A weighty issue
How a woman’s weight impacts the risk of miscarriage
A miscarriage is a devastating experience for couples, perhaps even more so for those who have struggled with infertility and gone through the initial joy of a successful fertility treatment. Statistics have shown that in both natural and IVF conception, about one in six pregnancies will end in a miscarriage before the 20th week, with the rate being higher in older couples.
Understandably, couples are frightened of miscarriages and would rather not think or talk about it. However, it is important for couples to understand why miscarriages happen, as well as what they can do to reduce their risks.
Although the exact reason for a miscarriage is often unexplainable, it can occur due to a number of reasons. These include chromosomal abnormality, improper implantation of the egg and maternal health problems or trauma. The mother’s age also plays a significant role, as does her lifestyle, which includes exposure to stress, smoking, drug use, malnutrition, excessive caffeine, radiation and toxins.
Another well-studied factor than increases a woman’s risk for miscarriage, is her weight. As these studies indicate, if the mother is obese or underweight, this increases her risk of not only infertility, but miscarriage as well, regardless of the method of conception.
According to researchers at the Department of Obstetrics and Gynaecology, University of Adelaide, Australia, being overweight increase a woman’s risk of miscarriage by 29%, while being obese can increase the risk by 71% or more. However, for women undergoing assisted reproduction, researchers at the Assisted Fertilization Center, Brazil concluded that maternal obesity could increase the risk of miscarriage by up to 1330%.
Obesity also compounds miscarriage rates in women with PCOS. The Department of Obstetrics and Gynecology, Faculty of Medicine, Erciyes University, Turkey found that the miscarriage rate in obese women with PCOS is about nine times higher than average.
And while miscarriage is often the result of an unhealthy fetus, researchers from the Department of Obstetrics and Gynecology, Stanford Hospital and Clinics, CA, USA found that the risk of miscarriage of a healthy fetus is significantly higher in obese women (with BMIs of 25 or more).
While obesity has been identified as a risk factor for spontaneous miscarriage, the mechanism for it remains unclear. But a study by The Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK points to the endocrinological changes in obesity as possibily causing complex adverse effects including circulating adipokines, sex steroids and insulin resistance.
Women who are underweight, with a BMI of under 20, also face an increased miscarriage risk. A study by researchers at the German Cancer Research Centre found that pregnant women who were underweight faced a 70 % higher risk of having a miscarriage.
Therefore, it can be concluded that among intrauterine environmental factors, nutrition appears to play the most critical role in influencing placental and fetal growth. Since maternal undernutrition or overnutrition during pregnancy can impair fetal growth, women must adopt healthier diets and incorporate exercise to lower their risk of miscarriage.
If you have any concerns regarding miscarriage, especially after IVF, please do not hesitate to consult with your fertility consultant for advice.
Dr George Lee returns to discuss the latest medical news. Expect deep insights delivered with generous humour. Dr Helena Lim joins him this week to discuss period-tracking apps and whether it makes her work as a Consultant Obstetrician and Gynaecologist easier, or more difficult.
Dr George Lee is a renowned Urologist who dealt with male issues, whereas Dr Helena Lim is a Fertility Specialist
Find out more about what they have to say:
What you should know about PGD & PGS
If you and your partner have been struggling with fertility issues and are seriously considering In-Vitro Fertilisation or IVF, the consideration of whether you should be undergoing PGD and PGS on top of an IVF can be quite daunting. This is because, in normal IVF procedures, the best embryos are selected based on their appearance and morphology only. Therefore, the genetic content of those embryos or any chromosomal abnormality cannot be detected. However, by undergoing PGD and PGS, you will be able to screen your embryos for any potential genetic and chromosomal issues. However, before we jump into the band wagon of having PGS or PGD, there are a few things we need to consider.
What is PGS?
PGS stands for Pre-implantation Genetic Screening. In PGS, a cell is taken from an embryo which was created following an IVF procedure, so that it can be tested for chromosomal abnormalities before the embryo is transferred to the womb. This test will be able to tell us whether the embryo has normal sets of chromosomes. However, it will not be able to tell us whether this embryo has a genetic problem or not.
It is important to note that not all the patients going through an IVF required a PGS. You may want to consider it if:
The PGS procedure involves:
1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days.
3. An embryologist will perform a biopsy and remove a few cells, usually on day 3 or 5.
4. All 24 chromosomes are analysed (22 non-sex chromosomes and two sex chromosomes X & Y).
5. If the embryo is normal, it will be transferred into your womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.
What is PGD?
PGD is an abbreviation for Preimplantation Genetic Diagnosis. In PGD, a cell is taken from an IVF embryo so that it can be tested for a specific genetic condition before the embryo is transferred to the womb. It can be used to test for any genetic condition that is known to be caused by a specific gene.
At present, PGD is used to screen for more than 250 genetic conditions, such as Huntington’s disease, Cystic fibrosis, Thalassaemia, Duchenne muscular dystrophy and Fragile-XPDG to name but a few. Therefore, PGD enables individuals with an inheritable genetic condition to avoid passing it on to their children. The PGD process is more tidious and challenging compared to PGS. It is used to test for a specific genetic disease which is known to your family, i.e. you or your partner is confirmed a carrier of a specific gene at a certain point of the chromosome. You need to bear in mind that by performing a PGD, it does not mean that screening of ALL genetic diseases are performed at the same time. This is because human beings have millions of gene and it is impossible to screen ALL of the genes in one go.
However, not all IVF patients need to undergo PGD. You may want to consider it, or your specialist may recommend it to you if:
• You or your partner (or both) are carriers of single gene mutations.
• You ended a previous pregnancy due to a serious genetic condition.
• You have a child with a serious genetic condition.
• Either of you has a family history of a serious genetic condition or chromosome problems.
The PGD procedure involves
1. You will undergo a normal IVF treatment and your eggs will be collected and fertilised.
2. An embryo is grown in the laboratory for a few days, until it has divided into around 8 cells.
3. An embryologist will remove one or two of the cells from the embryo.
4. The cells are tested to see if the embryo has a gene that causes a genetic condition.
5. If the embryo is free of any genetic condition, it is transferred to the womb.
6. Any remaining unaffected embryos can be frozen for later use.
7. Affected embryos will be allowed to perish.
Since PGD and PGS help detect genetic conditions and chromosomal abnormalities, they help IVF patients to decide if they wish to continue with pregnancy.
The Pros and Cons of PGD and PGS
Before you decide on undergoing PGD or PGS, your fertility consultant will explain their pros and cons to you, which include:
If you and your partner are interested in or have any concerns about PGD and PGS, be sure to speak to your fertility specialist to address concerns, inquiries and options.
A good reason to keep moving
Bed rest after embryo transfer negatively affect IVF success
After every embryo transfers, my patients are generally surprised when I ask them to get up from bed to walk almost immediately. Most of them looked at me with disbelief: ‘Doctor, will my embryos fall out?’. Some of them refuted me by telling me that their friends had to lie on bed for 2 weeks after the embryo transfers to ensure that the embryos ‘sticks’. There are some who refused to get out from my operating bed and few had demanded to be warded for 2 weeks.
Well, I can’t blame them for asking that, can I? After all, the internet is full of stories of having to lie in bed to ensure the best outcome for the IVF.
However, is this really true? Does bed rest positively influence the outcome of the IVF? Is this scientifically proven?
Since the birth of the first IVF baby back in 1978, numerous medical advancements have been made to help IVF patients achieve the best outcomes. Among them are procedures like ovulation induction, egg retrieval and sophisticated laboratory techniques. While these primary procedures have been tried and tested, some of the simpler procedures, such as bed rest immediately after an embryo transfer, have not been scientifically proven.
It is generally believed that bed rest, or the reduction of physical activity right after an embryo transfer procedure, is beneficial as it can reduce a woman’s stress levels and aid implantation. However, there is a study that shows bed rest after embryo transfer can be potentially detrimental!
