Are you seeing double? Recent CDC study reports on rising rate of twins.

  Reprint from post for Conceive Magazine Online > http://www.conceiveonline.com/articles/are-you-seeing-double

 If you haven’t had twins, chances are someone you know has. According to a recent report from the Centers for Disease Control and Prevention (CDC), one of every 30 babies born in 2009 was a twin. That’s nearly twice the rate of twins that was reported in 1980. The   biggest reason for this growth in twin rates is that more women are  having children later in life. Whether through fertility treatment or  naturally, the incidence of twins rose by 100 percent for women 35 to 39   years of age and by more than 200 percent when women over 40 conceived.Even when conception occurs naturally, women are more likely to have twins in their later reproductive years. That’s because as a woman ages the hormones produced by her brain to  signal her ovaries to produce eggs begin to shift into a higher gear. As   a result, a woman of 40 is at least twice as likely to conceive  twins—if she is still fertile—as she would have been at age 20. The  recent CDC report suggests that at least one-third of the rise in twin  rates may be related to the rise in the average age at which women are  having children.

But there are other factors at work as well. The increase rate of twins may be one of the best examples of how food choices can affect you hormonally. In 2006, a study demonstrated that women who ate two or more servings of non-organic  dairy per day were five times more likely to have twins as women who ate   no dairy at all. Other studies have shown that the growth hormones  given to dairy cows can stimulate a woman’s ovaries to release more eggs   at the time of ovulation. In fact, Britain banned the use of these  growth hormones in their dairy farms. British women are about half as  likely to have twins as women in the U.S.

These dietary influences aside, fertility treatment is the most easily documented factor in the rising rate of twins. More than half of the twins conceived today are through fertility treatment. A common strategy used to help women become pregnant is to increase the   number of eggs that they release; with this treatment comes the risk of  a multiple pregnancy. The use of medications to promote ovulation is   not easily monitored and is often prescribed by non-specialists, such as  gynecologists rather than reproductive endocrinologists (REs), which   specialize in the treatment of infertility. Nonetheless, these basic  fertility therapies are responsible for nearly half of the twin  pregnancies attributed to medical intervention; the remainder of the  twins produced through fertility treatment is the result of IVF (in  vitro fertilization) pregnancies.

In the process of IVF, eggs are  fertilized and allowed to go through their initial stages of  development in the laboratory. That allows REs to select the embryos  that are most likely to implant and become a healthy baby. Since the  process can be expensive, there is a tendency to put back more than one  embryo at a time. In fact, a recent experiment even suggested that when two embryos are transferred together they may interact in a way that improves the chance that they will both thrive. That can not only improve pregnancy rates, but it also increases the  risk of having twins.

As a fertility specialist, I know that many of my patients actually want twins. They are eager to complete their family and they view twins as a way of achieving their goal instead of having one child at a time. In other words, patient preference has also  contributed to the increase in twins. That said, the recent CDC report  did find that the rise in twin pregnancies due to fertility treatment  has leveled off considerably since 2005.

If you wish to minimize your risk of having twins, here’s what you can do:

• Go organic. By  avoiding growth hormones, especially in dairy products, you may  minimize any      dietary boost to your chance of having twins.
• See a specialist. A board-certified reproductive      endocrinologist is a fertility specialist      trained to safely improve your odds of  pregnancy while minimizing your risk of      a multiple pregnancy.
• Consider IVF with ESET. Many patients going through treatment are considering elective single embryo transfer (ESET),      in which just one embryo is transferred during IVF, to reduce their risk      of twins.

Have you had twins? Were you counseled on steps you could take to reduce your risk or was this your goal?

Robert Greene, M.D., FACOG, is a physician at the CNY Fertility Center in central New York and the author of Perfect Hormone Balance for Fertility, Perfect Hormone Balance for Pregnancy, and Happy Baby, Healthy Mom Pregnancy Journal. 

 

Are environmental toxins hampering your chances of becoming pregnant? Here’s what you need to know.**

**About a week ago, I submitted this post to Conceive Magazine Online [r1] for publication. The very next day, another study [r2] came out finding an increase in sperm DNA abnormalities in men exposed to higher amounts of PCB’s. Although I mention other studies below with similar findings, I wanted t include this recent and compelling data.

According to the U.S. Government Accountability Office, there are 80,000 industrial chemicals currently in use, with another 700 added each year. Oftentimes it takes years or even decades to discover if or how these products influence our health. Worse still, many of these chemicals are classified as “hormone-disrupting agents,” meaning that they can trigger a hormone imbalance if you’re exposed to them. The hormonal chaos that results can cause infertility, miscarriages, birth defects and may even contribute to certain types of cancer.

