Men's Meds and Sperm

There are many commonly used social drugs and prescribed medications that are really detrimental to making a baby from a man's perspective. Cigarettes, alcohol and marijuana are all directly toxic to sperm and cigarettes and alcohol also directly affect sexual performance by causing erectile issues.

Blood pressure medications such as metoprolol reduce libido and also are renown for erectile dysfunction whist calcium channel blockers such as amlodipine can directly block the ability of sperm to fertilise eggs.

Many men are being given testosterone supplements to boost libido or energy levels. Testosterone very powerfully suppress sperm production by blocking the hormones produced by the brain which cause the testes to make sperm. Any guy wishing to become a father should avoid testosterone supplements as there can be a very protracted time before sperm production turns on again. 

Building muscle and improving athletic performance by using anabolic steroids is also almost guaranteed to turn off sperm production so also should be avoided.

A number of psychiatric drugs are also asssociated with erection issues, libido reduction and altering the hormones to the testes such as olanzepine, amitryptilene and nortryptilene. Lithium also causes reduced libido and erection problems.

Some antibiotics such as nitrofurantoin, erythromycin and gentamycin are directly sperm toxic whilst tetracyclines can block fertilisation.

Gout drugs colchicine and allopurinol can also block fertilisation and inflammatory bowel disease drug sulphasalazine affect sperm motility.

So al men on meds should check with their doctors and also check out our website and many doctors and patients alike are unaware of the bad effects that many commonly used drugs have on sperm.

Best wishes,
Mary 

Helping men become Fathers

Helping Men Become Fathers 

Often when we think of fertility problems the focus is on the woman.  Female fertility seems so complex compared to men, with ovulation, periods etc. Men, well often they can feel that they just need to ‘come to the party’.

Unfortunately it is not always that simple.    

So what is bad for sperm?  Smoking, both tobacco and cannabis, heat (so maybe get your partners some nice loose cotton boxers), obesity, alcohol excess, previous testicular surgery or injury, and interestingly long distance cycling. 

So what to do? The good news is that the factory where sperm are made (the testes) is sending out new models every 72 days. 

Add some colour:  Think of colourful fruits and vegetables – greens, reds, yellows – they all contain a good amount of Vitamin C.  Peanuts, brazil nuts and almonds contain both zinc and Vitamin E and cooked tomatoes contain the powerful anti-oxidant lycopene which also helps.

Foods to avoid: Higher levels of saturated fat, trans-fats, dairy products and sweetened drinks are associated with lower sperm quality.

Add some movement: Sperm fitness can also be improved by addressing excess weight.  If he can’t see his manhood when he looks down – there is a problem. 

If you’re having problems conceiving, don’t assume it’s you – get your man checked out too.    To find out more or to book an appointment with one of our top NZ fertility specialists or visit www.fertilityassociates.co.nz  or call 0800 255 522

Best Wishes,

Mary Birdsall

I’m nearly 40 and I want to have a baby. What are my options?

I’m nearly 40 and I want to have a baby. What are my options?

Everyone knows that a woman’s fertility reduces with age but it is still possible to have a baby approaching 40 and beyond.  The first thing to do is to improve your lifestyle; stop smoking and drinking, make sure your body mass index is in the healthy range (19 to 25) and start folic acid to reduce the risk of Spina Bifida.  Check with your doctor about any medication you are on. It’s also important to know the best times for sex, so find an app to help or focus on having lots of sex from days 11 to 14 if your periods are monthly. And then just get started as soon as you can.

The chances of having a baby each month you try at age 40 are 6% and if it hasn’t happened after 6 months you should be visiting a fertility specialist. IVF at age 40 still has a reasonable chance of working with a 25% chance of a baby with each cycle.

For some women aged 40 and beyond, their egg supply has run out. There is still the option of egg donation to have a baby. This is when a younger woman with healthy eggs has a cycle of IVF and gives those eggs to an older woman. The pregnancy rates with egg donation are excellent as egg quality is the main determinant of IVF success rates. Egg donation is available in NZ and we see many women successfully have a baby this way at Fertility Associates.

If there isn’t a man on the scene, it is also still possible to have a baby using donor sperm. Fertility Associates has a donor sperm programme but there is a wait for donors follow this link to find out more: http://www.fertilityassociates.co.nz/Donor-services/Become-a-sperm-donor.aspx.  So if you are thinking about having a baby the best advice I can give is to talk to a specialist sooner rather than later.

Best Wishes,
Mary Birdsall

Questions I often get asked about Fertility

Questions I often get asked about Fertility

Fertility can be complex, at Fertility Associates I often gets asked the same types of questions:

 

Question 1: Do I need a referral to see a fertility doctor?

Answer: I would suggest that it is good to let your GP know what you are thinking in terms of your fertility health. Having a referral often means that your first consultation will take place with more information, and test results. Many couples like to make an enquiry without involving their GP and self-refer to fertility clinics, this is ok too, but you should try and come with as much information as you can.

Question 2: I am 42 and have been trying to have a baby for two years. What are the options available to me?

 

Answer: As you get older, your chance of conception month by month, declines significantly. At 42, your chance of having a baby naturally is around 4% each month. It is entirely possible you have not conceived yet by chance alone, however I would recommend you see a fertility specialist.  Where you will be given an assessment of your chance of conception as well as some suggestions about potential treatments.  Check out www.biologicialclock.co.nz.