The 2011 study, which was conducted by a team of researchers from Universidad de Valencia, Valencia, Spain, involved 240 patients between the ages of 25 and 49 years old. They were undergoing their first IVF cycle using donated eggs at a private IVF centre. The objective of the study was to evaluate the influence of just 10 minutes of bed rest after embryo transfer on the achievement of live births, as well as implantation and miscarriage rates.
The patients were divided into two groups – the R (Rest) and NR (No Rest) groups. Those in the R group were given ten minutes of bed rest after embryo transfer by being moved from the operating room with the help of a stretcher or in a lying-down position. Meanwhile, those in the NR group had no bed rest and were allowed to ambulate (move around) immediately after their procudure.
The study’s findings revealed that the live birth rates were significantly higher in the NR group (56.7%) than in the R group (41.6%). The NR group also had lower miscarriage rates (18.3%) as compared to the R group (27.5%). Although the implantation rate was higher in the NR than in the R group, the researchers noted that the difference did not reach statistical significance. Meanwhile, neonatal characteristics like height, weight and Apgar score were similar in both groups.
Therefore, the researchers concluded that bed rest immediately after embryo transfer has no positive effect, and in fact can be negative for the outcome of IVF. They surmised that this could be due to the common anatomical position of the uterus, as concluded by another study.
It is believed that the force of gravity could cause the loss of newly-transferred embryos. However, since the cavity of the uterus is in a more horizontal position when a woman is standing than when she is lying down, a horizontal position after embryo transfer would not be beneficial.
As a result of their findings, the researchers suggest that IVF clinics change their practice of encouraging bed rest after embryo transfer. They also call for more research to be conducted on the physiological or psychological reasons for the benefits of no bed rest after embryo transfer.
The results of such studies provide us with more clues on how best to maximise IVF success. Should you have any questions or concerns about IVF procedures, as well as what to do or not do after an embryo transfer, don’t hesitate to speak to your fertility specialist.
Baby in the making- Study shows 3 out of 4 couples undergoing IVF will have a baby within five years
There are various causes for infertility, including endometriosis, polycystic ovary syndrome, damaged fallopian tubes and ovulatory problems in women, and low sperm count and motility or problems with erections or ejaculating in men. Unhealthy lifestyle habits such as smoking, illnesses like diabetes, as well as being overweight are also contributing factors.
In most cases, infertility can be treated, but for many couples who are struggling with infertility, In-Vitro Fertilisation (IVF) is their best option. Couples undergoing IVF are often faced with uncertainty and wonder – What are our chances? When will we have a baby? Some undergo IVF multiple times without success, and as they are unsure of their chances, they end up giving up.
There has always been a debate on how best to measure the success of fertility treatments, however, now a Danish study is providing realistic information that’s reliable for the long-term prediction of treatment.
The long-term study was conducted by researchers at the Copenhagen University Hospital, who referred to rigorous registry records. Denmark is one of the few countries in the world where such a study could be carried out, due to their practice of keeping detailed records that link all fertility treatments to all live births.
The researchers analysed nearly 20,000 Danish couples from 2007 and 2010, following them from the moment they started their fertility treatments. The study’s findings were recently presented at the European Society of Human Reproduction and Embryology (July 2016).
The team found that more than half of the women (57%) had their baby as a result of treatment within two years, 65% had children within three years and 71% within five years. This means that almost 3 out of 4 couples undergoing IVF will eventually become parents within five years, whether as a result of the treatment or following natural conception.
The study also found that while most causes of infertility can be overcome, the odds of conception are heavily influenced by a woman’s age. They found that in women under the age of 35, about one in three IVF cycles were successful and 80% had children within five years.
However, the total birth rates fell to 61% in those between 35 and 40 years old; and fell again to 26% in women aged 40 and over. The study also revealed that women with a Body Mass Index under 30 and didn’t smoke also had better outcomes.
These figures provide encouraging news for couples who are seeking or embarking on fertility treatments, as they reveal that their chances of having a baby are good. According to study presenter, Dr Sara Malchau, “We are now able to provide couples with a reliable, comprehensible, age-stratified long-term prognosis at start of treatment”.
Although individual prognosis and factors play a role in the success of IVF treatments, this study has shown that overall, IVF treatments are working, but they take time. Therefore, couples may need several treatment cycles for their best chance at conception.
I am extremely pleased and excited to announce the arrival of my book: “Catching My Baby Dust’, which came to a reality after many months of hard work. This book consist of inspiring true stories on the journeys couples had been through in trying to have a baby. Many of these stories detailed the trials and tribulations of their Fertility journeys. These stories are deeply touching and in many ways humbled me as a Fertility Specialist.
Here is the small note I have written for the publication of this book:
Welcome to the first edition of ‘Catching My Baby Dust’. As the Chief Editor of this book, I would like to thank you for taking your time to read this special book, which is extremely close to my heart.
As a Fertility Specialist, I have the opportunity to work with women who are from various backgrounds, ethinicities & educational levels. They have one thing in common: They all want to have a baby.
As a mother of three, I can fully understand their desire to have these little bundle of joy in their arms, and how these tiny little babies would complete and fulfill their lives. However, the reason that they are sitting in my clinic is that pregnancies did not happen naturally, and therefore they are here to seek guidance and assistance.
I must say that I feel privilleged that I can do something to help them. My greatest pleasue of my daily life is to help these patients to identify the issues which prevent them from conceiving naturally and rectify their problems. Some need just a little bit of reassurance and things happenned. Unfortunately, some need much more than reassurance. And the good news is that most will eventually have a baby in their arms following fertility treatments.
Throughout these journeys, I have come across many women who had deeply touched me with their perserverance and determination which greatly humbled me. Some of these stories bring tears to my eyes and I hereby express my greatest gratitude to them by agreeing to share their stories with people out there who are trying to conceive.
I would like to thank my senior colleague, Dato Dr Prashant Nadkarni, the Medical Director of KL Fertility Centre for his valuable input. My co-editors, Dr Natasha Ain Mohd Nor & Dr Agilan Arjunan, who shared my passion in the field of fertility and had worked fervently in making this book a reality.
I would like to take this opportunity to thank Ms Sylvia Khoo, the director of Pitter Patter Sdn Bhd, Ms Adline A Ghani and Ms Lee Siew Fong helped us to co-ordinate the production of this book.
Last but not the least, I would like to thank all the readers for their constructive comment to further improve the quality of this book.
Dr Helena Lim Yun-Hsuen
Catching My Baby Dust
The Unknown Factor
Ethnicity can affect IVF success rates
For many couples who struggle with infertility, artificial reproductive techniques (ART) like In-Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) are their only options in the hopes of conception and starting a family of their own. However, if you are considering IVF, it is important for you to learn about IVF success factors that can either boost or hinder your chances at pregnancy.
The main factors that may impact IVF success are age, especially of the mother; a history of previous pregnancies or miscarriage with the same or different partner; the type of fertility problem; lifestyle habits; the use of donor eggs and the fertility clinic chosen. However, several studies have contributed another factor for IVF success – a woman’s ethnicity.
In an observational cohort study conducted by the Nottingham University Research and Treatment Unit in Reproduction (NURTURE), UK, it was found that live birth rates following IVF treatment was significantly lower in Asian and Black women, as compared with white European women.
The study involved 1517 women, of which 1291 were white Europeans and 226 belonged to ethnic minorities. All these women underwent their first cycle of assisted reproductive technology between 2006 and 2011.
Despite sharing favourable chances of conceiving, such as the quality of their egg reserves, only 35% of Asian and Black women successfully conceived and gave birth after IVF, as compared with 44% of white women who were treated at the same clinic during that period.
The researchers at NURTURE are unsure why this is, but suggest that it could be down to genetics, as well as social and environmental factors. According to lead researcher, Dr Walid Maalouf, “Further research into genetic background as a potential determinant of IVF outcome, as well as the influencing effects of lifestyle and cultural factors on reproductive outcomes is needed.”
