Breaking 7 Fertility Myths

While infertility is getting increasingly common today, we still tend to take issues around it for granted. A common misconception is that infertility gets cured on its own. This is generally why we refrain from breaking inertia and opting for enhanced life-style choices. Listed below are 7 such myths that need to be over-ridden in order to better combat the problem of infertility.

1. Male fertility is independent of age
Fueled by the fact that couples tend to give lesser importance to male infertility, it often goes unnoticed when an age-related issue arises. In addition to deterioration in semen volume itself, post 40 there is progressive decrease in both sperm quality and its ability pass on healthy genes.

2. You are fertile as long as you are getting pregnant.
Secondary infertility is often experienced by couples seeking to have a second child or ppl having infertility after one conception. A history of good fertility rates in one’s family or previous records of one’s own fertility need not necessarily mean that infertility is alien. Progressive degeneration of both eggs and sperm need to be checked for.

3. Weight and fertility are not linked
Women who are over-weight do conceive and therefore couples battling infertility under-mine the implication of those extra-pounds. However, lesser known is the fact that being overweight causes hormonal imbalances in both men and women. Every 5-10% weight gained leads to a recorded drop in fertility. For women battling ovarian cysts, weight reduction is often all it takes to conceive that bundle of joy!

4. A woman’s egg reserve does not diminish till 40
Women only have as many as 400-500 ovulating eggs in a lifetime despite having a reserve of thousands at puberty. The ovarian reserve decreases with age. While the reserve undergoes a loss of about 10% in late 20’s, in 30’s women often have about 15% chances of a healthy pregnancy. By the age of 35, a woman’s chances of having a baby is a meek 10% which is further reduced to 5% at 40.

5. Smoking does not affect fertility
Both active and passive smoking are risk factors for infertility. Researchers have proven that smokers experience infertility issues twice as often as non-smokers do. Besides a drop in sperm count, men who smoke tend to pass on mutated genes more often than men who do not smoke. In women, smoking causes a steep drop in egg reserve and leads to pre-mature menopause.

6. Infertility Runs In Family.
Infertility is not hereditary. However, there are medical conditions that are hereditary which may interfere with your ability to get pregnant. Some types of fertility problems can be hereditary. Endometriosis is one female fertility problem that can be hereditary. Generally speaking, fertility problems tend to have more to do with lifestyle factors than with heredity or genetics. The most severe fertility problems cannot, by definition, be passed on, because there are usually no children to which the problem could be passed.

7. How position affects conception
Whilst semen inevitably comes out of the vagina following an ejaculation, sufficient sperm is deposited in the neck of the womb which then heads towards the egg, regardless of the sexual position.

The silver lining is the fact that it is never too late to make wellness a way of life. The key is to accept the facts about one’s body and embracing realistic solutions for the same. Small changes in your day-to-day lifestyle can go a long way in preventing fertility problems.

Microsurgical Epididymal Sperm Aspiration

What is it?
Under direct observation, a special needle is used to aspirate viable sperms from the epididymis instead of the testis. Like TESE this is a useful adjunct to IVF and in particular to ICSE. Alternatively it can be done to extract sperms which can be kept refrigerated and used later. Cryopreservation offers the benefit of repeat procedure, should the IVF fail.

Who requires it?
Men with obstruction of the male reproductive tube – congenital or acquired. congenital absence of the Vaz deferens on both sides is a good indication. Acquired causes may be due to infection, injury, previous failed spermatic duct recanalization or failed duct – epididymis recanalization (called vasoepididymostory). Iatrogenic causes may be traceable bladder neck, pelvic, abdominal or inguino-scrotal surgery.

What is the rationale of using TESE?
It was a general conclusion that in a normal male the sperms undergo a certain amount of maturity, mobility and fertilizing capacity before proceeding to the Vaz deferens. However, recent research has shown that in reproductive tract obstruction, good quality sperms are available in the upper part of the epididymis. Microscopically and functionally y they are as good as the sperms of the testis and can be aspirated and used for IVF. However the same cannot be said for the distal epididymis. Here the sperms undergo destruction and plenty of macrophages can be found in histology. These observations become important while selecting the site of sperms aspiration during MESE.

Why it is preferred to donated sperm? Compared to a donor sperm, it is always preferable to have the husband’s sperm if the morphology is ok.

