Preserving your fertility
Laura L. Tatpati, MD
Clinical Asst Professor, Obstetrics and Gynecology
Live and Learn Lecture Series
KU School of Medicine
Obstetrics
and
Gynecology
Reproductive
Endocrinology
and Infertility
Preserving - Protecting:
Our goals today-
The Biological Clock
External factors impact on fertility
Protecting fertility - old and new
Almost 1 in 8 couples
Infertility
www.reproductivefacts.org
Causes of Female Infertility
Egg factors
Quality
Number
Tubal factors/Pelvic scarring
Infection
Endometriosis
Cervical/Uterine factors
Genetic
Acquired
Causes of Male Infertility
Sperm production problems
Genetic
Born without ability for sperm development
Born without tubes to release sperm
Acquired anatomical changes
Polyps obstructing outflow
Vasectomy
Environmental
Aging
Fertility and Aging
Born with all the eggs we’ll ever have
20% of women have their 1st child after
35
5% had their 1st child after 30 in 1975
At least 1/3 of those trying to conceive
after 35 have difficulty
Fertility and Aging
Fertility always declines with age
For most, major acceleration of decline = late 30s
Individual rate vs. Age group rate
Impact from genetics & environment
modifiable risks
“Goals for a healthier Me
and baby-to-be”
FERTILITY GOALS
HEALTH GOALS
BE AWARE OF GOALS AND COMMUNICATE
THEM TO YOUR DOCTOR
http://www.cdc.gov/preconception/showyourlove/documents/
Healthier_Baby_Me_Plan.pdf
Sexually transmitted
infections
Tubal Factor: 18% of infertility
Chlamydia: 2.9 Million cases and 1.5
Million cases treated annually
Gonorrhea: 8 Million cases annually
1 in 15 sexually active 14-19 yo females
have Chlamydia
Avoidance
Early Detection and treatment
http://www.cdc.gov/std/healthcomm/the-facts.htm
Smoking
http://women.smokefree.gov
54% higher chance of infertility
Accounts for up to 13% of infertility
50% lower chance of pregnancy with IVF!
Increased risk with increased amounts
Damages the ovarian “egg pool”
Quitting makes a
difference
Don’t Wait!
Alcohol
1 in 8 women binge drink (4 or more in 23h)
Infertility may be more likely with over 5 8 drinks / week or repeated binge
drinking
beyond infertility - breast cancer, heart
disease, unintended pregnancy, and fetal
alcohol syndrome
Weight
Low BMI
Body fat is key
Low BMI
Normal BMI, low body fat
Excessive intense cardio may
result in hormone problems
Menstrual irregularity
Infertility with regular menses
Goal 150 minutes moderate
intensity per week
Obesity/
Elevated BMI
Irregular menses
Regular menses
Still reduced fertility
Pregnancy complications
Health complications
Eat healthy
Fruits/Vegetables
Lean meat, small portions
Beans, eggs, nuts
Whole grains
Avoiding saturated / trans
fats
(Possibly) 1 full fat dairy
every few days*
Environmental toxins
Medical term: Endocrine disruptors
Interrupt hormones in our body
Cumulative effect
work toxins, solvents, plastics, cosmetics, detergents
http:/www.prhe.ucsf.edu/prhe/pdfs/ToxicMatters.pdf.
http://www.marchofdimes.com/pregnancy/stayingsafe_indepth.html
Stress / Mental Health
Infrequently the sole cause of true infertility
Sexual dysfunction
Ovulatory disturbances
Some meds can affect hormones
Conflicting data
Definitely associated with stopping
treatments
Can affect relationships
Seek support/Communicate
Health
Conditions
Contributing Medical Conditions
Insulin resistance/Type 2 Diabetes
Thyroid disease
Pituitary disease
Depression/anxiety
Vaginismus, painful intercourse, sexual dysfunction
Cancers (1/8 are reproductive aged or younger)
Gynecologic
Many more ...
Gynecologic issues
Fibroids
Polyps
Endometriosis
PCOS
Primary ovarian insufficiency
Irregular periods?
See your doctor
Prevent a bigger
Problem!
Cancer
treatments
Chemotherapy
Radiation
www.fertilehope.org
Cumulative effects
Each new issue
Builds on the last
Steroids/Testosterone
Supplements, topical, injections,
pills
Tobacco
First and second-hand smoke
issues!
Alcohol
Obesity
Illness/Injury
diabetes, severe kidney damage,
paraplegia
High heat environment
Varicoceles - consider monitoring or
treatment
Toxins
Men
Toxins
Sperm background
Lead
Sperm are made in about 72d
They live in storage for about 15-25
days in the epidymus
Dibromochloropropane
Welding
Sevin
Toluenediamine, Dinitrotoluene
1,000 shown to be harmful to animal
reproduction and nearly 4 Million untested
Ethylene Dibromide
Plastic Production
Safety
Avoid skin contact
Store in sealed containers
Ethylene Glycol
Perchloroethylene
Mercury Vapor
Heat
Military Radar
Wash hands
Change clothes (don’t bring it home!)
Safety gear
Kepone
Bromine Vapor
Radiation (high level)
2,4-D
Carbon disulfide
State of the rt:
Egg freezing
Infertility is
not an inconvenience;
it is a disease of the reproductive
system that impairs the body’s ability to
perform the basic function of
reproduction
www.reproductivefacts.org
Resources
www.asrm.org
www.reproductivefacts.org
www.cdc.gov
www.perinatalweb.org
http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_M
e_Plan.pdf
www.fertilehope.org
www.resolve.org