NURTURE’s findings are supported by a research conducted at the University of Kansas-Wichita, USA. The researchers there state that while the average birth rate after IVF using fresh eggs is 25.7%, this figure conceals the wide variation in the success rates for different ethnic groups.
After studying the records of more than 80,000 IVF treatment cycles carried out between 1999 and 2000, they found that the birth rate for black women was 18.7%, 20.7% for Asian women, 26.3% for white women and 26.7% for Hispanic women. They also learnt that black women had the highest miscarriage rate of 22%, compared to 13.9% for white women, 16.4% for Hispanic and 16.2% for Asian women.
Another US study, by researchers at the University of California, confirmed that Asian women had a lower pregnancy rate than non-Asians. The study looked at 1,200 IVF treatment cycles and found that the birth rate for Japanese, Indian and Chinese patients is about 60 per cent that of white women. However, the team stressed that the differences did not apply to natural conception.
Like the NURTURE team, the US teams are unsure of the reasons for these differences. According to Marion Damewoood, president of the American Society for Reproductive Medicine (ASRM), “The findings were preliminary but important, and we need to further explore these apparent racial differences to see if we can better understand and hopefully address their causes.”
While Asian couples may find these results worrying, it is crucial for all couples to be counselled on their realistic probabilities for IVF success. Based on these findings, Asian women are encouraged to seek treatment earlier to improve their chances of pregnancy.
Hard facts on a common bean
The impact of soy-based foods on fertility
Soy-based food products, like soy milk and tofu, are often considered a healthy alternative to meat and dairy. However, numerous scientific studies have shown that soy can actually cause unwanted side effects and more alarmingly, negatively impact fertility.
The main reason why soy is bad for fertility is that it contains phytoestrogens. This plant-based chemical mimics estrogen and disrupts the body’s endocrine function. Although few people realise the dangers of soy, this knowledge is not exactly new. Scientists have known about the ill-effects of soy since at least the early 1990s.
A study conducted in 1992 by the Swiss Health Service estimated that drinking two cups of soy milk per day has the same effect as taking one birth control pill. Then, a study published in 2000 by the Departments of Preventive Medicine and Obstetrics and Gynecology, University of Southern California, Los Angeles, USA found that soy decreases luteal estrogen levels and lengthens menstrual cycles.
Meanwhile, a 2005 study conducted by researchers at the National Institute of Environmental Health Sciences, North Carolina, USA found that soy causes miscarriage and infertility in mice. Another study, conducted by the Harvard Public School of Health in 2008, found that men who drank one cup of soy milk per day had a 50% lower sperm count than men who didn’t take soy.
Because soy has been proven to cause abnormal menstrual cycles, altered ovarian function, early reproductive deterioration and subfertility/infertility, it is considered particularly harmful for women and men who are trying to conceive. Women who are pregnant or breastfeeding and infants are also discouraged from consuming soy-based products.
But even if you rarely eat tofu or drink soy milk, you’re not completely out of the woods. In fact, you may be consuming soy in other forms. These days, many processed and refined foods contain soybean oil, soy flour, soy lecithin or soy protein. Therefore, you may not know that you’re actually eating soy-based foods as they’re hidden away in the ingredients list.
It is important to note, however, that traditional fermented soy products, like miso and tempeh, may be beneficial to health. But the high intake of processed soy has a less desirable effect on health. Therefore, if you’re trying to get pregnant, it is best for both you and your partner to exclude soy from your diets. If you have any doubts or questions, as always, be sure to consult with your fertility consultant.
The dairy seesaw
How dairy may lower or increase your risk for infertility and miscarriage
Dairy is a good source of calcium, protein, vitamin D and phosphorus, which is why pregnant women are often advised to include dairy in their diet. After all, these nutrients are essential for a baby’s developing bones, teeth, muscles, heart and nerves. However, some studies have shown that some dairy products can be good for you, while others can be bad. So before you reach for that glass of milk or bowl of ice cream, let’s weigh the pros and cons of dairy.
According to an eight-year Harvard study involving around 18,000 women, the moderate consumption of high-fat dairy products like ice cream, whole milk, yogurt and cheese is considered fertility and pregnancy friendly. This is because whole milk contains a complete protein that is important for egg quality. Their findings showed that dairy could reduce the risk of anovulatory infertility by more than 50%. and lower the risk of miscarriage by 33%.
Meanwhile, another study by the Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece, has found that dairy may reduce the body’s unwanted immune response, which secretes antibodies that affect the fetus and can cause recurrent miscarriages.
While the moderate intake of dairy is beneficial, the high consumption of milk has been linked to a decrease in fertility. This is because excess protein intake (more than 120 grams a day) can cause embryo implantation problems. In addition, women with dairy intolerance and allergies are more likely to miscarry.
However, many people are unaware that they are lactose intolerant. According to the Physicians Committee of Responsible Medicine, 75% of the world’s population is lactose intolerant. A study published by the European Journal of Obstetrics, Gynecology, and Reproductive Biology (2001) also found that eating butter and oil can double a woman’s risk for miscarriage.
What about low fat dairy?
It is known that full-fat dairy foods contain the female hormones estrogen and progesterone. But when fat is skimmed from the milk, the process removes these hormones and leaves behind male hormones or androgens, which impairs ovulation. The same Harvard study mentioned above found that low fat dairy can increase the risk of ovulatory infertility by 85%.
Milk and hormones
While we’re on the subject of hormones, it is important to note that because animal milk contains hormones, high intake of dairy may disrupt your own hormonal balance. Some of the fertility issues that can be associated with hormone imbalance are PCOS, Endometriosis and male infertility.
A study conducted by researchers from the Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Australia has found that women who eat high amounts of dairy can have 15% higher estrogen levels, which may influence circulating concentrations of estradiol. Estradiol is a form of estrogen that while is necessary for many processes in the body can also cause harm to pregnancy and unborn babies.
Milk and inflammation
In traditional Chinese medicine, dairy is believed to be ‘damp’ and cause inflammation, which hampers fertility and causes problems in getting pregnant. However, in Western medicine, several studies have been found that dairy can help reduce inflammation.
For example, researchers from the Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Iran discovered that probiotic yogurt can lower one marker of inflammation by 29%.
A similar study by the Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece also identified an inverse association between dairy products consumption and levels of various inflammatory markers among healthy adults. They found that dairy lowers inflammatory markers by as much as 16%.
These findings are supported by another study by the Department of Nutrition, University of Tennessee, Knoxville, USA, which found that calcium and dairy consumption can reduce tissue oxidative and inflammatory stress.
From the findings above, we can conclude that the moderate consumption of whole dairy products is beneficial to fertility and pregnancy. However, if you’re feeling uncertain, don’t take the drastic step of cutting dairy out of your diet completely. Instead, speak to your fertility consultant about how much dairy you should be consuming.
The right balance
Benefits of a high protein, low carb diet on fertility
Maintaining a well-balanced and healthy diet is highly recommended, especially when you’re trying to have a baby. But did you know that a high protein, low carb diet could help to boost your fertility? That is precisely what a study by the Delaware Institute for Reproductive Medicine (DIRM) in Newark, New Jersey, USA has found.
The study, which was conducted between January 2010 and December 2011, looked at 120 patients who participated in assisted-reproduction therapy programmes at the DIRM. The patients were asked to keep diet diaries and document what they ate, prior to undergoing an embryo transfer.
According to the head researcher, Dr Jeffrey B. Russell, they wanted to understand why their thin and healthy patients had poor quality embryos. After analysing his patients’ diet diaries, he was surprised to see that a large percentage of the women were eating more than 60% carbs each day and 10% (or less) protein. Those who ate like this were found to have poor quality embryos.
Meanwhile, patients whose daily protein intake was 25% or more of their diet and whose carbohydrate intake was 40% or less of their diet, had four times the pregnancy rates of other patients who ate less protein and more carbs daily.
While no differences were found in the body mass index (BMI) of either group, there was a significant difference in egg and embryo quality. “Protein is essential for good quality embryos and better egg quality, it turns out,” said Dr. Russell.
