Fertility

Melatonin and fertility

Melatonin and fertility: Princeton IVF blog
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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.


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. 

So how accurate is my fertility app?

Fertility apps for the iphone and android: Princeton IVF blog
Do fertility apps work?

Many couples trying to get pregnant use them, but do fertility apps for the iphone and android devices really give you valuable information?

As a fertility specialist, my patients are always sharing with me information they learn about their menstrual cycles and their fertile windows from apps on their cell phones. Knowledge about one's body is always a good thing to have, but are these apps really helping couples get accurate information?

To answer this questions, doctors at Weill Cornell Medical College in New York looked at whether these apps (and websites which give out similar information) actually properly inform normal fertile women with regular cycles on the correct days to try for a baby. What they found was a bit disappointing.

While fertility apps were able to select the most fertile day of the cycle, they were quite frequently inaccurate on advising women about their "fertile window."

The apps were not a total bust. Couples who followed the apps advice were not putting their chances of having a baby in peril, even if the app's advice was less than optimal. The iphone has still not replaced the advice of your fertility doctor or gynecologist, at least not yet.

Is it possible to stop the biological clock?

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Today, age is the most important determinant of woman's ability to conceive both naturally and with treatments such as IVF, but might it be possible to overcome the "biologic clock"? 

It is has been understood for many years that a woman is born with all the eggs she will ever produce and that she begins to lose eggs even before she is born. The eggs seem to work reasonably well into the early 30's but in the late 30's  and particularly in the 40's the number and quality of those eggs diminish considerably. We know that most if not all of that drop is the result of abnormal chromosomes in the eggs and when genetically abnormal eggs fertilize they produce genetically abnormal embryos. Most genetically abnormal embryos will not implant in the womb, and if they do, they usually miscarry.

These abnormal eggs result from errors in a process call meiosis. If this sounds familiar from high school biology, it is. Meiosis is the process by which reproductive stem cells produce eggs and sperm for reproduction. Most scientists nowadays believe that these errors result, at least in part, from a lack of the energy needed to divide the chromosomes properly, and that energy comes from cell's natural batteries, the mitochondria.

Now, a biotech company has come up with a technique to transfer fresh young, energy-rich mitochondria into a woman's eggs, and has even achieved a live birth with it. Sounds like a miracle cure? Maybe, maybe not.  If proven successful and safe, it has the potential to revolutionize IVF treatment for women over 35 and extend the age at which non-donor IVF may be successful. Still, don't expect to see it an IVF clinic near you any time soon. First, we do not know how effective this technique really is and most importantly whether it results in healthy children. The technology involves cloning technology and "3-parent IVF," and it is unlikely that will get past regulatory agencies here in the US anytime soon.

 

Soy and fertility

Are soy products good or bad for your fertility?

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Soy products such as soy milk and tofu are high in protein and have become popular for their reported health benefits. So, why the concern?It turns out that soy products also contain chemicals called phytoestrogens. These phytoestrogens are chemicals found in plants that look and act like estrogens, the "female" sex hormones that both women and men produce naturally.  It is commonly believed (but not universally accepted) that these phytoestrogens may have health benefits such as reducing the risk of cardiovascular disease and taming the symptoms of menopause. One of the main concerns over the use of these "dietary supplements" is that if they act like estrogens, they may very well carry the the same risks as taking estrogen pills like Premarin and Estrace.

 So, how does this tie in with fertility issues? One of the key ingredients in birth control pills is a type of estrogen (commonly ethinyl estradiol) so it should come as no surprise there may that taking soy products could potentially be a problem for women attempting pregnancy.

With that in mind, researchers at Harvard's School of Public Health, looked at women undergoing IVF treatment to see if the use of soy products had any effect on the pregnancy rates. The results were somewhat surprising. IVF patients taking soy supplements were actually more likely to get pregnant. While the study was small and limited, and it is certainly to early to encourage women doing IVF to take in more soy products, it does appear to be reassuring for those trying to get pregnant and don't want to stop the soy milk and tofu.

