It seems like there is a story almost every day about threats to our health from products we use almost every day. Today's threat is to reproduction. The Los Angeles Times reported, "In a study published today, a decreased likelihood of pregnancy is linked to flame-retardant chemicals in foam furniture, electronics, fabrics and more. Californians may have higher exposures compared with residents of other states.  Their study joins several other papers published in the last two years suggesting that the chemicals, polybrominated diphenyl ethers, or PBDEs, affect human health.

PBDEs have been used as flame retardants for four decades and are found in foam furniture, electronics, fabrics, carpets and plastics. The chemicals are being phased out nationwide, and certain PBDEs have been banned for use in California. But they are still found in products made before 2004. Californians may have higher exposures compared with residents of other states because of the state's strict flammability laws, according to the study authors, from UC Berkeley."

I have been impressed with the increasing numbers of men I am seeing with motility and morphology issues with no apparent reason and have thought that environmental factors may be partially to blame. This is just another of those potential threats.

There is now more evidence that women who have two copies (are homozygous) of mutations for genes that can cause inappropriate blood clotting (thrombophilia) are not as likely as previously thought to suffer from some pregnancy complications. The Jamuary 2010 issue of the medical journal "Obstetrics & Gynecology" contains two articles and an editorial, "The Truth About Inherited Thrombophilias and Pregnancy" discouraging random testing for thrombophilias, and when found, treatment with anticoagulants.

One study shows that although the prothrombin gene mutation results in an increased risk for the development of certain pregnancy complications in asymptomatic women, another thrombophilia, MTHFR, may actually protect against those complications. Their overall conclusion was that the majority of asymptomatic women who carry an inherited thrombophilia mutation have a successful pregnancy outcome. The other study showed no association between the prothrombin G20210A mutation and pre-eclampsia, premature separation of the placenta or small-for-gestational age babies in a low-risk group of women. These findings raised the question of the need for screening asymptomatic women for this mutation.

Based on these studies and others, Dr. D. Ware Branch wrote an editorial expressing concern that doctors are prescribing heparin and other anticoagulants too frequenlly after testing women who had almost any adverse pregnancy experience. The enthusiasm for using heparin and its derivatives comes from success in heparin treatment of antiphospholipid syndrome in pregnancy. He believes that a primary cause of an adverse pregnancy outcome may be inflammation, not thrombosis which would not be helped by anticoagulants. Using heparin and related drugs can lead to serious complications.

Regarding this question, infertility specialists deal mostly with patients who have experienced recurrent early pregnancy and Dr. Branch points out that two prospective trials show no improvement in live birth rates using low molecular weight heparin in women with antiphoispholipid antibodies and recurrent miscarriage. Years ago there was a great deal of enthusiasm for testing women with recurrent miscarriage and other pregnancy complications for thrombophilias and antiphospholipids and, when found, treating with heparin or one of its derivatives. Now the tide seems to be turning against even testing. Definitive multi-center studies are needed to determine "The Truth."

A question that I occasionally hear is whether inherited tendencies to clot abnormally (thrombophilias) are a cause of infertility or early pregnancy loss. Most people asking this question have gotten this notion from surfing the internet. Our group’s opinion on the subject has been that these conditions are not major factors in either early pregnancy loss or infertility.

A study in the December 2009 online edition of the medical journal “Fertility & Sterility” found no significant difference in the prevalence of three genetic mutations associated with the increased risk of thrombophilia (Factor V Leiden G1691A, prothrombin G20210A, and methylenetetrahydrofolate reductase [MTHFR] C677 T) in 100 infertile women with unexplained infertility when compared with 200 control fertile women without an infertility history.

There can be issues in late pregnancy in women who are homozygous (have two copies of the mutant gene) for some of these conditions and these women may require significant anticoagulation. But prevailing current thinking is that women with infertility or early pregnancy loss do not need significant anticoagulation even if homozygous for these genetic mutations.

This is important because anticoagulation beyond one baby aspirin a day may result in health and potentially even life-threatening complications