I have had a handful of inquiries in the last week about an inCYST fertility consultation. I thought I would lay out, honestly, what it is we do and what we do not do, in order that you know exactly what it is you are contacting us for when you do, and to prevent disappointment by hoping we might be something we are not.
1. We do not make babies. We are not fertility clinics. If what you are looking for, is someone to give you a baby, a fertility clinic is where you should be asking for help.
2. We DO, if there is anything about your lifestyle that has the potential to interfere with fertility…be it sleep, nutrition, activity, stress management…have a strong ability to identify what it is and to help you replace the behavior in question with a more fertility-friendly option.
3. We DO assume that you are willing to make changes in your behavior and that this is an active partnership. We cannot live those lifestyle changes for you. We cannot become pregnant for you.
4. We DO NOT consider ourselves to be an"either — or" issue, in competition with the fertility industry. In fact, I am quite surprised at how few of our fans do not invest in a proactive inCYST consultation on deciding to go with IVF. If anything, we can help to be sure you are in the absolute best physical and mental condition to be in upon engaging in a physically and mentally challenging procedure. Just as an Olympic athlete would want to be nutritionally and physically ready for the big event, we believe partnering with us is good insurance that all of the money and stress you are about to encounter is worth the investment.
5. We DO NOT believe that there is a high success rate among women who do have lifestyle issues interfering with their fertility, who believe they can bypass the effort and inconvenience of changing that lifestyle with a medical procedure. You cannot fool Mother Nature.
6. We DO NOT provide false hope. That would be cruel.
7. We DO NOT pressure potential clients. Women with infertility are stressed enough as it is.
8. We DO NOT hang our celebrity clients out on a shingle as marketing tools. Celebrities need their privacy too.
9. We DO believe enough in what we do to be willing to work to create a research foundation to pursue our findings in a scientific fashion.
10. We have seen miracles, but we do not promise them.
We'd like to think we have a whole lot to offer you, but we won't chase it down. That is because the clients most likely to succeed with our program are not the ones we have to chase down and convince of our value. It's the ones who already believe in us.
We hope that this describes you, but if it is not, we respect the differences and truly wish you the best.
We focus almost entirely on the women's side of infertility on this blog. Now here's information important to the other half of the equation. The beauty of this is…the very advice we're giving to you women…can help men with depression, too. This article comes from Natural News, links are at the bottom.
SSRI Antidepressants Linked To Male Infertility by S. L. Baker, features writer
(NaturalNews) The Food and Drug Administration (FDA) issued a warning a few years ago that pregnant women taking the selective serotonin reuptake inhibitor (SSRI) antidepressant paroxetine risk giving birth to infants with major birth defects, including heart abnormalities ( http://www.naturaln ews.com/021225_ P…). Now comes word that the same drug (sold as Paxil, Paxil CR, Seroxat, Pexeva, and generic paroxetine hydrochloride) carries another danger that could keep babies from being born in the first place. A new study just published in the online edition of the journal Fertility and Sterility concludes as many as fifty percent of all men taking the antidepressant could have damaged sperm and compromised fertility.
New York Presbyterian Hospital and Weill Cornell Medical Center researchers followed 35 healthy male volunteers who took paroxetine for five weeks. Then sperm samples from the men were studied using an assay called terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) to evaluate whether there were missing pieces of genetic code in the sperm DNA. This condition, know as DNA fragmentation, is associated with reproductive problems.
The results? The percentage of men with abnormal DNA fragmentation soared from less than 10 percent to 50 percent while taking the antidepressant. This is a crucial finding because DNA fragmentation has long been known to correlate with an increased risk of birth defects, poor fertility and unsuccessful pregnancy outcomes — even when high tech, extraordinarily expensive fertility enhancing techniques such as in vitro fertilization and intracytoplasmic sperm injection are used.
The study, one of the first scientific investigations into the effect of SSRIs on sperm quality, also confirmed that paroxetine impairs sexual function. More than a third of the research subjects reported significant changes in erectile function and about half had difficulty ejaculating.
"It's fairly well known that SSRI antidepressants negatively impact erectile function and ejaculation. This study goes one step further, demonstrating that they can cause a major increase in genetic damage to sperm," Dr. Peter Schlegel, the study's senior author and chairman of the Department of Urology and professor of reproductive medicine at Weill Cornell Medical College, explained in a statement to the media."Although this study doesn't look directly at fertility, we can infer that as many as half of men taking SSRIs have a reduced ability to conceive. These men should talk with their physician about their treatment options, including non-SSRI depression medications."
The scientists could not identify the exact way the SSRI caused the DNA fragmentation, but the evidence strongly suggests the drug slows sperm as it moves through the male reproductive tract from the testis to the ejaculatory ducts. When this happens, the sluggish sperm grows old and its DNA becomes damaged.
"This is a new concept for how drugs can affect fertility and sperm. In most cases, it was previously assumed that a drug damaged sperm production, so the concept that sperm transport could be affected is novel," Dr. Schlegel stated.
The study contains some good news for men currently on Paxil and related drugs who may be concerned about their fertility. All the changes the researchers found appeared to be totally reversible. Specifically, normal levels of sexual function and DNA fragmentation both returned to normal one month after discontinuation of the drug.
For more information: http://news. med.cornell. edu/wcmc/ wc… http://www.fda. gov/Drugs/ DrugSafety … http://www.naturaln ews.com/026483_ SSRI_fertility_ DNA.html
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]
I was on a flight from Chicago to Boston yesterday and struck up a conversation with the man sitting next to me. It turned out, he is a veterinarian who does a lot of work with horses. He asked about my profession, and I gave him the Cliff Notes version, telling him that I did a lot of work with infertility.
Without even having a chance to mention that my friends think I am obsessed with omega-3 fatty acids to the point of often being teased about being the"Fish Oil Queen," he said to me,"Nutrition is very important for fertility in horses. Especially omega-3's."
Turns out, he said, the process of breeding horses is so expensive (if you thought an in vitro procedure emptied your wallet, start pricing stud services!!), that there is a lot of pressure to"get it right" as quickly as possible. And research has discovered, that omega-3 fatty acids are particularly important as part of the success formula.
I commented that it was interesting that in humans the fertility research seemed to focus on the females, while in equine science, it tended to focus on the males. He just smiled and said…"Your women need to be feeding their priceless stallions as well as they feed themselves!"
Here is an excerpt from an equine article I found at http://www.horses.com/. You will have to register to access their other articles, but it is worth the time. Hopefully some day our own nutrition will be as important as veterinarians have found it to be in animals.
Squires said sperm quality problems can increase when artificial insemination with cooled or frozen semen is involved. The problem stems in part from the fatty acids found in equine sperm. Bull sperm contains high amounts of omega-3 fatty acids that enable them to withstand the rigors involved in freezing. Horses, on the other hand, have sperm that is high in omega-6 fatty acids, which hinders sperm ability to be cooled and frozen, and the sperm is low in omega-3 fatty acids. The most important omega-3 fatty acid is docosahexaenoic acid (DHA). An omega-6 fatty acid found in semen is docosapentaenoic acid (DPA).