Are there any problems with this procedure?
This is a minimally invasive procedure done using an operating microscope. Only a tiny segment of the epididymis is sliced (called micropuncture) to extract sperms. In comparison a bit of testis tissue is removed in TESE. In MESE, amount of blood contamination of the epididymal fluid is minimised due to the micropuncture. This improves the fertilizing quality of the sperms.

MESE procedure: A tiny surgical incision is made in the scrotum and the testis is first identified. The epididymis is then identified – this is located above and behind the testis. Using an operating microscope , a micropuncture is made on the tubule in the upper part of the epididymis. Epididymal fluid is gently aspirated. The aspirate is immediately handed over to the embryologist who immediately examines the same under the microscope and confirms adequacy and good quality of sperms (sperm count and motility). It optimal amounts of sperms of the right quality is not found, the efferent ductules can similarly be approached through micropuncture. This is one advantage on the procedure. Similarly only a few microliters of fluid is required to harvest the sperms. Hence the procedure can be considered minimally invasive.

Sexually Transmitted Diseases

Sexually Transmitted Diseases (STD) have an influence on your fertility levels on many levels. While the ability to conceive itself is disturbed, the health of the child is also affected. Here are pointers on how you could reduce risk factors as a pregnant STD patient-

• Seeking the right treatment while pregnant could as much as bring down the chances of your infant developing STD from 25%-2%.

• Pelvic Inflammatory Disease (PID ), a consequence of other sexually transmitted diseases can be avoided when you treat the initial intense discomfort caused.

• Chlamydia, has long term side effects, if left untreated. It not only affects your health, but also that of your baby.

• Neonatal Herpes Infection, a serious illness can be life threatening. While most women with herpes do not transmit neonatal herpes to their children, if you or your partner has genital herpes, it is important to inform your doctor about your risk.

• Symptoms of Gonorrhea include bleeding after sex and yellow or bloody vaginal discharge which can inflame the pelvic area, causing epididymitis. This is known to hamper your conception.
Women tend to be at the risk when it comes to STD. Therefore, most doctors agree that a pre-conception STD test is essential to check for undiagnosed STD from the past and to see if any unknown damage could impede the woman’s chance of getting pregnant.

Menstrual & Uterine Cycles

The menstrual cycle is entirely hormone driven and controlled by the ovaries and it is superior to the pituitary gland. It is not advisable to attempt any procedure for stabilization of uterine cycle unless the cause of the problem is known. The end result of hormonal imbalance is always anovulatory cycles. The patient however will present with history of menstrual irregularities and inability to conceive. A brief approach to such a case in terms of diagnosis and treatment is presented here. Specific strategy will depend on the nature of the problem.

If the bleeding is chronic, the patient may show evidence of anemia. This must be treated.
A urine based pregnancy test is done to rule out possible pregnancy as a routine precaution. This is to ensure that in the event of a pregrancy already in progress, the patient is not subject to any further investigation.

Tests to check the number and quality of platelet is done to confirm if the patient is suffering from any coagulopathies. If confirmed, this can be confirmed.

A PAP smear is a simple test to rule out cervical cancer.

Liver function tests and tests for thyroid hormone status can help eliminate these problems and if necessary correct them.

Progesterone, esterogen and prolactin levels may need to be checked. Prolactin level may be
high in a pituitary adenoma. Similarly DHEAS may be high in polycystic ovarian disease.
An endometrial biopsy may be necessary through a D & C procedure, direct hysteroscopy enabled biopsy to understand the histo-pathological status of the uterus. A transvaginal ultrasound may be needed to understand the state of the uterus and ovaries.

Generally, most cases of menstrual irregularities will have a high estrogen level in the cycle and a low progesterone level. Besides estrogen, optimal levels of progesterone at the right time is needed for ovulation. Hence using prepared hormones, the patient is placed on a regime that almost mimicks the normal menstrual cycle. If all other factors are normal, this itself will be sufficient to induce ovulation during the fertility window period. This in essence is the method of stabilization of uterine cycle. Oral contraceptive pills are prescribed with caution and only when the female does not want pregnancy. For couples desirous of a child , the female is given a series of progestin therapy. Cycles should stabilize in three months failing which hysteroscopy and if necessary, clomiphine induced release of eggs may be considered.

Non steroidal anti-inflammatory agents (naproxen, mefanemic acid) may be used to reduce bleeds and also pain if any.

