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a blog by Robyn Nazar, RN, BSN, July 20, 2011

To read more of Robyn Nazar's The Fertile World: A Nurse's Perspective blogs, CLICK HERE.

Although it may be hard to imagine how your dental care could possibly relate to getting pregnant, experts say it's true.

Gum disease, also referred to as periodontal disease or gingivitis, is caused by plaque buildup on the teeth. The plaque traps bacteria and other microbes that lead to infections in your gums and around the roots of your teeth.

Without treatment, gum disease can lead to high levels of inflammation in your body, raising your risk for many reproductive issues including impaired sperm production in men and miscarriage, premature birth and decreased fertility in women.

According to a study released from the annual meeting for the European Society of Human Reproduction and Embryology, researchers found that it takes, on average, two months longer for women with gum disease to become pregnant. They are also more likely to take more than a year to become pregnant — a key diagnosis in infertility.

You May Have Gum Disease and Not Know It

Many men and women are unaware that they have gum disease at all. Sometimes the disease can persist inside your mouth with very few symptoms. This is why it is important to schedule regular visits with your dentist so he or she can get a good look inside your mouth for plaque buildup and other signs of developing gum disease.

Fertility Tips for Your Mouth

Regular brushing every day is not enough to protect you from developing fertility-harming gum disease. Misaligned teeth, old fillings, crowns and permanent retainers are all places where bacteria can become trapped, and gum disease may occur. Furthermore, women undergoing infertility treatment or who are already pregnant are particularly susceptible to gum disease due to shifts in hormone levels and a decreased immune system.

In order to protect your fertility AND your mouth be sure to:

Brush your teeth at least twice a day, preferably after each meal and before sleeping.
Floss once daily and after eating foods such as popcorn or hard candy.
Use an anti-plaque toothpaste recommended by your dentist.
Schedule a visit to your dentist for a professional cleaning and evaluation once every six months.

A Cure for the Aging Ovary

a blog by Robyn Nazar, RN, BSN, July 13, 2011

To read more of Robyn Nazar's The Fertile World: A Nurse's Perspective blogs, CLICK HERE.

At some point our ovaries will let us down — it's an inevitable part of aging. Whether due to natural causes as we approach our 40s or premature ovarian failure, eventually our ovaries will no longer be able to mature eggs, ovulate and perform all of the necessary tasks needed to create a baby.

But what if this ovarian aging process could be reversed?

Fertility researchers have been working for quite some time to find a way to help reverse the effects of aging on the ovaries. Many treatments have come and gone, but one appears to be emerging as a real potential candidate for the future of aging ovaries: DHEA.

What is DHEA?

DHEA is an abbreviation for dehydroepiandrosterone, which is a natural steroid hormone produced primarily by the adrenal gland located on top of the kidneys, as well as in the reproductive organs and brain. When DHEA is released into your bloodstream, your body uses it to make testosterone and estrogens.

As one of the most abundant natural circulating hormones in your body, DHEA has a wide range of health effects. It has been studied for its effect on the reproductive system, mental function, mood, longevity, autoimmune disease, muscle growth, cancer, cardiovascular health and more. However, most recently it has drawn attention due to its beneficial effects on fertility.

DHEA and Your Ovaries

DHEA is believed to play a very unique role in preserving the number of healthy eggs a woman has in her ovaries. Research shows that DHEA may work in three different ways:

Maintains healthy levels of insulin-like growth factor, which prevent ovarian aging
Maintains normal levels of androgen hormones that control ovarian function
Improves the chromosome quality of eggs, which increases the likelihood of a viable pregnancy.

Around the age of 35 the body begins to slow down the amount of DHEA that it makes. Stress, genetics and other lifestyle factors can also play a role in declining DHEA production, resulting in a diminished quantity of high-quality eggs available and making natural conception very difficult.