Squires said in semen, the fatty acid profile of stallions is similar to that of boars (male hogs). Studies in boars have shown that a high DHA to DPA ratio in semen results in enhanced fertility, whereas higher levels of DPA relative to DHA result in reduced fertility.
He said fresh grass is high in DHA, but unfortunately, a lot of stallions are fed hay and grain.
"Men that have reduced fertility have also been shown to have lower levels of DHA in seminal plasma," Squires noted."The ratio of phospholipids (fats containing phosphorous) to cholesterol in the sperm, and the ratio of unsaturated to saturated fatty acids, determines the ability of sperm to handle the rigors of cooling and freezing. Those species that have high cholesterol to phospholipid ratio have sperm that are very resistant to cold shock and thawing.
"Humans, rabbits, and roosters produce sperm that are very resistant to cold shock and their sperm freezes very well," he continued."Sperm from boars and stallions have very low tolerance to cold shock, and, in general, their sperm freezes poorly. Sperm of bulls have high levels of DHA in the cell, where those of stallions have a high level of DPA. Increasing the ration of DHA to DPA in semen has been shown to increase fertilizing capacity and semen quality. Conversely, reducing the ratio of DHA to DPA was accompanied by a reduction in fertilizing capacity."
He said researchers found that adding omega-3 fatty acids to a stallion's diet resulted in a more fluid condition of the sperm membrane, which, in turn, allowed sperm to handle the stress of cooling and freezing with potentially less damage.
For some reason, I have been placed on the mailing list for a fertility researcher in the UK who is doing some interesting work looking at how fertility doctors conduct their treatments around the world. I actually tried to answer his survey, but since none of the choices available to me had anything to do with changing diet and lifestyle, I was not allowed to complete it.
That is something I find very interesting, that it would not even occur to a fertility specialist to consider the nutritional status of the client and the nutritional interventions provided clients as important variables to consider. Dr. Balen, if you ever wish to consider those factors, now you know where I am.: )
Anyway, I thought the readers of this blog would find some of the results of this study to be interesting. I'll put my commentaries in italics.
This is a summary of 179,300 IVF treatments conducted in 262 fertility centers on every continent where there is a fertility center…meaning Antarctica was not on the list.
1. 73.3% of these cases were assessed for impaired glucose tolerance. That means that 26.67%, or 47,694 women, were not. --I would be interested to see the geographic distribution of these answers. Several years ago, I moderated a listserve in Spanish for women with PCOS and it was rare in that group to hear of women being treated for insulin resistance. I actually had to go on strike and refuse to give out any more information until the women in the group who had not been evaluated, got the evaluation. About three months later, we had about 6 pregnant women amongst us.: ) --Not sure why, since PCOS has such a strong connection to insulin resistance and it is the number one cause of infertility, this assessment simply is not a universal precaution?
2. 61.3% of the physicians who chose to assess for impaired glucose intolerance were only doing so in obese patients. --Here we go again, the invisible lean cyster. If up to 70% of women with PCOS are NOT obese, consider the number of infertility cases that are made more complicated than they need to be, simply because of a misperception of what PCOS has to"look like" in order to be taken seriously.
3. 69% of the physicians surveyed, in their PCOS patients, considered clomiphene citrate to be the first line of treatment. --I would love to know how they would have answered this if they had been given the option of nutrition/lifestyle/sleep hygiene consultation had been an option to answer.
4. Cutoffs for treatment based on BMI: 30% would not treat if BMI was greater than 30 33% would not treat if BMI was greater than 35 20% would not treat if BMI was greater than 40 6% would not treat if BMI was greater than 45 --Which has me wondering, again, why nutrition/lifestyle/sleep hygiene consultations are not considered the absolute essential first line of treatment.
So lean women, apparently, even though their BMI's would be considered appropriate by these practitioners, would not be given the assessment that would help them get the proper treatment.
And obese women, apparently, are not given any direction regarding what to do to bring their BMI into a workable range.
If you're still wondering why your patients with PCOS can be so angry, skeptical, and emotional, maybe you would have better success with an accounting career.
Imagine how much more successful my colleagues in these 262 treatment centers would be if they partnered with professionals who know how to do something about those quandaries.
We'd love to help you improve on those statistics.
The invitation is open.
Source: PCOS – Definition, Diagnosis and Treatment, a survey compiled by Prof. Adam Balen, Leeds Centre for Reproductive Medicine, Seacroft Hospital, Leeds, U.K
Last night I settled in to watch the evening news, in time to see an ad for Country Crock's Omega 3 Plus brand margarine. With my reputation as somewhat of an"omega 3 queen," I figured I'd better pay attention. And by the time the ad was over, I knew I had today's post.
This label is a perfect example of why consumers are confused, and why they can have a hard time achieving the benefits of good nutritional choices.
First, the good news.
The margarine has no trans fats, because it contains no hydrogenated or partially hydrogenated oils. For fertility, this is a huge plus--with as little as 2% of your total calories per day coming from trans fats (about 2/3 tsp for the average woman), fertility can drop by as much as 73%.
Secondly, one serving provides 500 mg of omega-3's in the form of ALA.
Now for the confusing and potentially detrimental news.
When the professionals on this blog talk about what we're doing to enhance fertility and reduce inflammation, and we refer to omega-3's, we are primarily referring to EPA and DHA, the omega-3's that, except for omega-3 eggs and foods supplemented with algal DHA, contain either fish or fish oil. (Menhaden oil, which is what is found in Smart Balance Omega 3 Margarine, is a type of fish oil.)
Any other type of omega-3 is likely to be ALA. This type of omega-3 is found in canola oil, and flaxseed oil, among other things. In this margarine, the ALA source is canola oil.
But there is no fish oil or marine algae to provide a similar nutritional feature.
There are some things that flax and canola can do, and there are some that flax and canola simply cannot do.
Many people, nutritionists included, operate on the assumption that since the omega-3 found in canola and flax can be converted into EPA and DHA, that you can get enough of the latter two without having to eat fish. Most respected omega-3 chemists will tell you this is highly unlikely.
On a good day, when your diet is as perfect as it can possibly be (which, even in the case of the person writing this post is never), only about 2-3% of your flax and canola can be converted into the other omega-3's.
Bottom line, it's pretty non-negotiable, you are highly unlikely to get the amount of omega-3's your body needs, especially if you are trying to conceive, if you are assuming you can do it without fish.
Secondly, the primary oil in the margarine appears to be liquid soybean oil. Remember the rule about"S" and"C" oils? Soybean is one of those"S" oils with a tendency to be pro-inflammatory. It was impossible to tell from the label what the ratio of soybean to canola oil was, and I would suspect that it was higher than you're going to want if you're trying to choose fertility-friendly foods.