You can take an active role in reducing your exposure to these potentially toxic agents by actively taking steps toward achieving hormone balance. Get informed and create a diet and lifestyle that can reduce your exposure to specific chemicals that have been linked to problems. A great place to start: Consider what you can do to reduce your contact with polychlorinated biphenyls; commonly known as PCBs.

PCBs were banned from use in the United States in 1979 due to their toxicity. Even though three decades have passed since they were widely used in construction and insulation, these hormone-disrupting chemicals persist in our environment. Today our primary exposure to PCBs is through contaminated water, polluted air, and the consumption of high-fat foods made from fish or animal products.

Since PCBs are stored in fat cells, switching to a low-fat diet can dramatically reduce your risk. For example, endometriosis is a problem commonly associated with infertility. Several studies have demonstrated that women with high levels of PCBs are three to four times more likely to develop endometriosis. One interventional study indicated that women with endometriosis can reduce their risk of reocurrence by 40 percent or more simply by reducing their consumption of beef and ham and replacing these calories with fresh fruit and vegetables.

Making these healthy choices can also improve male fertility: A 2009 study found that men exposed to water pollutants (including PCBs) were at higher risk of infertility. These toxins can disrupt male hormones as well as interfere with sperm production. Rather than worry about the impact that water may be having on you, check out the database created by the Environmental Working Group. Not only do they report on pollutants that may be present in your tap water, they also provide links to simple water filtration systems that you can use to improve your health and that of your family.

If you needed even further proof that PCBs may be affecting your chances of becoming pregnant, a study published in 2010 found significant levels of this toxin in the fluid surrounding eggs that is collected during IVF cycles. More recently, U.S. research found that not only did a woman’s PCB level impact her chance of becoming pregnant, but it also may increase her risk of having a miscarriage. So clearly it is in your best interest to minimize your exposure to PCBs. Here are some simple steps that you should consider:

• Eat low fat—in particular reduce your consumption of beef and ham while boosting your intake of fresh fruits and vegetables.
• Avoid farm-raised salmon and catfish since these have been shown to be prime sources of PCB exposure.
• Drink filtered tap water instead of bottled water, which can often contain a variety of hormone-disrupting chemicals.
• If you live in an older home with hard-wood finished floors, consider having them professionally treated with safer products.

---

 [r1]Link to http://www.conceiveonline.com/articles/are-environmental-toxins-hampering-your-chances-becoming-pregnant

 [r2]Link to http://www.everydayhealth.com/mens-health/1228/chemical-exposure-linked-to-sperm-abnormalities.aspx?xid=aol_eh-news_7_20111226_&aolcat=HLT&icid=maing-grid7%7Cmain5%7Cdl6%7Csec3_lnk2%26pLid%3D123543

 

To freeze or not to freeze; that is question faced by many couples going through fertility treatment

One of the most vexing problems encountered during fertility treatment is how best to optimize the pregnancy rate will we also minimize the risk of triplet (and higher) pregnancies. Since we can’t currently tell which egg has the greatest potential to become a healthy baby, the most common strategy used by IVF centers is to produce as many eggs as possible. Attempts are then made to fertilize each one and let them grow to identify those that are most likely to be capable of implanting and becoming a healthy baby. Generally speaking, around 10-30% of eggs have the ability to complete this initial development in the lab. For those couples fortunate enough to have more than one or two healthy embryos; the question arises about what to do with the rest. Transfer them and risk experiencing a multiple pregnancy or freeze them?

The first pregnancies resulting from frozen and thawed embryos were delivered in 1984. Since that time, hundreds of thousands more have followed. In 2009 for instance—the most recent year with statistics available[r1] —there were nearly 22,000 frozen embryo transfers in the USA and about a third resulted in a successful pregnancy. It’s also noteworthy that once frozen, embryos retain their potential to result in the birth of a healthy child. A report in 2010 [r2] demonstrated this when a couple that conceived through IVF in 1990, donated their remaining embryos and one implanted resulted in the birth of a healthy baby after being frozen for nearly 20 years. One large European study [r3] found that pregnancies conceived with frozen embryos may have a lower risk of medical complications than those resulting from a fresh embryo transfer. So although cryopreservation is not fail-safe, it is viable option to reduce the risk of multiple births. The most common question is how many embryos survive the process of freezing and thawing.