DHEA Treatment for Fertility

A growing number of fertility clinics have begun to use synthetic DHEA supplements as a part of their treatment program for women who show signs of aging ovaries, such as diminished ovarian reserve, repeat miscarriages and ovarian failure. According to a 2010 study published by Tel Aviv University, women who were given DHEA supplements were thee times more likely to become pregnant than those who were not. Furthermore, ongoing research at the Center for Human Reproduction in New York has published results finding that DHEA:

Improves spontaneous pregnancy rates
Decreased the amount of time that it takes a woman to become pregnant
Increases the amount of eggs retrieved in IVF treatments
Improves the genetic quality of eggs and embryos
Decreases the incidence of miscarriage

Is DHEA Safe?

Despite the growing interest in DHEA treatment, there is still much unknown about the long-term use of DHEA for infertile women. There are very few well-designed studies that examine safety of the hormone, as well as its effectiveness on improving ovarian function.

DHEA supplements are available over-the-counter in the United States and, like other supplement products, are not regulated by the Food and Drug Administration (FDA). Therefore, the quality of DHEA products that are available at the local vitamin stores cannot be guaranteed for effectiveness or safety.

Furthermore, professional organizations such as the American Society of Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) have yet to take a stance on DHEA use, so no formal guidelines for use have been established. This means that fertility clinics and physicians are left to experiment with protocols of their own — a risky venture for those inexperienced with DHEA use.

However, to date there have been no serious side effects reported with DHEA use, and the positive results from these early studies are prompting many clinics to begin using DHEA for women with aging ovaries. In fact, a recent survey estimated that approximately 25 percent of fertility clinics worldwide are now using DHEA supplementation.

Consult with Your Doctor Before Using DHEA

Experts advise that women not try to treat themselves with DHEA supplements without the careful guidance of a qualified fertility doctor. Excess amounts of DHEA could potentially cause an imbalance of hormones and, without proper regulation and assessment, may have an adverse affect on fertility.

According to the government clinical trials website there are several studies of DHEA for infertility that are currently recruiting participants:

Dehydroepiandrosterone (DHEA) Treatment and Premature Ovarian Failure
Study of Oral Dehydroepiandrosterone (DHEA) to Treat Previously Unexplained Infertility
The Use of DHEA in Women With Premature Ovarian Failure
The Effect of DHEA on Markers of Ovarian Reserve in Women With Diminished Ovarian Reserve

Visit www.clinicaltrials.gov for more information.

Seven Simple Things to Avoid for Fertility

a blog by Robyn Nazar, RN, BSN, June 2, 2011

Want to get pregnant but worried about your fertility? Here are seven common things to avoid that may help you boost your baby-making potential!

1. Smoking

If you’re a smoker I know you have heard this before: stop smoking. If you are struggling to quit, at least begin by reducing the amount of cigarettes you smoke per day. The nicotine and chemicals in cigarettes can interfere with hormone production, as well as transportation of the egg through the fallopian tube to the womb. In a recent study, couples who smoke were found to be twice as likely to have trouble conceiving than smoke-free couples. If you do quit smoking (yay for you!), then experts believe it will take around three months for your body to regain its full fertility potential.

2. BPA Plastics

Did you know that nearly all of us have measurable amounts of a dangerous plastic chemical called BPA in our blood? Because BPA is used so frequently in the processing, packaging and storage of the products that we consume, most of us are affected by it even though we are unaware. Studies have shown that high levels of BPA can interfere with embryo implantation in the womb, decrease sperm quality and quality, and even alter gene expressions of reproductive organs. Bottom line: BPA is not something you want in your body at any time — especially when you're trying to become pregnant. The good news is: After just three days of a BPA-free diet, studies show you can significantly reduce your levels. BPA can be found in solid plastic packaging, the lining of food and drink cans, and beverage containers. Try to eat a fresh-food diet (free of packaging or processing) and store leftovers in stainless steel or certified BPA-free containers.

3. Trans Fats

Trans fats are the fats that manufacturers use in processing some foods, including french fries, doughnuts, baked goods, margarine, shortenings, crackers, cookies, etc. Trans fats not only raise your risk for heart attack, stroke and diabetes, they can also affect your fertility. In one study researchers found that just 4 grams of trans fat per day can double your risk of ovulatory infertility. Now, an occasional basket of french fries isn't going to render you infertile, but frequent consumption can cause inflammation in your body that can interfere with normal reproduction function. Instead fill up on good fats such as olive oil, avocados, fish and nuts, which actually help fight off inflammation and keep your body healthy.