Veterans and Fertility Care

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US Congress considers improving veterans access to reproductive health care

After faithfully serving our country in Iraq and Afghanistan, many of the brave men and women of our armed forces return home with injuries. While the more devastating injuries such as head injuries, missing limbs and PTSD, make all the headlines, there are other battle scars that remain unspoken. One of those is infertility.

Serving our nation can have an adverse effect on couple's ability to start or grow a family, whether it be from the direct trauma of battle or the inevitable delays that come from prolonged deployments. Appropriately, the Defense Department recognizes the importance of this for our fighting men and women and provides at least some fertility coverage for active service personnel.

The same is not true for our veterans. In fact, federal law prohibits covering these treatments through the VA system. On several occasions, Senator Patty Murray (D-Washington) has introduced bills to address this issue without success. Now, there is also movement on the other side of the aisle. Just this past week, Representative Jeff Miller (R-Florida), Chairman of the House Committe on Veterans Affairs has introduced a bill to correct this inequity. His bill HR 2257, if passed and signed into law, will allow veterans to treat fertility issues that arose during their service even after they leave the armed forces. Hopefully, this legislation will make it through the congress and on to the President's desk.

 

Basic facts about fertility and infertility for NIAW

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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

Tuberculosis and infertility

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Tuberculosis (TB) and Infertility

Just recently, we passed World Tuberculosis Day. If you are like most folks, you probably never even knew that such a day even existed. In fact, most doctors here in the US, including fertility doctors, don't pay much attention to tuberculosis anyhow and think of it as a disease of the past, not really much of an issue here at home. Certainly, tuberculosis is a disease that is uncommon here in 21st century America. But that is not necessarily true around the world.

Practicing here in New Jersey, we see patients who have moved here from all over the world, and particularly quite a few from India. TB is endemic in India where it has been estimated that 40 % or more of the population is affected. Many who have been infected with tuberculosis are not even aware of it. 

While we generally think of TB as respiratory disease, it can also affect the reproductive system. While here in the United States, it is very uncommon to see genital tuberculosis, that is not necessarily true in other countries. TB can infect and damage the fallopian tubes and the lining of the uterus resulting in infertility. While this is relatively uncommon, it seen by New Jersey fertility doctors and obgyns from time to time, though most are unaware that it is even a possibility. Many can be helped by modern technologies such as IVF.

It turns out after all there is a connection between World TB Day and the world of Reproductive Medicine. Its a reminder that not all of the diseases we though we have conquered have completely been defeated.

How old is too old to try IVF ?

With stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment.  When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40's. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual.  A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of  45 year olds' embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.

Common preception is often incorrect: Infertility rates are not rising.

A recent report from the Centers for Disease Control suggests that infertility is actually becoming less common despite the popular wisdom that it more common than ever. The why is unknown. It could be due to couples seeking treatment sooner, economic concerns in this uncertain age or reductions in sexually transmitted diseases.  For more on this story, click here.

Plastic bottles, BPA and infertility

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Bisphenol-A (BPA), a chemical found in some plastic bottles has been shown to affect egg development. Researchers at Brigham and Womens Hospital/Harvard Medical School showed that the left over eggs from IVF were less likely to develop properly if there were exposed to high levels of BPA. Click here from the story from the Boston Globe. Click here for the original article from the journal Human Reproduction. It is not clear whether the low levels seen in most plastic bottles is enough to cause any problems though.

Weight does impact the chances for IVF success

We have know for years that being overweight can affect fertility and lower success rates for infertility treatments such as IVF. Some centers have even set weight limits on IVF treatment for this reason. However, it wasn't clear if being overweight was harming the eggs or making the uterus less receptive to pregnancy. A recent study from Spain found that overweight patients had lower pregnancy rates even when they got eggs from a normal weight woman, meaning that this effect is due at least in part to a problem with the uterus. The take home lesson: weight loss may improve your chances of having a baby even with donor eggs. For more information from Dr. Sanjay Gupta's Guide, click here

Welcome to our blog from Seth G Derman, MD

I welcome you to the Princeton Fertility Blog. I am a specialist in Reproductive Medicine and the Medical Director at Princeton IVF in Lawrenceville, NJ. I have been caring for couples with infertility and recurrent miscarriages, polycystic ovarian syndrome, endometriosis and other reproductive hormonal disorders for the past two decades.