Alcohol Impairs Female Fertility; Little or No Drinking Best:  Prospective study of a random sample of 7,393 women ages 18-28, selected from the 445,000 inhabitants of Stockholm in 1969 were followed up 18 years later. High consumers of alcohol had an increased risk for infertility examinations, as compared with moderate consumers: relative risk ratio (RR) = 1.59 (95% confidence interval [CI]: 1.09-2.31); and low consumers had a decreased risk (RR = 0.64; CI: 0.46-0.90). Moreover, for both high and low consumers we observed a significantly lower number of first and second partus. Rates of miscarriage, extrauterine pregnancy, and pelvic inflammatory disease did not differ between high and low consumers of alcohol. Effects of alcohol consumption on female fertility during an 18-year period. Eggert J, Theobald H, Engfeldt P.  Karolinska Institutet, Stockholm, Sweden. Fertil Steril. 2004 Feb;81(2):379-83

Bee Propolis Helps Women with Endometriosis: A small 40 patient DB PC Egyptian study of women with endometriosis confirmed by laparoscopy reports and at least two years of infertility gave 500 mg of bee propolis twice daily or a placebo for up to nine months. Of the patients taking bee propolis, 12 women (60%) became pregnant compared with four (20%) in the placebo group (P < .001). Ain Shams University. American Society of Reproductive Medicine ASRM 2003 Annual Meeting: Abstract O-84. Presented Oct. 13, 2003. Ed:This is a very small study which hadn't been published in a refereed journal.

Births to Drop Dramatically in Europe: Births dropped dramatically in the Netherlands after 1969, attributed to the ease and availability of the pill. 1969’s 248,000 births dropped to a low of 189,521 in 1996. While there has been a slight upturn to 200,000 with a fertility rate of 1.64, the numbers of births will soon start falling again and further than ever before. Lancet 9/2/00 356:837

Birth Control Pills Might Lower Libido: The birth control pill increases the level of sex hormone binding globulin (SHBG) - a protein produced in the liver that lowers testosterone levels, thereby reducing sexual drive. This increase was still found in women who had stopped taking the pill for a year. The researchers studied the use of the pill on 124 women at a sexual dysfunction clinic. Those who continued taking the Pill had four times the normal SHBG levels of women who had never taken it. Those women in the study who stopped taking the pill at the beginning of the study still had twice the normal level of SHBG after a year. Claudia Panzer, et al. Boston University. 5/26/05. Ed: This uncontrolled study doesn't mean much. It needs to be replicated with controls and in women who have their libido levels measured before starting the pill.  I really doubt that any libido impact will be found.

Superovulation with Intrauterine Insemination Better: 231 couples treated with both superovulation and intrauterine insemination had 33% pregnant, 234 couples treated with superovulation and intracervical insemination 19% pregnant, intrauterine insemination alone 18% pregnant, and intracervical insemination alone 10% pregnant. Correcting for hazards, intrauterine groups were 3.2 times as successful as intracervical. David Guzick, U Rochester. NEJM 1/21/99 340:177-83. A randomized study superovulation and intrauterine insemination did 5.6 times better than no treatment. Literature analysis 4% pregnancy rate with interuterine, 8% superovulation, 18% intrauterine and superovulation. NEJM 1/21/99 Egbert te Velde 340:24-5 = % women think they have fertility problems increased from 5.7% 1988 to 7.7% 1995. Rate of multiple pregnancy during superovulation is about 30% with 9% triplets or more.

Fertility Drugs Increase Cancer: Meta-analysis of eight studies, 5,200 cases 7,700 controls. Those taking fertility drugs for five years vs. those trying less than one year = RR 2.67 ovarian CA. Am J Epidemiol 2002 Feb 1;155(3):217-24

Fertility Drugs Not Much Effect on Breast Cancer Rates: A retrospective cohort study of 12,193 women evaluated for infertility found 292 in situ and invasive breast cancers in follow-up. Infertile patients had a significantly higher breast cancer risk than the general population [SIR = 1.29]. Analyses within the cohort showed adjusted RRs of 1.02 for clomiphene citrate and 1.07 for gonadotrophins, and no substantial relationships to dosage or cycles of use. Slight and non-significant elevations in risk were seen for both drugs after > or = 20 years of follow-up (RRs = 1.39 for clomiphene and 1.54 for gonadotrophins). However, the risk associated with clomiphene for invasive breast cancers was statistically significant (RR = 1.60). Breast cancer risk associated with ovulation-stimulating drugs. Brinton LA, Scoccia B, et al. National Cancer Institute, Bethesda . Hum Reprod. 2004 Sep;19(9):2005-13.