This conclusion was made after the research team assessed embryo development after five days of culture or at the blastocyst stage. It was found that 54.3% of patients whose daily protein intake was greater than 25% had an increased blastocyst formation. Meanwhile, patients whose daily protein intake was less than 25% had 38% blastocyst formation. The study also found that pregnancy rates significantly improved in patients with greater than 25% daily protein intake.
Due to these findings, Dr. Russell and his colleagues at DIRM have made it a requirement for their patients to eat a diet consisting of 25% to 35% protein and 40% or less carbs for three months, before beginning their IVF cycles. So if you are looking to ensure the health and quality of your eggs, it is best to start changing your diet to include more proteins and less carbs.
However, it is important to keep in mind that it’s not just about the right amount of protein, but the right kinds too. It is best for you to load up on low mercury fish and seafood like pomfret, sardine, salmon, tilapia, shrimp, shellfish, tuna (canned light) and cod; skinless chicken or turkey; eggs and lean beef, as well as fresh and full cream milk, cheese and yogurt. If you’re vegetarian, your best sources of protein are legumes like beans and lentils; nuts and seeds; as well as organic soy products like edamame and tofu.
Up in smoke
How smoking affects fertility in both men and women
We all know that smoking is a bad habit and it can put us at risk of heart, vascular and lung disease, as well as cancer. But, did you know that according to the Centers for Disease Control and Prevention (CDC), smoking can lead to fertility problems in both men and women? Additionally, numerous studies have shown that smokers take longer to conceive – but that’s just the tip of the iceberg!
Cigarettes are so harmful because they contain over 7,000 chemicals, including formaldehyde, nicotine, cyanide and carbon monoxide. Needless to say, these chemicals are very harmful to the body and they can spread to all your internal organs. With regards to fertility, they can cause permanent damage to eggs, sperm and the genetic material they contain.
It comes as no surprise, therefore, that both male and female smokers have twice the risk of infertility as compared to non-smokers. According to the American Society for Reproductive Medicine (ASRM), available biological, experimental and epidemiological data shows that 13% of infertility cases may be attributable to smoking. Worse still, cigarettes are addictive and the more you smoke in a day, the higher your risk for fertility problems.
We know that a pregnant woman should never ever smoke, as it can cause miscarriage, pregnancy complications and birth defects. But a woman should be concerned about the effects of smoking well before she is pregnant. In women, cigarette smoke can accelerate the loss of eggs. This in turn leads to the early onset of menopause, which can be made faster by up to four years states the ASRM.
Smoking therefore adversely affects a woman’s chance of success if she undergoes IVF, as fewer eggs will be retrieved. Women smokers are also more likely to develop pregnancy complications like miscarriage, ectopic pregnancies and preterm labour. Cigarettes are equally harmful to men, as they cause hormonal imbalance, sperm abnormality, erectile dysfunction, as well as decrease sperm count, motility and ability to fertilise eggs.
But beyond that, men who smoke also put their non-smoking partners at risk. Research has shown that non-smoking women, who are constantly exposed to second-hand cigarette smoke, can suffer from a higher risk of infertility as well.
Therefore, if you have plans of starting a family, it is best for you (and/or your partner) to kick the smoking habit immediately. Fortunately, it is believed that most of the negative effects of smoking can be reversed within about a year of quitting. However, it is important to bear in mind that once a woman’s eggs have been lost, they cannot be retrieved.
How alcohol affects fertility in both men and women
You’ve probably heard of the saying, “Drink to your health,” but when it comes to safeguarding your fertility, moderation is definitely key in alcohol consumption. Women usually swear off alcohol once they find out they’re with child, but in truth, it is best for them to abstain from alcohol as soon as they’re ready to start a family. And it’s not just women who should keep tabs on their alcohol intake!
A growing number of scientific studies have shown that as little as one alcoholic drink a day can lead to detrimental effects in one’s chances at conceiving. For example, according to a study published in the American Journal of Epidemiology in 2004, alcohol can shorten a woman’s follicular phase and menstrual cycle.
Meanwhile, a 2009 study conducted at Harvard University found that in couples undergoing IVF, women who drank more than six units of alcohol per week were 18% less likely to conceive, while men were 14% less likely. This finding was supported by a study published in 2011 in the Annals of Epidemiology. Entitled ‘Alcohol, Smoking, and Caffeine in Relation to Fecundability, with Effect Modification by NAT2,‘ it concluded that alcohol intake was significantly associated with reduced fertility.
The study, which followed 319 women over an average of 8 menstrual cycles and 124 pregnancies, discovered that women who drink alcohol once a day can experience a 30% reduction in fertility, while those who took more than one alcoholic drink a day experienced a 50% reduction.
Another study published in 2011, entitled ‘Effect of alcohol consumption on in vitro fertilization,’ published in the Journal of Obstetrics and Gynecology found that drinking before becoming pregnant can lower live birth rates by up to 21% in IVF patients.
This prospective cohort study involved multicycle analyses with final models adjusted for potential confounders that included cycle number, cigarette use, body mass index, and age. From the 2,545 couples studied, it was found that women who drink at least four drinks per week had 16% less odds of a live birth rate compared with those who consumed less alcohol.
Although there is a link between drinking and fertility, researchers still do not know exactly how alcohol impairs fertility, says Dr Anthony Rutherford, a consultant in reproductive medicine and Chairman of the British Fertility Society.
However, it is clear to researchers that alcohol doesn’t just affect female fertility. According to Dr Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists, “Excessive alcohol lowers testosterone levels and sperm quality and quantity in men. It can also reduce libido, and cause impotence.”
Fortunately, however, any damaging effects alcohol has on fertility can be quickly reversed by reducing alcohol intake or abstaining from it, as well as getting proper nutrition and leading a healthier lifestyle. Therefore, before you raise your glass next time, spare some thought over how it can stand in the way of your goals of starting a family.
One of the most important lesson that I have learnt from my mentor in IVF is that IVF is equivalent to an exam. The likelihood of passing an exam (aka. achieve a pregnancy) is increased if you are prepared for it. Half of the battle is won not during the battle itself but during the preparation for the battle.
As a seasoned student (I have been through many exams including my professional exams), I could not agree more. A famous Chinese military general, strategist and philosopher, Sun Tzi (600 B.C.), who authored the famous book ‘the Art of War’ had clearly illustrated and emphasized the importance of being ‘prepared’ as the secret of a victory.
Therefore, before you embark on your journey of IVF, would you join the wining team by preparing yourself for the battle?
The benefits of acupuncture in IVF
In recent years, acupuncture has become an increasingly popular complementary treatment for those suffering from infertility, especially women undergoing IVF treatment. But what’s behind the buzz and does it actually work? Let’s examine the known facts.
What is acupuncture?
Acupuncture is a form of traditional Chinese medicine (TCM) and healing method that has been used for thousands of years across the world to treat a variety of ailments. It involves the gentle insertion of thin, sterile needles that are inserted into the skin at strategic points of the body to provide stimulation.
According to TCM practitioners, there are more than 2,000 acupuncture points on the human body, which are connect to 14 major pathways or meridians. These meridians conduct “qi,” which is a form of energy or life force that is believed to regulate our spiritual, emotional, mental and physical balance. Poor health habits can disrupt the proper flow of qi, leading to various ailments, including pain and infertility.
Benefits for those undergoing IVF
As acupuncture works on the principle of restoring balance, here’s how it can help:
Reduces stress – By lowering the levels of stress hormones released into the blood stream, acupuncture can help restore the body’s hormonal and neurochemical balance.
Improves blood flow – Stimulation at strategic points can increase blood flow to the ovaries and uterus, which increases chances for the egg to be implanted, nourished and carried to term.
Relieves aches – By alleviating existing aches and pains, acupuncture can provide further relief and stress reduction.
Relieves anxiety – By helping to treat conditions like anxiety and insomnia, which can have devastating long-term effects to wellbeing, acupuncture helps restore the body’s delicate balance.
