Eating Soy Associated With Lower Sperm Counts

Researchers at Harvard School of Public Health found that men who consumed a half serving of soy or more per day had lower sperm counts compared to men who consumed no soy. They analyzed the intake of 15 soy-based foods in 99 men who had attended a fertility clinic. The men were questioned on how often they consumed soy products (foods included tofu, burgers, milk, cheese, ice cream, etc) over the last three months. Men who ate the most soy foods had on average 41 million sperm per milliliter less than men who did not consume soy products. (The "normal" sperm concentration for men ranges between 80-120 million/ml). Soy products contain a high amount of phytoestrogens which are plant compounds that can behave like the hormone, estrogen. The researchers speculate that the increased amount of estrogenic activity may have an adverse effect on sperm production. This interference with other hormonal signals may be further strengthened in overweight individuals because men with higher levels of body fat produce more estrogen than slimmer men.

Financial Considerations Prior To IVF

By: Kathleen

Unfortunately many of us do not have health insurance coverage for IVF. Many couples start treatments without preparing financially. This is an easy trap to fall into, and frequently leads to a "we'll worry about how to pay for it later" attitude. A recent article lists many important things to consider that could make the financial toll less of a burden. Some things might not be obvious to people new to the world of insurance, such as signing up to get double-insurance if your spouse has coverage for IVF in his plan. Others require some forethought by talking to your HR department about your options. You can increase your flex spending account for next year or review your insurance options to see if your company offers a "premium" plan that covers IVF coverage (typically these items can only be changed once a year). It also touches on some difficult but sometimes necessary discussions you should consider having with your partner: how much money are we willing to spend on treatments? By setting financial boundaries for treatment, it might help you from digging yourself into debt because of a (well meaning) "whatever it takes" way of thinking.

Another Setback for International Adoptions

Recently adoption talks between the United States and Vietnam broke down for the second time in recent years. The US is insisting that Vietnam do more to ensure that adoptions from their country are free from criminal activity. The US has claimed for years that adoptions from Vietnam are frequently corrupt. After unsuccessfully lobbying the government of Vietnam to join the Hague convention (an international agreement on adoptions), talks broke down and currently have stopped. This leaves families in the US and children in Vietnamese orphanages held hostage until negotiators can bridge the gap that exists between the 2 countries policies. Vietnam announced that it has stopped accepting new adoption applications from the US, and no further talks are currently planned.

Should Pregnant Women Avoid Perfume?

Recently a number of UK sites ran stories about the need for pregnant women to avoid cosmetics, perfumes and scented body creams as they may increase the risk of unborn boys developing infertility in later life. This was based on a conference paper written by Professor Richard Sharpe at the Medical Research Council's Human Sciences Unit. Professor Sharpe’s research is looking at male fertility problems in rats and investigating how these may be caused. His work does not look specifically at the effects of wearing cosmetics, perfumes or scented body creams.

He clarifies his findings in this statement "Our research provides new insights into how common disorders of the reproductive system that affect newborn boys (incomplete testis descent; hypospadias - a disorder in which the opening of the urinary tract on the penis is misplaced) or young adult men (low sperm counts, infertility) may all have their origins during fetal development. This is probably at around 8-12 weeks of pregnancy i.e. very early. Our research, which is in laboratory animals, highlights that each of these disorders may result from lack of hormones called androgens, which are the hormones that cause masculinsation of the fetus (i.e. which literally ‘make a man’ ). Our research also provides a simple new way which may predict at birth whether a boy may be at later risk of a low sperm count when he is an adult."

Common environmental chemicals can affect the processes described above in experimental studies in laboratory animals, which raises concerns as to whether they might also cause, or contribute to, these disorders in humans. Phthalates are a large group of compounds that have been shown to have endocrine disrupter effects (they interfere with the normal actions of or reactions to hormones). Although this information has been presented via "scare journalism"; given the known effects of phthalates on fetal reproductive development, it is probably prudent for pregnant women to avoid exposure.

