This is the hardest thing that both patients and fertility doctors have to deal with. Women are born with their entire egg supply and never make new ones and about 10 years before the menopause their fertility declines precipitously. The average age at last birth in normally fertile women is 41. As egg supplies dwindle, then chromosomal abnormalities in eggs increase, leading to reduced implantations and increased miscarriages.
There are many women who know that their egg supply is low because of their age, FSH or AMH levels or previous response to treatment and who wish to know how they may improve their egg quality or egg numbers in an IVF cycle.
There is a large amount of research looking at whether the mitochondria in eggs may be refreshed which may mean that eggs do not age in the same way. Currently, there are no products that have been shown to be effective.
There are a variety of medications that have been used to try and increase response ie egg numbers in an IVF cycle, ranging from increasing doses of IVF drugs, DHEA, LH, testosterone and growth hormone. Increasing the dose of drugs only works to a degree as all receptor sites become occupied. There is no good evidence to recommend the use of DHEA or LH. There are 2 small trials suggesting that testosterone may slightly increase response to IVF drugs and pregnancy rates in women who respond poorly. There are 6 small trials suggesting a benefit with the addition of growth hormone. Fertility Associates is recruiting for the LIGHT study, which is a multi-centre Australasian study aiming to recruit 400 women to properly answer the question: Does the addition of growth hormone in women who respond poorly, improve take home baby rates? If you are interested in being part of this study please contact me on mbirdsall@fertilityassociates.co.nz.
Sometimes the only option is the use of donor eggs. There is an increasing demand for donor eggs and along with it an increasing amount of reproductive tourism which has sprung up. Next week's blog will be about travelling to get a baby, what everyone should know.
To find out more about the difference between trying to conceive in your 30s compared with your 40s, take a look at our website here.
Sunday 18 December 2011
Sunday 4 December 2011
Supplements and fertility
Many people ask me what supplements they should be taking to maximise their chances of having a healthy child.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
Thursday 24 November 2011
What can guys do to make great sperm?
Men make sperm continuously from puberty to death so general lifestyle factors and health can have a very direct influence on sperm production. So what can a guy do to improve sperm quality?
Firstly, start young as men's sperm quality worsens with age and there is a slightly increased risk of autism, schizophrenia and dwarfism in the children born from older dads. Secondly, keep the testes cool, they are located outside of the body for a reason, so being active, wearing baggier pants and not sitting in a hot bath or sauna every night is wise. Then, stay slim as fatter men have worse sperm and lower success rates on an IVF program compared to slimmer men. Having just said that, there should be some caveats around moderation as serious cyclists (greater than 200km per week) may have poorer sperm.
Avoiding cigarettes and dope also improves sperm health. Too much alcohol is also detrimental to both sexual performance and sperm production and the recommended limits are 20 units per week.
Antioxidants may also benefit sperm and they can be found in brightly coloured fruit and veg such as berries, dark chocolate, red wine and nuts such as brazil nuts. There was a recent study showing that men who had a prudent diet consisting of fish, fruit,vegetables, legumes and whole grains had better sperm motility compared to men having a typical Western diet.
Bisphenol A found in soft plastics are also thought to be disruptive to the DNA in sperm so avoiding drinking out of BPA bottles is wise.
Frequent ejaculation is also great for sperm, definitely saving it up does not help.
There are also some commonly prescribed medications which may be detrimental to sperm such as hairloss medication, sulphasalazines, paroxetine, methotrexate and some blood pressure medications. Check with your doctor.
Next week I am planning to blog about supplements, which are good, bad or downright ugly.
Thanks,
Mary
Firstly, start young as men's sperm quality worsens with age and there is a slightly increased risk of autism, schizophrenia and dwarfism in the children born from older dads. Secondly, keep the testes cool, they are located outside of the body for a reason, so being active, wearing baggier pants and not sitting in a hot bath or sauna every night is wise. Then, stay slim as fatter men have worse sperm and lower success rates on an IVF program compared to slimmer men. Having just said that, there should be some caveats around moderation as serious cyclists (greater than 200km per week) may have poorer sperm.
Avoiding cigarettes and dope also improves sperm health. Too much alcohol is also detrimental to both sexual performance and sperm production and the recommended limits are 20 units per week.
Antioxidants may also benefit sperm and they can be found in brightly coloured fruit and veg such as berries, dark chocolate, red wine and nuts such as brazil nuts. There was a recent study showing that men who had a prudent diet consisting of fish, fruit,vegetables, legumes and whole grains had better sperm motility compared to men having a typical Western diet.
Bisphenol A found in soft plastics are also thought to be disruptive to the DNA in sperm so avoiding drinking out of BPA bottles is wise.
Frequent ejaculation is also great for sperm, definitely saving it up does not help.
There are also some commonly prescribed medications which may be detrimental to sperm such as hairloss medication, sulphasalazines, paroxetine, methotrexate and some blood pressure medications. Check with your doctor.
Next week I am planning to blog about supplements, which are good, bad or downright ugly.
Thanks,
Mary
Sunday 13 November 2011
What can women do to improve their fertility?