Human embryos are at risk of thermal injury if not frozen carefully. Initially, they were typically frozen at a controlled rate while a substance called a cryoprotectant was added to reduce damaging ice crystal formation—a process now referred to as the “slow freeze” or “conventional” method. Once frozen the embryos are stored in liquid nitrogen at a temperature of -196⁰C.  Typically, most centers report that about 70% of the embryos survive the freezing and re-warming process using this technique.

More recently, many centers have adopted a new and very rapid freezing technique called “vitrification.” The advantage of this new rapid freeze technique is it occurs too rapidly for ice crystals to form therefore reduces the risk to the embryos. As a result, very few healthy embryos are damaged through this process. In fact, this technique is now being applied to freezing unfertilized eggs as well; an even greater challenge than freezing embryos. Several recent analyses published in the August issue of the journal Fertility & Sterility[r4]  predict that this technique will rapidly become the standard although currently not all clinics have switched to vitrification at this time.

So when considering how many embryos you wish to receive in an embryo transfer, consider the risk of multiple pregnancy as well as the success of frozen embryo transfer. It’s worthwhile to talk to your clinic about their freezing technique and their experience. It could make a world of difference you and your family.

---

 [r1]https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0

 [r2]http://www.christianpost.com/news/baby-born-from-20-year-old-embryo-47188/

 [r3]http://www.fertstert.org/article/S0015-0282(09)01297-7/abstract

 [r4]http://www.fertstert.org/article/S0015-0282(11)01045-4/fulltext

 

Correcting hormone imbalance improves fertility AND reduces cancer risk: even more reason to consider metformin to reduce insulin resistance

Most people have accepted the role of reducing insulin resistance in order to improve
fertility and reduce miscarriage in women with PCOS. The question that often comes
up is what is the most strategy to achieve this goal. True there are many dietary and
lifestyle modifications that can improve insulin sensitivity. The problem is that each
person needs a different combination of recommendations tailored to their unique
situation. That’s why having a simple and well researched medication to prescribe is
such a bonus. Metformin meets these needs.

Not only has metformin been shown to improve fertility; it has also been linked to
a reduced risk of miscarriage as well. Now there is a growing body of evidence that
metformin can reduce the risk of various cancers.

Many studies have shown the type II diabetes—the most severe form of insulin
resistance—is associated with elevated risks of various types of cancer. So it has long
been hoped that the types of medications that can reduce insulin resistance should also
reduce cancer risks. Better still; the data that has emerged with the use of metformin
has also been associated with a reduced risk of endometrial (uterian) cancer and breast
cancer.

So if you’ve got insulin resistance and want to become pregnant, there is even more
compelling reasons to consider metformin as part of your treatment regimen.

 

Go nuts! A simple and healthful food tip

As we turn toward that time of year when parties, feasts and get-togethers occur, there is good news to report. A recent study found that boosting consumption of nuts (raw unpeeled walnuts, almonds and hazelnuts) carries a variety of health benefits. These tasty little treats can boost your blood level of serotonin. The result is that you may experience fewer cravings, a happier mood and a healthier heart. Daily consumption of as little as 1 oz of nuts per day can also reduce insulin resistance and help with weight loss or at least help prevent weight gain. So rather than over-analyze this study and try to pick apart which of the healthy components produce these health benefits, just add some nuts to your diet instead. Whether you’re pregnant, trying to become pregnant or just trying live a healthier lifestyle, it’s time to “go nuts.”

 

Lies, damned lies and statistics; does IVF increase a woman’s risk of developing ovarian cancer

Mark Twain popularized the saying that “there are three kinds of lies: lies, damned lies and statistics” in his 1906 autobiography. Since that time, healthcare providers like myself often refer to this quotation when yet another study comes out producing numbers which scare our patients. I was reminded of this when discussing a study published this week in the journal Human Reproduction which boldly stated that IVF treatment “doubles a woman’s risk of developing ovarian cancer.” In reality, they found that patients that underwent IVF treatment between 1983 and 1995 had a risk of developing ovarian cancer estimated to be at 0.71% compared to a baseline risk of 0.45% in untreated women. Not only is that a lower increase than stated but they did not find any correlation between dose of medication and cancer risk. This means their theory lacks biological plausibility. Maybe more importantly is that they neglected to point out those women that successfully become pregnant experience a dramatic reduction in their risk of developing ovarian cancer. That fact is particularly important since pregnancy rates have increased profoundly during the intervening years. Unfortunately, those facts are often overlooked when inflammatory studies like this are published.

