The Hemp Connection:
in vitro fertilization

First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.

Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.

Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.

Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.

That's the bad news.

The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?

My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.

But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".

Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.

Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.

He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.

There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.

You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!

Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.

http://www.nytimes.com/2008/04/15/opinion/15tues1.html?hp

This is an interesting study out of Finland about women who sought IVF treatment. The researchers were interested to know if a history of induced abortion in any way might be connected to fertility treatments later on in life. A total of 19,429 charts were reviewed, which is a significant sample size. Twelve percent of women seeking IVF treatment and 11% of women seeking ovulation induction treatment reported having had a previous abortion. According to the researchers, this was statistically significant. The researchers encouraged that women receiving treatment for abortion be advised of the possibility of infertility at a later age. They also encouraged practitioners providing fertility treatments to be thorough in their assessment of patients and be sure to ask if this is part of a patient's reproductive profile.

There are many reasons why this relationship may occur. The important thing is, if it describes YOU, and you have not shared this information with your physician, it is important to be sure you do so. Every little piece of information you have to share allows your physician to develop a treatment plan with the best possible chances of succeeding.

Hemminki E, Klemetti R, Sevón T, Gissler M. Induced abortions previous to IVF: an epidemiologic register-based study from Finland. Hum Reprod. 2008 Jun;23(6):1320-3. Epub 2008 Mar 27.

I just found this abstract in Pub Med. The full article is referenced at the bottom. I would love to hear any and all comments from readers about this issue!

Resource allocation towards fertility treatment has been extensively debated in countries where fertility treatment is publicly-funded. Medical, social and ethical aspects have been evaluated prior to allocation of resources. Analysis of cost-effectiveness, risks and benefits and poor success rates have led to calls of restricting fertility treatment to obese women. In this debate article, we critically appraise the evidence underlying this issue and highlight the problems with such a policy. Poor success rate of treatment is unsubstantiated as there is insufficient evidence to link high body mass index (BMI) to reduction in live birth. Obstetric complications have a linear relationship with BMI but are significantly influenced by maternal age. The same is true for miscarriage rates which are influenced by the confounding factors of polycystic ovary syndrome and age. Studies have shown that the direct costs per live birth are no greater for overweight and obese women. With changing demographics over half the reproductive-age population is overweight or obese. Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity, feelings of injustice and social tension as affluent women manage to bypass these draconian restrictions. Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.
Pandey S, Maheshwari A, Bhattacharya S. Should access to fertility treatment be determined by female body mass index? Hum Reprod. 2010 Feb 3. [Epub ahead of print]

One of the main reasons women with PCOS are encouraged to take metformin is because it is widely believed that it can help to improve fertility and reduce the incidence of miscarriage.

A 2009 study challenges this belief. It comes from the Cochrane Collaboration, a not-for-profit organization that evaluates groupings of research independent of for-profit (read"drug company") funding. I like their studies because their sample sizes are large and their findings are evidence-based. It takes them a long time to adopt new ideas, but it is because they so heavily scrutinize the available information rather than jumping on any bandwagons.

In this study, authors searched several comprehensive medical databases for studies evaluating metformin used during in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). They specifically looked at randomized, controlled trials containing a"no treatment" or placebo group to compare to a group receiving metformin. They evaluated several types of outcomes that metformin may have an opportunity to influence: live birth rate, pregnancy rate, miscarriage rate, incidence of ovarian hyperstimulation syndrome, patient-reported side effects, and several hormone levels (estradiol, androgen, fasting insulin and glucose).

This exhaustive review, under rigorous statistical analysis…

"found no evidence that metformin treatment before or during assisted reproductive technique (ART) cycles improved live birth or clinical pregnancy rates."

The one benefit of metformin appeared to be a reduced risk of OHSS in women with PCOS and undergoing IVF or ICSI cycles.

I'm not a physician and therefore, I am not able to prescribe metformin. And I am ABSOLUTELY NOT ENCOURAGING ANYONE READING THIS TO DISCONTINUE USING MEDICATION THAT THEY HAVE BEEN PRESCRIBED. I do, however, see a tendency to hand this medication out without evaluating whether or not it is appropriate. It's important to discuss such issues with your physician and to be sure they are aware of the research supporting (or not supporting) their recommendation.

Here is the reference for anyone who wishes to share it with their personal provider.

Tso LO, Costello MF, Albuquerque LE, Andriolo RB, Freitas V. Metformin treatment before and during IVF or ICSI in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006105.

You all are must be sooooooooooooooooooooooooooo tired of hearing me talk about the benefits of sleep. But I work with a sleepless population and it takes a few times to present my case before I make my point. I figure if I hammer at this from as many different angles as I can, and present as many examples of how poor sleep quality can interfere with your health, at least one of my examples will hit home and inspire you to consider your sleep habits and choices.

This doesn't bode well for Jay Leno and David Letterman…unless they team up with TiVo for advertising!

Women whose eggs had been examined and found to be of poor quality had those eggs examined by researchers. It was found that levels of chemicals indicative of oxidative stress were higher in those eggs than they were in the eggs of women whose eggs had been determined to be of good quality.

Taking this one step further, 18 women with low quality eggs were divided into one of three groups and given one of the following 3 regimens: (1) 3 mg melatonin per day, (2) 600 mg vitamin E per day, or (3) 3 mg melatonin AND 600 mg vitamin E per day. Oxidative stress markers were reduced in all three scenarios.

And THEN…in the final phase, 115 women who had not become pregnant with in vitro fertilization (IVF) were divided into two groups. The first group received 3 mg melatonin per day and the second group received no supplement. Melatonin significantly improved the rate of fertilization.

The researchers concluded that oxidative stress (which is what happens when you stress all day and don't sleep well all night), damages the quality of eggs. They also concluded that melatonin supplements can help improve fertilization rate.

Just a note--take melatonin if you want, but don't lose sight of the big picture. If you backed yourself into a corner because you weren't managing your stress and sleep, a pill may not be the complete solution to the entire problem.

Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7.