I get asked this question at least 10 times per day so what I am going to talk about is the evidence for lifestyle changes that have been shown to impact fertility.
The first is age, but this is always a difficult one because you cannot change how old you are but I guess the key message in terms of fertility is always sooner not later, the average 30 year old woman has a 22% chance of having a baby each month she tries and by 40 it is 5%.
Weight also impacts fertility and the optimal healthy fertility range is 19 to 25, so being really skinny is not so great but also increasing weight reduces fertility and increases miscarriage risk.
Cigarette smoking is a big no no, halves the chances of conceiving each month, increases miscarriage risk and makes menopause happen sooner.
The alcohol question is less clear, in a perfect world probably no alcohol is best but probably a little has minimal impact but the problem is no one can define what a little actually is.
Caffeine is an interesting subject, as lots of caffeine (more than 5 to 6 coffees a day) does increase miscarriage risk and reduce fertility so minimising caffeine is reasonable.
Other recreational drugs are all bad.
Are there any special foods I can eat to boost my fertility is another commonly asked question. My opinion is a good balanced diet with lots of fruit and veg is great. There is no evidence that vegetarians have better fertility. There is some evidence coming through about transfats or hydrogenated oils being bad for fertility fertility. Bisphenol A which is found in any soft plastics is a compound that is attracting a significant amount of attention as it acts as a hormone disrupting agent. This is present in plastic bottles and in other plastic food containers and leaches out more in the presence of heating.
Moderate exercise is also a good thing and get a screen for thyroid disease and diabetes.
So this is what is good for women, next blog will be all about men and their lifestyle.
The first is age, but this is always a difficult one because you cannot change how old you are but I guess the key message in terms of fertility is always sooner not later, the average 30 year old woman has a 22% chance of having a baby each month she tries and by 40 it is 5%.
Weight also impacts fertility and the optimal healthy fertility range is 19 to 25, so being really skinny is not so great but also increasing weight reduces fertility and increases miscarriage risk.
Cigarette smoking is a big no no, halves the chances of conceiving each month, increases miscarriage risk and makes menopause happen sooner.
The alcohol question is less clear, in a perfect world probably no alcohol is best but probably a little has minimal impact but the problem is no one can define what a little actually is.
Caffeine is an interesting subject, as lots of caffeine (more than 5 to 6 coffees a day) does increase miscarriage risk and reduce fertility so minimising caffeine is reasonable.
Other recreational drugs are all bad.
Are there any special foods I can eat to boost my fertility is another commonly asked question. My opinion is a good balanced diet with lots of fruit and veg is great. There is no evidence that vegetarians have better fertility. There is some evidence coming through about transfats or hydrogenated oils being bad for fertility fertility. Bisphenol A which is found in any soft plastics is a compound that is attracting a significant amount of attention as it acts as a hormone disrupting agent. This is present in plastic bottles and in other plastic food containers and leaches out more in the presence of heating.
Moderate exercise is also a good thing and get a screen for thyroid disease and diabetes.
So this is what is good for women, next blog will be all about men and their lifestyle.
Wednesday 2 November 2011
Egg Freezing
For years we have talked about egg freezing and how great it would be if eggs could be frozen and then thawed and fertilised with the same success rates as fresh eggs. Now finally science has delivered. A group from Spain have reported on the vitrification ( a form of freezing) of more than 100,000 eggs and found the same success rates as with fresh eggs. They estimate that for women aged less than 38, if 13 eggs were frozen there was a 50% chance of an ongoing pregnancy, 15 eggs a 60% chance, 20 eggs 76% chance and with 35 eggs a 97.6% chance.
The Spanish group have also followed up all the babies made with frozen eggs and have found no increased chance of abnormalities.
Egg freezing is a useful option for women about to undergo chemotherapy, where no sperm can be found on the day of egg collection or for social reasons.The process is the same as for IVF, where drugs are given to stimulate the ovaries for around 10 to 12 days, the eggs are then collected under sedation by putting a needle through the vagina and into the ovaries. The eggs are then aspirated and frozen. Eggs may be frozen for 10 years in New Zealand. The cost is around $10,000 and there is an annual storage charge. When required, the eggs are thawed and injected with sperm and grown into embryos.
The success rates for frozen eggs are still largely determined by the age of the woman at the time of egg freezing. But is is really exciting that a technology that we have all wished for, is now looking so promising.
The Spanish group have also followed up all the babies made with frozen eggs and have found no increased chance of abnormalities.
Egg freezing is a useful option for women about to undergo chemotherapy, where no sperm can be found on the day of egg collection or for social reasons.The process is the same as for IVF, where drugs are given to stimulate the ovaries for around 10 to 12 days, the eggs are then collected under sedation by putting a needle through the vagina and into the ovaries. The eggs are then aspirated and frozen. Eggs may be frozen for 10 years in New Zealand. The cost is around $10,000 and there is an annual storage charge. When required, the eggs are thawed and injected with sperm and grown into embryos.
The success rates for frozen eggs are still largely determined by the age of the woman at the time of egg freezing. But is is really exciting that a technology that we have all wished for, is now looking so promising.
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