Question 3: I have a three-year-old and have been trying to get pregnant again for the past 18 months, without success.  What should I do?

 

Answer:  Your previous pregnancy doesn’t really change the rules about when you should seek advice, as there are many things that might limit your chance of conception (a man with a low sperm count is perhaps the most common). Fertility is all about chance. It’s important to understand how long “normal” is. On average, it takes a 27-year-old about four to five months to conceive but a 37-year-old will take around eight to nine months.

Question 4: I am single and in my mid-thirties. Is there a way to assess my future fertility?

Answer: There are good tests to assess the number of eggs you have, but without more complex investigations, it is difficult to know what your chance of pregnancy would be. The Anti-Mullerian Hormone (AMH) test can predict whether you are likely to continue to ovulate for as long as most other women. It’s a useful test, however, for younger women who are thinking of deferring conception.  If the AMH is low (fewer eggs than you would expect), then they may change their plan or look at treatment options like egg freezing.
 

Best Wishes
Mary Birdsall

Pregnant: Now what?

Pregnancies following fertility treatment are not the same as pregnancies following spontaneous conceptions. Women who are pregnant following IVF treatment have slightly increased risks of high blood pressure, small or early babies, antepartum haemorrhage ( bleeding during pregnancy) and caesarean section.
It used to be thought that these events were due to the age of the women or to the increased rates of twins. Recent studies however have controlled for these variables and still these increased risks are seen.
So what can we do about this?
Firstly, consider having a frozen embryo replaced, as fresh IVF pregnancies appear to have slightly worse outcomes when compared to frozen embryos. Secondly, choose to have only 1 embryo transferred at a time as twins have much worse outcomes. Even when 1 baby results after 2 embryos have been replaced, then the outcomes are worse compared to when only a single embryo has been replaced. Thirdly, choose a specialist obstetrician to care for women during pregnancy following IVF treatment.
The reasons for the increased perinatal risks are unknown and are probably due to a combination of the effects of stimulation on the endometrium, possibly the lab environment for the embryos along with the impact of infertility. Women who take a long time to conceive but who eventually become pregnant without treatment also have these same increased risks.
There are some groups of women who have some even higher risks, namely those women over 40 along with those women pregnant following donor egg treatment. These women have higher risk of high blood pressure and small babies.
Having said all of this, the vast of majority of women pregnant following fertility treatment have healthy term babies.
Best wishes
Mary Birdsall

Breast Cancer and IVF

Because it is Breast Cancer Awareness Month I thought I would blog about breast cancer and IVF . I get asked about this a lot. Many women are really worried that if they embark upon fertility treatment then they are increasing their life time risk of developing breast cancer.
The incidence of breast cancer is increasing and whilst the cause of breast cancer is unknown, it is linked with high sustained levels of oestrogen. Hence there have been concerns that women doing IVF treatment who are exposed to high levels of oestrogen for a short time may be more at risk of developing breast cancer.
There has recently been a large meta- analysis performed looking at the association of breast cancer with IVF www.ncbi.nlm.nih.gov/pubmed/16526416. 
This study looked at 8 studies with more than 1.5 million women and found no association between breast cancer and previous IVF treatment which is reassuring.
At the moment the general consensus is that IVF is not associated with an increased risk of breast cancer. However all women with predisposing risk factors should consider breast screening prior to starting IVF. Women should also be aware that the risk of breast cancer rises according to the age that a woman give birth to her first child.
Screening mammography is recommended annually from age 40 onwards.

If you do have breast cancer and would like to know what your options are for Fertility Preservation, there is more information on our website http://www.fertilityassociates.co.nz/Fertility-preservation-and-cancer.aspx

AMH - Why every woman should know her AMH level

A simple blood test measuring a hormone called Anti- Mullerian Hormone (AMH) is the best test currently available to estimate ovarian reserve. What this means is that this blood test can estimate your age at menopause (ie when your eggs have run out) and give you a reasonable idea of your reproductive time remaining. So if you have an AMH test performed in your 20s and it is an average result and sits on the 50th centile, then this means that your menopause will be at around 51 and your reproductive window is likely to close at about 41. How useful is that to know? You can know plan to freeze eggs if you knew that your reproductive lifespan was limited. Also super informative for women who may have had cancer treatment or ovarian surgery and are wondering how this may have impacted on their eggs.

The AMH blood test can be done at any time in the menstrual cycle, during pregnancy or on the pill. In New Zealand the test is not funded and Fertility Associates charge $75 in Auckland and slightly more outside of Auckland because of courier fees.

AMH is also useful in other scenarios. It allows IVF doctors to predict the right dose of drugs in an IVF cycle and therefore make IVF safer by reducing the chances of ovarian hyperstimulation syndrome. AMH levels are also higher in women with polycystic ovary syndrome (PCOS) and in the future may be used to diagnose PCOS.

AMH may also reflect egg quality. Our own data at Fertility Associates based on more than 2500 cycles, show that if your AMH is low (less than 3 pmol/l) then your take home baby rate on our IVF programme is significantly reduced compared to women with an AMH of 7 or more.
So really why would you not have an AMH test?

You can find out more from the PDF on our website http://www.fertilityassociates.co.nz/Downloads/0313-AMH-info-card-A5_LR.aspx