4. Red Meat

In a Harvard study, known as the “nurses' study” researchers followed almost 19,000 nurses over eight years. They found that those who ate the most red meat were 39 percent more likely to have difficulty conceiving than those who ate the least. Furthermore, those who had the highest intake of plant protein (grains, legumes, nuts, soy, etc.) were the most fertile. You don't have to go vegetarian, but make sure your diet is well-balanced with a variety of protein sources, including fish, eggs, poultry, and plants.

5. Too Much or Too Little Weight

As one of the most heavily studied infertility factors out there, weight has proven itself to be a major player in conception success. Body fat helps regulate estrogen levels. Therefore, having too much or too little fat stores can interfere with this hormone regulation. In addition, excess weight can also cause increased levels of inflammation throughout your body, which counteracts your body's efforts to conceive. So, if you’re trying to get pregnant, be sure to maintain your BMI within the normal parameters of 18.5-24.9.

6. Stress

Although this has become somewhat debatable, most experts still agree that stress and fertility do not mix. Stress can come in many forms including physical and emotional stress. For example, if you are not a regular runner, don't start training for a marathon now. That would be increasing your physical stress (not to excuse you from regular moderate exercise, though!). Physical stress can also come from working irregular hours, lack of sleep or even working night shifts. Emotional stress, on the other hand, may be much less noticeable. It can come from a job, relationship challenges or even anxiety about trying to conceive. No matter where your stress is coming from, reducing it may increase your chances of conception. Try incorporating lifestyle changes, joining a yoga or meditation class, or simply talking to a qualified medical professional.

7. Lack of Sleep

Chronic lack of sleep can cause a disruption in an important female fertility hormone called leptin. This hormone, also known for controlling weight and appetite, has been found to drop to low levels when a woman hasn't had enough sleep. Studies show that low leptin levels can prevent a woman from ovulating. Therefore, making sure that you get enough sleep is one way to help regulate your menstrual cycles and promote normal ovulation.

Man Made Sperm!

a blog by Robyn Nazar, RN, BSN, April 5, 2011

It's only the beginning of April, and yet, fertility researchers have already given us much to talk about. Here are the fertility headline highlights of 2011 thus far.

Sperm Made Out of Testicular Tissue Could Cure Male Infertility

After more than a century of trying, researchers in Japan accomplished what everyone thought was impossible: man made sperm. The scientists used testicular tissue to create not only viable sperm, but sperm that were able to fertilize a female egg and produce healthy fertile offspring. Although this accomplishment was achieved in mice sperm, the scientists believe that it can be replicated for other mammalian species, including humans. If this happens, then this could be the gateway to finding the cure for male infertility.

Medical Clowns May Double Your Chances with IVF

Laughter is apparently the best medicine. In an unusual study of more than 200 women undergoing fertility treatments in Israel, researchers discovered that spending just 15 minutes with a Medical Clown immediately after fertility treatment nearly doubled the chances of a successful pregnancy. The researchers believe the laughter reduced stress in women while they waited for the embryos to settle after treatment and thus contributed to better outcomes.

Laptops Cause Male Infertility

This one was bad news for every man who likes to sit on the couch, bed, train or any other surface that lacks table space for his laptop. Italian researchers announced in February that the warmth of a computer sitting on your lap can raise the temperature of a man's testicles by 4 degrees in one hour, which is more than enough to impair sperm production and cause problems with fertility.

Excess Weight, Ethnicity Proved to Decrease Fertility

In a study published by the Journal of Fertility and Sterility of more than 32,000 women who underwent fertility treatments, researchers found that women who were overweight were 20 percent more likely to fail their fertility treatment than thin women. Furthermore, both overweight and thin women of either black, Hispanic or Asian ethnic decent were overall less likely than white women to have a successful fertility treatment. Researchers believe that this discrepancy occurs in overweight women as a result of inflammation and hormonal shifts caused by excess weight. However, it is not yet known why this occurs among different ethnicities.

Antioxidants May Improve Male Fertility, Decreases Female Fertility

Good for Men! In a study published in January, a New Zealand research team found that antioxidants, such as vitamin E and zinc, could help improve male fertility by reducing oxidative stress on sperm cells in men. Oxidative stress is believed to cause up to 80 percent of cases of decreased male fertility.

