Planning for pregnancy

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

Losing weight before conception

Weight loss before baby: Princeton IVF blog
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This time of year is a time when many couples who are having trouble conceiving decide it’s time to start seeking help. That help could come from the OBGYN, a midwife or a fertility specialist. It’s also a time in the year, after indulging during the holidays, when many of us have a few extra pounds to shed.

For those who are overweight, part of that advice will be to lose weight before conception.

While this may not be easy, there are multiple reasons why weight loss before pregnancy is good advice.

  • Being overweight will reduce the chances of you getting pregnant on your own

  • Being overweight will increase the chances that if you do get pregnant, you will miscarry

  • Being overweight will increase the chances of medical complications during pregnancy such as diabetes and high blood pressure.

  • While diet and exercise during pregnancy can help limit weight gain during pregnancy, it is not likely to reduce the likelihood of pregnancy-related complications such as diabetes and hypertension.

Delaying pregnancy and excess weight are both bad for fertility, so delaying pregnancy for weight loss is balancing two risks.

At what point do the risks of delaying pregnancy offset the benefits of weight loss?

  • According to a recent study presented at the American Society for Reproductive Medicine, women in their late 30’s or those have poor ovarian reserve may be best off not delaying childbearing despite the obvious benefits.

AMH blood test- everything you wanted to know about this common blood test but were afraid to ask

AMH testing, a Q&A: Princeton IVF blog
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Common questions and answers about AMH testing

What is AMH?

Antimullerian hormone, commonly known at AMH, is hormone that is secreted by follicles in the ovary. It was initially studied for its role in reproductive development but is now widely used as a test of ovarian reserve.

What is ovarian reserve?

Ovarian reserve is a measure of the aging of the ovaries, and how many eggs the ovaries are likely to produce when given fertility medications. AMH, day 3 FSH and estradiol levels and antral follicle counts on ultrasound are commonly used measures of ovarian reserve.

What does a low AMH level mean?

A low AMH level, which most doctors consider a level of less than one, indicates that the ovary has fewer eggs available to stimulate. Women with low AMH levels, will usually make fewer eggs when given fertility drugs for IVF or insemination cycles.

Does a low AMH level mean that I am less likely to get pregnant?

AMH is a great test to determine how a woman will respond to medications, but it not as good at predicting pregnancy rates. It is true that women who produce more eggs are more likely to get pregnant, but particularly in young women, who do not need a large number of eggs, there does not seem to be reason to be concerned.

What does a high AMH level mean?

A high AMH level suggests that you are likely to respond very well to fertility injections and may be more likely to become hyperstimulated when taking them. It is also is considered a sign of polycystic ovaries (PCO) although AMH levels are not currently used to make the diagnosis.

Can the AMH level be used to predict if I will have trouble getting pregnant in the future?

Not really. Despite the early hope that AMH could help women know in advance if they might have infertility in the future, it turns out there is no evidence that AMH can predict future fertility.

The Golden Arches and your Fertility

Fast food and time to conceive: Princeton IVF blog
Eating too much fast food may cause infertility

Can eating too much fast food be making it harder to get pregnant?

New research suggest that eating too much fast processed food may actually lower your chances of getting pregnant, or at least delay the time to conception.

Researchers in Australia decided look at how long it took women to conceive and compared that to how many times a week they consumed fast food and how many times a week they ate fruit. They found that women who had fast food more than 4 times a week took longer to get pregnant than those who had it 2-4 times a week, who in turn took longer than those who did not consume fast food. The exact opposite was true with eating fruit. Those women who ate fruit regularly got pregnant faster than those who did not. Interestingly, green leafy vegetables and fish conception did not speed up the time to conception.

So, what does this mean if I am trying to get pregnant.

Lay off the fast food.

Despite, the title of this post, in all fairness to McDonald’s, this is not unique to to the golden arches or any other hamburger joints. This also applies to fried chicken from the Colonel, the forth meal at Taco Bell, the greasy Chinese food place at the mall and any number of fast food restaurants. Processed, high calorie, high salt, high carbohydrate food may taste good and be quick and convenient, but it may make it harder to get pregnant. They are also not great for your health or the baby’s.

