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For thousands of years, infertility was considered a female problem. The word “barren” sounds almost comical now but was a commonplace label a century ago. In The Cottage Physician, written at the end of the 19th century, a section entitled “Barrenness” lists possible causes, including “want of tone or strength in the system” and “nervous debility.” Treatments included “cold bathing, general tonics or strengtheners to the system, electricity applied locally” as well as “abstinence from sexual indulgence for a time.” Fortunately, medicine has progressed considerably since then and the diagnosis and treatment of infertility have improved dramatically. But the misconception that it’s solely a female problem has persisted.

About 40 percent of infertility is due to a male factor. Unfortunately, many couples and even doctors neglect to evaluate the male partner – leading to unnecessary testing on the female as well as needless anxiety, cost, and delay in starting a family. So don’t forget to have a basic sperm analysis and even an extensive one before you waste more time then is necessary. I have seen plenty of women go through this process for years before getting these tests done and discovering it had nothing to do with them!

Source: Dr. Jon LaPook

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A new study from the University of Texas Health Science Center has confirmed that the hormone melatonin plays an essential role in reproductive health.

Melatonin is a hormone that your body produces during darkness. It is not produced during daylight hours or when your lights are on. Melatonin helps to regulate your day-night biorhythm and is a powerful antioxidant.

In addition, melatonin has a direct on your ovarian function.

Authors of the study concluded: “Melatonin could become an important medication for improving ovarian function and oocyte [egg] quality, and open new opportunities for the management of several ovarian diseases.”

An earlier report from the St. Louis University School of Nursing said that light exposure may affect menstrual cycles and symptoms through the inhibition of melatonin. The also said that women with PCOS may have a greater vulnerability to the influence of light-dark exposure.

What does all this mean?

It means that adequate melatonin production during darkness could improve the functioning of your ovaries, and possibly also improve the quality of your eggs.

People who are “night owls” and leave the lights on until late at night are less likely to produce enough melatonin. Nightly melatonin production is also reduced if you turn on the lights when you get out of bed to go to the bathroom.

Melatonin production is enhanced if you sleep in total darkness.

It’s quite important to get to bed at a reasonably early hour, in a very dark room. You want to give your body a chance to start producing melatonin.

Getting a good night’s sleep in total darkness should be an integral part of your strategy for dealing with PCOS.

Ask your doctor about supplemental melatonin. It is available in the United States without a prescription.

Sources:
Tamura H et al, Melatonin and the ovary: physiological and pathophysiological implications, Fertil Steril. 2009 Jul;92(1):328-43
Barron ML et al, Light exposure, melatonin secretion, and menstrual cycle parameters: an integrative review, Biol Res Nurs. 2007 Jul;9(1):49-69

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Thyroid has a lot to do with our fertility and ovulation.  I have posted some information here regarding the variety of thyroid conditions.  This is a standard test that should be done to rule out this possibility, however there is a thyroid antibody test that is rarely done.  I myself am someone who has been affected by this condition. It has taken me almost 3 years and 2 miscarriages to figure this out.  I just happen to ask about getting my thyroid antibody test done and it came back positive.  So do your research and ask for all the tests, you never know!  This is the last place I suspected to find the answers.

Hyperthyroidism – or having an overactive thyroid gland – can pose special concerns during pregnancy. When the body delivers too much thyroid hormone, both the mother and the baby can suffer. Miscarriages, premature births, and intrauterine growth retardation can occur when the disorder goes undiagnosed or untreated. Pregnant women with hyperthyroidism can also develop high blood pressure, and are at greater risk of heart conditions.

While a thyroid condition can sometimes complicate the process of getting – or staying – pregnant, the good news is that when your disease is properly managed, most of you with thyroid conditions — whether hypothyroid or hyperthyroid — can have a safe, uneventful pregnancy and delivery. Taking your medications, keeping your thyroid levels — including TSH and T4 — under control, getting regular care with a specialist familiar with treating pregnant thyroid patients, and taking charge of your own health appears to be key to a successful outcome.

In some cases, pregnancy can actually lessen the symptoms of thyroid disease, and you may be one of the many women who enjoy a nine-month respite from some of the undesirable effects of thyroid conditions.

If I could urge women with thyroid disease who are contemplating pregnancy to do one thing, it would be to become educated about how thyroid dysfunction can affect fertility and pregnancy – and what to do about it. Read all you can, ask questions, and urge your doctors to perform the necessary blood tests to keep your levels in check.

