One of the emerging therapies in advanced reproductive techniques involves combining the parts of a healthy egg donor to rejuvenate or correct deficiencies in a woman’s own egg. When a sperm is then added, the resulting person can actually contain the DNA of three people rather than two. Although this technology is currently not available for use in the USA–the first babies have been born in England through this technique. Interestingly, there were 17 babies born in the USA using this technique more than a decade and a half ago. This procedure was then banned due to potential health concerns in the children that resulted. We now have a follow up report on these original children who are now teenagers. Most importantly, this update is reassuring that although caution is recommended, this procedure does seem safe and reasonable for continued investigation.
One of the most challenging problems to diagnose and treat for couples trying to conceive is the problem of recurrent early pregnancy loss (REPL). As fertility specialists, we spend a tremendous amount of time and energy making sure that we control all of the variables that might improve the chances that a pregnancy gets a healthy start. New evidence shows that women can—and should—make some simple changes in their lifestyle to also improve their chances for a successful outcome.
A study presented at the 2015 meeting of the American Society for Reproductive Medicine recently highlighted the potential impact of a chemical called phthalates on the pregnancies of women going through IVF. This was part of a study called the EARTH study; an investigation on how environmental and lifestyle can impact reproductive health. They measured phthalate levels in the urine of about 250 women going through fertility treatment and then followed these levels in nearly 300 pregnancies. What they found was that women going through fertility treatment that had higher levels of this chemical in their body had a much higher chance of miscarrying then the fertility patients with lower levels. In fact, their risk could be as much as three to four times higher—depending upon their level of exposure.
An important aspect of modern research is to pose the question of “why?” In this case, the question would be “why would phthalates increase the risk of miscarriage.” The answer to that question is by interfering with the ability of ovary to support the development of the early pregnancy. Specifically, after an egg is released from the ovary; the cells that remain at the site of the egg’s origin form a hormone producing unit called a corpus luteum (CL). The function of this CL is to help get the pregnancy off to a strong start until the placenta is large enough to take over hormone production. In 2014 a well designed study found that phthalates directly interfere with the ability of the CL to perform this critical role.
A recent multi-centered clinical study found that women pursuing Advanced Reproductive Treatments (ART) like IVF had lower levels of phthalate in their body than infertility patients pursuing other forms of treatment. The believed explanation for this finding was that patients undergoing IVF may pursue healthier lifestyle choices. For instance, it is estimated that at least 90% of the phthalates in our bodies are due to dietary intake. By reducing processed foods and decreasing consumption of animal fats, phthalate levels fall rapidly. In fact, our bodies are able to eliminate phthalates after only 6 to 12 hours. So it is only through the continued exposure that these chemicals persist in the bloodstream. So by making better choices, patients may be able to reduce their risk of miscarriage by 75%.
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.
A recent survey estimated that nearly half of the US adult population (~114 million people) regularly takes dietary supplements. In fact, last year Consumer Reports estimated that our passion for these products costs us over $15 billion; more than $150 per person and that didn’t even include the amount that we spend on vitamins. Unfortunately, emerging information shows that we’re often not getting what we’ve paid for, or worse, we can be taking in products that can actually impair our health.
In this consumer driven market, products tend to target the most popular problems or conditions including infertility and pregnancy. Unfortunately the US Food and Drug Administration (FDA) have identified a growing trend of tainted products. Many have been found to be contaminated with toxic plant material, poisonous heavy metals and bacteria that can create various illnesses. Worse still, the supplements that have been confirmed to be problematic are believed to be a small fraction of the growing problem. How did we get to this point? It dates back to the 1994 Dietary Supplement Health and Education Act (DSHEA) under which vitamins, minerals, botanical products, amino acids and tissue extracts were all classified as “dietary supplements.” According to this regulation these products are presumed to be safe and can be marketed to consumers with no pre-release testing and very little oversight. The end result has been a growing list of consumer complaints, possible health complications, and uninvestigated claims of efficacy.
In reality, anything that promotes health can also have adverse effects. This is as true for supplements as it is for medications. That’s why as more of these products target men/women wanting to conceive or women that are already pregnant it is important to be your own advocate; both as a consumer and as a patient. Especially since a growing number of supplements are tainted with impurities and unlisted ingredients.