Media Infertility Distortions

By: Kathleen

It's hard to find a story about IVF in the media without absurd references about creating "designer babies". This blog entry talks about many of the most common myths that the media propagates. It's in the nature of the media to sensationalize any given topic, and infertility is not immune to this process. The most often cited issues include references to casually choosing the features of your baby such as eye color or athletic ability (as if this technology existed). Assisted Reproductive Technology (ART) can be used to screen for some of the most devastating genetic disease which is a welcome option for many couples who are known carriers of these conditions. To read some of these articles, you'd think everything is just a checkbox away when you decide to pursue IVF treatment. The Jolie/Pitt twins story in which they were allegedly conceived via IVF does little to help the media distortions. It has been reported that the couple was desperate to quickly expand their family and turned to IVF so they wouldn't have to "deal with the stress" of trying to get pregnant.

A recent summer movie "Sex and the City" highlighted yet another infertility cliche. During the TV series Charlotte struggled with infertility, and ultimately chose to adopt. The baby, now about 3 years old, is back in the movie. And in the movie after years of infertility Charlotte suddenly becomes pregnant on her own. I am certain many women in the audience who struggle with infertility cringed during this movie that just perpetuates the saying "just relax or chose to adopt and you will get pregnant". If only real life was just like the movies.....

Older Men Are More Likely To Father Children With Bipolar Disorder

Recent research brings to light more bad news for older fathers. This Swedish study showed that children born to fathers 55 years or older were 1.37 times more likely to go on to be diagnosed with the mental illness bipolar disorder than those of men aged 20 to 24. The study examined 13,428 people diagnosed with bipolar disorder and took into account family history and socioeconomic status. Bipolar disorder is often a cyclic condition with which people periodically exhibit elevated (manic) and depressive episodes.

Harry Fisch, MD, a male infertility expert and the author of "The Male Biological Clock", states "We're finding that as the father's age increases, there's an increased chance not just of infertility or Down's syndrome, but also schizophrenia, autism-related disorders and bipolar, too." He says "The message here for men is: don't wait too long."

Exercise and Infertility

Exercise is a well-recognized approach to the enhancement of general health and well-being. In contradistinction to the beneficial effects of exercise, there is increasing evidence that heavy exercise may have detrimental consequences in female athletes. When exercise is started during adolescence, athletes have increased ovulatory dysfunction reflected as menstrual irregularity. It is well recognized that long distance runners, swimmers, dancers and other competitive female athletes have varying degrees of menstrual dysfunction. Menarche (onset of menses) may be delayed by as much as 3 years and these women have more menstrual abnormalities in adulthood than their non-athlete peers. Menstrual dysfunction is usually a reflection of abnormal folliculogenesis and ovulation. Consequently, female athletes and others engaging in heavy physical exercise are often subfertile.

Female participation in high school athletics has increased 800% in the last 30 years. Menstrual abnormalities have subsequently increased. One study evaluating cross country runners found that 23 percent of these women reported irregular menstrual cycles. Interestingly, 19 percent of these cross country runners reported previous eating disorders. As many as 40 percent of female triathletes have menstrual dysfunction. As many as two thirds of runners who have menstrual periods have short luteal phases or are anovulatory. The extent to which exercise related infertility exists has been underestimated because of a lack of attention to anovulatory cycles in female athletes.

Although the pathophysiology of exercise induced amenorrhea and infertility remains to be elucidated, some common themes have emerged. The preponderance of the evidence indicates that the condition is influenced by modulators of the hypothalamic-pituitary-ovarian axis. Gonadotropin releasing hormone (GnRH) is a peptide hormone that is synthesized and released by the hypothalamic portion of the brain. GnRH causes the release of both follicle stimulating hormone (FSH) and luteinizing hormones (LH) from the anterior pituitary gland. FSH and LH are the primary hormones that control ovarian function. Disturbances within the hypothalamic-pituitary-ovarian axis alter the pattern and quantity of FSH and LH release resulting in abnormal ovarian function often reflected as abnormal menses. Central inhibition of GnRH can be discerned in some female athletes even before there is perceptible evidence of menstrual irregularity. This is a very important observation in view of the fact that not all of these athletes will exhibit overt menstrual irregularities. There appear to be three primary modulators of exercise-induced infertility: a critical level of body fat, energy expenditure, and stress.

