What’s in a Prenatal Vitamin?

What?

  • FOLATE aka FOLIC ACID (most important)
  • Iodine
  • +/- Iron (this can also be supplemented separately as needed, such as for anemia)

Why?

  • Folate reduces risk of neural tube defects (birth defects), such as spina bifida
  • Iodine optimizes thyroid health and fetal brain development

When?

  • Optimal to start about 3 months prior to conception
  • Take 1 serving (number varies by vitamin) daily

How much?

  • At least 400 mcg folate per day, but individual needs may be higher
  • 150 mcg per day of iodine

Where?

  • Any pharmacy or grocery store, or available online

Other ingredients?

  • Limited evidence for other ingredients, but they are usually not harmful.
  • It is important to avoid excessive quantities, such as for Vitamin A or B vitamins.

Which are legitimate products?

  • Prenatal vitamins can be given as a prescription from your doctor
  • Prescription brands are FDA-regulated
  • Direct-to-consumer (aka over-the-counter, or OTC) brands are not as strictly regulated
  • If you buy it OTC, check for the following certification standards:
    • Look for NSF (National Sanitation Foundation) certified
    • Or look for USP (United States Pharmacopeia) verified

Caution about Sunscreen Use

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If your family is anything like ours, sunscreen is a routine part of our daily lives. Sunscreens protect our skin from sunlight using mineral or chemical filters. Mineral sunscreens use zinc oxide or titanium dioxide. Most sunscreens use chemical filters that contain active ingredients such as oxybenzone. Studies have demonstrated that these chemical filters mimic hormones and can act as endocrine disrupting chemicals.

 

Sunscreen exposure increases our exposure to chemical filters, such as oxybenzone. Oxybenzone use is widespread throughout the US. It is detected in nearly every American.

 

The reproductive system is sensitive to environmental factors. Early pregnancy is a particularly vulnerable time for endocrine disruption. Exposures when trying to conceive can impact the likelihood of conceiving as well as the health of the pregnancy.

 

Oxybenzone exposure and exposure to related compounds is associated with male infertility  and poorer reproductive success in men undergoing fertility treatments. Similarly, men with greater exposure to a similar compound found in sunscreen had poorer sperm quality and took longer to conceive. Female exposures to oxybenzone and related chemicals have been linked to increased risk of endometriosis and problems with ovulation. These chemicals have also been associated with oxidative stress and inflammation in pregnancy.

 

The good news is that we can be informed consumers and change our exposure.

This is a great resource of safer sunscreen alternatives.

 

 

Take home points

  • Avoid sunscreens with chemical filters, particularly oxybenzone
  • Use mineral sunscreens when possible when trying to conceive

Updates on BPA

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Bisphenol A (BPA) is commonly found in plastics and the majority of us are exposed to this hormone disruptor multiple times daily. We previously introduced BPA and the negative health impacts here. We know that BPA exposure when trying to conceive can negatively impact multiple aspects of your health, including your fertility and the likelihood of your children having health problems.

New basic science research is adding to our previous concerns about this endocrine disrupting chemical:

  1. BPA negatively impacts how an egg matures and egg quality by increasing DNA damage and oxidative stress. This study also shows the potential for the damage that BPA causes for mom to impact her future children.
  2. BPA can decrease sperm count in males and lead to neurodevelopment problems in their children. This study also was associated with increased obesity in female offspring.

What you can do:

  • Switch to BPA free drinking bottles like those with a #5 stamped on them or use either glass or metal instead;
  • Purchase soups and foods packaged in cardboard cartons or glass instead of the plastic lined cans;
  • Hand wash plastic dishware with mild soap in warm water instead of using dishwashers for these products;
  • Don’t place plastic ware in microwave ovens to warm;
  • Express your support to companies that are voluntarily phasing out the use of BPA in their products.

Happy moms

It is estimated that up to 54% of couples with infertility experience a high level of stress, anxiety, and depression before and/or during fertility treatment. It is incredibly common to need additional help when going through fertility treatment, which is why I encourage the use of complementary stress reduction techniques with my patients. But sometimes yoga, acupuncture, and mediation isn’t enough and more help is needed. The most commonly prescribed antidepressant is a group of medications called selective serotonin reuptake inhibitors (SSRIs).