As a patient advocate, I do feel that it is important that we inform our patients of every possible risk but that we also provide a fair and balanced perspective. To date, there have been at least15 studies that have looked for a link between fertility medications and ovarian cancer without finding any increase in risk. By contrast, I believe that this is 4th study suggesting a slight increase may exist. So although we cannot say that there is no rise in cancer risk associated with IVF treatment, we can state that any risk increase is small and that a successful pregnancy likely offsets that risk. Better still, we can also recommend our patients that are concerned to consider taking an oral contraceptive when not attempting to become pregnant as reported in 45 studies—recognized as reliable by the American Cancer Society—indicate that doing so can reduce ovarian cancer risk by at least half. So in considering your treatment options, look beyond the statistics and consider how any treatment as well as its outcome may actually impact your health and wellness.

 

The Obesity Dilemma

Over the last 25 years, infertility rates have risen in proportion to the rise in obesity in men and women in their reproductive years.  One analysis determined that at least 10 percent of today’s fertilty problems are related to overeating. The good news for obese people is that losing 10 percent of your body weight will improve your chance of conception (if you’re overweight, not obese, you’ll see the benefits after losing only 5 percent of your body weight). So create short-term goals on your path to hormone balance and don’t focus on attaining your ideal body weight.

Excerpt from Perfect Hormone Balance for Fertility

 

Thyroid Hormone, conception and miscarriage: here’s what the studies show regarding borderline low thyroid levels

There are many hormones that are involved in establishing and maintaining your health so that you can conceive and carry a pregnancy. One of the most important is the hormone called thyroxine which is produced by your thyroid gland. The role of this hormone is to regulate your metabolism much like the computer that regulates the idle speed in your car. If your thyroid hormone production is too low; you may feel sluggish like a car that is trying to stall whereas if your levels are too high you may feel overheated and agitated like a car whose engine is revving inappropriately. Although these examples of the extreme shifts of thyroid hormones are fairly easy to diagnose and treat; there are many subtle imbalances that may still hamper your fertility. An example is the condition called “subclinical hypothyroidism.”

Subclinical hypothyroidism is defined as the state of having an elevated level of TSH (thyroidstimulating hormone) but a normal thyroxine level. In other words, the brain is sending a signal to the thyroid gland to boost production of thyroxine but the thyroid gland isn’t responding fully. This imbalance occurs in about 8% of the general population but it is much more common in women with infertility. If left untreated, several studies suggest that overt hypothyroidism can result; having an adverse effect upon both the mother and her developing baby.  New studies are now providing much needed information to settle this debate on when and if this subtle hormone imbalance should be treated.

Earlier this year, a study reviewed the impact that treating subclinical hypothyroidism had upon the outcome of IVF treatment. Since the IVF process allows us to assess egg quality, fertilization, embryo quality and the implantation rate following embryo transfer, it offers us the most precise means to assess the impact of this therapeutic intervention. In this study patients with subclinical hypothyroidism were randomly assigned to treatment with thyroid supplementation or placebo. Those that received the hormone boost had better embryo quality, higher implantation rate and a reduced chance at having a miscarriage–all positive findings for couples trying to have a child.

Another larger study was published last year which was designed to evaluate the pregnancy loss rate as well as the preterm delivery risk in pregnant women with subclinical hypothyroidism. This was a “non intervention study” which means that they were just observing the outcome of the pregnancies without deciding when or who to treat. They found that women with untreated subclinical hypothyroidism had twice the risk of first trimester loss providing strong evidence to support the therapeutic intervention with thyroid supplementation.

Finally, there have been studies suggesting that women with subclinical hypothyroidism may develop low thyroid hormone levels if they consume a diet that is high in products made from soybeans (defined as more than 30g of soy protein per day which includes 16 mg or more of phytoestrogens). That’s because these estrogen-like chemicals produced by soy can reduce the ability of your body to convert thyroid hormone into its active form. In one study that actually looked at the effect of this dietary change, they found that 6 out of 60 patients developed low thyroid hormone levels due to a shift to a high soy diet. So although this healthy change in food choices can increase the risk of hypothyroidism it is not an inevitable change.

My recommendation is that if you have subclinical hypothyroidism that you monitor your condition closely and consult with your doctor as to whether or not you may benefit from supplementation with thyroxine (thyroid hormone) during your fertility treatment and pregnancy.

