One of the most vexing problems in human reproduction has been the accepted fact that women are born with every egg that they are ever going to have. As women age, the number of viable eggs goes down until she is no longer able to conceive her own biological child. A new study [u1] has questioned this current position by actually creating new eggs from stem cells.

Stem cells are the special cells within the body that have not been assigned a specific identity. As a result, they can become kidney cells or skin cells or muscle cells. But until now, there has not been confirmation that they can become the special cells that are necessary to support reproduction (eggs or sperm). This new study has changed that perspective.

It is important to point out that this is the first report and therefore the technique needs to be repeated and verified before we can be certain of this new breakthrough. It is also noteworthy that this study involved a process where women were having their ovaries removed as part of gender re-assignment surgery. The ovaries were then processed in the lab in order to derive the cells that reportedly produced a limited number of eggs. It is therefore possible that even if this study is confirmed that it will only apply to young women and that the technique would require that they lose an ovary in order to create these eggs. Since it is older women that typically need to generate new eggs, we aren’t yet certain that this new breakthrough will ever be of practical value to women most in need of these results. Nonetheless, each step toward overcoming a potential barrier to reproduction is cause for celebration—even if we simply develop new information that assists us in understanding other aspects of reproduction.

There have long been rumors that lipstick contains lead and but since cosmetic producers are not mandated to release the ingredients of their products, this fact remained hidden for many years. Back in 2007 the Campaign for Safe Cosmetics [r1] sent 33 brands of lipstick to an independent lab for testing and found that 61% tested positive for up to 0.65 parts per million of lead. What’s more they found top selling brands—including one that sold for $24 each—had the highest lead content! They reported their results to FDA and were promised an investigation.

It took the FDA two years and a letter from 3 US Senators to perform a follow up study. They found lead in every brand that they tested[r2] . Some of the brands had four times more lead in them then the Campaign study results. Despite these findings, the FDA did not take any action to protect consumers. More recently, an expanded analysis found lead levels as high as 7.19ppm. Even more surprising 5 of the top 10 most heavily contaminated brands were made by a one manufacturer[r3] , Loreal USA. Why aren’t consumers being made aware that something as toxic as lead is being sold to apply to their lips? That’s a hard question to answer.

The US Center for Disease Control and Prevention states that there is “No safe blood level for lead.” Lead is a neurotoxin. It accumulates in the body and it can even cross the placenta to harm a developing fetus. That’s why the only effective strategy against heavy metal poisoning is to minimize your risk of lead exposure. The effects of lead are well known and include lower IQ scores, behavioral problems, aggression and learning (especially language) disabilities.

More recently, a study demonstrated that high levels of lead can also contribute to infertility. In this study[r4] —conducted by the National Institute of Health—they found that women and men with higher levels of the heavy metals lead and cadmium experienced a nearly 30% reduction in their chance of conceiving. Although their study considered cigarettes to be the primary source of exposure to these toxic metals; their study was completed before the high lead levels in lipstick were revealed. Be a smart consumer and check out your personal care products and cosmetics before you apply: http://www.ewg.org/skindeep/browse/lipstick .

Everyone likes to look and smell their best. But what is the real cost of that silky smooth skin and shiny hair? Cosmetics and personal care products contain various combinations of nearly 11,000 chemicals; only 11% of which have been evaluated for their safety. Maybe more concerning is that the Food and Drug Administration (FDA) [r1] has not set any premarketing standards for testing these products or disclosing the results when problems are detected. With the exception of California—which passed the California Safe Cosmetics Act of 2005 (Senate Bill 484)—the production of cosmetics is a self-regulated industry that generates over $50 billion annually. One easy (but inaccurate) way of trying to put consumer’s minds at ease by these companies is by promoting the notion that beauty products are applied externally and therefore have minimal opportunity to impact internal physiology.

Even though personal care products are applied topically; they are absorbed. How much they are absorbed depends upon several factors like, are they are applied near an opening (lipstick and eyeliner for instance gain entry easily); are they applied to a part of the body that is shaved (making for easier absorption); is it a moist or covered area (boosting the amount that penetrates the skin) and how often does is it applied or how long does it linger after application (dose). Another important aspect of a cosmetic’s ability to penetrate has to do with fragrance; the simple rule is if you can smell it, it is getting into your body and often into the bloodstream.

