"Big News" About New Eggs Is a Big Maybe

This week, a study published in the journal Nature Medicine is promising to scramble a long-held belief about women's eggs.

Scientists at Massachusetts General Hospital have isolated egg-producing stem cells from human ovary tissue. Then, in laboratory conditions, the cells eventually resulted in new egg cells.

Image: Carlos Porto / FreeDigitalPhotos.net

It's the big health news du jour. (So I'm sure my inbox will fill with hopeful "Dr. Kristiansen, did you see the news?!")

For years now, we've all believed that females are born with the most eggs they'll ever have and that when the number dwindles down, natural infertility is the result. This new finding is exciting in terms of possibilities for related infertility treatments.

But good research takes time. Often, a very long time.

Do you recall when we started learning more than a decade ago that, contrary to long-held beliefs, human brains can generate new cells? It's very exciting to consider people with brain injury may be able to recover more fully! But now, many years of research later, experts in neuroscience are skeptical again.

There are still far more questions that must be addressed before this knowledge about "new" egg cells is usable by fertility specialists in helping women with age-related infertility or premature ovarian aging. In fact, I'd bet that the necessary details will come too late to institute a related plan for any woman who is currently considering fertility treatment. For those who want to delay conception but take advantage of their youthful fertility, the best options remain egg or embryo freezing via IVF. And my team at Houston Fertility Center will be happy to serve you with those tried-and-true techniques, today.

Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.

Celebrate Fertility Freedom

The Memorial Day weekend brings to mind time off from work and fun in the sun. It's also a time to remember those who sacrificed so we could enjoy that freedom. If infertility's a part of your life, it might be tough to conjure up this feeling of freedom -- but if you look closer, you'll see it.

Did you know that in some countries, egg and sperm donors are required to reveal their identity throughout the process? Since anonymity is what many prefer, the result of such laws is far fewer donors and fertility patients who must travel internationally just to get pregnant.

Even tighter restrictions exist in other nations where donor eggs are simply not allowed to be used for fertility treatment. Just imagine -- the only options available for these women is adoption, unless they travel to access IVF.

Just as incredible: freezing excess embryos is of questionable legality in some places. Imagine being lucky enough to create many embryos in an IVF cycle, but the law requires you transfer them all, increasing your already upped chances for multiples to dangerous proportions.

The United States continues to demonstrate leadership in the championing of individual rights, and this includes the health care arena. Fertility treatment is a highly personal choice and, so far, it's still very much up to the patient and her physician to decide which treatments to use and when. You can find out about the services we're free to offer at Houston Fertility Center's website, http://CallDrK.com.

Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.

~Sonja Kristiansen, M.D.

Tis the Season For Donor Eggs: Fresh or Frozen Work

In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.

Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.

Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.

I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.

Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.

Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."

Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.

Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.


Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.

There Really Is No Magic to Getting Pregnant

I'd really like to be able to give my patients an easy how-to for getting around their fertility issues. And people who are desperate to finally get pregnant and become parents are easy prey to reputed quick fixes. Fortunately, long gone are the old days of the tonic seller with ridiculous promises. But today's marketing techniques, finely-tuned with psychological research data, can be pretty convincing even to educated fertility consumers.

Take the idea of fertility supplements.

Granted, research studies linking nutrition and fertility have boomed in the last few years. What you eat is indeed a key factor in how you feel and how your body functions, even when it comes to fertility. Every qualified dietitian will tell you that the best source of health-promoting nutrients is food. Supplements are considered a back-up plan, and in some cases, their effectiveness is unproven.

In a Los Angeles Times article, Chris Woolston, aka The Healthy Skeptic, discusses two popular supplements: FertilAid for Men and FertilityBlend for Men. Both are promoted as providing nutritional enhancement for male fertility, specifically, sperm motility and count.

It's a good article that balances the claims of the supplements' makers with commentary by male fertility specialists. The important take-away message that eager-to-be-dads need to hear: supplements can be good for your health, but they aren't miracle cures.

And by the way -- the very same can be said for women, supplements, and fertility.

Is Putting Off Pregnancy The Best Idea?

An article in the Los Angeles Times recently touted the benefits of the economic recession in terms of women delaying pregnancy.

While I believe that there are certainly advantages (as described by the author) to later-aged motherhood, I think we need to tread carefully when discussing the impact of age on fertility in general.

The majority of women (and men) have no idea what their body's fertility status is until they try to conceive. Unfortunately for some, the news is not only alarming but comes too late for them to take advantage of treatment in an optimal way.

Of the many causes for infertility, many (perhaps most) are not age-related, it's true. But that rosy perspective can work in reverse -- if a woman's not ovulating or if her tubes are blocked, it doesn't matter how old she is: she won't get pregnant without assistance.

While we're looking for silver linings to the recession's dark cloud, let's not throw the baby out with the bathwater.

Your Environment & Your Fertility

A small-scale study, recently published in Fertility & Sterility, adds to what we know about a woman's environment and the quality of her eggs.

In "Serum unconjugated bisphenol A concentrations in women may adversely influence oocyte quality during in vitro fertilization," the study authors conclude that, during IVF cycles, as levels of bisphenol A (BPA) rose, the number of fertilized eggs fell.