 

HIS age and YOUR Fertility

It is well known that as a woman ages, her ability to have a child with her own eggs declines and eventually ceases altogether. What has not been well studied nor as widely discussed is the impact that paternal age has upon fertility. With a growing number of couples delaying marriage or remarrying, there are more men in their forties, fifties and sixties that are trying to father a child. In the USA, the birthrate of children to men between 35 and 54 years of age has gone up by over 30% between 1980 and 2000[g1] . There is evidence that this trend is continuing to rise.

Advanced paternal age has been associated with a higher risk miscarriage in at least one study. Other studies suggest that women with an older partner are at higher risk of pregnancy complications. But the data on the chance of actually conceiving is more difficult to interpret.

As men a man becomes older the volume of semen that he produces declines. We know also that the number of sperm producing cells and the production of testosterone decreases as well. We also know that the hormone signal from his brain to the sperm producing cells increases suggesting that they are less sensitive to this signal. But the factors that we typically evaluate to assess male fertility--sperm count, sperm motility and sperm shape (morphology)--do not predictably decline as a man reaches his 50’s or 60’s. So to answer the question of male fertility and aging, we get the most predictable information by looking at the results of IVF treatment.

When pregnancies are created through advanced reproductive techniques like IVF; we are able to directly observe the ability of sperm to fertilize an egg and then track how the embryo develops. Better still, we can then follow the outcome of those embryos in order to determine how well they implant and how often the result in the birth of a healthy baby. Recently, a review [g2] was published that tried to gather and quantify all of the studies published so far that could help answer this question. Here is what they found:

·       Fertilization Rate—this is defined by the ability of a sperm to penetrate an egg and initiate embryo development. The existing studies do not show a decline in this critical step associated with aging in men.

·       Embryo Development—is the critical stage that an egg must go through before it can implant into a woman's uterus. This is a process that typically takes place over 5-6 days. The first three days are not impacted by sperm quality and therefore are not impacted by the age of the male. Studies do suggest that there is a greater decline in embryo quality between day 3 and day 6 as men age suggesting that sperm quality may be impacted by age.

·       Implantation Rate—this is determined by the positive pregnancy rate following embryo transfer. The data suggests that the implantation rate does decline with paternal age but this does not become a noticeable impact upon success until a man is older than 60 years of age.

·       Birth Rate—the data on live birth rate is conflicted. Some studies show a lower birth rate after implantation as a man ages while others found no higher risk of miscarriage. Typically, such inconsistent results suggest that it is not strictly an age related phenomenon and may in fact be impacted by other factors.

 

 

 

Food, Fertility & PCOS

Nearly 5 decades ago, geneticist James Neel proposed that there is a genetic basis for the increased risk of developing diabetes that is experienced by populations that have more recently become exposed to our modern diet and lifestyle. Since that time, considerable data has been gathered and analyzed to explain this "thrifty gene hypothesis." Simply stated, there seems to be a survival advantage to having physiology that is adapted to storing calories when food is plentiful and utilizing them more slowly when food is scarce. Yet during the last century, our diet and lifestyle has changed so that currently we exercise less and actually have to make an effort to avoid overconsumption. So what once was a survival advantage is now an invitation to hormone imbalance.

Interestingly, studies [g1] of domestication of animals suggest that it takes 12 to 25 generations for a species to adapt from a wild to suburban lifestyle. That's why our dogs and cats are experiencing rising rates of obesity, diabetes and heart disease while cows and pigs seem immune to these conditions. So how does this information relate to humans? More importantly, what can we do about it? Take corrective actions. 

It is now well established that our modern trends promote "insulin resistance." This hormone imbalance is associated with an elevated risk of obesity, heart disease and diabetes. In men, it often leads to a low sperm count and failing testosterone production whereas in women it triggers higher testosterone and polycystic ovarian  syndrome (PCOS)[g2] . The bottom line is that was once a survival advantage for our ancestors is now a fertility challenge for couples today. The simple truth is that a conscious change in food choices will redirect many couples on a path toward better health as well as improving their chance of becoming pregnant.

My colleague, Dr. Ernest Zeringue, has developed a diet [g3] based upon food choices that blunt the insulin response. We have found that when properly instructed, many women with PCOS lose weight easily on this diet while also improving their egg quality and their chances of conception. If you haven't considered a similar intervention to correct your insulin resistance; I'd encourage you to do so.

Although some medications or surgical procedures can create similar results, it is very empowering for most people to learn that they can often control their own destiny.