Few side effects – Unlike some forms of Western treatment, which can be invasive and causes undesirable side effects, acupuncture has relatively few to no side effects other than causing bruising at the needle site.
Some experts in complementary medicine have cautioned that the positive effects of acupuncture may actually be due to a “placebo effect” that is caused by patients expecting acupuncture to work. To understand the phenomenon better, some scientific studies have been carried out to review the benefits of acupuncture in infertility treatments.
One study, jointly-conducted by the University of Maryland’s School of Medicine, Georgetown University School of Medicine, Washington and the University of Amsterdam, Holland, compared the results of needle acupuncture in women receiving IVF, against women who received fake treatments and no treatments at all.
The results were very positive, as according to the study, “IVF with acupuncture increased the odds of pregnancy by 65% (according to early evidence on ultrasound), increased the odds of ongoing pregnancy by 87% (according to ultrasound evidence of pregnancy at 12 weeks) and increased the odds of a live birth by 91% compared with IVF on its own.”
The researchers concluded that their results suggest that, “Acupuncture given with embryo transfer, improves rates of pregnancy and live birth in women who are undergoing in vitro fertilisation.” While their findings are significant and clinically relevant, the researchers consider them to be “somewhat preliminary” and call for further investigation in the link between pregnancy rates and the effect of acupuncture.
With these encouraging facts and figures, there is no wonder why more and more couples are choosing to include acupuncture in their infertility treatment routine. If you’re interested to find out more about using acupuncture as a complementary form of treatment, don’t hesitate to bring it up to your doctor.
Getting it just right
Exercise and how it affects pregnancy rates
We all know that staying physically active is beneficial to our overall health and wellbeing. But did you know that the right amount of exercise can also improve your chances of conceiving? Here’s why.
Firstly, regular exercise is known to help optimise the reproductive system. It does this by stimulating the endocrine glands, which releases hormones that help your eggs to grow. Secondly, exercise can enhance your metabolism and circulation, which in turn optimises your egg production.
Thirdly, exercise can help you manage or achieve an ideal body weight. Since being overweight or obese can impair fertility in both men and women, weight management is widely known and used to prevent and treat infertility. And lastly, regular workouts also help to relieve stress, which in itself can inhibit fertility.
While regular moderate exercise can have positive effects on fertility and conception, the opposite is true for vigorous exercise. According to a 2009 study in Human Reproduction, and a Harvard study of elite athletes, vigorous exercise is linked to reduced fertility and pregnancy rates. Therefore, when it comes to exercise and fertility, it is possible to have too much of a good thing.
While there are no guidelines for women to follow when it comes to workout intensity for fertility, there is a way to strike a balance. Studies have shown that women who exercised moderately for at least 30 minutes a day can reduce their risk of infertility due to ovulation disorders. Evidence also suggests that moderate regular exercise can positively influence assisted reproductive technology (ART) outcomes. But what is the right amount of exercise?
If you’re already at your ideal weight, it is safe to stick to your regular routine, but keep it to half an hour maximum per day. Studies had shown that vigorous aerobic exercise of more than 4 hours per week reduces the chance of pregnancy in women going through IVF. If your cycle is still irregular and you haven’t conceived after a few months, you might want to cut back on the intensity of your workouts. However, if you’re underweight, focus on gaining weight and increasing your body fat to the recommended amount of over 12%. If you exercise regularly, cut back on the frequency and opt for a less vigorous routine.
Meanwhile, if you’re overweight, work on cutting down on your calories with healthy eating. You can also increase your exercise routine gradually to achieve your ideal weight. Lastly, if you’re undergoing fertility treatments, it is best to avoid high-impact exercises, as they can be detrimental to your ovaries, which have been enlarged by fertility drugs.
Still have doubts on where to begin? Before you step up your exercise routine, start by speaking to your doctor. If you’ve been having trouble conceiving, your doctor will need to assess your condition first. This includes your age, cycles, ovulatory status, the condition of your uterus and tubes, as well as your partner’s sperm. Once certain conditions have been identified or ruled out, your doctor will be able to advise you on whether the underlying cause may be too little or too much exercise.
How paternal age affects reproduction and offspring
When it comes to discussions on fertilisation and reproduction, there is often an emphasis on the mother. This includes her age, which is also known as “maternal age.” This is quite understandable, because multiple studies have been conducted on women’s health and the effects it can have on the pregnancy and baby. And the bulk of the research shows that women over 35 do have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies and perinatal complications.
But what about paternal age? How come it’s rarely discussed? Could the age of the father have an effect on reproduction and the health of the baby both in vitro and after birth? The answer is – Yes, it’s possible.
Today, however, late fatherhood has become more commonplace. In fact, in Hollywood it has become a trend, with celebs like Steve Martin, George Lucas, Jeff Goldblum and Robert DeNiro fathering children in their 60s. And it’s not just celebs that are having children later in life.
In the last decade, we’ve seen a rising number of men becoming fathers for the first time at an advanced age. This is largely due to the increase in life expectancy, the use of contraceptives, delayed marriages and so on. Arguably, there are various social advantages to having children at a later age. For example, older fathers are often more advanced in their careers and are better equipped to provide financial security to the family. But what about potential risks? Do they outweigh the advantages?
Despite this rising trend of delayed fatherhood, research on the effects of paternal age on reproduction and offspring has been lacking. However, there is a growing body of literature on the topic, and they point to several risk factors that couples must be aware of and take into consideration.
Firstly, studies have shown the negative effects of paternal age to sperm quality and testicular function. In addition to this, older men have an increased risk of male infertility, which can adversely impact reproductive and fertility outcomes, including the success rates of treatments like IVF/ICSI.
Research also indicates that children conceived by men over the age 40 might face a higher risk of miscarriage; preterm birth; birth defects such as the bone growth disorder achondroplasia; disorders like autism, schizophrenia and bipolar disorders, as well as childhood leukemia.
But why do the risks for these health conditions increase with paternal age?
Researchers believe that these health conditions might be caused by age-related genetic mutations and chromosomal abnormalities, which in turn results in genetic mutations that are then inherited by the offspring. With these facts in mind, it’s essential for couples, especially those facing fertility issues, to consider the links between advanced paternal age and the potential risks to conception and the health of their offspring.
But, if you’re a man in your 40s or older who is considering fatherhood, or are concerned about your reproductive health, don’t hesitate to speak to your doctor. It’s best to address your worries and find out more about the potential risks involved.
A timely decision
How age affects your chances of IVF success
Have you been seriously considering In vitro fertilisation or IVF treatment? If you have, it’s best that you understand how your age can affect your chances of success. This is so that you can make an informed decision on when to begin. But before we get into that, let’s take a brief look at IVF and what it entails.
For some couples facing fertility problems, IVF is a viable method that can help them to conceive. During IVF, a woman’s ovaries are stimulated and an egg is removed to be fertilised with sperm in a laboratory. Once fertilised, the egg becomes an embryo, and it is returned to the woman’s womb to develop.
Studies have shown that the success of IVF treatments can be affected by a woman’s age. This is because it’s an inescapable fact that a woman’s fertility declines as she grows older. So if you were to undergo IVF using your own eggs, your chances of conceiving would be higher if you were younger.
According to the Human Fertilisation and Embryology Authority (UK), in the most recent study conducted in 2010, on average, the percentages of live births resulting from women having IVF using their own fresh eggs are: 32.2% for women aged under 35, 27.7% for women aged between 35–37, 20.8% for women aged between 38–39, 13.6% for women aged between 40–42, 5.0% for women aged between 43–44 and 1.9% for women aged 45 and over.
As you can see from the statistics above, a woman’s fertility begins to decline at around age 30 and this exacerbates at about age 38. By the time she is 44, her chances of having babies via IVF with her own eggs is nearly nonexistent at less than 2%. This is why women above the age of 42 are generally discouraged from undergoing IVF, as the success rate is considered far too low.