I immediately became suspicious about this Country Crock product when I went to the website and nowhere, I mean absolutely nowhere, could I find a plainly stated ingredient list. Sure, there's a label to look at, but it's strategically posted in a way that all the nutritional information is there except for the ingredients. Hmmmm…
…so I went to the FAQ section. Couldn't find it there either. I found a lot of long-winded explanations of trans-fat labeling, and that was my second red flag.
Since I had to go to the grocery store anyway, I stopped in and looked at the label. Here, for the benefit of the rest of the people on the Internet, is the list of ingredients from the side of the container of this product:
For more information on healthy fats, go to http://www.zingbars.com/science-of-zing.html, where my Zing Bar friends describe why they did--and didn't--include certain fats in their new product.
Any fat that is going to be solid at room temperature is going to have to have some saturated fat in its formula. Otherwise, it would melt. So even though the total saturated fat content is low, the type of fat being used to provide the solid quality is not one you want to get much of in your diet.
I'm not really a butter or margarine person so giving those up was not an issue for me. But I did start my career in the Chicago area, and I remember how people used to look at me like I was purple-polka-dotted if I even hinted that dairy intake might need to be adjusted. So I know it's an issue for some of you.
Bottom line--if you choose to use the product, do so only once in awhile and sparingly. I'd rather see people use olive oil-based dipping sauces for breads and cook with either canola or olive oil.
If you're interested in learning more, the authors of the study below also wrote a recently released book in plain English entitled, The Fertility Diet. I'd check it out.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007 Nov;110(5):1050-8.
One of my biggest frustrations with dietary advice I see for PCOS, is that the first word out of anyone's mouth regarding the issue, is"lose weight". I don't disagree, for some women there are hormone issues related to weight that are important to consider. Extra weight, while it does not CAUSE PCOS, does tend to worsen existing symptoms. Additionally, for the lean woman with PCOS, and there are many, it's simply useless to recommend weight loss as a fertility strategy. It certainly doesn't help your credibility to only have this advice to offer.
Now research suggests that how you eat, especially if you're unnecessarily restricting, in your perinatal years, has far reaching effects. It could hurt the baby you're trying to have, to restrict excessively during the time you are trying to conceive.
Researchers in this study used genealogical records in Finnish churches and plotted births against information about agricultural trends, mainly crop yields for rye and barley). The time period they researched was the 18th century. The analysis consistently showed that individuals who were born in a year in which crop yields were low (in other words, when they were in the wombs of women who were not eating adequately), had a strong predilection to not bear children as adults. Babies born in years in which there was a bumper harvest would have at least one child later in life.
Bottom line: How you eat affects how your child reproduces. Rigid dieting may not interfere with YOUR fertility, but it's a short sighted strategy. It may prevent you from becoming a grandparent.
A side note: the two crops studied in this research, barley and rye, that promoted fertility, are both gluten-containing. So for those of you who are restricting gluten who have not officially confirmed that you have trouble with gluten, you may be barking up the wrong nutritional tree. Best not to restrict a food unless you are absolutely sure you do not tolerate it.
If you eat well, learn to deal with stress in ways other than binge eating and dieting, and if you are carrying extra weight when you include these changes in your eating style, chances are you WILL lose weight. But you will be better nourished and better able to create a healthy baby.
If you're going to work as hard as you're working to conceive…don't you want the end product to be as healthy as possible?
Ian J. Rickard, Jari Holopainen, Samuli Helama, Samuli Helle, Andrew F. Russell, Virpi Lummaa. Food availability at birth limited reproductive success in historical humans. Ecology 91:3515–3525
Everyone’s telling you to “just relax and you’ll get pregnant,” or “take a vacation and it’ll happen.” Isn’t that a huge pressure, besides the basic fact that getting pregnant hasn’t proven to be so easy for you? Getting pregnant can be so frustrating when it involves medical procedures, carefully timed intercourse, self-tests and monitoring, medication, and the like. With PCOS, it’s even more complicated. The good news is, even when it seems like your body just won’t mind your wishes, there are relatively simple and inexpensive things you can do on your own to support yourself in your fertility journey.
If you’ve been dealing with infertility for a while, you’ve likely tried or at least considered some alternative medicine or holistic health practices that you hope will help you conceive. Here’s why you should consider some of the more common approaches to decreasing stress and improving overall health, which include:
Acupuncture is an ancient healing art, part of the system of Traditional Oriental Medicine. It has been used successfully for thousands of years to enhance fertility; you may even find that your physician is able to offer you a referral. Acupuncture is nearly painless – in spite of the needles – and works in conjunction with your traditional treatments. Many acupuncturists also offer nutritional support. Most larger communities have at least one acupuncture school, and their student clinics offer carefully supervised sessions for as little as $20/treatment.
Nutrition – Decreasing or eliminating caffeine, refined sugar, and refined flour will give your body a rest, reduce stress on your digestive system, enhance your immunity, and make your body an optimally healthy place for both you and a baby. If you’re saying “yeah, yeah, yeah, I know all that – and it’s too overwhelming” – start today with a small change, like switching out regular coffee for decaf, or trading in a soda for some iced herbal tea. Your nerves will thank you too.
Yoga is another traditional dating back thousands of years. Yoga is said to massage and stimulate or “tonify” the internal organs, thereby leading to increased health. The slower-paced forms of yoga, such as hatha yoga, or yin yoga, are relaxing practices. But in my opinion, the best thing about yoga is that it helps you love and accept your body, precisely where it is today – not where you hope it will be. If you’re daunted by those fancy yoga studios, head on over to your nearest YMCA or other gym for some great introductory classes. Many yoga studios offer community days, or donation classes, where you pay what you can afford for the class.
Meditation can be as simple as closing your eyes and focusing on the sound and rhythm of your own breath for just five minutes. If you can’t handle five minutes, try three minutes. It can also be a complex and evolving process, if you choose to expand your practice. Regulating your breathing, clearing your mind, and giving yourself time for introspection are all benefits of meditation. If you want more information, do a search for the terms “meditation” or “the relaxation response.”
Positive Thinking/Mindfulness/Visualization – although these are all distinct techniques, the overlap is that they are conscious ways of re-orienting yourself towards remaining in the present, focusing on what is, and using the power of your mind to create the future – or at least improve your experience of the future. As with meditation, the internet is full of information on these techniques, or you may wish to consult with a mental health clinician who utilizes such techniques in her practice.
Optimizing fertility is an activity in which you, the patient, play a very active role. You are already learning how to become proactive in managing your PCOS; this is just an extension of that. Of course your doctor will want to know what other things you’re doing to support your fertility, but you can start right now to take steps to improve your overall physical health and state of mind, thereby reducing the stress actively, instead of just hoping that it will happen “somehow.”
Dr. Gretchen Kubacky is a Health Psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website atwww.drhousemd.com, or e-mail her atGretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.
I do encourage you to hang in there through the end of this post…it's got wonderful news! I received an email alert today about a study coming out, suggesting that infertility treatments may increase the risk of autism in the babies those treatments produce. (Normally I publish the original reference but since I can't seem to find it online…here's the link to the Time magazine article.)
Well, that pretty much rots! What gives?
