I want to call to your attention a very informative article in today's Health Journal section of the Wall Street Journal on surprising risks to men's fertility. This is in additon to the article posted here yesterday on BPA in plastics causing a potential risk.
All these environmental risks may explain why we are seeing so many otherwise healthy men with morphology issues in their sperm.
Two recent articles outline potential dangers to mens fertility from environmental causes.
In a study performed on mice reported in Science Daily, daily exposure to a chemical that is prevalent in the human environment, bisphenol A (BPA), causes lowered fertility in male mice.
Mice that received daily BPA injections for two months had lower sperm counts and testosterone levels than those of mice that received saline injections without BPA. Compared with untreated controls, mice exposed to BPA produced litters that were 50 percent smaller.
"We are being exposed to BPA in our daily lives at a level much higher than the safe recommended exposure," said the study's principal author, Surya Singh, PhD, associate professor in the university's biochemistry department. "In this study, we are trying to explore what the outcome can be if we are continuously exposed to BPA in our routine life." BPA-exposed mice received a dose that was twice the daily upper limit of safe exposure recommended by the U.S. Food and Drug Administration and the Environmental Protection Agency.
These new research findings add to a growing body of scientific evidence that links exposure to BPA, an endocrine (hormone) disrupter, with numerous adverse health effects, including on reproductive function. Human exposure to BPA comes from sources such as epoxy resin-lined food cans and hard polycarbonate plastics, which leach the chemical, especially when heated to high temperatures.
According to s new study reported in Science Daily, AMH (anti-Mullerian Hormone) has been shown to be of predictive value in determining the response of IVF patients to various stimulation protocols.
According to the study to be printed next month in the American Journal of Obstetrics & Gynecology and reported online, AMH is made by small follicles in the ovary and helps regulate their growth. AMH levels in the blood are an indicator of how many follicles a woman has at the time of the hormone measurement.
The research team measured AMH levels in 190 IVF patients, ages 22 to 44, both at the beginning and end of their preparatory course of follicle stimulation hormone treatment. They counted the eggs that were eventually harvested and then performed blood tests and later an ultrasound to confirm pregnancy.
The researchers found that women with low AMH levels in the first test (less than one nanogram per milliliter) on average yielded only about six eggs, while women who had more than three times as much AMH provided about 20 eggs on average.
In this study, AMH similarly predicted whether pregnancy became established. Only about a quarter of women with less than one nanogram of AMH were pregnant five to six weeks after the IVF procedure. Among women with more than three nanograms, three in five were pregnant at that stage. Most other studies have not found an association of AMH levels and pregnancy success though delivery.
At Reproductive Partners we have been using the test for some time in selected patients to help fine-tune stimulation protocols when other factors gave conflicting information. Now we predict the test will soon come into universal use based on the finding this and other confirmatory studies.
The relationship between stress and infertility remains controversial. Despite that, a number of interventions have been developed to reduce stress, especially in IVF cycles, including Mind-Body (MB) programs, acupuncture and yoga. In fact RPMG is sponsoring a new session of Strong Yoga 4 Fertility beginning July 9th.
A study reported in the June 2011 issue of Fertility & Sterility demonstrates the benefit of a Mind-Body prorgam on IVF success. They ramdomized patients to participation in a Mind-Body program or a control group. Only nine percent of the MB group had completed a least half of the sessions prior to their first IVF cycle. Pregnancy rates were 43% for all subjects in the first cycle. 76% of the subjects had attended at least one-half of their sessions at cycle 2 start. Pregnancy rates for cycle 2 were 52% for MB participants and 20 for controls.
This demonstrates that MB participation was associated with increased pregnancy rates in cycle 2.
For more information on he yoga program, call Jackie at (818) 769-3857 or email strongyoga4fertility@gmail.com.
This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
A poster presentation showed that omega-3 fatty acids are beneficial in improving the fertilization rate in IVF cycles.
98 couples with unexplained fertilization failure were randomized to 1,000 mg omega-3’s versus no treatment. The fertilization rate was higher (76.5% versus 50.4,%), there were more good quality embryos, and the implantation rate was increased. These results suggest that the prominent role of omega-3 fatty acids in sperm membranes may increase fertilization and that they also may influence sperm DNA (see previous post), therefore influencing embryo quality and implantation. It is not clear whether the female partner was also treated.
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This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
A poster presentation showed that omega-3 fatty acids are beneficial in improving DNA fragmentation in sperm.
Forty-six men were randomized to 1050 mg of DHA or placebo. DHA is one of the two main omega-3s and is found in high concentration in sperm membranes.