In 2007 the US FDA published a report titled “Survey Data on Lead in Women’s and Children’s Vitamins.” I find it disturbing that the investigators concluded that of the 324 products tested they contained levels of impurities that were considered “safe/tolerable exposures.” Yet, they all tested positive for lead! As a healthcare provider and patient advocate I’m outraged People shouldn’t unknowingly purchase and consume products that introduce toxins into their body. Fortunately there are steps that you can take to protect yourself and your family:
• Go organic—A growing number of studies show that organically produced products are higher in health promoting vitamins, minerals and antioxidants. By choosing organic products when you can, you’ll decrease your need to supplement your healthy diet.
• Be an informed consumer—Since most supplement manufacturers don’t voluntarily hire agencies to monitor the quality of their product, investigate the quality of the ones you are using. Independent agencies like Consumer Lab test and report on the quality of many supplements.
• Notify your healthcare provider of everything that you’re taking—A growing number of products have been found to be deliberately tainted with active ingredients including prescription medications not approved for use in the United States. Therefore it is important that your doctor know about everything that you’re taking in case you develop a reaction to your supplement or experience an adverse response due to how it interacts with your other medications.
• Periodically re-evaluate your needs—Most dietary supplements have not been well tested despite the claims to the contrary. I recommend that my patients reconsider each product that they’re using at least once a year by asking themselves two questions. First, why did I start this? Second, is it meeting or exceeding my expectations? If you’re not satisfied with these answers discontinue anything that isn’t specifically recommended by your healthcare provider.
Hormones represent an integral communication system. They are chemical messages that are made in one part of your body and sent through your blood stream to coordinate everything from digestion to ovulation. They even make it possible for you to sleep. They are essential to your health and wellness. Yet most people don’t realize that they also impact how you feel. Your energy level, your hunger even your physical attractions are profoundly impacted by what is happening in your body hormonally. Although we may not think of this delicate balance when we’re at our peak of fitness; people often have a strong sense of “imbalance” they’re not doing well. Yet these symptoms are often overlooked when they can actually provide tremendous insights into what’s going wrong as well as provide strategies to improved health and quality-of-life. By paying attention to your symptoms, you can feel better while boosting your chances of conceiving as well as improve the health of your baby. Here’s how it works.
There are over 200 hormones that can be circulating through your blood stream at any given time and new ones are being discovered every month. I like to think of these hormones in groups according to their function. Most people have heard of the fight-or-flight hormones associated with the stress response. The other groups to consider are tend-and-befriend, rest-and-digest, mate-and-relate. Think of them as if they are different elements on a mobile in a dynamic state of equilibrium; an imbalance in one group can cause an imbalance in another. If you have too much stress hormone for instance, it can cause digestive problems, difficulty with sleep and infertility problems.
Some of the most exciting research in this field is shedding light on the dual role some hormones can play. For instance, one study recently demonstrated that the same hormone—called oxytocin—which is responsible for promoting feelings of love and affection can also contribute to jealousy and envy. Some imbalances can be ominous. For instance, another recent study demonstrated that women with even slightly reduced levels of thyroid hormone during pregnancy are associated with blood pressure problems during pregnancy. That’s why I feel it is so important to consider how hormones interact with one another.
I’ve spent a decade and a half now studying symptoms and how they relate to hormone balance. In my books, I’ve tried to use questionnaires in order to help people gain insight into their own hormone milieu as well as provide practical tips on how they can restore harmony when problems occur. I encourage you to check out PERFECT HORMONE BALANCE FOR FERTILITY and PERFECT HORMONE BALANCE FOR PREGNANCY in order to learn more about how you can optimize how you feel as well as maximize your chance of success. And please check back here as I update this blog with the latest research in this exciting field.
Although most fertility treatment focuses on women; at least 1/3 of couples have a male factor contributing to infertility. Newer studies even show that subtle changes in sperm quality—that aren’t detectable by standard testing—can contribute to poor fertilization, abnormal embryo development and even recurrent early pregnancy loss. That’s because the sperm contributes half of the genetic material to the developing embryo as well as factors that contribute to normal fertilization and early development. But they are easily damaged.