Apparently women exposed to fertility medications such as Clomid have a greater chance of having children with autism, and the risk increases with greater (more frequent) exposure to the medication. A second study reports a similar risk for women undergoing in vitro fertilization.
One glaring oversight in this research is the consideration of whether or not there may be a genetic predisposition to both infertility and autism. In other words, are women who tend to be infertile already carrying some type of genetic predisposition to autism? Maybe Mother Nature knows something when infertility happens, and she's trying to encourage us to look at that. Maybe we can fool her part of the way but not all of the way.
My comment is not meant to be judgmental, as I've seen plenty of women battle infertility, then commit to bringing their lives and their bodies back into balance…and have perfectly healthy babies. Our genetic predisposition is heavily influenced by choices we make, and we can make choices to maximize the genetic expression that encourages fertility. We're going to have a webinar on an aspect of this issue, nutrigenomics, in about a month.
The GOOD news in the fertility world today is that great things are being done with acupuncture!!! A study dated June 2010 found that acupuncture therapy could promote the following: (1) increased ovarian blood flow, (2) reduced ovarian volume, (3) reduced number of ovarian cysts, (4) better insulin function, (5) lower blood glucose, (6) reduced stress hormone levels, and (7) normalized appetite, encouraging more balanced eating.
So there is plenty you can do to improve your fertility. Bottom line is, be informed before you make your treatment choices.
Lim CE, Wong WS. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocrinol. 2010 Jun;26(6):473-8.
One of the things I love about social networking…is that I have more information at my fingertips than I would ever have access to if I had to find it all by myself.
One of the things I hate about social networking, especially Twitter, is how much bad information is passed along without any fact checking. I would have to say, 99% of all links that come across my screen were just retweeted without being read. People state their opinions as if they are facts, without providing any references. And the more followers a person has, the more entitled they seem to be, to state their opinion as if is fact, leaving their hundreds or thousands of followers thinking,"Well if _____ said so, it must be true."
Recently I've been reading a lot of things about stevia that are opinion-based, but not factual, which are being circulated without fact checking, so I went in to PubMed and found some references I thought I would throw out to help level the playing field.
Stevia is a natural sweetener. It is not sugar, but it is not a chemical artificially created in the laboratory. It is a plant native to Paraguay that is processed to be used as a sweetener. I have friends here in Phoenix who actually have stevia plants in their gardens in early summer.
Here are some other facts.
Stevia may or may not affect fertility. The very first article appearing in a stevia search, way back in 1968, reports that it does. Others follow with mixed results, looking at both male and female fertility. It does not appear to be related to any toxic aspect of the plant, merely how it affects hormone balance. Anyone using the right mix of references can create an argument leaning in either direction.
Stevia may improve glucose tolerance. It may actually improve function of the pancreatic cells (beta cells) that produce insulin. This is a pretty consistent finding.
Stevia is not cariogenic.
Stevia may help to reduce blood pressure.
Stevia is anti-inflammatory, has antioxidant characteristics, and may discourage tumor production.
Stevia does not cause you to eat more of other sweet foods. I have seen more than one dietitian assert this, and there is no reference (as of this date) to validate that.
For most of you, if you're not trying to conceive, stevia may be a very nice addition to what you're doing to balance your hormones. If you're trying to conceive, it gets a little tricky. If your main barrier to conception is insulin resistance, stevia may actually be beneficial. If it's another issue, such as sperm count, you may want to stay away. I'm providing references so that you can share this information with your reproductive physician and together decide which course of action is most appropriate for your personal situation.
Planas GM, Kucacute J. Contraceptive Properties of Stevia rebaudiana. Science. 1968 Nov 29;162(3857):1007.
Schvartzman JB, Krimer DB, Moreno Azorero R. Cytological effects of some medicinal plants used in the control of fertility. Experientia. 1977 May 15;33(5):663-5.
Yodyingyuad V, Bunyawong S. Effect of stevioside on growth and reproduction. Hum Reprod. 1991 Jan;6(1):158-65.
Das S, Das AK, Murphy RA, Punwani IC, Nasution MP, Kinghorn AD. Evaluation of the cariogenic potential of the intense natural sweeteners stevioside and rebaudioside A. Caries Res. 1992;26(5):363-6.
Melis MS. Effects of chronic administration of Stevia rebaudiana on fertility in rats. J Ethnopharmacol. 1999 Nov 1;67(2):157-61.
Jeppesen PB, Gregersen S, Poulsen CR, Hermansen K. Stevioside acts directly on pancreatic beta cells to secrete insulin: actions independent of cyclic adenosine monophosphate and adenosine triphosphate-sensitive K+-channel activity. Metabolism. 2000 Feb;49(2):208-14.
Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol. 2000 Sep;50(3):215-20.
Lee CN, Wong KL, Liu JC, Chen YJ, Cheng JT, Chan P. Inhibitory effect of stevioside on calcium influx to produce antihypertension. Planta Med. 2001 Dec;67(9):796-9.
Jeppesen PB, Gregersen S, Alstrup KK, Hermansen K. Stevioside induces antihyperglycaemic, insulinotropic and glucagonostatic effects in vivo: studies in the diabetic Goto-Kakizaki (GK) rats. Phytomedicine. 2002 Jan;9(1):9-14.
Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol. 2000 Sep;50(3):215-20. Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism. 2004 Jan;53(1):73-6.
Lailerd N, Saengsirisuwan V, Sloniger JA, Toskulkao C, Henriksen EJ. Effects of stevioside on glucose transport activity in insulin-sensitive and insulin-resistant rat skeletal muscle. Metabolism. 2004 Jan;53(1):101-7.
Hsieh MH, Chan P, Sue YM, Liu JC, Liang TH, Huang TY, Tomlinson B, Chow MS, Kao PF, Chen YJ. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study. Clin Ther. 2003 Nov;25(11):2797-808. Chen TH, Chen SC, Chan P, Chu YL, Yang HY, Cheng JT. Mechanism of the hypoglycemic effect of stevioside, a glycoside of Stevia rebaudiana. Planta Med. 2005 Feb;71(2):108-13.
Boonkaewwan C, Toskulkao C, Vongsakul M. Anti-Inflammatory and Immunomodulatory Activities of Stevioside and Its Metabolite Steviol on THP-1 Cells. J Agric Food Chem. 2006 Feb 8;54(3):785-9.
Ferreira EB, de Assis Rocha Neves F, da Costa MA, do Prado WA, de Araújo Funari Ferri L, Bazotte RB. Comparative effects of Stevia rebaudiana leaves and stevioside on glycaemia and hepatic gluconeogenesis. Planta Med. 2006 Jun;72(8):691-6. Epub 2006 May 29.
Chen J, Jeppesen PB, Nordentoft I, Hermansen K. Stevioside counteracts the glyburide-induced desensitization of the pancreatic beta-cell function in mice: studies in vitro. Metabolism. 2006 Dec;55(12):1674-80.