A recent study compared women on SSRIs going through IVF to women who were not on antidepressants. They found that the embryo health and IVF outcomes did not differ between the groups. This suggests that, from a fertility standpoint, there is no reason to avoid using an antidepressant if you need it.

Fertility treatment is hard enough. There is no reason to suffer through poorly controlled anxiety and/or depression while going through fertility treatment. If you need additional help, please reach out. The best way to have a happy healthy family is to start with a healthy mom before conception. You are not alone.

Take home points:

  • The diagnosis and treatment of infertility is stressful
  • It’s common to struggle with stress, anxiety, and depression at any phase of treatment
  • Antidepressant use does not impact IVF success rate.
  • Do not hesitate to get additional help if needed

Considering IVF? Limit your exposure to DEHP.

Phthalates are a group of chemicals found in many types of plastics in a variety of consumer products. We have previously discussed the negative impact of phthalates on fertility. A recent study adds to this: phthalates negatively impact an IVF cycle. Women are disproportionally impacted by phthalate exposure.

 

In this study, women with high levels of phthalates had fewer eggs at the time of egg retrieval, fewer fertilized eggs, and fewer top quality embryos. This group suggests that DEHP, a specific type of phthalate, may impair early IVF outcomes, specifically targeting the oocyte. If you are thinking of undergoing IVF this year, I encourage you to investigate what you can do to optimize your IVF cycle by limited your exposure to phthalates!

 

What you can do:

IVF might not be enough

I am incredibly proud to work at a REI clinic that has the highest live birth rate in the country. A recent study, however, suggests that IVF may not be enough. Lifestyle and the environment can impact your IVF success rates, even at a top notch REI clinic.

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In this study, levels of pesticides and common pollutants were measured in the fluid that was obtained from the ovary during an egg retrieval. They found that higher levels of Pretilachlor, β-cyfluthrin, PCB 28 and 180 was associated with fewer eggs at retrieval, lower fertilization rates, and impaired embryo development. They also found that high PCB and pesticide concentrations negatively affected embryological outcomes. This study provides evidence that these harmful chemicals are found in the fluid surrounding individual eggs and are associated with decreased success with IVF. This suggests that if you want the very best chances of success with IVF, you should consider optimizing your lifestyle to minimize exposure to these harmful chemicals.

 

What you can do:

  • Learn how to minimize your exposure to PCBs and pesticides
  • Make a plan to optimize your health before you invest in an IVF cycle
  • Talk to your doctor about a timeline for implementing these changes

The hard work is worth it

Changing your habits is HARD– it’s hard to change what you eat, to make time for regular exercise, and to prioritize your well-being. But it’s absolutely worth it!

So many patients with infertility tell me they feel powerless and hopeless.  I want to empower you to believe that there are some things that you can do to boost your fertility. And it starts with taking care of yourself.

Your weight is very important for your health and your fertility. So important that we have discussed it here, here, here, and even here. It’s a recurring topic on the blog because it’s important and it is, unlikely your age, something that you can change.

A study was recently published that the hard work that is needed to lose weight is worth it. Women who consumed fewer calories and started exercising were much more likely to lose weight, ovulate on their own, and get pregnant compared to people who didn’t make these changes.  A combination of fewer calories by reducing fat and refined carbohydrate intake, and increased aerobic exercise is the cornerstone of healthy weight loss.

 

What you can do

  • Do something, ANYTHING for exercise 30 minutes, 5 days a week.
    • Consider using a fitness tracker or pedometer like FitBit
    • Schedule your workouts when nothing will interrupt your session. Make your fitness a priority.
  • Take a closer look at your diet and what you can cut out easily. Consider an app like MyFitnessPal.
    • Start by eliminating refined carbohydrates found in juices, sodas, and sweets
  • Don’t get discouraged. Any step is a step in the right direction.
  • Talk to your doctor for more information about local support groups and fitness programs in your area.