DNA fragmentation by TUNEL decreased progressively over time from 26 to 9. This dose of DHA would be equivalent to 3,000 mg of omega-3 fatty acids in fish oil containing both DHA and EPA. It is surprising that such a favorable effect was seen without a concomitant increase in antioxidants, as these highly unsaturated fats are very sensitive to oxidation and semen of infertile males has increased reactive oxygen species.
We have recommended a dose of 500-1,000 mg per day. Doubling that dose could be considered in men with a high percentage of fragmented sperm.
This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
Apparently it does, at least according to these poster presentations
Pregnancy outcome in 9550 IVF pregnancies was evaluated according to endometrial thickness. With thickness < 5 mm, the risk ratios for first trimester and second trimester losses and preterm delivery were 1.5, 2.8, and 1.4, respectively. Birth weights were also reduced. Stillbirth was increased 4-fold. Women with endometrial thicknesses less than 5 mm should be advised on the risks of proceeding with hCG and that any resulting pregnancy should be treated as high risk. In fresh IVF cycles, freezing all embryos using vitrification should be considered with maximum efforts to achieve an endometrial thickness of over 5 and preferably over 7 in the frozen (FET) cycle. These outcomes may or may not pertain to non-IVF pregnancies.
But in another poster presentation, that issue was addressed and the outcome was similar. In a cohort of 2090 women receiving clomiphene with gonadttropins for IUI, multiple logistic regression analysis showed a correlation of endometrial thickness and pregnancy. Clinical pregnancy rates varied from 9.3% with endometrium under 5 mm to 19.6% with endometrium > or = 10 mm. The greatest impact was observed under 7 mm. Measurement of endometrial thickness would be helpful in clomiphene cycles and estrogen could be considered for 5 days following clomiphene for those women with a thin endometrium. An alternative would be to change the protocol to gonadotropins without clomiphene.
So in this instance, size does matter.
This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
Most of the evaluatation and treatment of infertility is focused on the female partner. Of course the male's semen parameters are carefully evaluated and lifestyle issues are addressed. But weight is rarely mentioned as a lifestyle factor. A poster presentation at ASRM shows that male weight may be more of a factor than we realize.
In this study the chance of clinical pregnancy decreased 28% for each 5 unit increase of male partner BMI when controlled for female BMI. This may be because the oxidative stress associated with obesity could increase sperm DNA fragmentation. In the female it clearly has the potential for causing reduced granulosa cell, egg, and embryo quality. Increasing antioxidant intake may be helpful for both overweight male and female partners. For more lifestyle information see the Lifestyle & Fertility pages on our website.
This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
We advise all couples trying to conceive to stop caffeine. Many are relectant to give it up. Now here's more evidence of how important it is.
In a poster presentation, a dose-dependent decrease of the pregnancy rate with IVF was observed according to caffeine intake (33% with none and decreasing to 12% with the equivalent of 2 cups of coffee). Enough said?
Here's more: In a mouse model, ovarian response, fertilization, and blastocyst development were decreased.
This confirms the previous study showing no caffeine is important to IVF outcome.
This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.
To my way of thinking there is very little "natural" about an IVF cycle. People associate the word "natural" with something good and so "natural" cycle IVF has some appeal because it sounds better than the alternative which is, I guess, unnatual. Actually "natural" cycle IVF refers to doing an IVF cycle without fertility drugs. But it still requires hormones to start the release of the egg, egg retrieval under sedation or anesthesia, laboratory work to fertilize the egg and sustain the embryo, an embryo transfer, two days of bedrest and two weeks of hormones to sustain a possible pregnancy. Natural?
In a poster presentation 243 cases of "natural" cycle IVF were reported with hCG to start egg release given with estradiol levels over 150 and mean diameter over 15 mm. Mean age was 32. Pregnancy rate per retrieval was 22%.The retrieval rate was high at 88%, probably related to the smaller follicles. The results were surprisingly good and must be due to the young age of these patients.
If you contrast that 22% pregnancy rate with our 2010 results showing 63.7% pregnancy rate per transfer, it would take three "natural" cycles to achieve the same pregnancy rate. That's three retrievals, the most physically risky part of the procedure, and three laboratory charges, the inconvenience of six days of bedrest and three courses of pregnancy-sustaining hormones. More risk, inconvenience and expense to counter the low risk of hyperstimulation with the drugs and multiple pregnancy associated with conventional cycles, both of which can be minimized by careful stimulation and limited numbers of embryo transferred. That does not take into account the emotional impact of repeated failure.
Young patients are at the highest risk for multiple pregnancy and have the lowest financial resources. So if there is a place for "natural" cycle IVF it may have a place in such patients. But if you look at all aspects of a cycle, I think it is more prudent to use fertility drugs carefully, consider single embryo transfer or at the most two to maximize the chance of success.
I think it was the Green Bay Packer's legendary football coach who said, "Success isn't everything; it's the only thing." Or something like that.
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