Ghanta S, Banerjee A, Poddar A, Chattopadhyay S. Oxidative DNA damage preventive activity and antioxidant potential of Stevia rebaudiana (Bertoni) Bertoni, a natural sweetener. J Agric Food Chem. 2007 Dec 26;55(26):10962-7. Epub 2007 Nov 27. Shukla S, Mehta A, Bajpai VK, Shukla S. In vitro antioxidant activity and total phenolic content of ethanolic leaf extract of Stevia rebaudiana Bert. Food Chem Toxicol. 2009 Sep;47(9):2338-43. Epub 2009 Jun 21.
Melis MS, Rocha ST, Augusto A. Steviol effect, a glycoside of Stevia rebaudiana, on glucose clearances in rats. Braz J Biol. 2009 May;69(2):371-4. Figlewicz DP, Ioannou G, Bennett Jay J, Kittleson S, Savard C, Roth CL. Effect of moderate intake of sweeteners on metabolic health in the rat. Physiol Behav. 2009 Dec 7;98(5):618-24. Epub 2009 Oct 6.
Anton SD, Martin CK, Han H, Coulon S, Cefalu WT, Geiselman P, Williamson DA. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite. 2010 Aug;55(1):37-43. Epub 2010 Mar 18.
Shukla S, Mehta A, Mehta P, Bajpai VK. Antioxidant ability and total phenolic content of aqueous leaf extract of Stevia rebaudiana Bert. Exp Toxicol Pathol. 2011 Mar 4. [Epub ahead of print]
Yesterday I shared some great news from an Italian research group about myoinositol for improving fertility. In the process of corresponding, they sent me a series of articles from their lab. One of their most recent investigated the combination of myoinositol and melatonin in fertility treatment.
Here's how it looks like the story goes.
Ovulation is an inflammatory process Yes, the process of releasing an egg, and giving life, is pro-inflammatory. It takes a lot of energy to do this, and as that energy is metabolized, it's oxidizing tissue around it.
Melatonin is one of the most powerful antioxidants we have You know, if you think about this the way Mother Nature does, it makes sense that we'd want to roll over and sleep all cuddled up after sex. It is her way of protecting that fragile egg from all of the stresses of the day.
The research I read yesterday was about INOFOLIC PLUS, an Italian proprietary blend of inositol, folic acid, and melatonin. Forty-six women who had previously undergone in-vitro fertilization (IVF) and failed, used this supplement daily for 3 months before undergoing another IVF procedure. They also continued to take INOFOLIC throughout the entire IVF cycle. This study, by the way, did NOT focus on women with PCOS, merely women who had failed IVF.
Here are some of the results of the second IVF in which the supplement was used: --Higher number of embryo transfers --Higher embryo quality --Where all of the subjects had failed with their first IVF the first time, 13 (28%) became pregnant during the study, 4 miscarried.
What is remarkable about this study is that the average age of these women was 39 years, an age where fertility is starting to become difficult even without a diagnosis of infertility.
The supplement is not perfect, but it shows promise for helping women for whom other strategies have failed. It seems to be a great combination of compounds for peeling off the layers of inflammatory/oxidative damage have inflicted on reproductive systems…talking your ovaries down out of the tree, so to speak. What it seems to do, is both create a higher quality egg and then protect it from the ravages of oxidation long enough for it to meet a sperm, conceive, and create an embryo.
Ahhhhhh…just love the power we have within ourselves to create healing solutions!
As I mentioned yesterday, unfortunately, INOFOLIC is not available in the United States. However, there is an important bottom line message here that cannot be ignored.
When you're not eating enough antioxidants, not delegating, working too hard, not sleeping well, not managing your stress, the melatonin Mother Nature given you to protect your eggs, may likely be channeled into fighting other damages those lifestyle choices have promoted.
Not trying to shake the eFinger at you here, it's just becoming apparent from listening to so many of your stories that when we don't take good care of ourselves, the effects can stick around for a very long time. And when we do things in an effort to eat well but don't do our homework first (such as eating vegan but not making sure all nutrients are still adequate in the diet or panicking and going on a crash diet in order to get pregnant, or overexercising as the only way to manage stress), they can hurt us in the long run.
If you start to think about your choices as"What can I do to not unnecessarily use my own antioxidant power so it can be there for that egg?"…perhaps making some of those choices you've been reluctant to take on, might become easier to embrace.
Unfer V, Raffone E, Rizzo P, Buffo S. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study. Gynecol Endocrinol. 2011 Apr 5. [Epub ahead of print]
If you've been contemplating attending our couples fertility getaway, September is the last month of summer room rates at the Clarendon Hotel, our host facility. Please consider joining us. We have a great lineup of sessions, and are anxious to be partners with you on your fertility journey!
Please email me at marika@google.com or call me at 623.486.0737 for more information.
I'm going to be a little less active for about a week here, but it's for an important reason that will hopefully serve at least a few of you who regularly visit my blog!
For the past few years I've been training colleagues around the country in some of the practical aspects of using nutrition to help with fertility. The colleagues I've been working with, as we've gained an understanding of how it all fits together, have been reporting some wonderful success stories in clients who had been told they might never have a child of their own.
As we've grown as a network, we've gained the attention of sponsors, and one of those sponsors, Nutrabella, approached me about collaborating with them to contribute to a fertility report that will be appearing in East Coast newspapers this coming Friday--the Washington Post, Wall Street Journal, and Boston Globe, to name a few. Another sponsor, SGJ Consulting, contributed to the project as well. It's been a great team to work with from start to finish!
That kind of opportunity has the potential to reach quite a few people (2.1 million is what has been projected)! So I've been busy making sure we're ready to handle the traffic and that everyone who's been going through my training is ready to take referrals.
If you know of anyone who is struggling with infertility, please tell them we have several resources: (1) this blog, of course! (2) individual consultations. Many of the professionals listed on this page do contribute to this blog. (3) Fertile Intentions (TM), our new couples infertility spa day experience, in Marina del Rey, California.
This is such a great audience with whom to share the message that there are many options outside of medication for helping with fertility.
I'll be back in about a week, hopefully with some exciting updates, and definitely with more comments on nutrition and mental health. In the meantime, I'm hoping other contributors have some helpful hints and interesting notes!
Due to some unusual cramping and bleeding, I went in to see my reproductive endocrinologist (RE), who is dually board certified as a gynecologist and an endocrinologist. If you have PCOS, and especially if you’ve ever tried to get pregnant and had a problem doing so, you have probably been referred to a RE. REs have a specialized understanding of the way our hormones affect our fertility, blood sugars, insulin resistance, and other PCOS-related conditions. They treat many PCOS patients, because PCOS is a primary cause of infertility.
One vaginal ultrasound and one pregnancy test later (the doctor and I duly noting that I am well over 40, infertile by all medical definitions, and just about as likely to be pregnant as Mother Teresa), it was determined that there’s a UFO in my uterus! Well, not really, but that’s what it looks like on the ultrasound screen. So, if it’s not a polyp, a cyst, a fibroid, or a baby, what is it?
