What do mental health, HIV, and erectile dysfunction have in common? These are just some well-known medical conditions that are still highly stigmatised. Why are some medical conditions stigmatised and how did some of them manage to break the stigma? Upper GI and Bariatric Surgeon Dr Reynu Rajan shares her experience dealing with bariatric patients in the face of weight-bias and discrimination, while Fertility Specialist Dr Helena Lim shares what it’s like to help patients overcome the taboo of infertility.
Parenting Adventures is about brutally honest discussions in the world of parenting. In this sixth episode, we explore the subject of infertility. How do couples recover from the grief of knowing they may never have children? Why are they not open to the option of adopting or using a donor? We find out from a fertility specialist and, we will also hear from someone who didn’t take her infertility diagnosis as the final result, and did everything she could to become a mother.
Do click on this link to hear the podcast:
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.
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.
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:
- Vitamin D receptors (VDR) and vitamin D metabolising enzymes are present in the reproductive tissues of both men and women.
- Laboratory mice deprived of VDR tend to suffer significant gonad (sex gland) insufficiency, decreased sperm count and motility, and abnormalities in the microscopic structure of tissues in the testis, ovary and uterus.
- Vitamin D is involved in female reproduction including IVF outcome (clinical pregnancy rates) and polycystic ovary syndrome (PCOS).
- In PCOS women, vitamin D supplementation might improve menstrual frequency and metabolic disturbances.
- Vitamin D might influence steroidogenesis of sex hormones (estradiol and progesterone) in healthy women.
- In men, vitamin D is positively associated with semen quality and androgen status.
- Vitamin D treatment might increase testosterone levels.
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!