Most IVF clinics also have an age limit for IVF treatments that use a woman’s own eggs. This is because the age of the eggs is crucial, not the age of the uterus. But, why is egg age so important? Two words – quality and quantity.
But what is egg quality? In fertility, an egg’s quality refers to its chromosomal status. As a woman’s age increases, the risk of chromosomal abnormalities in her eggs also rises. During IVF, we hope to obtain multiple healthy embryos, whereby the best ones will be selected for transfer into the mother’s uterus. But before embryos are transferred, we need to check their chromosomal status. Therefore, the embryos undergo Preimplantation Genetic Screening or PGS, which checks for chromosomal normalcy. On average, healthy embryos with normal chromosomes have a much higher potential for implantation and live birth.
Meanwhile, egg ‘quantity’ refers to how many eggs are left in a woman’s ovaries. As such, her egg quantity is often called her “ovarian reserve”. Although egg quantity doesn’t greatly impact the chances of a natural conception, in IVF, egg quantity may influence a woman’s response to ovarian- stimulating medications.
So if you’re considering IVF, don’t hesitate to ask questions and seek the advice of a fertility consultant. The information you receive can help you make a decision on when best to start your treatment.
Fertility on ice
What you should know about egg freezing
We often hear of the expression “ticking biological clock,” but what does this actually mean for a woman? Well, here are the facts and figures. As a woman, you were born with about one to two million immature eggs or follicles, and these begin to die off as soon as you leave your mother’s womb.
By the time you’ve reached puberty, you’ll only have about 400,000 follicles left, and with each menstrual cycle, you’ll lose thousands more. Due to the loss of follicles throughout your reproductive life, when you’ve reached your mid 30s, your fertility would have sharply declined. And in your late 40s, any follicles that remain are unlikely to mature due to the hormonal changes brought on by menopause.
Now that you understand a little more about eggs, let’s find out why some women choose to freeze theirs and what it entails.
What is it?
Just as the name suggests, in egg freezing, a woman’s unfertilised eggs are frozen through a process called vitrification. This is done so that the eggs can be stored for many years. When a woman is ready, the eggs can be thawed and fertilised with sperm. Once the egg has developed into a healthy embryo, it can be transferred to the woman’s uterus for a chance of pregnancy.
Some women choose to freeze their eggs because they are currently not in the position to become pregnant and they want to preserve their healthiest eggs. One of the leading reasons for egg freezing is serious illness. For example, a woman who is undergoing cancer therapy may worry about the impact of the treatment on her fertility. As such, she may have her healthy eggs removed and frozen for future use before she undergoes treatment.
Other women, on the other hand, may be concerned about age-related infertility. Though a woman may be at her most fertile between her 20s and early 30s, for some women, childbearing is unavoidably delayed due to education, career or personal goals. Through egg freezing, a woman can store her healthy eggs for use in the future, enabling her to start a family when she is ready. A woman’s age when her eggs are frozen also affects her chances of conceiving later in life. For example, if she opts to freeze her eggs during her late 30s, her chances of pregnancy are significantly lower.
Much like the early stages of IVF, the egg freezing cycle takes about 10-12 days. The woman will give herself daily shots of hormone injections, which stimulate her ovaries and ripen her eggs. When her eggs have matured, they are removed using a special needle that is inserted through her vagina. An ultrasound is used to help guide the needle and the woman is sedated, so she will not feel any pain. Once retrieved, the eggs are immediately flash frozen.
Is it safe?
In a word – yes! To date, more than 300,000 children have been born worldwide from frozen embryos and studies conducted in recent years have shown that the use of frozen eggs does not increase pregnancy complications or birth defects.
If you’d like to learn more about egg freezing and the costs involved, don’t hesitate to speak to a fertility specialist.
Fight Oxidative Stress
The effects of alcohol, smoking and pollutants on women’s fertility
We all know that the excessive intake of alcohol, smoking and environmental pollutants are bad for our health, but can they negatively impact a woman’s chances of getting pregnant? The answer is a resounding (and unsurprising) yes! Here’s why – Firstly, as toxicants, they cause our bodies to produce Reactive Oxygen Species or ROS, which are highly-reactive ions and molecules that contain oxygen. ROS are a lot like free radicals, and they are both known to wreak havoc in our bodies by damaging proteins and impairing their function.
Usually, our bodies are able to neutralise the harmful effects of ROS and free radicals with antioxidants. However, when an imbalance in the production of ROS and free radicals occurs, our bodies are unable to cope. As a result, our bodies undergo what’s called – oxidative stress. Oxidative stress is a physiological condition that’s linked to a variety of health issues, including neurodegenerative disorders such as Alzheimer’s disease; cancer; heart problems; blood vessel, gut and vision disorders; lung conditions; chronic fatigue syndrome; kidney, autoimmune, arthritis and inflammatory disease; diabetes; pancreatitis and more.
There is also mounting evidence on the negative effects of oxidative stress on male subfertility, including decreased sperm motility and numbers. And now, findings indicate that oxidative stress can increase the risk for female infertility, as well as delaying pregnancies and lowering pregnancy rates. It can even lead to pregnancy complications like preeclampsia and even miscarriage.
While the field is currently understudied and there is so much more to discover, there is no denying that it is crucial for us to gain a better understanding of how to combat oxidative stress. “If we can identify factors that can be modified to decrease oxidative stress in women, it may be an inexpensive and non-invasive treatment for infertility,” states a study called The Impact of oxidative stress on female fertility by Elizabeth H. Ruder, Terryl J. Hartman, and Marlene B. Goldmanc.
But does this mean we have to play the waiting game for more research to be conducted on the subject? While it may be a few years time before scientists can identify the factors that can be modified to fight oxidative stress, there are steps you can take right now.
We know that oxidation occurs when we’re exposed to toxins, chemicals and stress. Therefore, it would be highly beneficial for you to minimise your exposure to triggers that are present in your lifestyle, foods and environment. Numerous studies have also shown the benefits of a healthy and varied diet, which is supplemented with multivitamins and antioxidants.
In addition, you can maintain your reproductive health by limiting caffeine and alcohol intake, quitting cigarettes, getting adequate exercise, learning ways to manage daily stress and maintaining a healthy body weight. By taking these steps and making crucial lifestyle changes, you can significantly enhance your fertility and boost your chances of conception. Not sure where to begin? Don’t hesitate to speak to a healthcare professional to get on the right track.
How a fathers’ lifestyle influences the health of future generations
We all know that a woman who is trying to conceive should eat a healthier and more nutritious diet. In addition, she should abstain from drugs, alcohol and cigarettes. This is because these factors can affect her chances of becoming pregnant, as well as have a negative effect on her developing fetus should she fall pregnant. Even a woman’ level of emotional stress could influence her fertility and pregnancy success. But does the same apply to men? How does a man’s lifestyle affect conception and the health of his offspring?
Unlike women, men’s reproductive health is under-emphasised and men are largely left out of pre-conception planning. This is despite the fact that male infertility is on the rise, with lower sperm counts and damaged sperm becoming more prevalent. Now, however, new studies are beginning to show that a father’s lifestyle can impact the possibility of pregnancy, as well as the long-term health of his children.
More than genes
Though the saying goes, “It’s all in genes,” scientists have discovered there’s more to our genetic inheritance than that. Beyond our DNA code is epigenetics, which can be defined as, “a heritable layer of biochemical information associated with DNA, and transmitted via the sperm and egg.”
According to Sarah Kimmins, PhD, who holds a Canada Research Chair in Epigenetics, Reproduction and Development and is an Associate Professor at McGill University, Montreal, “We are now beginning to understand that sperm epigenome contains a lifetime memory of paternal experiences. Everything is a man’s daily lifestyle, including his environment, diet, exercise, alcohol and smoking have the potential to disrupt (or support) the setting of the sperm epigenome, which is then passed on to future generations.”
Danger of chemicals
Besides lifestyle, says Kimmins, other factors that can contribute to male infertility are “Chronic conditions like obesity, cardiovascular disease and metabolic disorders, as well as paternal age and heightened stress.” Furthermore, the researchers at McGill University also believe that, “Reduced fertility may be in part attributable to the dramatic increases in chemical production and consequent human exposure.”
