Think of the children

Transcription

1 Help US Help YOU As a specialist in infertility I treat both women and men, and one sentence that my patients often hear from me is, Help me help you! This is because, in my opinion, lifestyle has a major influence on fertility and this fact is not sufficiently well known. This means that you may be able, using simple strategies, to enhance your fertility, or at least help us make your fertility treatments more effective. You may be able, using simple strategies, to enhance your fertility, or at least help us make your fertility treatments more effective. by Dr. Patricia Monnier If you are overweight, lose a few pounds One aspect you can work on is weight control. We all know that obesity has reached epidemic proportions all over the world. This phenomenon has not spared fertility patients, and numerous studies have shown that excess weight damages the fertility potential. In fact, the risk of infertility is three times higher in obese women than in women with a healthy weight. Indeed, fat tissue is not considered anymore as a passive depot for storing excess energy but as an active organ secreting several hormones. One explanation of the negative relationship between obesity and fertility is that fat tissue promotes the production of bad hormones which do not help the ovary to perform its duties. If one burns fat through 14 Créons des familles FALL/AUTOMNE 2013

2 The good news is that you do not have to be paper thin to enhance your fertility. A woman with a body mass index over 30 who loses as little as 6.5 kilos (14 lbs.) will improve her ovulatory function. losing weight, this regulates ovarian physiology, in plain terms, ovulation. The same is true for men. Extra pounds hinder sperm production, especially in overweight men whose diet is high in saturated fats, such as those found in butter, fat cheeses and frying oil. 1 The good news is that you do not have to be paper thin to enhance your fertility in fact, being too thin is equally detrimental to your reproductive health. According to several studies, a woman with a body mass index over 30 a person with a BMI between 25 and 30 is considered overweight, while someone with a BMI over 30 is considered obese who loses as little as 6.5 kilos (14 lbs.) will improve her ovulatory function. After losing weight, an obese woman will have a 90% chance of ovulating on her own, a result which no medical treatment can achieve. 2 Think of the children Losing weight is not easy. One factor that may boost your motivation is that by shedding a few kilos you will actually do a great service to your future children. Indeed, there is increasing evidence that the environment in the mother s womb conditions the health of the child once he or she becomes an adult. An overweight or obese mother will tend to produce children who will be more vulnerable to obesity later in life. These children will also tend to be at risk of problems associated with sugar levels in their blood and of developing insuline resistance. This may lead to an array of health problems, from diabetes to heart disease. Moreover, recently, researchers found a preconceptional impact of paternal obesity, via spermatogenesis, on the offspring s future health status. 3 Ban alcohol, recreational drugs, tobacco and sauna baths! Other steps which are relatively simple to take and are totally under your control are related to your intake of alcohol, drugs and tobacco products. No matter what you may hear about some positive effects of alcohol, of red wine in particular, alcohol is toxic for the reproductive system. 4 And so is cannabis, usually referred to as a soft drug. Well, when it comes to your reproductive health, studies show that it is not that soft 5 As for tobacco, it should be banned from any household where one person or a couple is trying to conceive. 6 Not only does tobacco lower a man s sperm count, it also cuts by 50% a woman s chances of success when undergoing IVF if her partner is a smoker, even if she doesn t smoke herself. Furthermore, women exposed to passive smoke also take longer to achieve a spontaneous pregnancy. Why ban sauna baths? 7 Men are increasingly aware that heat is harmful to the production of healthy sperm, but this may be worth Tobacco should be banned from any household where one person or a couple is trying to conceive. Not only does tobacco lower a man s sperm count, it also cuts by 50% a woman s chances of success when undergoing IVF if her partner is a smoker, even if she doesn t smoke herself. FALL/AUTOMNE 2013 Creating Families 15

3 We now know that small doses of endocrine disruptors, day after day, have a cumulative effect that damages not only our reproductive health, but also our health in general. repeating: hot baths, saunas, heated seats (in cars), laptops held near their body are all activities that men trying to conceive should stay away from. 8 Cut your head off! A relationship has been established between the head and the hormonal system, with the result that pregnancy rates are adversely affected in women who suffer from high levels of stress. 9 This is why we offer yoga classes to our patients at the McGill Reproductive Centre. Indirect evidence of the influence of stress on the reproductive system is that a spontaneous pregnancy after a successful round of IVF is not rare, indeed even after an appointment with the fertility clinic has been made. We can surmise that the logic behind this phenomenon is that patients level of stress goes down once they have achieved a pregnancy or have the assurance they will be taken care of. When my patients ask me what they can do to maximize the chances of implantation following embryo transfer, my answer usually is, Do not have a bath in the next few days, drink plenty of water so that you will eliminate large quantities of liquid and thus reduce the risk of infection and cut your head off! Meaning that they should do their best not to worry. Beware of endocrine disruptors I will admit, however, that it is difficult not worry about endocrine disruptors. An endocrine disruptor is a natural or synthetic molecule which interferes with the functioning of our hormones. It does that either through mimicking our hormones or through preventing them from taking effect. BFRs are everywhere Nowadays, the environment we live in could be described as a soup of endocrine disruptors. Unfortunately, they are found in objects we use every day, from plastic containers to lipstick, from computers to hair dryers to personal care and cleaning products. One class of endocrine disruptors which pervades our environment are called BFRs (for brominated flame retardants ). These chemicals are added to many consumer products to make them less flammable. Our clothes, our electronic devices, even the material covering our sofa are likely to carry BFRs. We absorb over 80% of the BFRs in our environment in the form of contaminated dust, while the remainder is absorbed through food. An association between the toxins found in BFRs and male infertility has already been suspected, and studies are under way including some by my McGill colleagues to assess their impact on men s and women s fertility and fetal development. Among the things we have learned in recent years about endocrine disruptors, two stand out. The first one is that one can no longer rely on the age-old principle, The dose makes the poison. We now know that small doses of endocrine disruptors, day after day, have a cumulative effect that damages not only our reproductive health, but also our health in general. The second thing we learned has to do with a cocktail effect. Much is still unkown about how endocrine disruptors act, and, moreover, how they interact. This notwithstanding, we are nevertheless able to analyze the impact of specific classes of chemicals on specific targets, which may give us indications as to how we may, if not avoid them completely this is unfortunately not feasible at least diminish our exposure whenever possible. and so are phthalates Phthalates are another class of chemicals found in our household objects and living spaces. To give you an idea, a survey found that over 95% of the population in the United States had measurable levels of phthalates in their urine. Phthalates have been associated with fertility problems in animals. In humans, women s 16 Créons des familles FALL/AUTOMNE 2013