Stages of Menstruation

Menstruation is a monthly occurrence for almost all sexually mature females. Menstruation occurs when the uterus sheds the endometrium (inner nutrition rich mucous membrane of the uterus) in the absence of pregnancy. It happens in women from puberty (between age 11to 15) to menopause (between age 45-50.)
Here is a brief description of the four stages that the endometrium undergoes during Menstruation. The animation graphically represents this process. (The myometrium is a layer of the uterus that consists of uterine myocytes).
Stage of Menses (Days 1-4)
Also known as the bleeding phase, menses is caused due the withdrawal of the ovarian hormones – oestrogen and progesterone at the end of the ovarian cycle. Normal bleeding consists of dead endometrial cells, blood, vaginal cells, mucous from the cervix and other necrotic tissues. Most women bleed for 3 to 5 days.
Stage of Repair (Days 4-6)
Post the menstrual bleeding, for a short duration of about 48 hours the endometrium rests and repairs itself. The endometrium is disorganized and about 1mm thick during this stage.
Stage of Proliferation (Days 6-16)
As estrogen gets produced in the ovary, the endometrium proliferates. It increases in size and thickness. New blood vessels grow from the stumps of the old vessels. Endometrial glands grow bigger although their number remains the same. At the end of the proliferative stage, the endometrium is about 2-3 mm thick.
Women who are being treated to cure infertility undergo ultrasonography to measure the endometrial thickness.
Stage of Secretion (Days 16-28)
Once ovulation occurs, progesterone produced in the ovary increases and the endometrium continues to grow to reach a thickness of around 5-7 mm. Women undergoing ultrasound treatment for Infertility tend to have thickness up to 10 -15mm.
The endometrial glands begin to secrete in this stage, due to which it’s called the stage of secretion. Initially, the secretions get collected in the cells of the glands but towards the last few days of this stage, the secretions are pushed out of the cells and get collected in the endometrial cavity.
Endometrial growth stops from the 22nd day of the cycle as the corpus luteum (the essential lining that grows waiting to nourish a healthy pregnancy) degenerates. Eventually it begins to shrink, after which shedding of the endometrial lining occurs. Thus starts the next menstrual cycle.

Environmental Pollution and Fertility

Decline in semen quality and reproduction has been attributed to changing lifestyle and pollution. However, there have been contradictory reports during the past 50 years.
Studies have shown that constant genetic and evolutionary pressure has led to a decline in spermatogenesis. Semen quality decline in Paris, Italy, Denmark, Norway, Scotland, Belgium, Finland, India and USA has been related to increasing pollutants and industrialization.
Possible causes for semen quality decline are pollution due to physical (heat, radiation) and chemical (halogens, glycols/glycol ethers, disinfectants, organophosphates, pesticides, insecticides, organic solvents, carbon disulphide, dibromochloropropane; heavy metals like lead, cadmium, chromium, mercury, beryllium, manganese, zinc; phytoestrogens/ estrogenic/ androgenic/ hormonal compounds; smoke, automobile/ industrial emissions, nuclear dust, contraceptive residues) factors present in general environment and occupational areas.
Smoking, obesity, excessive heat to testicles, drinking excess alcohol and caffeinated beverages, eating estrogenic/androgenic foods have been reported to affect male fertility adversely.
Prolonged cell phone usage affects sperm motility. Increased sperm abnormalities and reduced sperm motility have been seen in metal welders.
Semen quality (motility, count, normal sperms) and fecundity decrements were also related to stress, working duration and occupational posture.
All above factors induce oxidative and DNA damage, teratogenecity, congenital defects, endocrine disruption, abortion, still birth, anatomic, genetic, immunological disturbances etc affecting semen quality and reproduction.
However, due to contradictions and non replications in various epidemiological findings (due to methodological problems), a wide integrated study with various parameters should be undertaken to address the issue.
According to National Health Survey reports the level of infertility in India is 2.5 % at national level and varies from 1.4 to 4.4 % among different states of India and Karnataka as per our statistics is 3.1%. In India alone, 18 million couples suffer from infertility which accounts for 14 % of all infertile couples in the world. The global magnitude of infertility is 60 to 80 million couples suffer infertility each year.

Semen quality

The meta-analysis report of Carlsen et al. (1992) that semen quality in men worldwide has undergone a decline. Decrease in semen quality has also been reported from different geographical regions like Paris (Auger et al., 1995), Italy (Bilotta et al., 1999), Denmark (Bostofte et al., 1983; Jorgensen et al., 2006), Norway (Bendvold, 1989), Scotland (Irvine et al., 1998), Belgium (Van Waeleghem et al., 1996), Finland (Horte et al., 2001) and USA (Leto and Frensilli, 1981; Swan et al., 2003).Published information in Asia is limited. Zhang et al. (1999) analysed the change in sperm quality and male infertility among men in China from 1983 to 1996. The results of the analysis showed a definite negative correlation and statistical significant decrease in sperm concentration, motility and morphology.
Sperm quality in men attending our clinic shows a 15 % decline in sperm motility and 2 % decline in morphology over the last 5 years.

