Infertility Issues in the Teen Years, Not Just for Girls

As I wrote earlier this year, we're starting to see more awareness of the need for even teens to consider how their current health can impact future fertility. Polycystic ovarian syndrome (PCOS) generally begins in very young women, although most women don't even learn about the hormonal condition until they have problems trying to get pregnant. Now, just as research is showing us that men's lifestyle choices – including diet and exercise – can make a difference in their fertility, we're also learning that teen boys' health might foretell whether they'll have obstacles in becoming fathers later.

A study published in Clinical Endocrinology produced mildly alarming results – a 50 percent reduction in testosterone in teen boys who are obese. According to this related article on the SUNY website, such findings point to an increasing risk of impotency and infertility later in life.

Granted, the sample size is small, so the researchers advise that more studies are needed with greater numbers of subjects to confirm this study's findings. And the research group plans to next look at weight loss and any resulting (hopefully positive) changes in obese teens. But there is already a wealth of strong data pointing a strong connection between obesity and negative reproductive consequences, and now, that data appears to hold up across the lifespan for both genders.

~ Dr. Sonja Kristiansen M.D.

Before Infertility Strikes, PCOS Is Common, Treatable, Even for Teens & Young Women

A little bit of facial hair in “the wrong places” can be normal, even if aggravating, for women near and after menopause. But for younger women, hirsutism (hair growth in abnormal patterns) can signal something to be worried about – polycystic ovarian syndrome.

image: freedigitalphotos.net

PCOS is one of the most commonly-presented female disorders in a fertility clinic. Not every woman with polycystic ovarian syndrome has infertility, but many do. In fact, not all PCOS sufferers have the same symptoms, which in addition to hirsutism might include:

• small cysts on the ovaries

• irregular menstrual periods

• weight gain for no apparent reason

• acne beyond the teen years

This article in UK's Daily Mail says that one in 10 British women are affected by PCOS. A fact sheet from the U.S. Department of Health and Human Services Office on Women's Health says similar numbers of affected women are found in the U.S., as many as 5 million of them, and that it can occur in girls as young as 11 years old.

This is a point I want to impress: PCOS is a hormonal condition, not merely a nuisance of facial hair and weight gain, and it begins in most cases during puberty. Unfortunately, most woman don't become knowledgeable about PCOS until it's created a problem for them – most of the time, that problem is infertility.

Most important to know is that infertility is not the only problem to which PCOS can lead. It's also been linked to a number of very serious metabolic disease-related health conditions like diabetes, high blood pressure, high cholesterol, and cardiovascular disease. So treating PCOS is something that should be initiated as soon as it's discovered, and not just for fertility-related reasons.

How can teens and young women know if PCOS is a worry for them?

• Develop an ongoing relationship with either a family practitioner or OB/Gyn.

• Keep close track of your menstrual periods and report on them to your physician annually. If you notice something different (for your body) happening – such as longer or shorter times between periods, more pain than usual, or periods that are heavier or lighter than usual – let your doctor know that you are concerned.

• If you have “male-pattern hair growth,” let your doctor know.

• If you notice extreme weight loss or gain within a brief period of time that cannot be explained by changes in your activity level or eating habits, tell your doctor.

There's more good information about PCOS specifically for young women on this website by the Center for Young Women's Health.

Finally, as a reproductive endocrinologist, I have a great deal of expertise and experience in treating hormonal conditions related to the reproductive system -- and PCOS-related infertility is indeed successfully treatable. If PCOS is your issue, the Houston Fertility Center can help.

~ Dr. Sonja Kristiansen M.D.

Is IUI All You Need?

Did you know that many fertility patients don't need IVF? With all of the information about in vitro fertilization that goes around the Internet, it might seem otherwise. But the truth is that many people need a far simpler boost in fertility than IVF affords.