The onset and regularity of menstrual function necessitates maintaining body weight above a critical level, and therefore, above a critical amount of body fat. A loss of body weight in the range of 10 to 15% of normal weight for height represents a loss of about one third of body fat which will result in abnormal menstrual function. This concept is recognized as the "critical weight hypothesis". The proportion of body fat is also very important to maintain normal menstrual function. It has been estimated that approximately 22 percent body fat is necessary to maintain normal menstrual function. This body fat criterion is not completely accurate; nevertheless, the concept is valid and remains useful to illustrate the concept. Competitive female athletes have about 50% less body fat than the non-competitor and less than the 22 percent required for normal menstrual function. Fat is converted to lean body mass during exercise. As a result, there may be no discernible change in total body weight in the athlete.

Energy availability is defined as dietary energy intake minus energy expenditure. Low energy availability appears to be the factor that impairs reproductive function. Restrictive eating behaviors practiced by girls and women in sports or physical activities that emphasize leanness are of special concern. Differential physiological mechanisms controlling energy balance are closely linked to fertility. Metabolic status is transmitted to the brain via peripheral (e.g. leptin, insulin, and ghrelin) and central (e.g. neuropeptide Y., melanocortin, and orexins) metabolic fuel detectors. When oxidizable fuel is scarce, these detectors function to inhibit the release of gonadotropin releasing hormone and luteinizing hormone, thereby prompting alteration of ovarian function and reproductive cyclicity.

Infertility can result when resources are abundant, but food intake fails to compensate for increased energy demands. Examples of these conditions in women include anorexia nervosa and exercise-induced amenorrhea. Caloric restriction caused by under-nutrition or over-exercise is increasingly common, and has significant health consequences such as hypothalamic amenorrhea and infertility. Several observations provide further evidence of the tight association between energy balance and reproduction. For example, fifty-three percent of female triathletes were found to be in caloric deficit, forty-seven percent had a fat deficit, forty percent had a protein deficit in one study. These findings highlight the importance of metabolic imbalance in female athletes.

Exercise represents a physical stress that challenges homeostasis. Stress and stress hormones play a profound role in the etiology of the onset of menstrual dysfunction in female athletes. Adrenocorticotrophic hormone (ACTH), corticotrophin releasing hormone (CRH), adrenal steroids and cathecholamines are increased in female athletes. Endogenous opiates are thought to decrease GnRH secretion and, thus, the release of LH and FSH for ovarian stimulation. Abnormal luteinizing hormone pulse frequency has been observed in high performance female athletes. When the stressor (heavy exercise) is removed, menstrual function returns to normal. For example, dancers experience the return of normal menstrual function during periods of rest. This observation implies that abnormal ovarian function associated with the stress of exercise is a reversible endocrine metabolic phenomenon. The degree of reversibility is unknown, although general experience indicates that the majority of women regained ovulation upon decreasing the stress of exercise and correction of caloric intake.

Historical and physical evidence should lead the clinician to suspect exercise or dietary related ovulatory dysfunction in patients with a history of heavy exercise. Abnormal ovulatory function associated with heavy exercise is usually reversible, providing that there are no other underlying neuroendocrine causes for the problem. The prognosis for return of normal menstrual function and pregnancy is excellent with early recognition, and simple weight gain will often reverse the state of amenorrhea. Nutritional counseling should be an integral part of the treatment plan. Full weight recovery and restoration of metabolic balance can lead to reversal of ovulatory dysfunction. A multidisciplinary treatment team should include the physician or other health care professional, a registered dietitian, and, for athletes with eating disorders, a mental health practitioner. When pregnancy is desired, reduction in the amount of exercise and weight gain should be recommended, or induction of ovulation may be pursued. It is important for the clinician to realize that suboptimal ovulatory function may exist in female athletes with regular menstrual cycles and that routine hormone testing may not detect subtle changes in the patterns of hormone secretion. Advanced assisted reproductive techniques may be necessary depending on the severity of the patient's ovulatory dysfunction.