Preserving your fertility

Laura L. Tatpati, MDClinical Asst Professor, Obstetrics and Gynecology

Live and Learn Lecture SeriesKU School of Medicine

Reproductive Endocrinology and Infertility

Obstetrics and

Gynecology

Preserving - Protecting:Our goals today-

The Biological Clock External factors impact on fertility Protecting fertility - old and new

Almost 1 in 8 couples

www.reproductivefacts.org

Infertility

Causes of Female InfertilityEgg factors

Quality

Number

Tubal factors/Pelvic scarring

Infection

Endometriosis

Cervical/Uterine factors

Genetic

Acquired

Causes of Male Infertility

Sperm production problems

Genetic

Born without ability for sperm development

Born without tubes to release sperm

Acquired anatomical changes

Polyps obstructing outflow

Vasectomy

Environmental

Aging

Fertility and Aging

Born with all the eggs we’ll ever have

20% of women have their 1st child after 35

5% had their 1st child after 30 in 1975

At least 1/3 of those trying to conceive after 35 have difficulty

Fertility and Aging

Fertility always declines with age

For most, major acceleration of decline = late 30s

Individual rate vs. Age group rate

Impact from genetics & environment

modifiable risks

“Goals for a healthier Me and baby-to-be”

http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf

FERTILITY GOALSHEALTH GOALS

BE AWARE OF GOALS AND COMMUNICATE THEM TO YOUR DOCTOR

Sexually transmitted infections

Tubal Factor: 18% of infertility

Chlamydia: 2.9 Million cases and 1.5 Million cases treated annually

Gonorrhea: 8 Million cases annually

1 in 15 sexually active 14-19 yo females have Chlamydia

AvoidanceEarly Detection and treatment

http://www.cdc.gov/std/healthcomm/the-facts.htm

Smoking54% higher chance of infertility

Accounts for up to 13% of infertility

50% lower chance of pregnancy with IVF!

Increased risk with increased amounts

Damages the ovarian “egg pool”

Don’t Wait!

Smoking

Quitting makes a difference

http://women.smokefree.gov

Alcohol1 in 8 women binge drink (4 or

more in 2-3h)Infertility may be more likely with

over 5 - 8 drinks / week or repeated binge drinking

beyond infertility - breast cancer, heart disease, unintended

pregnancy, and fetal alcohol syndrome

Weight

Low BMIBody fat is key

Low BMI

Normal BMI, low body fat

Excessive intense cardio may result in hormone problems

Menstrual irregularity

Infertility with regular menses

Goal 150 minutes moderate intensity per week

Obesity/Elevated BMI

Irregular mensesRegular menses

Still reduced fertilityPregnancy complicationsHealth complications

Eat healthyFruits/VegetablesLean meat, small

portionsBeans, eggs, nuts

Whole grainsAvoiding saturated /

trans fats(Possibly) 1 full fat dairy

every few days*

Environmental toxins

Medical term: Endocrine disruptors

Interrupt hormones in our bodyCumulative effect

work toxins, solvents, plastics, cosmetics, detergents

http:/www.prhe.ucsf.edu/prhe/pdfs/ToxicMatters.pdf.http://www.marchofdimes.com/pregnancy/stayingsafe_indepth.html

Stress / Mental HealthInfrequently the sole cause of true infertility

Sexual dysfunction

Ovulatory disturbances

Some meds can affect hormones

Conflicting data

Definitely associated with stopping treatments

Can affect relationships

Seek support/Communicate

Health Conditions

Contributing Medical ConditionsInsulin resistance/Type 2 Diabetes

Thyroid disease

Pituitary disease

Depression/anxiety

Vaginismus, painful intercourse, sexual dysfunction

Cancers (1/8 are reproductive aged or younger)

Gynecologic

Many more ...

Gynecologic issuesFibroidsPolyps

EndometriosisPCOS

Primary ovarian insufficiency

Irregular periods?See your doctorPrevent a bigger

Problem!

ChemotherapyRadiation

www.fertilehope.org

Cancer treatments

Cumulative effects

Each new issue Builds on the last

MenSteroids/Testosterone

Supplements, topical, injections, pills

Tobacco

First and second-hand smoke issues!

Alcohol

Obesity

Illness/Injury

diabetes, severe kidney damage, paraplegia

High heat environment

Varicoceles - consider monitoring or treatment

Toxins

ToxinsSperm background

Sperm are made in about 72d

They live in storage for about 15-25 days in the epidymus

1,000 shown to be harmful to animal reproduction and nearly 4 Million untested

Safety

Avoid skin contact

Store in sealed containers

Wash hands

Change clothes (don’t bring it home!)

Safety gear

LeadDibromochloropropane

WeldingSevin

Toluenediamine, Dinitrotoluene

Ethylene DibromidePlastic ProductionEthylene Glycol

PerchloroethyleneMercury Vapor

HeatMilitary Radar

KeponeBromine Vapor

Radiation (high level)2,4-D

Carbon disulfide

State of the rt:Egg freezing

Infertility is not an inconvenience;

it is a disease of the reproductive system that impairs the body’s ability to

perform the basic function of reproduction

www.reproductivefacts.org

Resourceswww.asrm.org

www.reproductivefacts.org

www.cdc.gov

www.perinatalweb.org

http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf

www.fertilehope.org

www.resolve.org