Preserving your fertility Laura L. Tatpati, MD Clinical Asst Professor, Obstetrics and Gynecology Live and Learn Lecture Series KU School of Medicine
Preserving your fertility Laura L. Tatpati, MD Clinical Asst Professor, Obstetrics and Gynecology Live and Learn Lecture Series KU School of Medicine.
Dec 18, 2015
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Preserving your fertility
Laura L. Tatpati, MD
Clinical Asst Professor, Obstetrics and Gynecology
Live and Learn Lecture SeriesKU School of Medicine
Reproductive Endocrinology and Infertility
Obstetrics and
Gynecology
Preserving - Protecting:Our goals today-
The Biological Clock
External factors impact on fertility
Protecting fertility - old and new
Almost 1 in 8 couples
Causes of Female Infertility
Egg factors
Quality
Number
Tubal factors/Pelvic scarring
Infection
Endometriosis
Cervical/Uterine factors
Genetic
Acquired
Causes of Male Infertility
Sperm production problems
Genetic
Born without ability for sperm development
Born without tubes to release sperm
Acquired anatomical changes
Polyps obstructing outflow
Vasectomy
Environmental
Aging
Fertility and Aging
Born with all the eggs we’ll ever have
20% of women have their 1st child after 35
5% had their 1st child after 30 in 1975
At least 1/3 of those trying to conceive after 35 have difficulty
Fertility and Aging
Fertility always declines with age
For most, major acceleration of decline = late 30s
Individual rate vs. Age group rate
Impact from genetics & environment
modifiable risks
“Goals for a healthier Me and baby-to-be”
http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf
FERTILITY GOALSHEALTH GOALS
BE AWARE OF GOALS AND COMMUNICATE THEM TO YOUR DOCTOR
Sexually transmitted infections
Tubal Factor: 18% of infertility
Chlamydia: 2.9 Million cases and 1.5 Million cases treated annually
Gonorrhea: 8 Million cases annually
1 in 15 sexually active 14-19 yo females have Chlamydia
Avoidance
Early Detection and treatment
http://www.cdc.gov/std/healthcomm/the-facts.htm
Smoking
54% higher chance of infertility
Accounts for up to 13% of infertility
50% lower chance of pregnancy with IVF!
Increased risk with increased amounts
Damages the ovarian “egg pool”
Don’t Wait!
Smoking
Quitting makes a difference
http://women.smokefree.gov
Alcohol1 in 8 women binge drink (4 or
more in 2-3h)
Infertility may be more likely with over 5 - 8 drinks / week or repeated binge drinking
beyond infertility - breast cancer, heart disease, unintended
pregnancy, and fetal alcohol syndrome
Weight
Low BMI
Body fat is key
Low BMI
Normal BMI, low body fat
Excessive intense cardio may result in hormone problems
Menstrual irregularity
Infertility with regular menses
Goal 150 minutes moderate intensity per week
Obesity/Elevated BMI
Irregular menses
Regular menses
Still reduced fertility
Pregnancy complications
Health complications
Eat healthy
Fruits/Vegetables
Lean meat, small portions
Beans, eggs, nuts
Whole grains
Avoiding saturated / trans fats
(Possibly) 1 full fat dairy every few days*
Environmental toxins
Medical term: Endocrine disruptors
Interrupt hormones in our body
Cumulative effectwork toxins, solvents, plastics, cosmetics, detergents
http:/www.prhe.ucsf.edu/prhe/pdfs/ToxicMatters.pdf.http://www.marchofdimes.com/pregnancy/stayingsafe_indepth.html
Stress / Mental Health
Infrequently the sole cause of true infertility
Sexual dysfunction
Ovulatory disturbances
Some meds can affect hormones
Conflicting data
Definitely associated with stopping treatments
Can affect relationships
Seek support/Communicate
Health Conditions
Contributing Medical Conditions
Insulin resistance/Type 2 Diabetes
Thyroid disease
Pituitary disease
Depression/anxiety
Vaginismus, painful intercourse, sexual dysfunction
Cancers (1/8 are reproductive aged or younger)
Gynecologic
Many more ...
Gynecologic issuesFibroids
Polyps
Endometriosis
PCOS
Primary ovarian insufficiency
Irregular periods?See your doctorPrevent a bigger
Problem!
Chemotherapy
Radiation
www.fertilehope.org
Cancer treatments
Cumulative effects
Each new issue Builds on the last
MenSteroids/Testosterone
Supplements, topical, injections, pills
Tobacco
First and second-hand smoke issues!
Alcohol
Obesity
Illness/Injury
diabetes, severe kidney damage, paraplegia
High heat environment
Varicoceles - consider monitoring or treatment
Toxins
ToxinsSperm background
Sperm are made in about 72d
They live in storage for about 15-25 days in the epidymus
1,000 shown to be harmful to animal reproduction and nearly 4 Million untested
Safety
Avoid skin contact
Store in sealed containers
Wash hands
Change clothes (don’t bring it home!)
Safety gear
Lead
Dibromochloropropane
Welding
Sevin
Toluenediamine, Dinitrotoluene
Ethylene Dibromide
Plastic Production
Ethylene Glycol
Perchloroethylene
Mercury Vapor
Heat
Military Radar
Kepone
Bromine Vapor
Radiation (high level)
2,4-D
Carbon disulfide
State of the rt:Egg freezing
Infertility is not an inconvenience;
it is a disease of the reproductive system that impairs the body’s ability to
perform the basic function of reproduction
www.reproductivefacts.org
Resources
www.asrm.org
www.reproductivefacts.org
www.cdc.gov
www.perinatalweb.org
http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf
www.fertilehope.org
www.resolve.org
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