Will my thyroid disease hamper my ability to get pregnant?

Sometimes – but certainly not always – thyroid disease can affect your fertility. According to Dr. Sheldon Rubenfeld, a practicing thyroidologist, and Founding Chairman of the Thyroid Society for Education and Research, fairly common problems caused by thyroid dysfunction are anovulation (no ovulation, or release of an egg) and menstrual irregularities. With no egg to fertilize, conception is impossible.

Thyroid dysfunction can halt ovulation by upsetting the balance of the body’s natural reproductive hormones. One way to tell if you’re ovulating is to test the level of a pituitary hormone called LH (or luteinizing hormone) by using an ovulation predictor kit. LH stimulates the ovaries to release an egg. The kit will show you if you have that surge in LH that indicates ovulation. If there is too much or too little thyroid hormone, ovulation might not occur. Remember…even though you may be menstruating regularly, you may not be ovulating – and may never know that fact until after years of infertility.

In addition, some women experience a short luteal phase. The luteal phase is the timeframe between ovulation and onset of menstruation. The luteal phase needs to be of sufficient duration — a normal luteal phase is approximately 13 to 15 days — to nurture a fertilized egg. A shortened luteal phase can cause what appears to be infertility, but is in fact failure to sustain a fertilized egg, with loss of the very early pregnancy at around the same time as menstruation would typically begin.

Dr. Rubenfeld said that “the mechanisms by which thyroid problems interfere with fertility are often unknown, but there is no question that other aspects of thyroid function affect fertility.” For example, Dr. Rubenfeld said that hypothyroidism can cause an increase in prolactin, the hormone produced by the pituitary gland that induces and maintains the production of breast milk in a post-partum woman. Excess prolactin has a negative effect on fertility – sometimes preventing ovulation, or sometimes causing irregular or absent monthly cycles.

The increase in prolactin may be caused by an elevation of a hormone from the hypothalamus called TRH (or thyrotropin releasing hormone) that stimulates the pituitary gland to send out both prolactin and TSH.

Some women with hypothyroidism also have polycystic ovaries, or cysts on the ovaries, which hamper ovulation and can cause fertility problems as well.

This all sounds pretty grim. Should I even bother trying? What can I do to maximize my chances of getting pregnant?

Yes, you should bother trying – there are many, many success stories (I happen to be one of them, as it only took a few months to get pregnant with my daughter). You shouldn’t go into this thinking it’s going to be a long, arduous process. But attempting pregnancy with a thyroid condition may require a little preparation.

First of all, talk to your doctor about when you should attempt conception. Many doctors think TSH levels of 3, 4, or even 5 may acceptable to try to get pregnant. But research suggests otherwise. In 1994, a study in the Journal of Clinical Endocrinology and Metabolism looked at pregnant women with thyroid antibodies and TSH in the normal range. The study found that women with autoimmune thyroid disease had TSH values significantly higher, though still normal, in the first trimester than in women with healthy pregnancies used as controls.

The higher TSH level of the women with autoimmune thyroid disease? 1.6.

The normal TSH level for the control group of pregnant woman without autoimmune thyroid disease? 0.9. A TSH of .9 is a far cry from the so-called “normal” TSH levels of 3 or 4 or 5 that some doctors feel are no impediment whatsoever to getting — or staying — pregnant.

My endocrinologist at the time I was trying to get pregnant believed very firmly that most women with a thyroid problem should be maintained at a TSH level of between 1 and 2 in order to help them get pregnant — and maintain the pregnancy.

Second, ascertain whether you’re ovulating. An excellent, empowering book is Toni Wechsler’s Taking Charge of Your Fertility.. You can learn how to use basal temperature and other fertility signs to chart your monthly hormonal cycle. You can also use an over-the-counter ovulation predictor kits, available for around $10 at the drugstore, to confirm ovulation. Or the more expensive ovulation predictor electronic devices can also be used.

What if I can’t get pregnant, but my thyroid tests “normal?” Or what if I test positive for “antibodies?”

Some women who have fertility problems actually have underlying autoimmune thyroid problems, but they and their doctors are not aware. If you or someone you know is having difficulty getting pregnant, or is suffering recurrent miscarriage, thyroid antibodies should be tested.

Many doctors do not appear to know about this link between antibodies and infertility, yet it is published in conventional research journals. The respected journal Obstetrics & Gynecology reported that the presence of antithyroid antibodies increases the risk of miscarriage. And according to U.S. research reported in the Journal of Clinical Endocrinology and Metabolism, that risk of miscarriage can be twice as high for women who have antithyroid antibodies.