Grandmothers Used to Help Fertility: In 2,800 women living in two 18th and 19th century farming communities in Finland and Canada, researchers found that women had two extra grandchildren for each extra decade they lived after 50. They found the link was true whether the women had sons or daughters, and was valid even after social and cultural differences between the two communities had been taken into account. Women were more likely to have children at a younger age if their own mothers were still alive, and the grandchildren were more likely to survive, the study found. Children who reached the age of two were more likely to reach the age of five if they had a living grandmother. Around 12% more grandchildren survived to adulthood when their grandmother was under 60, though the benefit was reduced to 3% if the grandmother was older. Mirkka Lahdenpera. Nature 3/13/04.

Hot Tubs Bad for Fertility: Men attending a fertility clinic who were exposed to more than 30 minutes per week of 'wet heat' through hot baths, Jacuzzis or hot tubs, were studied. Sperm counts in five of 11 men with fertility problems soared by 491% after they stopped having baths or using the hot tub for 3-6 months. Other research has shown heat from laptop use and wearing tight underwear can reduce fertility the  reports. Sperm motility also increased from 12% to 34% in the men who responded to cutting out baths. Five of the six men who showed no improvement were chronic smokers, which the researchers said could have influenced the lack of response. University of California, San Francisco. Journal of the Brazilian Society of Urology 3/07. Ed: Similar research with women has documented harmful effects.

Kisspeptin from the Kiss-1 Gene Releases LH Hormone Surge: London's Hammersmith Hospital has shown that shots of the hormone kisspeptin stimulate the release of the LH hormone that stimulates ovulation. Kisspeptin is the genetic switch that turns on puberty. Humans that lack the hormone remain sexually immature. The gene and hormone were named by researchers in Hershey, Pennsylvania, where they were discovered. Society for Endocrinology conference 3/07.

Male Birth Control Developed: Every three-monthly injections of progestin - a synthetic version of the female sex hormone progesterone, used in the female contraceptive pill - and an implant of the male sex hormone testosterone renewed every four months works with no serious side-effects. The treatment works by suppressing sperm production. Progestin acts on the pituitary gland in the brain, which is responsible for producing two hormones required for sperm production: follicle stimulating hormone (FSH) and luteinising hormone (LH). Progestin reduces the production of LH and FSH, which are essential for spermatogenesis. Aarnoud van der Spoel is developing a male contraceptive pill at Oxford University's Glycobiology Institute. But LH also stimulates testosterone production in the Leydig cells in the testes. The implant was therefore needed to balance the reduction in testosterone. J Clinical Endocrinology and Metabolism 10/03.

Minimum 6-Month Spacing Best: 89,143 women in Scotland who had given birth a second time between 1992 and 1998. All conceived 2^nd within five years of the first. Women who had conceived within six months of the first, normal birth were more than two times as likely to give birth to an extremely premature baby (24 to 32 weeks), 60 percent more likely to give birth to a "moderately preterm" birth (33 to 36 weeks), and the baby was more than three and a half times more likely to die at birth. Jonathan Muraskas, Loyola University 8/9/03 BMJ

IVF Increases Beckwith-Wiedemann: (IVF) treatment run four times the normal risk of a rare genetic imprinting disorder, Beckwith-Wiedemann syndrome, which causes gigantism and increases the risk of childhood renal cancer. Birmingham University and the Babraham Institute in Cambridge (Journal of Medical Genetics 2003;40:62-4).

IVF May Increase Retinoblastoma: Dutch study suggested IVF conception could be linked with retinoblastoma, a malignant tumour of the retina which occurs in childhood. Between 1% and 1.5% of Dutch babies are born through IVF, which is used to treat 3,000 women in the country each year. Lancet 1/24/03.

