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The American Fertility Association Blog

What do male frogs with eggs, genital defects and your everyday products have in common?

July 20, 2009 - Monday
Posted by admin

By:  Heather Sarantis

Yesterday as I trolled the New York Times, I was excited to see that Nicholas Kristof was at it again. I am a fan of his under normal circumstances, but his recent columns focusing on hormone (or endocrine) disruptors just really hit the nail on the head.

Hormone disruptors are substances not naturally found in the body that interfere with the production, release, transport, metabolism, binding, action or elimination of the body’s natural hormones. They can scramble messages that natural hormones normally transfer between cells.

They are used in numerous everyday products, including plastic bottles, cosmetics, the lining of food containers, medical devices, pesticides and many others. And the vast majority of people are being exposed to them-some tests showing more than 90% of the people tested by the Centers for Disease Control having certain hormone disruptors in their bodies.

Kristof’s columns highlight several important trends. First, we are seeing evidence of hormone disruptors in wildlife, such as male fish developing eggs, which means their use is widespread enough that they are dispersing into the environment. Second, we are seeing evidence in humans - for example, baby boys developing genital malformations or young girls entering puberty prematurely, which means we are putting ourselves and our children at risk for reproductive and other health problems.

Researchers have known for years that hormone disruptors may cause health problems. For example, Bisphenol A, a hormone disruptor found in some plastic bottles (including some baby bottles), was known to have potential health problems as early as the 1930’s.  But scientific consensus about chemical safety-and subsequent regulation-is often a tough row to hoe. Last month marked a big success in the struggle - the Endocrine Society released a ground breaking report stating that exposures to endocrine disrupting chemicals are a growing threat to human health and well-being. Recognition from professional societies such as this is critical in tipping the scales toward better safety regulation of chemicals, and many of us who work on chemical safety applaud the Endocrine Society for taking a bold stand on this issue.

So, what do hormone disruptors mean in everyday terms? If you are reading this blog, you are likely either thinking about having children or are several months or even years into trying have children. This is a good time to be learning about these chemicals.  What a woman is exposed to throughout her life, especially during pregnancy, can have long-term impacts on her baby’s health. There are too many hormone disruptors, and too many health risks from exposure to list them all here, but they can increase risk for a wide range of reproductive health problems, such as impaired fertility or infertility, polycystic ovarian syndrome, uterine fibroids, endometriosis, miscarriage, shortened lactation and breast cancer.  For a more complete understanding of these issues, see Girl, Disrupted: Hormone Disruptors and Women’s Reproductive Health.
No formula currently exists that can determine the exact effects hormone disruptors will have on a person’s health. Research indicates that the effects depend on the potency and dose of the chemical, the timing of the exposure (especially if exposure happens during pregnancy), and overall health. Taking good care of your general health is important, and other ways to protect your and your potential future babies’ health include:

1. Support policies to prevent exposure to hormone disruptors and other chemicals that have not been proven safe. Current standards for chemical use do not adequately protect us. New national policies are needed to identify and phase out harmful chemicals and to require that safer substitutes be used.
2. Use healthier products when possible. There are many easy, affordable and simple changes anyone can make at home to reduce their exposure to environmental contaminants. For ideas on how to make these changes, please see www.womenshealthandenvironment.org.

Heather Sarantis is the Women’s Health Program Manager at Commonweal/Collaborative on Health and the Environment. She is the author of the women’s health and environment toolkit, works on the Campaign for Safe Cosmetics and does many other things to help people reduce the exposure to harmful chemicals.

Categories
Endometriosis • Family Building • Fertility • Fertility and the Environment • Infertility • Miscarriage • PCOS • Pregnancy Loss • Reproductive Health

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Stories of Persistence

July 15, 2009 - Wednesday
Posted by admin

By:  Dr. Fred Licciardi



Dr. Fred Licciardi of NYU Fertility Center in NYC was one of the first voices in reproductive endocrinology to blog.  Being ahead of the curve has always characterized Dr. Licciardi for us here at The AFA, where we are some of his biggest fans.  We wished to share his compassion, insight and wisdom with all of you.  Please welcome Dr. Licciardi as the newest voice on our growing blogger team.  We will be syndicating Dr. Licciardi’s blog, as well as resurrecting many of his past posts, for you to read and learn from.