Keeping plastics out of your kitchen

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We have previously reviewed the negative impact that chemicals in plastics may be having on our health and fertility. One of the best ways that we can reduce this exposure is in our kitchen. When food is stored or heated up in plastic, the dangerous chemicals can leach into the food that we ingest. These chemicals can then interact with our endocrine system and cause disease.

When I first started considering my exposure to plastics, it felt like an impossible uphill battle. By starting in my kitchen, the task of reducing plastic exposure felt more manageable. I started by removing all plastic storage containers and making sure that we do not heat up food in plastic.

Here is a quick article that I thought I would share to help reduce your plastic exposures at home in the kitchen. I hope this helps you find reasonable solutions for limiting your plastic exposure in your home.

Are hand sterilizers making you “sterile?” The impact of triclosan on ovarian health

At a recent trip to Target, I realized just how many things are labeled as “antibacterial.” But what is antibacterial, anyways? And why do we need it?

“Somehow, through marketing or misinformation, we’ve been led to believe that if we get rid of bacteria, we’ll improve our lives and our health. In fact, the opposite is probably true” –Dr. Martin Blaser  In fact, to date, there is no evidence that washing your body and home with antibacterial products does any good compared to old fashioned soap, water, and scrubbing!

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Triclosan is an anti-bacterial compound added to personal care products like soaps but it is also added to plastics found in toys and medical devices. Triclosan is so common that the majority of people in the US population are exposed to this chemical; triclosan exposure is real and widespread.

Breaking news this week reveals that triclosan may target the ovary and make it harder for a woman to conceive.  This group investigated whether ovarian reserve, a marker of how many eggs a woman has and how she might respond to fertility treatment, was different in women with high levels of exposure compared to those with lower levels of exposure. They found that antral follicle count, a marker of ovarian reserve, decreased as the triclosan levels increased. Perhaps even more concerning was that this relationship became even stronger in lean and young women, suggesting that this may contribute to reduced natural fertility and could lead to a need for fertility treatment at a younger age.

Other studies have found similar concerning results: women with higher levels of triclosan exposure take longer to conceive when compared to women with lower levels of this chemical. Triclosan is also associated with lower oocyte yield in couples undergoing IVF. Similarly, triclosan has been found to disrupt implantation of a pregnancy and alter placental function, leading to pregnancy complications in animal models.

The good news is that the FDA is banning the use of triclosan in antibacterial soaps, effective next month (September 2017). Way to go FDA! Thank you! Unfortunately, manufacturers can still add this chemical to dish soaps and toothpaste.

What you can do:

  • Reduce your exposure. Avoid purchasing anything labeled “antibacterial”.
  • Use bar soap and water, instead of hand-sanitizers.
  • Avoid toothpastes that include triclosan, such as Colgate Toothpaste
  • Read here if you want to learn more about triclosan and how to reduce your exposure

 

 

Be Kind to Yourself

One of the best parts of my job, is getting to know individuals and hearing their “story.” I love learning about occupations, interests, and their goals for a family. I spend a lot of time listening to my patients so that I can fully grasp all that my patients have been through leading up to their visit with me.

I have to be honest: I’m saddened by how hard my patients are on themselves. There is so much unnecessary blame and justifying in fertility. For example, a common thing I hear can be something like the following: “I love coffee, but after trying to conceive for so long I gave it up. I miss it but I’m willing to give up anything in order to prove that I’m ready for a family.” Does this sound familiar to you? First off, you can drink coffee. Secondly, please try to be kind to yourself.

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Research suggests that kindness and mindfulness will not only help you cope with fertility struggles, but may even improve your outcomes. Unfortunately, this important step is often overlooked in many fertility clinics. I try to address the potential benefits these practices may have with my patients.

As a self-diagnosed perfectionist, I will be the first to admit that I have very high expectations that I set for myself. When I fail to meet a certain goal that I’ve set for myself as a physician or a mom, I beat myself up about it. My advice to you: try kindness instead. Pretend a friend told you the exact same story. How would you react to your friends’ tribulations?

Life is stressful and that won’t change, even once you get pregnant. We can’t control the stressors in our life but we CAN control how we react to them. So please, consider being kind to yourselves and help me support you through this fertility journey.