioxidant/anti-inflammatory called pycnogenol. In 2007, a large study [G1] randomly assigned women with endometriosis to take either a 30 mg capsule, twice a day of a pine bark extract or to take Lupron. In only four weeks, all women experienced a reduction in their symptoms. Women using the herbal extract reported that pain was reduced by about 80% and cramping by about 75%, where were the same as those on Lupron. But the women on the extract continued to have regular menstrual cycles, whereas those on Lupron didn’t, and those on the extract did not experience the menopausal side effects of Lupron. What’s more, at least 5 women on the pine bark extract became pregnant. Finally, women on Lupron had a rebound return of symptoms when they went off the drug, whereas pine bark extract had no such effect. Talk to your doctor about whether you should consider taking this herbal remedy if you’re in pain.
This is excerpt from my book PERFECT HORMONE BALANCE FOR FERTILITY[G2] (p. 299). A follow up study[G3] on this same compound found that women with painful menstrual cycles also experienced an improvement in their symptoms on pine bark extract even if they did not have a history of endometriosis. If you’d like to learn more about endometriosis as well as other diet and lifestyle tips on reducing the impact of this upon your fertility you’ll find more evidence-based suggestions in my book.