IVF Causes No Increase Childhood Cancer: three large studies, covering almost 20,000 IVF children, had found no increased cancer risk, and that there were no cases of retinoblastoma amongst 6,000 IVF children on the Scandinavian IVF database. BBC News 1/24/03

ClearPlan Easy Ovulation Test Pack Best: $30.32 for 5 tests. Wick-type and most sensitive although it didn’t detect an LH surge in 12% of women. Use monoclonal antibodies. In 38% of women, the LH surge lasts just 10 hours or less, so maybe test twice a day. Some women ovulate as early as day 10 or as late as day 22. The LH surge identifies the 24-48 best hours. Consumer Reports 2/03 pg 48-9.

Thinness Increases Miscarriages 72% If Under BMI 18.5; Chocolate, Fruits, Vegetables Good; Morning Sickness Good: A London School of Hygiene and Tropical Medicine team looked at 600 women who had miscarried and 6,000 whose pregnancies continued past 12 weeks. They found that eating fruit and vegetables, and also chocolate, daily helped reduce the risk of miscarriage. The two-thirds of women who took vitamin supplements during early pregnancy reduced their risk by around 50%. The effect was most pronounced among those taking folic acid or iron and multivitamins containing these. Eating fresh fruit and vegetables daily or on most days was also found to halve the odds of miscarriage. Eating chocolate every day, as half the women did, also appeared to lower the risk. Single women were at an increased risk of miscarriage, as were women who had had a previous abortion (60% higher risk) and those who had had IVF (40% higher risk). Those who described their pregnancy as "planned" had 40% reduced odds of miscarriage. Those who took more than a year to conceive were twice as likely to miscarry as those who had conceived within three months. Morning sickness is an indicator that the pregnancy is progressing well. Women who suffered from nausea and sickness in the first 12 weeks were almost 70% less likely to miscarry, and the more severe the sickness, the better the odds of the pregnancy continuing. Noreen Maconochie, et al. BJOG 3/07.

STDs Awareness Absent in Most Tubal Infertility Women: Pelvic infection is a major cause of tubal subfertility. Infective tubal damage can be caused by sexually transmitted diseases, or can occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. The severity of tubal subfertility after pelvic infection depends on the number and severity of episodes. Although a history of symptomatic pelvic inflammatory disease may heighten suspicion of tubal damage, most women with tubal infertility do not report it. Even in women with serological evidence of past chlamydial or gonococcal infections, most are unaware of the infection. First episode STD makes 15% infertile and 2nd and 3rd episodes add 20% each. Screening women of reproductive age for chlamydial infection has been shown to reduce its prevalence and the incidence of pelvic inflammatory disease. Aggressive treatment of suspected pelvic inflammatory disease reduces late sequelae. The sexual partners of patients must be treated rapidly to decrease the risk of reinfection. BMJ 2003;327:610-613

Alcohol Decreases Fertility: 430 Danish couples aged 20-35 years trying to conceive for the first time. In the six cycles, 64% (179) of women with a weekly alcohol intake of less than five drinks and 55% (75) of women with a higher intake conceived. After adjustment for cycle number, smoking in either partner or smoking exposure in utero, center of enrolment, diseases in female reproductive organs, woman's body mass index, sperm concentration, and duration of menstrual cycle, the odds ratio decreased with increasing alcohol intake from 0.61 among women consuming 1-5 drinks a week to 0.34 among women consuming more than 10 drinks a week (P=0.03) compared with women with no alcohol. Among men no dose-response association was found. Decreased fecundability even among women with a weekly intake of five or fewer drinks. BMJ 1998;317:505-510 ( 22 August )

Low-Fat Dairy Bad for Fertility: In the long-term Harvard prospective study of 116,000 nurses, those who frequently ate low-fat dairy foods were 85% more likely to have ovulation problems while full-fat products cut the risk by 27%. Two or more portions of low-fat dairy produce a week, the risk of infertility due to ovulatory failure appeared to be 85% higher. Jorge Chavarro et al. Human Reproduction 3/07.