Researchers have also demonstrated that antithyroid antibodies can cause greater difficulty conceiving after in vitro fertilization, regardless of whether or not there are clinical symptoms of hypothyroidism. The researchers had greater success in achieving successful pregnancies when they gave low doses of heparin (an anti blood clotting agent) and aspirin and/or intravenous immunoglobulin G (IVIG) to women who had antithyroid antibodies.

Thyroid INFO by Mary Shomon

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Correction: Sleep-deprivation linked to infertility. (I had a feeling that would get your attention.) Did you ever consider that? How could you with all the other things to worry about:
You’ve cut down on alcohol, caffeine, and even processed food.

You’ve scheduled more time to relax and tried to reduce the stress in your life.

You’ve started a consistent exercise routine and detoxified your house.

You’ve charted your monthly cycle, bought ovulation kits, and still…nothing.

But you’ve overlooked one very important element: sleep, which you don’t get enough of.

The word “infertility” can quickly generate a response, especially among the 10 percent (more than 6 million) of women struggling with it. The topic routinely graces the covers of magazines and academic health reports.

Lately, the talk about toxins in our food, water, and air have been blamed for increasing the likelihood of infertility. But what if it’s much simpler than that? What if infertility can be partly blamed on how many hours of sleep you get a night. OR hours you don’t get?

A new report puts the spotlight on exactly this issue. The highlights:

  • Missing your required number of sleep hours a night can impact your ability to conceive.
  • The average woman (30 to 60 years old) gets only 6 hours 41 minutes of sleep during the work week, according to the National Sleep Foundation, when she really needs 7 to 9 hours.
  • Sleep has a powerful influence on the body’s hormonal system, which controls a woman’s cycle and regulates ovulation.
  • Too little sleep leads to low leptin levels, the hormone responsible for appetite and which can impact ovulation.
  • Insomniacs have a significantly higher level of the stress hormones cortisol and adrenocorticotropic, both of which can suppress a healthy fertility cycle.

The take-home message is clear: you could be doing “everything right” when it comes to preparing your body to conceive and bring a healthy baby to term. But with so much focus on external factors like your environment and what you put in your mouth, the time has come to add another aspect to this big equation: sleep.

All the healthy, pure food in the world and all the attention to getting your body into tip-top prenatal shape won’t cure a hormonal system gone awry from missing sleep. So if you’re thinking of having a baby, put sleep on the list. At the top. And if you’re going to worry about your environment, remember to also think about the one in the bedroom.

Article by Michael J. Breus, PhD, DABSM

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They were surprised to discover new research indicating that nearly three of every four women with PCOS may have vitamin D levels that are below optimal. The Medical University of Graz in Austria studied 206 women affected by PCOS and found that 72.8% had insufficient vitamin D levels.

The most common treatment for polycystic ovarian syndrome is birth control pills or metformin. The issue of vitamin D adequacy is rarely if ever discussed.

Yet vitamin D is needed to help you reduce insulin resistance, which is thought to be a primary cause of PCOS. Vitamin D is also necessary for a multitude of functions in your body, including bone health.

Moreover, another report from the Royan Institute in Iran suggests that PCOS women have some genetic variation that affects how effectively vitamin D functions in the body.

It’s possible that these genetic variations may contribute in some way to insulin resistance and PCOS. The researchers said: “The findings of the present study indicate that genetic variation in the vitamin D receptor may affect PCOS development as well as insulin resistance in women with PCOS.”

The Austrian study reported a close association between metabolic syndrome, PCOS and low vitamin D. Metabolic syndrome has a lot of overlap with PCOS.

A few common symptoms of metabolic syndrome are large waist circumference, high waist-to-hip ratio, high blood pressure, high blood sugar, insulin resistance, and high blood fats. In this study, women with PCOS who also had metabolic syndrome also had the lowest vitamin D levels.

The bottom line is that if you are overweight, have insulin resistance or metabolic syndrome, it’s highly recommended that you get a vitamin D blood test. You could also take a supplement formula that contains a good level of vitamin D, such as d-pinitol. A small study from Aristotle University in Greece showed favorable results in treating overweight PCOS women with vitamin D.

What if you are lean? Your need for vitamin D may be less than for someone who is overweight. But who knows? Regardless of your weight, it’s wise to get a vitamin D blood test and find our where you stand.