Intrauterine insemination, sometimes simply called “artificial insemination”, is very often a first step for fertility patients who have no structural infertility conditions, like blocked fallopian tubes. The insemination itself is conducted in less than a day within the clinic, and patients are able to return immediately to work and other daily activities. Prior to the actual insemination procedure, the woman may or may not use fertility medications – oral or injectable, depending on her body's needs – to optimize the number of eggs she ovulates during that treatment cycle. Then when tests indicate that she is near ovulation, semen (from either a partner or a donor) is introduced to the uterus via a tiny catheter threaded through the cervix.

Placement of the sperm cells directly into the uterus via IUI allows us to bypass what's sometimes called “hostile” cervical mucus, a condition in which the woman's naturally-occurring mucus has properties that prevent sperm from reaching their destination. IUI also works well for women who have timing issues that prevent intercourse from being the optimal route; for example, some active military couples have frozen semen prior to deployment, for use with IUI at a future date. IUI enables even fertile women without male partners to use donor sperm in a clinically safe manner. Women with PCOS (polycystic ovarian syndrome) also are often quite successful in getting pregnant with medicated IUI.

There are cases in which trying IUI might be more wasteful of the patient's time, money, and effort, including patients with:

• Tubal factor infertility
• Ovarian failure, or elevated Day 3 FSH levels
• Severe male-factor infertility
• Woman's age over mid- to late-30's

It is recommended that patients in such cases consider using IVF, in vitro fertilization.

~Dr. Sonja Kristiansen MD

Infertility E-Books - More Snake Oil?

The other day I opened an email from a website making helpful claims for women with PCOS. Polycystic ovarian syndrome is very common, not just among infertile women. Untreated PCOS is linked to infertility and to more serious, chronic conditions involving cardiovascular health. There are many well-established websites about PCOS, some that are backed by medical institutions, to which I refer my Houston Fertility Center patients. So I took a quick look at this relative newcomer site to judge its reliability as a patient education resource.

Quick red flag: If the words "cure" or "miracle" appear on a treatment website, be very wary. (I won't credit the site by linking to it in this post.)

Fortunately, there are many other reputable websites that educate and support patients with PCOS. But what I found especially disturbing about this one (and there are others out there) is their tactic of making money from the dissemination of medical information that's already available to consumers for free. That's the miracle of the Internet.

Before you're tempted to spend your money on e-books, email "programs" or newsletters, or even virtual face-to-face counselors who claim to have cures for PCOS -- or any other cause of infertility -- stop and do your research first. Investigate the authors, as well as the company marketing the products and services. Even more importantly, connect with the many available patient groups (like PCOSChallenge) who can tell you what you need to know and offer you support and tested resources, too.

When Fertility Really Is About Your Diet

No woman wants to be told she needs to lose weight, least of all my patients who have struggled (sometimes for years) with trying to get pregnant. Whether we decide their fertility treatment will include fertility medications, IVF, IUI, or some other assisted reproductive technology, the best starting point is a healthy body -- and for many, that means coming to a more optimal weight.

This article in the Belfast Telegraph describes a rather novel approach to meeting the challenge of weight versus fertility, specifically as it relates to polycystic ovarian syndrome (PCOS), one of the most common causes of female infertility.

Are there similar programs in the United States?

You Asked For It: Predicting Ov with PCOS

One of my readers asked me to discuss PCOS, in conjunction with my earlier comments on using ovulation predictor kits at home.

It's true that PCOS and several other ovulatory disorders can make home ovulation prediction a very inaccurate process. If you're determined to use at-home testing kits, try to look at the results as information that is helpful but that may not be giving you the full picture of your ovulatory function.

A very important point here: regular menses does not necessarily mean you are ovulating during every cycle. Women with PCOS come with a range of cycles -- from amenorrhea (completely absent periods) to wildly irregular cycles to fairly consistent menstrual periods.

In short, when a woman has PCOS or other ovulatory disorders, menstruation and ovulation may be different, seemingly unrelated events. You can't always use "Aunt Flo" as an indicator of how well your ovaries are working.