Orexin Thought to Play a Role in Fertility: Orexin stimulates the human adrenal gland to produce cortisol which in turn can cause obesity. Orexin activity can be found in several areas of the male genitals with receptors in the testis and penis where it has a more positive affects on testicular cells responsible for making testosterone, the primary male sex hormone, and in tubules that are responsible for producing sperm. Receptors are also present in the epididymis, implicating orexins in events that include transport and storage of sperm cells. Orexin may help control penile function including the maintenance of penile erection. Harpal Randeva et al, Univ Warwick, J Clin Endocrinology and Metabolism 4/6/04

TCE Damages Male Sperm: Drug Metabolism and Disposition 3/03. Wayne State University, University of Montreal, University of California at Davis. TCE is a volatile chemical used extensively in the automotive and metal industries as a de-greasing agent. Adhesives, lubricants, paints, varnishes, paint strippers, pesticides, spot removers and rug cleaning fluids, and has been detected in both underground and surface water. Linked to liver, kidney and lung damage. 3.5 million workers are exposed to the chemical. Mice showed damage to reproductive tissue following TCE exposure, and the findings suggested impaired fertility. In the most recent study, seminal fluid from mechanics who had been exposed to TCE in the workplace – and who had previously been diagnosed with infertility – was analyzed for TCE and its by-products (metabolites). All the semen samples contained TCE and metabolites.

Viagra May Damage Fertility: A lab study has found that sildefanil (Viagra) causes a large majority of sperm to be "fully reacted" and unable to fertilize an egg due to having used up the chemicals necessary to do so before reaching the egg. Whether this is occurring in real life is uncertain. Queen's University, BBC Online, 3/31/04.

Shorter Female, Longer Male Ring Finger, Higher Fertility: Also, longer male ring finger tends to be linked with higher level of depression. Compare finger length to height and if 4^th finger longer than 2^nd. Testosterone higher in fetal development may increase right brain growth, decreases reading but incr math and musical abilities, depression, autism, schiz. Evolution and Human Behaviour 20: 203-214 (1999)

Natural Cycle IVF Cost-Effective: Human Reproduction 2001;16:221-5

Caffeine May Decrease Fertility: Our findings suggest that especially nonsmoking women who wish to achieve a pregnancy might benefit from a reduced caffeine intake. Danish f/u of 430 couples. Reprod Toxicol 1998 May-Jun;12(3):289-95. No effect of caffeine on low birth weight, preterm births or intrauterine growth retardation. Am J Epidemiol 1998 Apr 1;147(7):620-7

Lower Spontaneous Abortion on Good Diet: 0.3 for fruit, 0.5 for cheese, 0.6 for green vegetables and milk and 0.7 for fish and eggs. The major type of seasoning fats have showed a direct association with risk of miscarriage. Comparing the highest with the lowest intake, the ORs were 2.0 and 1.6 for butter and oil. Eur J Obstet Gynecol Reprod Biol 2001 Mar;95(1):132-6

Male Fecundity Peaks at 24: Europ J Human Reprod study 8/1/00 reports that after age 24, the older a man gets, the longer it takes for him to make his partner pregnant regardless of her age.

Sperm Mutations Increase with Age: Apert syndrome (webbed fingers & early fusion skull bones) itself affects 1 in 160,000 births, the scientists believe a combination of increased mutation rate and "mutation advantage" might also be behind some of the 20 or so other genetic conditions linked to older fathers, including achrondroplasia dwarfism. These disorders begin to increase rapidly with the father's age at about the same time as maternal risks increase -- age 33 to 35. Most of the evidence for paternal age effects has come from determining how many children with these conditions are born to fathers of various ages. Hopkins scientists studied sperm from 148 men of various ages and looked for two genetic changes that are responsible for 99 percent of Apert syndrome cases. They found that men over 60 were, on average, three times as likely as men under 30 to have sperm with at least one of these changes. The mutations didn't appear in the men's blood. Men over age 52 are six times more likely than a 27-year-old to have a child with Apert syndrome, so the mutation rate alone can't account for the condition's link to paternal age,Rivka Glaser. The two genetic mutations that cause most cases of Apert syndrome affect a protein called fibroblast growth-factor receptor-2 (FGFR2). AJHG 10/03

Double Ovulation in 10% of Cycles: A growth wave of 15 to 20 egg-carrying follicles occurs before ovulation. One will become dominant while the others die off. Roger Pierson, All the women in our study had at least two waves and 30 per cent of them had three. Daily, high resolution trans-vaginal ultrasound examinations on 63 women with normal menstrual cycles who were aged between 18 and 40. Over six weeks, the women's individual follicles were measured. 50 ovulated only once, but six ovulated twice and seven not at all. Why some waves lead to ovulation while others do not unknown. U Saschatewan. 7/10/03

Abstaining No Benefit: Men with normal fertility tests remained the same whether they abstained from sex for one, two or 10 days before providing a sample.