Air pollution

Air, water and soil pollutants are commonly known as environmental endocrine disruptors or xenoestrogens or environmental hormones. Disrupting chemicals like alkylmercury, carbon disulphide, vinclozolin, procymidone, pesticides, insecticides, plastics, gums, paints, glycols, glycolethers and glycolesters.
Air pollution is mainly caused by smoke resulting from automobiles, industrial gases and domestic cooking using wood, cow-dung cake which increases the levels of lead, carbon monoxide, sulphur, nitrogen oxide, fluorides etc. and thus influence the male reproductive health.
Comparison of semen quality revealed decrease in sperm motility, normal sperm numbers, decreased normal head shape but increased abnormal chromatin sperms in higher air pollution period. Air pollution also increases DNA damage in human especially in susceptible groups. Intermittent exposure to environmental pollution results in sperm DNA damage causing male infertility and miscarriage.
In a study in Italy people who were exposed to traffic fumes had poorer sperm quality and in particular, had lower sperm motility.
Ozone exposure is known to cause oxidative stress, which is documented to disrupt testicular and sperm function.
As with smoking, exposure to ozone may induce either an inflammatory reaction in the male genital tract or the formation of circulating toxic species and, thus can cause a decline in sperm concentration.
Besides ozone, nitrogen oxide, carbon monoxide and fine particulate matter, each of these air pollutants was believed to be capable of impacting sperm production.
Heavy metals
Heavy metals affect male reproduction causing various lesions in reproductive organs leading to infertility. Cadmium is a ubiquitous heavy trace metal toxicant and is well known as an industrial pollutant. Exposures to cadmium have been reported to reduce male fertility.
Chromium is an important heavy metal which possesses several industrial applications Occupational exposure to chromium leads to alteration of semen status and may adversely affect the reproductive success of exposed workers.
Lead is the most significant toxin of the heavy metals. Industrial decisions, such as the addition of lead to paints, dyes, and gasoline, have created an epidemic of lead poisonings. Lead is a naturally occurring substance and can be found in organic and inorganic forms.
Lead is a reproductive toxicant detrimental to human semen quality. Decreased sperm count, motility, acid phosphatase, succinic dehydrogenase, fructose, surface reaction of sperm head DNA besides increasing abnormal sperms was reported in occupational exposure of lead in printing press workers in India. Higher lead level lowers sperm’s ability to bind and fertilize the egg.
Mercury, widely used in modern technology and industrial revolution, has become an important pollutant for animals and humans. Mercury intoxication has been associated with male reproductive toxicity in experimental animals and mercury may have the potential to produce adverse effects on fertility of men. In a small population in India, it was found that occupational exposure to metals, solvents, pesticides, extreme heat or vapours increases incidence of poor motility (oligo-asthenospermia) and even zero sperms (azoospermia).

Changing lifestyle

There is a good evidence that diet and lifestyle can impair a man’s fertility. Several studies have clearly shown that cigarette smoking lowers both sperm counts and sperm motility. Excessive alcohol consumption has also been shown to impair normal. It is well known that the testicles should be cooler than the rest of the body for sperm production to be at its best. The harmful effect of a varicocele on sperm production is believed to result from the extra warming of the area caused by the dilated veins.
Hormone-like substances such as DHEA or “androgens” intended to build muscle mass can actually stop sperm production completely. Excessive consumption of coffee or other caffeine-containing beverages have been reported to be deleterious for sperm production. It is probably best to avoid high intake of soy products, since they can contain weak plant estrogens. Moderate exercise may be beneficial. However, prolonged, excessive and no exercise may be bad.
Oxidative stress is a common factor in some male and female infertility. This is due to certain molecules known as “reactive oxygen species” or oxidants in the semen which can damage the sperm cell membrane, DNA and fertility.
Prolonged cell phone usage may negatively affected sperm motility characteristics, though still needs to be validated.
It is still not clear whether the psychological strain in normal jobs affects male reproductive function or sperm counts. However, stress has some effect on ability to conceive in men with already low sperm concentration.