Cancer comes to mind, and the possibility of cancer necessitated an endometrial biopsy, which is a very uncomfortable procedure in which the tissue in your uterus (the endometrium) is sampled (that’s medical-speak for pulled out in tiny chunks) and sent to the laboratory to be tested. Fortunately, no cancer was found. However, given that PCOS patients are much more prone than average to conditions such as hyperplasia (a proliferation of sometimes questionable looking cells) and endometrial cancers, the recommendation is almost always surgery to remove the tissue, be it a polyp, a cyst, or in this case, something unidentified. I am fortunate to have a highly skilled, aggressive doctor, who knows me and my condition very well, and I agree with this recommendation.
That was the good news, but then I learned the bad news – that my eggs had officially expired. While some doctors question the accuracy of the anti-mullerian hormone assessor, it’s a pretty accurate way to determine whether your eggs are still of use (and to what degree), or if you are pre-menopausal or post-menopausal. No longer having viable eggs was not unexpected, given my age. Nonetheless, there’s an emotional hit to all of this. There is a sense of loss, of unrealized potential, and a need to acknowledge that the door on having a biologically related child, created with my own eggs, has officially closed. At the same time, there is a surprising sense of freedom and relief accompanying this news. Given my personal and family medical history, I no longer have to make an active choice about passing on my genes. With assisted reproductive technology, the doors are open to carrying a pregnancy anytime up to age 53. I just know now for certain that, for me, a pregnancy would mean using donor eggs.
A visit to the RE can be painful or uncomfortable, confusing, enthralling, educational, inspiring, or worrisome – all at the same time. Surgical procedures and testing add to the complex mix of emotions aroused by having a condition or conditions you don’t entirely understand, an equally confusing array of treatment options, time pressures, and a host of medical practitioners, all with their own particular slant on what constitutes your best treatment plan, and why.
For me, that means surgery next month to remove the UFO, continued monitoring of my endometrial condition, and of course, more visits to the RE, especially should I decide to pursue a pregnancy with donor eggs in the future. I like the idea that I still have options, the immediately pressing medical concern is being addressed appropriately, and some aspects of my fertility still offer possibilities. PCOS has a rhythm and a flow of its own, shifting in prominence at various stages in your life and reproductive cycle, and contributes to a mix of emotional experiences. In choosing how to manage your care, your fertility, and your emotions, I hope you too are able to focus on the positive.
If you have not had the opportunity to hear Gretchen's interviews with pcoschallenge.com, please take the time to do so! Gretchen will also be hosting a PCOS expert webinar next Tuesday…to attend please contact www.pcoschallenge.net for more details on how to do so.
This is actually a post from Ellen Goldfarb, who you can hear on Internet radio tomorrow (see previous post). I am pasting her link on my blog roll for anyone who wishes to continue to follow her. She'll be here…and there!
So, I got married at a later age than most, 38 and knew that I wanted to have a family and so did my husband. We succesfully got pregnant on our own a year and a half after we got married however, sadly this ended in a miscarriage in the 10th week, when I went to the doctor there was no heartbeat. I had no idea. It was what they call a missed AB and so I had to get a DNC procedure. They asked if I wanted to have the tissue examined by a lab to see what had gone wrong, I told them yes. The determined that the cause of the miscarriage was due to a chromosome issue and they said most likely had to do with my age. My husband and I were devastated! were we too late, he was 44 and I almost 40 and we had no children yet! what were our options? We then spent and enormous amount of money doing IVF, we did one round in which we made 3 healthy embroyos and inserted them but …alas… nothing! what were we to do? I then started to think about adoption, but in the meantime, in the back of my mind I thought to myself, there must be something else I can do Being a Dietitian, I started to research more about hormones, fertility and nutrition I began to find an number of correlations between certain dietary patterns, sleep and exercise and fertility I began to make changed in all of these areas and encouraged myhusband to do the same We then took a trip to Hawaii and relaxed to get our minds off things Right before I was to begin another round of fertility injections, we found out that I was pregnant(on my own) and we immediately stopped the injections Now I am a nervous wreck again thinking something bad was going to happen and the first trimester was hell just waiting it out, but fortunately everything went fine, we had a CVS done and they said we were going to have a healthy baby girl! I have birth to Arianna Belle on Sept 19th 2006, 4 months later, I was naturally pregnant again with my second healthy daugher Lauren Ivy who was born on October 10th 2007 These pregancies were both concieved naturally and both children are very healthy and doing great! I really believe that if you make lifestyle changes, it can really effect your body and outcome I now have expanded my private practice to support and help women who struggle with infertility and PCOS in addition to my specialty of treating Eating Disorders My goal is to get as many women pregnant as I can with good nutrition and healthy lifetstyle practices for more information about me, contact my website at www.ellenreissgoldfarb.com I would love to hear from you:)
Last week on the PCOS Challenge Radio Show, I was asked about the relationship between CoQ10 and fertility. I promised Sasha I would investigate the issue, since I did not have an informed answer on the tip of my tongue. Here is that answer!
My gold standard for information is peer-reviewed literature in the National Library of Medicine database. When I used the keywords,"CoQ10" and"PCOS", there were no studies listed. When I used the keywords,"CoQ10" and"fertility", 16 different references appeared, but none of those references were about fertility in women. Two studies did report an association between low CoQ10 levels and miscarriage.
When I used the keywords,"fertilization" and"CoQ10", abstracts from the list of studies done on men were all that appeared.
Bottom line: CoQ10 could be important for conception and maintaining pregnancy, but there have been very few studies on the topic, and none of them that I found had a recommended dose. It may be important with this particular supplement to consider the father's regimen as well.
What is CoQ10, anyway? CoQ10 is an antioxidant made by our own bodies. As the Mayo Clinic writes, CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes, and HIV/AIDS. Since PCOS is a pre-diabetic, inflammatory condition, it makes sense that there would be interest in its role in this diagnosis as well. The link I provided above also evaluates the strength of the evidence supporting the use of CoQ10 for a variety of medical conditions.
For adults, Mayo also reports a dose 50-1,200 milligrams of CoQ10, in divided doses, by mouth, to be what was commonly reported.
Even though CoQ10 may help prevent miscarriage, it has also been known to reduce blood glucose levels. This can be a plus…but when another life is being taken into consideration, and the detailed effects of exactly how blood glucose responds to CoQ10 in supplemental amounts, given the fact that the use of CoQ10 has not really been studied during pregnancy, my first inclination is to not recommend it for women with PCOS who are trying to conceive and who may be pregnant without knowing it.
CoQ10 levels have been found to be lower in people using certain medications, such as statins (which lower cholesterol), beta-blockers (which stabilize heart rate), and blood pressure medications. If you are not trying to conceive and you are on medications in any of these categories, it wouldn't hurt to ask your pharmacist and physician about the potential benefits of supplementation.
CoQ10 is an antioxidant. It makes sense to me that in an inflammatory condition such as PCOS, there would be a risk of lower levels. But rather than view this as a situation where you have PCOS because you have low levels of CoQ10, I encourage you to consider whether your CoQ10 levels are lower than they should be, because of choices you are making that promote inflammatory processes. This blog is full of information about ways to slow down inflammation (which, in essence, is accelerated aging). There are many things you can do which can head off the need for even needing a supplement.