Abstaining May be Detrimental: Analyzed 7200 samples from 6000 men. In men with low sperm counts, the volume of semen increased after prolonged abstinence, but the quality got gradually worse the longer the men held back. The number and proportion of motile sperm, meaning active and moving sperm, fell significantly from day two onwards, reaching a low at day six and remaining low. In normal men, the study found no change in sperm motility. The percentage of malformed sperm increased only after 11 days. Long residence in the male reproductive tract might in some cases mean the sperm do worse, perform worse, than they could do if they abstained less. Eliahu Levitas. Ben-Gurion University. 6/29/03. AP Madrid. 

Toll Booth Workers Lower Sperm Quality: Sperm count, and serum levels of FSH, LH and testosterone were within normal range in both groups. Total motility, forward progression, functional tests and sperm kinetics were significantly lower in 85 Italian tollgate workers versus 85 controls. In a subset of tollgate workers with motility below normal, methemoglobin was inversely correlated with total motility, viability, the hypo-osmotic swelling test, the acridine orange test, the cervical mucus penetration test, linearity, and amplitude of lateral movement of the sperm head, whereas blood levels of lead were inversely correlated with viability and sperm count. Traffic pollutants affect fertility in men. Human Reproduction, Vol. 18, No. 5, 1055-1061, May 2003

Chemicals Lower Rat Fertility: di-n-butyl phthalate (DBP) and linuron researched. DBP a plasticizer ubiquitous in environment and linuron corn and soy pesticide. Testicular cancer up 500% in Denmark in last 20 years but not in Finland. Paul M.D. Foster, Ph.D., of the National Institutes of Environmental Sciences, Research Triangle Park, 7/23/03

ASA, NSAID Increase Miscarriages: prospective cohort study of 1055 pregnant women in the Kaiser Permanente population of northern California, Li and colleagues found that the use of NSAIDs or aspirin around the time of conception or during pregnancy increased the risk of miscarriage by 80%. Using acetaminophen (paracetamol) did not. BMJ 8/14/03.

Women With Degrees 50% Higher Childlessness: women born in England and Wales between 1954 and 1958, published by Britain's government statistics agency, found that 22.5 percent of those with degrees were childless, compared to only 15.2 percent of those without. Among mothers who had degrees, half were 29 years old before they had their first children. Most first-time mothers without degrees were 24 or younger. "Attaining a higher qualification is not only associated with delayed first child bearing, but also with a greater likelihood of remaining childless. But women with degrees are quicker to have second and third children than other women who had their first children at the same age. Nearly three-quarters of women with degrees who had their first child at 35 had a second child, against only about 60 percent of women without degrees who waited until they were 35 to have their first child. London 4/25/03 Reuters

Female Fertility Starts Fall After 26, Males after 35: 782 healthy Italian couples using natural methods of contraception to determine the impact of age on conception. Their research is published in the journal Human Reproduction. youngest women had a 50 percent chance of achieving a pregnancy in any one menstrual cycle. It fell to 40 percent for the 27- to 34-year-olds. For women in their late 30s it dropped to less than 30 percent and if their partner was five years older, the chances of conceiving slumped to about 20 percent.

STDs #1 Cause of Infertility: In three regions of France, over a period of 1 year, we registered all couples (women and men) who have consulted and obtained a medical evaluation (medical causes and risk factors) for primary or secondary infertility. For women with secondary infertility caused by tubal disorders (compared to other causes) the risk factors are: STDs (RR = 7.5; previous surgery, including appendectomy (RR = 4.7); history of salpingitis (RR = 32.1); and ectopic pregnancy (RR = 21.5). For consulting men, secondary infertility risk factors are varicocele (RR = 4.1) and previous genital infection (RR = 5.8) for oligoteratosasthenospermia, and histories of major treatment or exposure to toxic agents such as X-rays, benzenes, or pesticides (RR = 6.6; 1.3-30.4) for secretory azoospermia. Risk factors in men and women consulting for infertility. Thonneau P, Ducot B, Spira A. France. Int J Fertil Menopausal Stud. 1993 Jan-Feb;38(1):37-43

Clomiphene Citrate Challenge Test: Used to determine ovarian reserve to as to avoid unnecessary stimulation cycles. Measure before and after FSH and E-2 as well as progesterone and ultrasound of the number of follicles.