Thanks,

The AFA Staff



Reprinted from:  Wednesday, November 26, 2008


Anything we need or want, we hope for.

As stories from the internet have shown, some women with low chances can become pregnant.

Here are a few of my own. And these are only a few out of many others, these just came to mind.

Ms. A was 38 when we met. Her FSH was 22. She was “dismissed” from another program. 2 years earlier she delivered, but this was after trying for 18 months. The sperm motility was a little low, but the sample was close enough to normal, ICSI was not needed.

She first tried a day 2 start, her FSH was 13,4, and was cancelled and converted to IUI because there were only 3 follicles. The plan: keep trying. Her second cycle never got off the ground because of a day 2 FSH of 17.7.

Her FSH was 11.9 on her 3rd attempt and she went on to make 4 eggs, 4 fertilized . On day 3 one looked good, the other fair. This ended in an early biochemical loss.
Her next cycle we changed up the protocol a bit. She had 4 eggs, and 2 embryos transferred, both looked good. This worked, and she just delivered.
So here we have a woman who most doctors would tell there is no chance, but she persisted.

Ms. B was 35 when we met. Her FSH was 14. Her resting follicle count was less than 5. She started a cycle with an FSH of 12, got 6 eggs, poor fert and a cancelled transfer for arrested embryo growth.

Her second cycle was cancelled for no response (not one follicle).

She got pregnant on her own. This theme is an internet favorite. Buy the way, she did not use DHEA.

Mrs C. was 36 and suffered from severe edometriosis. She did 2 IVF cycles before we met.

She did 3 more retrievals with me, always making a good egg number and having good embryo quality. She travelled long distance to get to NYU. On her 3rd cycle (5th total) she became pregnant.

The next one goes under the dumb doctor category (that would be me). Mrs D, a 38 year old from overseas, e-mailed me and told me about her FSH of 25. Realizing she was from far away, I tried to save her some travel time and money and told her IVF was out, but donor egg was in. The couple came to see me, heard the donor egg schpeal and as I finished the husband looked up and said that his wife was going to be day 2 in a few days, could they try IVF while they were still in the States? Without boring him with the low odds speech, I just said, “sure why not.”

Sure enough the FSH was 12, she made 9 eggs and delivered twins. I think they are happy with me, but I am sure they have their reservations.

How can we put these all together?

1) They about women under 40. I don’t mean to exclude the 40 and over crowd from the hope discussion, as there are plenty similar stories about women in their 40’s, but the facts support that it’s easier to beat the odds when you are younger.
2) FSH may not be as important as we once thought. Again, a bad FSH is better under 40. Every so often there is a paper or abstract reminding us that pregnancy rates shoot down with increasing age and FSH levels. Which leads us to the next point:
3) Some infertile women can at times become pregnant on their own. We do use this fact when recommending that some women cancel their cycle or give up on IVF. We say yes you can get pregnant with IVF, but your odds are low, about the same as getting pregnant on your own. Of course this is much more difficult concept to accept when there is a severe male factor.

So for Mrs. A, C, and D, their persistence is what lead to their success. They did not accept the advice of a doctor; they did what they felt they needed to do. Of course we have to keep in mind that it is also true that there are women who try and try unsuccessfully.

Sometimes the fertility establishment is criticized for giving a bit too much hope, while profiting nicely from tons of women who are needlessly spending tons of dough. And sometimes we are criticized for not giving an infertile woman the chance she deserves.

But it will always be true that for most women with low odds, there is a small chance, and sometimes their only chance, using IVF. So it all goes back to getting to the right clinic and getting informed about your odds. After that it’s between you and your doctor, sometimes with a little tug of war.

Dr. Licciardi

Categories
Donor Egg • Endometriosis • Fertility • FSH • ICSI • Infertility • IVF

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