And you thought this potentially magical compound was going to replace the need for healthy eating, activity, stress management, and sleep hygiene choices. Cyster friends, if that was true, you wouldn't have spent all that money on all that CoQ10 and still be here looking for another answer. Dang!
Mancini A, Leone E, Festa R, Grande G, Silvestrini A, de Marinis L, Pontecorvi A, Maira G, Littarru GP, Meucci E. Effects of testosterone on antioxidant systems in male secondary hypogonadism. J Androl. 2008 Nov-Dec;29(6):622-9. Epub 2008 Jul 17.
Littarru GP, Tiano L. Bioenergetic and antioxidant properties of coenzyme Q10: recent developments. Mol Biotechnol. 2007 Sep;37(1):31-7. Review.
Li W, Li K, Huang YF. [Biological function of CoQ10 and its effect on the quality of spermatozoa]. Zhonghua Nan Ke Xue. 2006 Dec;12(12):1119-22. Review. Chinese.
Mancini A, De Marinis L, Littarru GP, Balercia G. An update of Coenzyme Q10 implications in male infertility: biochemical and therapeutic aspects. Biofactors. 2005;25(1-4):165-74. Review.
Li K, Shi Y, Chen S, Li W, Shang X, Huang Y. Determination of coenzyme Q10 in human seminal plasma by high-performance liquid chromatography and its clinical application. Biomed Chromatogr. 2006 Oct;20(10):1082-6.
Sheweita SA, Tilmisany AM, Al-Sawaf H. Mechanisms of male infertility: role of antioxidants. Curr Drug Metab. 2005 Oct;6(5):495-501. Review.
Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Fertil Steril. 2004 Jan;81(1):93-8.
Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Metabolism. 2003 Apr;52(4):402-6.
Balercia G, Arnaldi G, Fazioli F, Serresi M, Alleva R, Mancini A, Mosca F, Lamonica GR, Mantero F, Littarru GP. Coenzyme Q10 levels in idiopathic and varicocele-associated asthenozoospermia. Andrologia. 2002 Apr;34(2):107-11.
Ducci M, Gazzano A, Tedeschi D, Sighieri C, Martelli F. Coenzyme Q10 levels in pigeon (Columba livia) spermatozoa. Asian J Androl. 2002 Mar;4(1):73-6.
Palmeira CM, Santos DL, Seiça R, Moreno AJ, Santos MS. Enhanced mitochondrial testicular antioxidant capacity in Goto-Kakizaki diabetic rats: role of coenzyme Q. Am J Physiol Cell Physiol. 2001 Sep;281(3):C1023-8.
Sinclair S. Male infertility: nutritional and environmental considerations. Altern Med Rev. 2000 Feb;5(1):28-38. Review.
Alleva R, Scararmucci A, Mantero F, Bompadre S, Leoni L, Littarru GP. The protective role of ubiquinol-10 against formation of lipid hydroperoxides in human seminal fluid. Mol Aspects Med. 1997;18 Suppl:S221-8.
Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med. 1997;18 Suppl:S213-9.
Angelitti AG, Colacicco L, Callà C, Arizzi M, Lippa S. Coenzyme Q: potentially useful index of bioenergetic and oxidative status of spermatozoa. Clin Chem. 1995 Feb;41(2):217-9.
Mancini A, Conte B, De Marinis L, Hallgass ME, Pozza D, Oradei A, Littarru GP. Coenzyme Q10 levels in human seminal fluid: diagnostic and clinical implications. Mol Aspects Med. 1994;15 Suppl:s249-55.
Noia G, Littarru GP, De Santis M, Oradei A, Mactromarino C, Trivellini C, Caruso A. Coenzyme Q10 in pregnancy. Fetal Diagn Ther. 1996 Jul-Aug;11(4):264-70.
Noia G, Romano D, De Santis M, Cavaliere AF, Straface G, Alcaino S, Di Domenico M, Petrone A, Caruso A, Mancuso S. [The antioxidants (coenzyme Q10) in materno-fetal physiopathology][Article in Italian] Minerva Ginecol. 1999 Oct;51(10):385-91.
Sometimes I find interesting medical news in somewhat unusual places, namely the July 1, 2009 issue of the Wall Street Journal. On the front page of the “Personal Journal” section, there’s an article entitled “Fertility Methods for Older Women Spawns Doubts: Evidence Fails to Support Use of Popular Technique for Screening Embryos.”
The technique, PGS (pre-implantation genetic screening) is believed to reduce the risk of serious chromosome-related disorders, such as Down syndrome. While PGS is routinely practiced by reproductive endocrinologists (the doctors who are there to help you get pregnant when you’re struggling with infertility), the American Society of Reproductive Medicine (www.ASRM.org) now states that numerous clinical trails have concluded that live birth rates are not enhanced by the use of PGS.
What does this mean for you if you’ve got PCOS, you’re over 35 (not so charmingly referred to as “AMA,” or “advanced maternal age,” which pretty much instantaneously places you in the high-risk category) and you’re trying to get pregnant? I am an AMA PCOS patient, and I’m aware that it means several things, all of which point to the need to be a proactive patient:
Be aware of where you stand in terms of fertility timeframes – as stated above, biologically speaking, the clock really starts ticking at an accelerated rate once you hit 35. Although we hear about celebrities who are giving birth well into their 40s, they are almost always taking advantage of assisted reproductive technology when doing so. Thinking you have another decade to go before your fertility declines is neither realistic nor helpful, especially if your goal is to have more than one pregnancy.
Know your doctor’s practices – while there are commonalities among reproductive endocrinologists in the ways they practice, refer back to the ASRM for “best practices” guidelines and see if your physician is in compliance. If you aren’t comfortable with what you know, talk to your doctor, and ask questions until you’re satisfied. If you’re still not satisfied, consider changing physicians.
Know your doctor’s tendencies – is he or she precise, analytical, thorough, and well-versed in the very latest in reproductive medicine? Do you feel like your doctor is treating you as an individual, and not just a member of a particular demographic? You have the right to comprehensive assessment, a detailed treatment plan, and enough explanation about the doctor’s policies, procedures, practices, and success rates.
Exercise your right to say “no” — your doctor may not have read the very latest research, or may adhere to a belief that PGS or some other technique constitutes the best treatment for you. Your doctor is here to advise, consult, and treat, not dictate (except in life-threatening circumstances), so take the time to study proposed treatments and tests before making a decision. By the way, PGS is considered an experimental technique, and it is a costly one – adding approximately 20% to the average $10,000 cost of a round of IVF.
In the journey through assisted reproductive technology, the AMA PCOS patient needs to be aware, realistic, thorough in her research, and unafraid to question the value and price of technology. To learn more about assisted reproductive technology, I recommend the ASRM website, as well as RESOLVE: The National Infertility Association (www.RESOLVE.org).