Occupational hazards

However men working in hot environment like welders had reduced progressive motility, increased sperm defects like coiled tails. Job stress also affects sperm motility and morphology causing abnormal heads and coiled tail. Prolonged occupational heat, radiation, chemical exposures were found to affect spermatogenesis.

General environmental pollution

There is an unexplained three fold increase in US male infertility (sperm density, semen volume) between 1965-82 was due to environmental /occupational pollution (with increasing toxic substances, halogenic compounds, glycols and glycol ethers, metals, hormones), abnormal lifestyle, heat, smoking, consumption of alcohol and drugs etc. affecting sperm production.

Radiation

Radiation causes degenerative changes in germ cell affecting steroid synthesis. It also causes genetic damages in germ cell like gene mutations, chromosomal aberrations, spermatogonial apoptosis and sterility.

Fluoride

Fluorine and fluoridesoccur only in the form of compounds with other elements. It is used in small amounts to purify water and to decrease tooth decay. Fluoride toxicity may cause adverse effects on the reproductive system of males living in fluorosis endemic areas.

Female Aging & Infertility

Female age is important when considering probability for getting pregnant. Increased infertility rates with aging are well documented and apparent in our society. The real issue is egg quantity and quality -which translates into embryo quality after fertilization. As women wait longer to have children, more couples have fertility problems due to declining egg quality and other issues that are more common in older women.

Many couples end up needing advanced treatments such as IVF, in vitro fertilization to overcome this age related decline. Women’s liberation brings many advantages to women. However, as women delay childbearing, society has not educated us about this fertility decline. The age of the male partner does not appear to matter much when it comes to fertility. Reasons for this include:

• All of a woman’s eggs are present at birth. They cannot divide or be “resupplied”, whereas sperm are produced constantly after puberty in men.
• Eggs age over time, while new sperm are constantly coming off the production line.
• Sperm from older men can have a reduced fertilizing potential compared to younger men. However, this tends to be “all or none”. If the sperm can fertilize eggs – we usually don’t see poor embryo quality due to reduced sperm quality.
• Sometimes older men have less interest in frequent intercourse, which can be a factor.

In the developed world, deferment of marriage and postponement of child-bearing in marriage are resulting in unprecedented numbers of couples who desire pregnancy relatively late in life. These factors combine with a decline in fertility and an increase in pregnancy wastage with advancing age to present new challenges for the clinician treating infertility.

Cinnamon Helps you Fight with PCOS

Poly Cystic Ovarian Syndrome (PCOS) is a common cause for infertility among women. Women with PCOS suffer from hormonal imbalance and develop cysts in their ovaries. The condition causes irregular menstrual cycles, excessive hair growth, sudden weight gain and problems in conceiving. When the condition remains unsolved, it might lead to diabetes and heart problems.

Women with PCOS typically have very high levels of insulin resistance that prevents stability in blood sugar levels. While weight reduction, medicines that treat diabetes and ovulation inducing medicines are common ways to treat PCOS, cinnamon is increasingly gaining popularity as a natural medicine for women plagued by PCOS.

Some of the adverse effects that insulin resistance has on normal menstrual cycle include:

• Deterioration of egg quality that prevents it from reaching optimum maturity.
• Miscarriages as the imbalance in hormones hinder the embryo from attaching to the uterus.
• Higher levels of insulin resistance are often an indication of Type 2 diabetes as well.

Cinnamon has properties that reduce insulin resistance and help glucose enter cells. Research findings have shown a steep shift toward regularity in menstrual periods of patients who consume cinnamon on a daily basis when compared to other PCOS patients. Besides, as an organic solution, it does not have the side effects that many other medicines tend to have.

Cinnamon supplements that maybe obtained as a concentrate of the aromatic spice is a great way to boost fertility. Water soluble compounds made from cinnamon have a great way of enhancing insulin activity. This property of cinnamon is found to be highly effective to treat Type 2 diabetes as well.
For those of you battling PCOS, having a teaspoon full of cinnamon powder with two tablespoons of honey is very beneficial. Another great idea is to add cinnamon in beverages like lemon juice or green tea. In fact, they are available as Ayurvedic juices as well.

PCOS can be treated effectively as long as you are willing to make wellness a priority. Exercise regularly and set small-term weight-loss goals. Avoid junk food and incorporate a wholesome diet. Maintain an ideal sleep-cycle.

Take care of yourself today, to be able to give your best to the little one tomorrow.