Eat whole foods.

That does not mean go to one of Amazon Inc.’s high priced supermarkets. It means avoiding processed foods, like those that are served at fast food places.

Eat fruit.

Your grandmother was right. Most fruits are good for your fertility and health.

Green leafy vegetables are still good for your pregnancy.

Even if this study did not show a benefit to speeding up the time to conception, the folic acid in these veggies can help reduce your baby’s risk of birth defects such as spina bifida.

The oils in fish is also good for your pregnancy and it may reduce the rates of some complications.

Many prenatal vitamins contain fish oils. Just be wary of getting too much mercury from large ocean fish.

Celebrities having babies over 40

Pregnancy in your 40s- how realistic is it?: Princeton IVF blog
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The media shows plenty of Hollywood stars having babies in their 40s, but are they telling the whole story?

For many it is exciting to hear about the celebrities they adore having babies. Like many women in the society at large, many celebrities have chosen to delay having children for a variety of reasons. It should come at surprise, then, that many of the celebrity moms depicted in the magazines are in their 40s.

Knowing how women trying to start a family (or growing her current family) as they get older face an uphill battle,  are the media who cover these stories doing a disservice to women's reproductive health?

To answer this question, researchers at New York University looked at all the issues of 3 popular magazines widely read by women of reproductive age over a 4 year period.

This is what they found:

  • There were 1,894 references to pregnancy or fertility
  • 1/3 of the issues had cover stories related to fertility
  • There 240 celebrities, who averaged age 35
  • Only 2 articles on 40+ year olds using donor eggs
  • There were 10 stories about adoption and 5 about using a gestational carrier. Not one of these mentioned that they had previously suffered from infertility

It is understandable that a celebrity (or anyone else for that matter) would not want to share the very personal details of what it is like to go through fertility testing and treatment.  Still, the stories presented to the public are far from complete. While there is nothing that appears to be inaccurate in the articles, they present an unrealistic view of normal fertility after 35.

Modern fertility treatments have revolutionized the ability of couples suffering from infertility to get pregnant, but it has not been able to eliminate reproductive aging. Implying that waiting to have children is not harmful to your fertility through human interest stories is doing a disservice to women. 

Should I stop alcohol before pregnancy?

Moderate alcohol does not harm fertility but not safe during pregnancy.

Many women stop all alcohol when starting to attempt pregnancy, but does it really help?

Probably not. Research suggests that moderate alcohol intake will likely not harm your fertility.

Before we go any further, this means prior to pregnancy. No one including your doctor or midwife can reassure you that alcohol is safe to take in any amount during pregnancy, and that includes the week that you are pregnant before the pregnancy test comes out positive.

Anyhow, getting back to the story, researchers in Denmark compared a group of women who more moderate drinkers (between 1 and 14 glasses of wine per week) to another group of women who did not drink at all while attempting pregnancy. The researchers did not find any difference in the chances for pregnancy between the 2 groups. The same was not true for heavier drinkers. Those who drank the equivalent of 2 bottles of wine per week or more were actually less likely to conceive.

So what this mean for drinking alcohol when trying to conceive?

According this study, light to moderate alcohol likely does not affect your chances of having a baby, but heavy alcohol consumption likely does.

Can I drink when I'm trying to get pregnant?

In moderation, alcohol consumption before a pregnancy implants in the uterus is fine.  A pregnancy implants about a week before you expect your period, and it is impossible to say if it is safe to drink from that time on.

What about alcohol during the rest of pregnancy?

Heavy and moderate alcohol are well known to cause serious birth defects. Ask your doctor or midwife. They will almost certainly agree.It is not clear whether have an occasional glass of wine will increase your risk of birth defects or not. In the absence of information to reassure our patients, most of obstetricians and midwives will advise against it.