One of the more frequent searches bringing readers to our blog is"vegetarian" and"fertility"…and"vegetarian" and"pcos". I've also noticed when doing Fertility Friendly Food Tours at Whole Foods, that a disproportionate percentage of women attending these classes, are vegetarian. And, in my individual counseling, it's not uncommon to learn during an assessment that if a client is not currently vegetarian, she was at some point in her life.
So I wasn't surprised to find this study reporting that women with PCOS tend to be deficient in vitamin B12.
I often teach that PCOS is a counterintuitive illness. By that, I mean that what often needs to be done is the opposite of what you might think. In this case, rather than immediately assuming that the most important strategy is to restrict food choices because your appearance suggests overnutrition, it may actually be to add foods back into your diet to correct underlying deficiencies.
This B vitamin is found almost exclusively in animal products, including fish, meat, poultry, eggs, milk, and milk products. It is also found in some fortified breakfast cereals, but if you're avoiding carbohydrates as well as trying to be vegetarian, you're likely not getting enough vitamin B12 in your diet.
Some fermented soy products, namely tofu, tempeh, miso, and tamari, may contain vitamin B12, if the bacteria, molds, and fungi used to produce them were vitamin B12 producing. This is a project I'll look into and blog about in a later post.
Finally, some nutritional yeast products also contain vitamin B12. Lucky for you Aussies reading this blog, that means Vegemite and Marmite, made from yeast extracts, can be excellent choices to include in your diet!
It is possible to obtain vitamin B12 by taking a vitamin supplement, but the amount of the vitamin that is actually absorbed through the digestive tract may be very low. For this reason, physicians who note a low vitamin B12 level may recommend an injection, to bypass the digestive tract.
Women over 14 years of age, if not pregnant, should be consuming 2.4 mcg of vitamin B12 per day. They should aim for 2.6 mcg per day when pregnant, and 2.6 mcg per day when breastfeeding.
It's clear, if you don't do vegetarian eating in a thoughtful, proactive way, it carries considerable health risks. As you've seen before in this blog, inCYST believes that healthy vegetarian eating is about what you DO choose to eat, more than what you DON'T choose to eat.
It is a good idea, if you're vegetarian, or ever have been, to ask your physician to check your vitamin B12 levels. A low status is easy to correct and that can be part of your strong foundation for managing your PCOS and improving your mood, insulin function, and fertility.
Kaya C, Cengiz SD, Satiroğlu H. Obesity and insulin resistance associated with lower plasma vitamin B12 in PCOS. Reprod Biomed Online. 2009 Nov;19(5):721-6.
When working with women who desire very much to conceive, it can be challenging to help them understand the big picture. They want a baby…they want it NOW…and if that's not something you can promise…well, there are a gazillion other people out there who will gladly take their money if they say what these women want to hear.
We're establishing a pretty good track record when it comes to fertility help, but what I want to be sure everyone understands, who comes to this blog, is that we're equally concerned about your long term health, and preventing infertility in the babies you might have.
One of the patterns I'm seeing when evaluating clients, is that they were either formula fed, or breast fed for a short time before being switched to formula. Yes, what happened to you as a child can definitely affect your fertility. We can do a pretty good job of playing catch up, but if you only play catch up long enough to become pregnant, then go back to your former way of eating, you're setting up your babies to have similar problems in THEIR adulthood. Knowing what you've likely gone through yourselves…why would you wish that on anyone? Especially your own child?
So even though you may not really be thinking about the fertility prospects of the baby you may not even have yet, I'm encouraging you to think long-term and big picture. Here's an example of research that tells you why I'd do that.
Seventy-seven healthy babies born to term were compared to each other based on the following: (1) breast fed longer than 6 months, (2) breast fed between 3 and 5 months, and (3) exclusively formula fed.
Baby's DHA levels (that's the omega-3 found primarily in fish oil and marine algae) did not differ much at birth, but DHA significantly decreased between birth and the first year of age in babies who were not breast fed. The researchers concluded that breast feeding for at least months is what is required to prevent this decline.
Because every milligram of DHA a baby gets in breast milk comes from mama's personal supply, it is crucial that mama's diet be adequate in DHA throughout nursing. Fortunately, the very diet we've been encouraging you to consume to become pregnant and stay pregnant…is the diet that facilitates this process. It wasn't that you were healthy and just needed a little push to become pregnant. You were out of balance, and the way you chose to eat restored that balance. Once you get there, the goal is to maintain balance, not go back to being out of balance because you've achieved your important goal and want to get back to the easier way of doing things.
It's about your pregnancy, your baby's health, your brain and baby's brain. And it's not really that hard. Hopefully we're helping you to see that.
Sanjurjo Crespo P, Trebolazabala Quirante N, Aldámiz-Echevarría Azuara L, Castaño González L, Prieto Perera JA, Andrade Lodeiro F. [n-3 and n-6 fatty acids in plasma at birth and one year of age and relationship with feeding.] An Pediatr (Barc). 2008 Jun;68(6):570-5.
New Infertility Program Puts Mother Nature Back Into The Equation
Phoenix, AZ and Marina del Rey, CA (August 19, 2008). Monika M. Woolsey, a registered dietitian, knows the story well. “Can you please help me? I failed fertility treatment, and I’m desperate for a baby, but I’m emotionally and financially exhausted.” She finally decided to do something about it. During ten years of specializing in infertility, she used her training in nutrition and exercise physiology to create a lifestyle program that naturally balances hormones. She’s trained a few dozen colleagues in the concept, and they’re confirming her findings—a few simple tweaks in diet and lifestyle can greatly enhance fertility.
Michele Gorman, MS, RD, LD, of Twin City Nutrition in Minneapolis, trained with Monika. “My client who was trying for over 2 1/2 years, tried in-vitro fertilization, and was working with one of the best reproductive medicine clinics in the city. She was sophisticated and well educated on treatments for fertility, however after 2 1/2 years she found herself depressed, exhausted and believing that she would never conceive. She never had any expectation that she would leave my office with a plan to promote ovulation, but that day we did exactly that and at her 5-week visit, she shared in tears that she was PREGNANT!”
The results from this program have been so profound that Gorman and Woolsey, along with dietitian Susan Dopart of Santa Monica, are now setting up their first research study to officially document their findings.
In the meantime, Woolsey has created a day spa, Fertile Intentions, for couples who would like to learn more about a natural option to try either as a first step or as an adjunct to traditional medical treatment. The first event will be Saturday, October 25, 2008, at Creative Chakra Spa in Marina del Rey. In addition to teaching the science and application of this program, this day spa will focus on emotionally supporting couples whose pursuit of familyhood has started to erode their relationship.
“The entire day is filled with information and experiences completely devoted to the COUPLE. And how that couple can live, relax, and communicate in ways that promote better balance all around. If the goal is to bring children into this world, as much as possible, I want those parents to be happy and excited, not completely exhausted when it finally comes to be,” says Woolsey. For further information on Fertile Intentions Couples Day Spas, visit www.afterthediet.com/fertileintentions.htm