Their studies show that there are now about 80,000 chemicals registered for commercial use. We are exposed to these chemicals daily, be it at work, in household products, in the environment, as well as food and cosmetics. As an alarming result, high levels of common toxicants, like bisphenol A and phthalates can now be detected in urine and blood analysis of not just adults, but children too.
While only a handful of research groups worldwide are addressing the cause and effect of lifestyle and chemical exposure to human infertility and epigenetic inheritance, it is becoming increasingly that a father’s way of life plays a vital role in determining his child’s development and health. As such, Kimmins suggests that, “Men should become more involved in pre-conception planning and young men must be educated that their choices today may influence health beyond their own.”
Unravelling a Mystery
Epigenetics as a possible cause for male infertility
One of the common problems subfertile couple faced is the issue concerning sperm quality and quantity. In the past, male issue had deemed to be responsible for 15-20% of the reason for subfertility. However, over the last 10 years, this issue had become more prevalent and it is estimated that around 40-50% of couples are suffering from male fertility issues.
A recent study in French men between 1989 and 2005 found a significant widespread declines in sperm quality , with average sperm counts falling while percentages of abnormally formed sperm rose. These findings are a “serious public health warning,” the authors wrote. The same findings were observed world wide suggesting a global decline in male fertility.
What can possibly be the culprit causing such decline? Could it be the air we breathe? Could it be the water we consume? Could it be the pesticides, fertilizers, genetically modified food and etc?
There is no straightforward answer to this.
According to a 2011 study called Starting Families Asia, which surveyed 1000 women from 10 countries (including Malaysia), there is a widespread lack of knowledge about male fertility issues throughout Asia. The study showed that, “51% of women do not know that a man may be infertile even if he can achieve an erection, and 49% do not realise that a man may be infertile even though he produces sperm.”
Despite the lack of awareness, male infertility is a common problem, affecting 1 in 20 men. And among married couples struggling with infertility, 40% of the cases may be attributed to the man. Though it has been extensively studied, male infertility remains a complex problem and the underlying causes are usually unknown. However, a study by researchers at the University of Southern California (USC) has suggested that the underlying cause for male infertility is epigenetics – the way that DNA is processed and expressed.
The consequences of epigenetic modification
Epigenetics are processes that alter gene activity, without changing the DNA sequence. They have a vital role to play in the body’s many processes, including those involved in conception, such as implantation, placentation and fetal growth. When these epigenetic processes are modified, due to genetic and environmental factors, the consequences are usually unfavourable.
To identify the link between epigenetic modification and male infertility, USC researchers studied the epigenetic state of DNA from semen samples of male patients at an infertility clinic. Their findings showed that, “Sperm DNA from men with low sperm counts or abnormal sperm had high levels of methylation. However, DNA from normal sperm samples showed no abnormalities of methylation.”
DNA methylation is the result of biochemical changes that happen during epigenetic reprogramming, and according to Rebecca Sokol, M.D., MPH, Pofessor of Obstetrics and Gynecology at the Keck School of Medicine of USC, “Disturbance of epigenetic programming can result in abnormal gene activity or function, even if there is no change in DNA sequence.”
The findings of this ground-breaking study show that there is a link between epigenetic defects and abnormal semen development. In addition, says Sokol, “It is plausible to speculate that male infertility may be added to the growing list of adulthood diseases that have resulted from fetal origins.”
As the results of this study point to underlying mechanisms that can cause epigenetic changes, the next step is for researchers to identify what causes these changes to sperm DNA. Once they have been identified, we will be one step closer to preventing certain types of male infertility. At present, it is believed that one of the possible causes of epigenetic alterations is chemical exposures. It has even been suggested that exposure to chemicals as a fetus may lead to adult diseases.
A journalist who came to interview me a few years ago asked me a question: ‘What makes you become interested in reproductive science and inspired you to become a Fertility Specialist?’
I was quite taken aback by this question. I knew where this question was coming from: Being a daughter of a Professor in Chinese Literature, one who had thought that I would end up in field related to Sociology, Literature or Humanity. A doctor and a Fertility Specialist from such family, hmmm….an unlikely species.
I searched my mind long and hard, everyone who knew me knows that I have a passion for literature and social science. But why reproductive science? And why Fertility?
The answer became clear suddenly: I have the privilege to know a couple who was my parents’ neighbours and friends, whom I have have fondly called Uncle Chong Lek & Aunty Sam. This couple are both Professors in the field of Genetics. At the age of 9, I used to listen to Uncle Chong Leh and Aunty Sam, who came to join us for a meal or a tea, and shared on their field of research and findings. I was fascinated and in awe, even at the tender age of 9.
How fascinating it is that we are governed by our genes which determined how we look like or the colour of our skin? How did these DNA coding became the essential aspect of life forms ?
At that time, we have not discovered the secret of nurture versus nature in modifying our gene expression.
As I progressed in pursuing my acaedemic advancement, I find myself becoming more and more inclined to science related subjects. I was, genetically inclined to arts, but an exposure to this lovely couple had altered my genetic expression…..I became who I am, a doctor, then a Gynaecologist and then a Fertility Specialist, who works closely with scientists. Being involved in Fertility work, my practice is closely related to understanding of chromosomes and genes.
Nature or nurture?
An introduction to epigenetics
Many people believe that children are more the product of nurture than nature, meaning that the environment in which a child is brought up in has a greater effect on his or her well-being, personality and traits than the child’s genes. Yet, there are those who believe that a child’s inherent nature can’t be changed, despite the amount of nurturing received. Now, however, this debate has become academic, enter – epigenetics.
What is epigenetics?
Epigenetics is a new and complex science that looks at how lifestyle and environmental factors can affect a baby’s genes. In particular, it studies how the millions of markers in our genes can change our traits at a cellular and physiological level. Although the sequence of the genes we’re born with can’t be changed, it is believed that the way that they’re activated or expressed can be altered – for better or for worse. Furthermore, it is possible that these traits can then be passed down by an individual through the generations.
How it affects IVF patients
Most IVF patients who receive donated eggs and sperm feel that their baby won’t be taking much after them, as they don’t share the same DNA. However, according to epigenetics, this doesn’t have to be the case. In epigenetics, factors such as the uterine environment, stress levels and pregnancy diet can have a direct influence on the way that a baby’s genes are expressed. Therefore, in epigenetics, it is thought that IVF patients have a degree of control over how their egg/sperm-donor child might turn out, if they adopt healthy lifestyle choices.
But can the IVF procedure itself cause negative epigenetic consequences? According to a small Danish study conducted in 2010, it is possible. The study suggested that, “Babies born via assisted reproduction (i.e. IVF) had a slightly higher chance of getting childhood cancer.” As alarming as it sounds, the study was inconclusive and the risk appears to be minimal at best.
The importance of eating well
Through the decades, scientists have established a link between a healthy maternal diet and the well-being of babies. However, the effects can also be seen in reverse. For example, during the Dutch famine of 1944, thousands died of malnutrition due to Nazi blockades and a prolonged and harsh winter. The babies born during this period were not only underweight, but their genes were damaged.
Decades later, the Dutch Famine Birth Cohort Study would reveal that the offspring of children who were born during the famine were equally susceptible to being underweight and contracting illnesses like diabetes, obesity, cardiovascular disease and microalbuminuria. It is as if their genes had been ‘programmed’ with the adverse effects of malnutrition.
A greater power
Although epigenetics is yet to be scientifically proven, it certainly offers promise. True, it can’t be said for certain that the positive lifestyle changes you adopt before and during pregnancy can influence your baby’s genes. However, science notwithstanding, parents who have struggled to conceive possess a greater, innate power that rivals nature itself – love. And this love, coupled with positive thinking, has been known to conquer and surmount the greatest of odds.
Some of you may have known that one of my interest in the field of Fertility is the impact of Nutrition on Fertility & Pregnancy.
