Male fertility

Infertility and women in the military

Fertility issues may be common in women in the US military

A recent survey suggests that infertility may be a common problem among American servicewomen

How common are fertility issues among women in the US military?

According the Service Women’s Action Network, 37% of women from the various branches of the military (army, navy, air force, marines) surveyed experience difficulty in conceiving.

Is it easy to get infertility treatment in the military?

While treatment is available, respondents reported that treatment services were limited and difficult to access. Many basic fertility procedures such as IUI and access to a fertility specialist were unavailable on base, and for those who require advances treatments such as IVF, there are only a few military medical facilities which offer it. Frequently, those centers have long waiting lists, and require significant travel.

What about off base fertility treatment for service women?

Like other practices in different parts of the country, we are close to an active military base. Joint Base McGuire-Dix-Lakehurst is not far and we do participate with Tricare, so we do get to help many couples from the base seeking fertility treatment. The obstetricians and midwives in our practice also see many of the service women and family members for pregnancy care and gynecologic issues.

Does marijuana cause infertility?

Marijuana and fertility: Princeton IVF blog
Marijuana effects on fertility and pregnancy

All across the country, and likely soon in our state of New Jersey, recreational marijuana us is likely to become legal in more and more places. That means that more couples than ever who are trying to conceive will be users. If you are one of them, should you be concerned?

Here is what we know now:

Does marijuana affect a woman’s fertility?

We know that pot can affect a women’s hormones and her menstrual cycle. Ovulation problems which are related to hormone imbalances are a very common cause for female infertility.

Does marijuana affect a man’s fertility?

The main test fertility doctors use to diagnose male infertility is a semen analysis. We have known for some time that marijuana can have an adverse effect on the most important things we check for in a semen analysis, the number of sperm present (the count), how well they are swimming (motility) and the percent of the sperm that are normally shaped (morphology). We also know that exposure to active ingredient in marijuana THC can cause the breakage of chromosomes and abnormalities in a methylation, a natural chemical process which is responsible for how the genetic material is expressed in the body. Again, we do not know if this directly harmful to a man’s ability to father children or may affect the health of those children.

Is marijuana safe for my baby once I am pregnant?

If you believe the studies in animals, marijuana is not safe for pregnant moms to take. Rats whose mothers were exposed to marijuana in utero were more likely to have cognitive and memory problems in multiple studies. We do not know if this is the case in humans though. Keep in mind that a century ago, alcohol was thought to be safe in pregnancy and it was even used by doctors as a treatment for premature labor. We know now that alcohol causes very specific and severe birth defects when taken during pregnancy.

Is marijuana safe to take when I am breastfeeding?

THC can be found in the breast milk for days after use. Whether this poses any risk to a newborn is not known.

What about extracts that are sold at dispensaries?

No one knows for sure if these preparations are more safe or less safe than whole marijuana smoked or eaten.

So, do I need to be concerned?

No one can say definitively that marijuana use is dangerous during pregnancy nor can it be said to be definitively safe. There are however lots of red flags that raise concern. Most prudent doctors will advise that you and your partner consider avoiding pot if a baby is in your near future

Melatonin and fertility

Melatonin and fertility: Princeton IVF blog
melatonin-ivf-pregnancy.jpg

What is melatonin?

Melatonin is a hormone that is produced in the pineal gland, at the base of the brain. It is involved in the regulating your natural circadian rhythms of sleep and wakefulness. It is considered a “dietary supplement” by the FDA and is available over the counter at pharmacies and vitamin stores.

What is melatonin used for?

Many people find melatonin useful to help them sleep and take a pill (typically 3 mg) at bedtime. It is often helpful for insomnia, for those with unusual  work schedules, overcoming jet lag and to help blind people who do not experience the light and dark cycles. It has also been tried for a number of other medical and psychiatric disorders.

Why would melatonin affect fertility?