Let’s consider the example phthalates. These chemicals are plasticizing agents that add flexibility and a moisturizing sheen to products like nail polishes/nail hardeners, fragrances, mascara, lotions, shampoos/conditioners and sunscreens. If they appear on labels—not all cosmetics reveal ingredients—they are named for their specific chemical like DEP—most commonly used; DBP—used widely in nail polish; DMP—becoming more popular amongst manufacturers. They are well known for their ability to cause hormonal imbalance in both people and animals. They have been linked to early onset of puberty in girls[r2] , genital malformations in boys[r3]  born to women exposed during pregnancy and now there have been several studies linking them to an elevated risk of obesity[u4] . Most troubling of all, they aren’t even a necessary ingredient.

Nail products tend to be one of the greatest sources of exposure for women. Although one would not think a product could be absorbed through the nail, DBP is water soluble so slight amounts leach out each time the nail is wet. As a result, it can be absorbed by the skin or taken in orally if the leaching takes place during food preparation. In fact, the reason that nail polish becomes brittle and chips over time are due to the loss of DBP which is used to keep polishes flexible. Rest assured, there are phthalate-free products available now, and consumers have the right to be educated on why avoiding such hormone disruptors is important to their reproductive health.

The simplest way to reduce exposure to phthalates is to buy products that don’t contain them. By doing so, you’re also supporting manufacturers that are making more responsible decisions. If you’d like to check out your favorite brands as well as get some leads on healthy alternatives, go the Environmental Working Group’s Skin Deep Cosmetics Database[u5] . They have the lowdown on over 69,000 products.

*Excerpt from my book PERFECT BALANCE[r1]

Optimists see the glass as half-full, and it stands them in good stead. Between 1962 and 1965, a group of investigators from the Mayo Clinic performed personality testing on nearly five hundred study participants. They recently followed up on them some thirty years after the original test and found not only that the “pessimists” has lower overall scores in terms of their health, but that over the three intervening decades, the “optimists” had about a 50% higher survival rate. Other studies have had similar results. Psychologist Dr. Richard Wiseman, author of The Luck Factor, has shown that the way we assess various situations changes how effectively we accomplish our goals. And a positive outlook wins every time.

A recent study [u1] from the National Institute of Health found lowering dietary fat intake can reduce a woman’s risk of developing gestational diabetes. They were tracking the diet and lifestyle habits of 13,000 women that were between 22 and 45 years of age and enrolled in the US Nurses’ Health Study II. They found about 6% of women developed gestational diabetes. However upon analysis they found that women eating more foods that were high in animal fats had double the risk of developing this problem compared to women on a low fat diet. When they performed a more detailed nutritional analysis, they found that dietary cholesterol and animal fats were the only foods consistently associated with an increased risk of gestational diabetes. So carbohydrates (sugars) did not create any measurable impact. Exercise was found to reduce the risk of diabetes but not enough to offset the effects of a high fat diet. They concluded that reducing the consumption of animal fat by as little as 5% while trying to become pregnant –even if replacing it with plant derived fats—measurably reduces a woman’s risk of diabetes during pregnancy.

*The following is an excerpt from my book PERFECT HORMONE BALANCE FOR FERTILITY[u1] . If you’re working to lose weight or wondering if/how this may improve your chance for conception then read on…

Fat cells are not passive calorie warehouses, but rather mini endocrine factories that produce at least 20 different hormones, collectively called adipokines. These hormones direct your metabolism and help your brain keep track of your energy stores to control appetite and budget how your body uses this energy. Adipokines also help your brain determine if you have enough fat stores to sustain pregnancy. Your brain also takes into account how effectively you can share your energy with your baby—if you’re insulin-resistant, your body doesn’t channel energy to the fetus as effectively. As you modify your diet, fat cells adjust their adipokine secretions to bring them more into balance, improving your fertility profile. Here are some of the key adipokines and how they affect your weight.

  • Leptin tracks how many calories you have stored as fat—the more fat you have, the more leptin in your blood. When leptin levels are high, your brain suppresses your appetite and revs your metabolism to help you burn calories. But when leptin is chronically elevated, at it is in obesity, your brain tunes out the appetite-suppressing effect. Low leptin, on the other hand, signals low fat stores—a red flag that your brain should halt ovulation.
  • Adiponectin helps your body use fat as fuel. As you gain weight, though, you produce less adiponectin, and low levels are associated with fertility problems. As you lose weight, fat cells release more adiponectin, increasing your chance of conception.
  • Resistin is released by fat cells, resisting insulin’s ability to help store glucose. If you’re overweight, resistin rises, leading to insulin resistance and reduced fertility.
  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

**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.

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.

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.

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