4 during preparation or packaging. - Take out your magnifying glass and shop for cosmetics without parabens and phthalates they exist. Keep in mind that a woman may put kilos of cosmetics on her face throughout her lifetime. Take out your magnifying glass and shop for cosmetics without parabens and phthalates they exist. Keep in mind that a woman may put kilos of cosmetics on her face throughout her lifetime. The good news is that we are now more aware of the damages inflicted on our health, and in particular on our reproductive health, by endocrine disruptors. It is hoped that the numerous studies now being carried out in this field will lead to the replacement of harmful chemicals with safe ones. Until we reach this happy stage, trying to minimize your exposure and leading a healthy lifestyle, including losing a few pounds if need be, and learning to manage your stress, could go a long way in helping you achieve your dream of becoming a parent. This is the best way you can help us help you. exposure to these endocrine disruptors is greater because they are commonly found in cosmetics, particularly in lipstick, mascara, nail polish and moisturizers as well as household products. The literature examining the relationship between human fertility and phthalate exposure is sparse. One epidemiological study suggests that phthalates increased time to pregnancy (the number of menstrual cycles required to conceive). 10 What you can do I hear you ask: Considering that endocrine disruptors seem to be inescapable, isn t trying to avoid them a lost battle? As I mentioned earlier, banishing them from your environment altogether is not easy at the moment you would have to give up your computer, for one thing. In addition to the recommendations stated earlier, there are nevertheless measures you can take in order to reduce your daily exposure: - Do not use plastic containers to warm up food in the microwave oven. Doing so would transfer some phthalates into your dinner. Glass containers are preferable. - Avoid wrapping leftovers in plastic film, especially fatty foods. Phthalates are made of mobile parts and they love fat. Wrapping fatty food in a plastic film would encourage endocrine disruptors to migrate into your food. - Eat home-cooked meals rather than commercial ready-made dishes that can be contaminated by plastic products FALL/AUTOMNE 2013 Creating Families 17

5 References About the Author Dr. Patricia Monnier is an obstetriciangynecologist specialized in infertility at the McGill University Health Centre Reproductive Centre - Montreal, and an Associate Professor at the Department of Obstetrics and Gynecology of McGill University - Montreal. She holds a Ph.D. in cellular biology and immunology from the University of Nancy, France, and her research projects focus on the impact of environment on reproductive health. 1 Attaman JA, Toth TL, Furtado J, Campos H, Hauser R, Chavarro JE. Dietary fat and semen quality among men attending a fertility clinic. Hum Reprod May;27(5): Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod Jun;13(6): Soubry A, Schildkraut JM, Murtha A, Wang F, Huang Z, Bernal A, et al. Paternal obesity is associated with IGF2 hypomethylation in newborns: results from a Newborn Epigenetics Study (NEST) cohort. BMC Med. 2013;11:29. 4 Joo KJ, Kwon YW, Myung SC, Kim TH. The effects of smoking and alcohol intake on sperm quality: light and transmission electron microscopy findings. J Int Med Res. 2012;40(6): Battista N, Meccariello R, Cobellis G, Fasano S, Di Tommaso M, Pirazzi V, et al. The role of endocannabinoids in gonadal function and fertility along the evolutionary axis. Mol Cell Endocrinol May 15;355(1): Soares SR, Melo MA. Cigarette smoking and reproductive function. Curr Opin Obstet Gynecol Jun;20(3): Garolla A, Torino M, Sartini B, Cosci I, Patassini C, Carraro U, et al. Seminal and molecular evidence that sauna exposure affects human spermatogenesis. Hum Reprod Apr;28(4): Avendano C, Mata A, Sanchez Sarmiento CA, Doncel GF. Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation. Fertil Steril Jan;97(1):39-45 e2. 9 Csemiczky G, Landgren BM, Collins A. The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment. Acta Obstet Gynecol Scand Feb;79(2): Burdorf A, Brand T, Jaddoe VW, Hofman A, Mackenbach JP, Steegers EA. The effects of work-related maternal risk factors on time to pregnancy, preterm birth and birth weight: the Generation R Study. Occup Environ Med Mar;68(3): Créons des familles FALL/AUTOMNE 2013