male infertility

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

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.

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. 

Noise and fertility

Traffic noise may increase time to conceive: Princeton IVF blog

Could a noisy neighborhood be making it harder to get pregnant?

Danish study suggests couple who live in neighborhoods with lots of traffic noise may take longer to get pregnant.

A study from Denmark suggests that it may have some impact.

The researcher looked at 65,000 Danish women who delivered between 1996 and 2002, and interviewed them to determine, among other things, how long it took them to conceive. They also looked at the traffic volumes for their neighborhood to see if they could compare the two.

They found that for every 10 decibels of additional traffic noise, there was a 5-8% increase in the chance it would take more than six months to conceive. 

Fortunately, increased traffic noise did not affect a couples chances to take longer than a year to get pregnant. Infertility is defined as a disease in which a couple is unable to conceive after one year's time, so the traffic noise itself did not cause infertility.

They could not determine whether the delayed time-to-conception (TTC) was due to the male or female partner, and the this delayed TTC was not affected by other factors such as poverty or levels air pollution that could delay conception.

AMA calls Infertility a disease

AMA agrees Infertility is a diesase: Princeton IVF blog

It's official now. Infertility is now what we know it has been for years, a disease, not a problem or an inconvenience.

At the encouragement of the American Society for Reproductive Medicine, the American Medical Association has voted to call infertility a disease.

According to the ASRM, 

Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.

Now the AMA has accepted this fact.

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

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.

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.