Figuring Fertility: Clean Plan Easy fertility monitor identifies the 4-5 days before egg released. Only 12 hours after release, egg degenerates. Best intercourse 1-2 days before ovulation. Monitor tracks cycle using urine samples on disposable sticks 10 days every month. $200 for monitor and 20 sticks. Device guaranteed for years.

Ideal Interval 18-23 Months for Pregnancy for Health of Second Child: Lowest perinatal adversity when 2^nd child conceived 18-23 months after previous live birth although if only 6 months RR only 1.4. If 120 months, RR 2.0. NEJM 2/25/99 340:589

College Education Causes Dramatic Shift to Late Childbirth: In U.S. women, dramatic shift from ’63 to ‘90. Rindfuss, Demography ’96;33:277

Vegetarians Have Girls: According to a Nottingham Univ study, vegetarian moms had 100 girls to 81 boys while meat eaters had 106 boys to 100 girls. Time 9/4/00

Medications

Aspirin Helps IVF: Women taking aspirin 100mg (1/3 tab) during IVF and using fertility drugs produced nearly twice as many eggs per month as those taking a placebo. Fertility & Sterility 1999.

Alpha Blocker Helps: Increased fertility in DB PC study of alpha-blocker bunazosin for men with oligospermia at 2 mg/d for six months with 25% vs. 7% pregnant wives. Yamamoto, Japan, Fert Steril ’95;63:396

Metformin Helps Polycystic: 70% of polycystics develop diabetes. Side effects extra insulin = excess plasminogen-activator inhibitor, a protein keeping body from breaking down clots, and male hormones. These together = excess body hair, wt gain, balding, waist fat = all hallmarkds of polycystic disease. Metformin made fertility normal and helped lose weight and normalize LDL and insulin. Dec 99 Metabolism.

Vitamins

Chasteberry Concoction Helped Fertility in Small Study: In a DB PC study of 30 infertile women with half using Fertility Blend (Daily Wellness Co., Sunnyvale, California), a proprietary nutritional supplement containing chasteberry and green tea extracts, L-arginine, vitamins (including folate) and mineral, after 3 months there was a trend toward an increase in mean midluteal phase progesterone level (from 8.2 to 12.8 ng/mL, P = .08) and a significant increase in the average number of days in the cycle with basal temperatures >37 degrees C during the luteal phase (6.8-9.7 days, P = .04) in the supplemented group only. After 5 months, 5 of the 15 women in the supplement group were pregnant (33%), and none of the 15 women in the placebo group were (P <.01). No significant side effects were noted. A nutritional supplement for improving fertility in women: a pilot study. Westphal LM, Polan ML, Trant AS, Mooney SB. Stanford University. J Reprod Med. 2004 Apr;49(4):289-93

Folic Acid & Zinc Help Subfertile Males: Subfertile men (103) given both supplements showed a 74 percent increase in the number of normal sperm in their semen and a 4 percent increase in abnormal sperm. Men in the fertile group (1008) had small increases in sperm count when given folic acid 5 mg/d plus zinc, or zinc alone, according to the study. Fertility and Sterility 3/2002

Multivitamin Helps: Hungarian DB PC study led to significant benefit to fertility. Czeizel, Int J Vit Nutr Res ’96;66:55

Selenium May Help Male Fertility: DB study of infertile males for 3 months found those on selenium had 11% children vs 0% for placebo as well as some improvement in sperm motility in 56%. Br J Urol 1998 Jul;82(1):76-80

Selenium-Vitamin E Help Sperm: DB PC 54 infertile males 3 months Vit E 400/d & Selenium 225/d. Arch Androl 2003 Mar-Apr;49(2):83-94

Thomas E. Radecki, M.D., J.D.

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