Melatonin has been known for sometime to the influence reproduction in some animals so it is not a long shot to think it might affect humans. In one study, they found that the follicular fluid, the liquid that surrounds the eggs and is extracted during an IVF procedure, contains high levels of melatonin.

Is there any evidence the melatonin may help?

There is some research that show eggs retrieved from IVF are more likely to fertilize, produce higher quality better looking embryos, and are more likely to implant. The problem with these studies is that oftentimes they are given along with other supplements (folic acid, inositol and antioxidants) that have been shown to help fertility. Also, just taking a pill or supplement that you think will help you, will help even if it does not contain any active ingredients. That is called the placebo effect. The bottom line is that we do not know.

What about melatonin for men?

There is some evidence that melatonin may lower sperm counts and motility (the percent of sperm that are swimming). For that reason, it is a good idea for men trying to father children to avoid taking melatonin.


Sperm selfies?

Testing for male fertility on your smartphone: Princeton IVF blog

Could your smartphone replace a semen analysis?

At home, iphone and android based sperm test kit

 

Can this device replace a semen analysis with your doctor? Maybe in the future.

Based on research from Harvard University, engineers have developed a new device for an at home "semen analysis." There are already at home sperm test kits available in stores, what is so unique about this one? Simply put, it is the smart phone. This device attaches to and taps the power of your iphone or android device through it's app, to analyze the data and give you a visual display of what the laboratory folks would see under the microscope.

The pros:

  • low cost
  • quick results
  • can be done at home without the awkwardness
  • you get to see what the actual sperm look like

The cons:

  • lacks the details your doctor may need (actual sperm concentration and motility)
  • unable to accurately determine morphology (another important part of the semen analysis)

The idea is a good one.

Reliable, inexpensive testing in a comfortable setting, and a way to determine when it's time to visit the fertility doctor or urologist. The reality is not quite there yet. The information is not quite enough to replace the formal semen analysis at a clinic, but with improvements in the software, it may well be in the future.

Sperm counts are dropping

Sperm counts are declining across the west: Princeton IVF blog

A recent publication suggests that sperm counts may be declining all across the western world

Research suggest sperm quality is going down across the western world.

It is been all over the news lately.  Some in the media have even suggested this may bring our doom as a species. So, what's the real story behind this...


A recent paper published suggests that sperm counts may be declining in Western countries.  


While this is not entirely new, it is a continuation of a trend that has been noted for years.  This there has been a decline in sperm quality noted in the United States and other western nations. The authors compiled studies done over a number of years including:

  • 185 studies
  • over 42,000 men
  • between 1973 and 2011
  • from US, Europe, Australia and New Zealand

Over the 39 years, the sperm concentration dropped 52.4% and the total sperm count went down 59.3%, a hugh decline.

While this is concerning, it raises even more questions:

  • Have the counts really declined or is it just the techniques used to count the sperm?
  • If the counts are going down, is it actually affecting male fertility?
  • Is this a problem in the developing world or just in the west?
  • If this being caused by increasing obesity?
  • Is this being caused by something in the environment?

 

Only time and further research will answer these questions.

Basic facts about fertility and infertility for NIAW

infertility-facts-for-national-infertilty-awareness-week.jpg

This week April 19-April 25, is National Infertility Awareness Week (NIAW).  In recognition of NIAW, we would like to share some of the basic facts about fertility and infertility

Abnormal sperm and healthy babies

The advent of ICSI (intracytoplasmic sperm injection) two decades ago has enabled men with very low sperm counts to father children through IVF.  Prior to this, as fertility specialists, we could offer these couples only donor sperm. Despite this "miracle" of modern medicine, one of the lingering concerns was as to whether using sperm from men with very low counts might lead to a more birth defects. Adding to this concern, were some studies suggesting that ICSI or even regular IVF might result in a higher than normal rate of abnormalities. Some good news, however.  A recent study from the NIH suggests that this is not a concern. The researchers found that  couples who conceived with very low sperm counts did not have children with more birth defects.