Bad for Women! Contrary to previous beliefs, antioxidants may actually be harmful to female fertility. Shortly after release of the study showing the benefits of antioxidants on sperm, another study from Israel came out that found high levels of antioxidants actually significantly reduced egg quantities in female mice. The study's author believes that the powerful anti-inflammatory effect of the antioxidants may hinder normal ovulation, causing decreased fertility in women. In fact, he reports his team may now look at antioxidants as an alternative form contraception.

Women Find New Use for IVF Treatments: Giving Birth To Their Grandchildren

Demonstrating just how far we have come in fertility medicine, physicians are making it possible for post-menopause grandmothers to give birth to their own grandchildren. Two great examples:

Judy Arnold, age 51, is pregnant with her first grandchild due to be born in April. Her own daughter, Katie, was born without a uterus, making pregnancy impossible. Katie asked her mother to be a surrogate for the embryos created by her own eggs and husband's sperm.

Kristine Casey, age 61, gave birth in February to her first grandson, Finnean. She was the surrogate carrier for her daughter and son-in-law who had been unsuccessful in their own efforts to have a baby.

Gender Selection Comes Out of the Closet

a blog by Robyn Nazar, RN, BSN, March 8, 2011

Gender selection isn't anything new. People have been trying to manipulate the sex outcome of their babies for as long as baby-making has existed. However, people used to be quite open about their efforts to have a boy or a girl and even swapped old wives tales (Oh! There are many of them!) on how to achieve the desired sex.

The irony is that now that we finally have the technology to select a baby's gender with nearly 100 percent accuracy, nobody is talking about it.

Shhh...

It's somewhat understandable. People don't want to appear biased against one sex or the other, especially when it comes to their own children. What would others think if they knew you paid the big bucks to have a little boy? Or would it be difficult to explain to your daughter why you took great measures to ensure that your next child after her was not another little girl? I get it. It's difficult to explain. However, rest assured, you are not alone.

You Are among Many Who Want to Choose the Baby's Sex

There are millions of couples, just like you, who are considering (or already have gone through) gender selection. In fact, each day hundreds of people get online and search for information about gender selection on the internet. Everybody's story and reasons are different and can range from medical to personal to social.

Up until about 20 years ago in the United States, gender selection was only acceptable for medical reasons. The technology available then would allow for couples to select the baby's gender in order to avoid passing along known sex-linked genetic disorders. Since then advances in technology, along with broadened social and industry acceptance, has made gender selection available to the public for a wide variety of purposes.

The most common of these purposes is called “family balancing,” which is simply the act of choosing one sex over an other in order to obtain both sexes within your family unit. Take, for example, a couple who only wants three children and already has two boys. It is not uncommon for a couple such as this one to seek genetic selection technology to ensure that they complete their family with a baby girl.

Breaking Through the Silence of Sex Selection

Unfortunately, and yet undeniably, there is a stigma that comes along with gender selection. This seems to stem primarily from both a general misconception about gender selection and the known abuse of gender selection in countries such as India and China.

Many believe that gender selection means discrimination against one sex. Others believe that it will lead to gender imbalances in the population, as has happened in China and India where boys tend to be the preferred gender.

However, the reality is that in the United States most reputable fertility clinics offering gender selection technology adhere to strict ethical standards. For example, many programs require that a couple be married or already have a child of the opposite sex. Furthermore, the American Society for Reproductive Medicine (ASRM) conducted a thorough ethical evaluation of gender selection for family planning and concluded that: “Sex selection aimed at increasing gender variety in families may not so greatly increase the risk of harm to children, women, or society that its use should be prohibited or condemned as unethical.”

Going Forward

Organizations such as “Generations Ahead” are working with fertility clinics, legislators and human rights groups to collaborate on creating more conversations about gender selection. These efforts are aimed not only to protect the fertility community against abusive practices, but to preserve the rights of families to make choices about their reproduction.

So, whether or not you are ready to come out of your gender selection closet, just know that if you do, there are many others just like you waiting to talk.

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