Sources:
Wehr E et al, Association of hypovitaminosis D with metabolic disturbances in polycystic ovary syndrome, Eur J Endocrinol. 2009 Jul 23. [Epub ahead of print]
Mahmoudi T et al, Genetic variation in the vitamin D receptor and polycystic ovary syndrome risk, Fertil Steril. 2009 Jun 5. [Epub ahead of print]
Kotsa K et al, Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome, Fertil Steril. 2008 Oct 16

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Is fertility treatment really the emotional roller coaster I keep hearing about?

For most people, it is. While undergoing fertility treatment, many couples tend to live in month-to-month cycles of hope and disappointment that revolve around ovulation calendars and menstruation.

As they navigate a tight schedule of tests and treatments, they place their lives on hold — postponing vacations, putting off education, and short-circuiting their careers. Others find that the sorrow, anger, and frustration that can come with prolonged fertility problems invade every area of life, eroding self-confidence and straining friendships.

Realize and accept that you and your partner will have some ups and, most likely, a great many downs as you deal with your fertility problem. Examine your commitment to becoming parents and consider joining a support group if you decide to go ahead with treatment. Connecting with others in your situation is extremely important!

Why do women seem to suffer so much more than their male partners?

Most women are raised to think that they’ll become mothers someday. From the first baby doll to the last baby shower, girls and women are surrounded by images and expectations from parents, peers, religion, advertising, and the media.

For some women, motherhood is a large part of their self-image as a female. For others, it’s their highest ambition. Even women who don’t necessarily want to become mothers are aware of social expectations to do so.

The pressures to marry and raise a family can be enormous — to the extent that women who are unable to do those things can feel as though something must be deeply wrong with them or sorely lacking in their lives.

Men are not pressured in the same way to become fathers. And many men are brought up to repress their feelings or at least keep them to themselves.

A man may be feeling similar frustration and disappointment as he and his partner go through yet another treatment and yet another month without a pregnancy. But many see their role as being strong for their partner. Or they may be so used to holding in their feelings that they don’t know what they feel or that they can ask for help.

If the fertility problem is clearly his, such as poor sperm quality, then a man’s image of himself can start to suffer.

Studies show that, as a group, women with fertility problems are as anxious and depressed as women with cancer, heart disease, or HIV. One reason for this may be the physical demands of fertility treatments — blood tests, pills, daily hormone injections, ultrasounds, egg retrievals, and surgery can all be a source of stress and emotional upheaval in women.

Also, society often fails to recognize the grief caused by infertility, so people denied parenthood tend to hide their sorrow, which only increases their feelings of shame and isolation.

Our love life seems so mechanical now. Does this happen to other couples?

Yes. Many couples say that once they start worrying about having a baby, sex becomes more of a chore than a pleasure. Most fertility treatments require you to make love at very specific times — hardly an ideal way to set the mood for romance or enjoy sexual spontaneity.

If you find your sex life deteriorating and yourselves unable to remember the meaning of romance, take a break from your treatment regimen for a month or two and try to revive the love and fun that brought you together in the first place.

Keep in mind that this crisis is temporary — sooner or later, it will be resolved, and once it is, you’ll want to continue a healthy, fulfilling sexual relationship with your partner. For now, if difficulties persist, consider couple’s therapy with a counselor who has experience with fertility issues. Look for a referral through RESOLVE, the American Society of Reproductive Medicine, or the InterNational Council on Infertility Information.
Learn how to avoid the most common pitfalls for couples facing fertility problems.

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We hope you’re not consuming a lot of saturated animal fats and milk products containing saturated fat. But if you are, they could be causing problems for your brain function, according to recent studies.

A study from the University of Kuopioin in Finland found that higher saturated fat intake from milk products and spreads during midlife may be associated with poorer cognitive function, increased risk of clinical mild cognitive impairment later in life, and poorer memory.

The saturated fat issue is one reason why you won’t find milk products in our recommended diet in The Natural Diet Solution for PCOS and Infertility.

In the Finnish study, those who consumed fish and polyunsaturated fats (oils from plant material and fish) had better cognitive function and memory.

Another study, from Brigham and Women’s Hospital in Boston, showed that “higher intakes of saturated and trans fat since midlife…were each highly associated with worse cognitive decline” in women with Type 2 diabetes. (Since diabetes is an end point for a significant proportion of women with PCOS, this information may apply to you.)

For more information about saturated fats and trans fats, please refer to Section 6 of our PCOS diet book.

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