There is no simple test for BPA that can be administered in clinics. So, as with many things that may impact fertility, the best advice I can give patients is to try and reduce your exposure to BPA.

This Mayo Clinic article - What is BPA, and what are the concerns about BPA? - offers a quick list of things anyone can do to avoid BPA.


For more on this study:
BPA can affect egg quality, study claims

Another Reason to Be Glad You're in America: Donor Supplies

Getting pregnant with the help of a third party, either an egg or sperm donor, is a tough decision to make. And how much to share with the resulting offspring about their beginnings is best left to the parents. At least, that's the American stance.

This piece in the Scottish paper, the Daily Record, illustrates how bad things have gotten in the UK since anonymity of donor records was made illegal. So few men step forward to donate sperm there now that the health system is helping out by importing semen from London. Many hopeful parents-to-be are spending time and money to go abroad, to countries where third-party supplies are more plentiful.

For patients at Houston Fertility Center, we collaborate with highly reputable agencies that have both sperm and egg donors available and waiting. The level of interaction between fertility patient and donor can vary with the agency and, most importantly, with the needs of all parties involved.

The U.S. may still have quite a few unsettled issues in the healthcare arena, but we can at least rest assured that supplies for third-party reproductive care are just fine.

Weight Issues & Fertility Not Just a Woman's Concern

Here we are again -- the end of year holidays. This time can have a real double whammy effect on people trying to conceive. First, there are the joyous gatherings... with babies everywhere. Then, there's the abundance of food, much of it rich and not-so-nutritious. You know, the kind that's so much fun to enjoy too much of...

Why is food a problem for people trying to get pregnant?

By now you've probably heard about the impact that weight has on a woman's fertility -- both too little and too much weight can result in ovulation disorders. Also, overweight women increase their surgical risks even for procedures as commonplace as egg retrieval. But there's more research now that says men need to keep an eye on their fatty food intake, too.

At this year's meeting of the American Society for Reproductive Medicine, researchers presented evidence that men with the highest intake of saturated fat had 41% fewer sperm than those who ate less. Also, men who ate more omega-6 and omega-3 polyunsaturated fats, specifically, had better sperm motility and morphology.

There is some good news on the research front for men who are overweight. The low testosterone levels that apparently go along with high BMI (body mass index) do respond positively to clomiphene citrate (Clomid).

But on this eve of one of our country's biggest binge-eating holidays, I'd recommend having a double helping of the carrots and lay off the gravy a little bit.

Also see:

When Fertility Really Is About Your Diet

Weight & Fertility (from my April 2007 newsletter)

The Other Side of the Age & Fertility Message

Just on the heels of a study declaring that 30-year-old women have lost most of their 'good' eggs, comes a report out of the UK that women in their 30's and 40's are winding up "accidentally" pregnant because they thought their chances at pregnancy were up.

The claims being made by the British Family Planning Association (FPA) are that messages about women's age and fertility are "overplayed" and leading to something like reverse anxiety. The organization, with a mission of enabling informed sexual health choices, is heading up a new public information campaign to remind women that unless they're willing to get pregnant without trying, contraceptives should be used until after menopause.

One of the messages in the FPA campaign: "Fertility. You'd be surprised how long it takes to disappear."

Menopause is defined as not having a period for at least a year. Perimenopause is what we call the years leading up to that final menstrual period. Perimenopause can last from a couple of years to more than five, and some women are fertile throughout that time.

I'm in agreement that women should remain vigilant about their chances for pregnancy until they are clearly no longer fertile. However, to imply that the messages being sent (about women's age and the natural decrease in fertility) are anything other than appropriate is itself an overstatement.

Translating Molecular Science: Marijuana Use Slows Down Sperm

This article in Scientific American is rather complex reading but reveals some important findings. One of the items in the piece, about study results just published in the journal Cell, is tucked in at the very end -- which is too bad, because it's a tidbit of data that even the least technical reader can grasp.

According to researcher Yurij Kirichok of the University of California at San Francisco, "Marijuana likely activates sperm prematurely, leaving them burnt out in a matter of hours."

Importantly, this study was not about marijuana's effects on male fertility. Rather, the researchers were investigating molecular components that impact how and when a sperm cell gets moving. Besides pinpointing a molecule (Hv1) that activates a resting sperm cell, they also found a few more pieces to the puzzle linking marijuana and male infertility, via endocabbinoids.

Too much medical geek talk? Just simplify it to what we typically recommend: avoiding toxins of all kinds can enhance fertility.

Trying to Get Pregnant After 30 - Time to Panic?

Good Morning America featured a Scottish study that concluded by the time a woman is 30 years old, she's already lost 90 percent of her eggs.

That's enough to make the typical young woman panic.

We've always known that female fertility is more dependent on age than any other variable. This study points to a sharper decline in fertility than we like to believe.

Before everyone rushes to assisted reproductive treatment, though, let's remember that stress can negatively impact fertility.

Next, it's easy enough to have a consultation and do a quick work-up to determine your baseline level of fertility. That won't provide the definitive answer as to whether or not you will have a baby later, but it can certainly help a woman determine if she has an unexpected, silent infertility condition. Then, a plan of action can be put together to promote her future fertility.

Panic won't help you get pregnant. A little foresight and action can.

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.