Sperm are particularly susceptible to free radical damage—the charged particles that are a normal byproduct of oxygen metabolism. They are so compact, that they contain very low concentrations of the scavengers that neutralize these damaging little sparks of energy. When a free radical encounter DNA—which the mature sperm is loaded with and ready to contribute to the awaiting egg—the genetic material can be damaged; a process called “fragmentation.” Sperm lack the ability to repair this damage when it occurs. As a result, seemingly healthy looking sperm can prevent a pregnancy from getting off to a healthy start.
The good news is that there are steps that men can take to minimize the naturally occurring damage to sperm and markedly improve your chance of having a baby together. Here’s what he can do:
- Avoid exposure to tobacco and other products that promote free radical formation (more about this in future posts).
- Eat foods rich in the following antioxidants:
- β-carotene (i.e., spinach, carrots, tomatoes, cherries, melons, peaches)
- Vitamin C (i.e., citrus fruits, tomatoes, broccoli, cabbage, berries, mangos, pineapples)
- Vitamin E (i.e., peanuts, almonds, soy, olive oil, wheat germ, cereals)
- Zinc (i.e., asparagus, eggs, potatoes, fish)
- Consider a “preconception supplement.”
A recent study confirmed that making these healthy changes can improve pregnancy rate while also reducing the risk of miscarriage. I know when my wife and I were going through fertility treatment; I took the product called Conception XR despite my healthy diet and normal semen analysis. Not only did I feel it was the least I could do but I do believe that it helped us to conceive our daughter.
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.
Few disorders can be more difficult to diagnose or more frustrating to treat then recurrent early pregnancy loss (REPL). Traditional diagnostic criteria call for at least three pregnancy losses prior to evaluation and treatment of this vexing problem. With more women choosing to delay pregnancy until their thirties or even their forties, REPL can create an additional burden on their already limited opportunities to achieve a successful pregnancy. Ironically, as women age they are more likely to experience a miscarriage when/if they do become pregnant. A new technique called comparative genomic hybridization (CGH) offers couples some reassurance.
Studies show that most pregnancy losses (50-70%) are due to genetic abnormalities. In fact, the earlier that miscarriage occurs the more likely it is to be due to abnormal changes in the DNA. These are not typically abnormalities that are detected by testing the parents but rather spontaneous mutations that occur during early development. Moreover, they often go undetected by the most commonly used technique for genetic assessment, called G-banded karyotype analysis. That’s because karyotype analysis has limited resolution. It is only able to detect the addition or deletion of relatively large portions of the genetic code. By contrast however, CGH is able to detect genetic changes that are far smaller. In fact, this technique has been reported to identify genetic causes for unexplained mental retardation in about 10% of patients that had previously had a “normal” conventional genetic karyotype. Moreover, a study in the current issue of the journal Obstetrics & Gynecology found that CGH was able to identify genetic abnormalities in 13% of miscarriages that were missed using conventional genetic testing. More exciting still is the potential of CGH to detect certain abnormalities before birth.
Maybe the best use of this technique however is when testing is performed on embryos prior to becoming pregnant. Combining CGH with in vitro fertilization (IVF) allows us to perform a biopsy upon an embryo for genetic analysis prior to transfer into a woman’s uterus. Early data using IVF with CGH has been very reassuring. We’re finding that by identifying and transferring only the embryos that are determined to be genetically competent—meaning without identifiable deletions or additions to the genetic code—we may be able to double or even triple the chance of a healthy live birth. Since this technique is still relatively new, more studies are needed before it is widely accepted but it is already revolutionizing the diagnosis and treatment of couples seeking fertility treatment.
Although we still recommend prenatal screening once pregnancy is established, CGH can dramatically reduce the anxiety of couples during those critical weeks of the first trimester; especially those with a history of recurrent early pregnancy loss. Remembering when my wife and I conceived—both of us are in our forties—I know that we would have had fewer sleepless nights early in our pregnancy had we been able to have CGH as part of our fertility treatment. There is certainly an additional therapeutic benefit of that stress reduction as well!