Some of the research work which I am involved in surrounds this unique aspect of Fertility.
Recently, I was invited to speak to a group of O& G and Paediatric doctors on this topic. The most interesting thing is that I was asked to speak on a platform erected on a beach and my dress code was white and a flower in my hair!!!! So, the picture above was definitely NOT a singing contest but a actual scientific lecture.
I had lots of fun researching for the talk and here is some of the interesting findings I wish to share about Nutrition and Pregnancy:
The Importance of Nutrition
Lessons from the Dutch Famine Birth Cohort Study
In this post, I’ll discuss another topic related to fertility and nutrition – the findings of the Dutch Famine Birth Cohort Study. Prior to the study, very little was known about the role and effects of a maternal diet on a baby’s health. However, using the medical records collected during the famine, scientists have been able to measure the adverse effects of fetal malnutrition.
Background of the Study
The Dutch famine of 1944, also known as “Hunger winter,” was a famine that took place in the Nazi-occupied part of the Netherlands. Affecting some 4.5 million people, the famine was caused by the shortage of food supplies in the Netherlands towards the end of World War II. Although the Allied Forces had liberated the south, their efforts to free the western parts of the Netherlands were repeatedly thwarted, worsening the situation.
This was followed by the Nazi embargo on all food transport to western Netherlands and the onset of an unusually early and harsh winter. During the period, which lasted until the Allies liberated the area in May 1945, rations were as low as 400-800 calories a day. This is less than a quarter of the recommended adult caloric intake. Though estimations vary, as many as 22,000 people are believed to have died due to the famine.
The Dutch Famine Birth Cohort Study was conducted by the departments of Clinical Epidemiology and Biostatistics, Gynecology and Obstetrics and Internal Medicine of the Academic Medical Centre in Amsterdam, in collaboration with the MRC Environmental Epidemiology Unit of the University of Southampton in Britain. They based their study on the antenatal and maternity records of babies born at the Wilhelmina Gasthuis in Amsterdam between November 1943 and February 1947. The first results of the study were published in 1976 and the study is still ongoing.
Here is a summary of some of their findings:
The most well-known survivor of the Dutch famine is perhaps Audrey Hepburn. Often admired for her gamine figure, Hepburn spent her childhood in the Netherlands during the famine. Throughout her life, she suffered from a series of health problems, including anemia, respiratory illnesses, edema and clinical depression, which were attributed to the malnutrition suffered in her early years.
The Dutch famine study has shown us that poor maternal nutrition during gestation can have detrimental effects on the health of children and even subsequent generations. Therefore, we cannot ignore the importance of maternal nutrition during pregnancy, especially in preventing chronic degenerative diseases in future generations. We must also be wary of the possible detrimental consequences of undernourishment in mothers due to unbalanced diets, rigorous fasting and severe morning sickness, especially during the first trimester.
The link between Vitamin D and fertility
Caucasian women love showing off a sun-kissed tan, so much so they would dedicate a good portion of their holidays to sunbathing. We Asian women, however, are the exact opposite, preferring to keep out of the sun, sometimes taking considerable pains to do so. This aversion to the sun is largely due to the desire to maintain a fair complexion, but is driven in part by concerns over harmful UV rays. This penchant for shunning the sun, however, has had an undesirable side effect on Asian women, as we are known to have lower levels of Vitamin D despite living in tropical climates.
Few people realise that vitamin D plays a significant role, not only in their general health, but their fertility as well. It has been shown that people living in countries with strong seasonal contrasts have always had fewer pregnancies during winter and more in summer, resulting in a baby boom around spring. Scientists have discovered that this ebb and flow has to do with exposure to the sun.
Over the years, this link between Vitamin D and fertility has been extensively investigated, but it has been further detailed in a systemic review published in 2012 by the European Journal of Endocrinology. The review, by Elisabeth Lerchbaum and Barbara Obermayer-Pietsch from the Medical University of Graz, Austria, assessed studies that evaluated the relationship between vitamin D and fertility in women and men, as well as in animals.
Here’s what the review, entitled ‘Vitamin D and fertility: a systematic review,’ found:
While the results are encouraging, the researchers emphasise that vitamin D supplementation alone can’t improve fertility issues. However, what is certain is that it is a safe and inexpensive treatment that can be a boon to conception. So if you’re trying to conceive, don’t shy away from the sun! Instead, aim to get about 15 minutes of sun each day and take care not to overexpose yourself to UV rays.
In my next post, I’ll be discussing another topic related to fertility and nutrition – the findings of the Dutch Famine Birth Cohort Study. Stay tuned!
The importance of micro-nutrients to conception
The adage goes, “You are what you eat,” and the same is true for fertility. But when you’re trying to conceive, you want to rely on much more than just an old saying. Statistics show that around 11% to 20% of couples experience subfertility. Of this, 10% can be classified as unexplained infertility, while 60% are classified as anovulatory subfertility. In my experience, couples today also find their infertility issues compounded by their hectic lifestyles.
Factors such as stress; unhealthy body weight; excessive smoking, alcohol and caffeine intake; exposure to toxins, as well as recreational drug use, can all play a role in affecting fertility. But even those who maintain a healthy weight, manage their stress and abstain from unhealthy habits may neglect a very important factor – nutrition. Fortunately, there is now hard evidence in the form of scientific proof that shows you can indeed improve your fertility by eating right, particularly by including micro-nutrients in your daily diet.
While macro-nutrients, like protein, unsaturated fats and carbohydrates can be easily obtained from the foods that you eat, micro-nutrients like vitamins, minerals and trace elements are often left out due to an unbalanced and unhealthy diet. Realising that micro-nutrient deficiencies are not uncommon in women of reproductive age, Dr Rina Agrawal, a consultant and associate professor in reproductive medicine and obstetrics/gynaecology at the University Hospital at Warwick University, conducted a study on the role of micro-nutrients in improving pregnancy rates.
The study, which involved 58 suitable candidates consisting of subfertile women with an average age of 32.3 years (range 19–40), investigated whether subfertile women undergoing ovulation induction using standard treatment regimens have higher pregnancy rates when given multiple micro-nutrient (MMN) nutritional supplements, as compared with folic acid alone. The findings of the pilot study unveiled that the women on MMN supplementation had a higher pregnancy rate of 66.7%, as compared with 39.3% for those on just folic acid.
This therefore suggests that additional MMN supplementations, such as vitamins B6, B12, folates, vitamin E, multivitamins, iron, zinc, copper and selenium, does improve female fertility. In addition to finding that the women on MMN supplementation had a higher chance of pregnancy compared to their peers, the women on MMN supplementation also required significantly fewer attempts to become pregnant, as compared with women on folic acid. But there are also other benefits to taking MMN supplements, including reduced reproductive risks ranging from infertility to miscarriage, and fetal structural defects to improved embryogenesis or placentation.
You may need only small amounts of micro-nutrients, but they are no doubt essential. Each vitamin and mineral plays a specific role in ensuring that your bodily systems function in top form, and needless to say they are vital to your overall wellbeing. In order to get more micro-nutrients from your daily diet, you should eat a wide variety of foods from the different food groups. It is also best to avoid eating fast foods and processed foods that are of low nutritional quality. Instead, opt for fresh fruits and vegetables, legumes, nuts and seeds, whole grains, lean meats, fish and low-fat dairy products.
Stay tuned to find out more about foods that can boost fertility.
Are you suffering from Endometriosis and do not know what to do and where to turn to?
Here is some good news:
Selangor and Kuala Lumpur Endometriosis Association (MyEndosis) will be holding an event called ‘MyEndosis Walk: Stand Up, Speak Up, Let’s Unite’ on 28 March 2015 from 7.30am to 11am. The venue is at Concourse area JayaONE, Jalan Universiti, Petaling Jaya & PC 203, Faculty of Creative Industries, UTAR, No 3, Jalan 13/6, 46200, Petaling Jaya.
Come and join us to stand up and unite against endometriosis