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Preserving your fertility. Laura L. Tatpati, MD Clinical Asst Professor, Obstetrics and Gynecology Live and Learn Lecture Series KU School of Medicine. Reproductive Endocrinology and Infertility. Obstetrics and Gynecology. Preserving - Protecting: Our goals today-. The Biological Clock
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Preserving your fertility • Laura L. Tatpati, MD • Clinical Asst Professor, Obstetrics and Gynecology • Live and Learn Lecture Series • KU 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
Infertility • www.reproductivefacts.org
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
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
FERTILITY GOALS HEALTH GOALS BE AWARE OF GOALS AND COMMUNICATE THEM TO YOUR DOCTOR “Goals for a healthier Me and baby-to-be” http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_Me_Plan.pdf
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 yofemales have Chlamydia • Avoidance • Early Detection and treatment http://www.cdc.gov/std/healthcomm/the-facts.htm
http://women.smokefree.gov 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” Quitting makes a difference Don’t Wait! Smoking
Alcohol • 1 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
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 effect • work 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
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 issues • Fibroids • Polyps • Endometriosis • PCOS • Primary ovarian insufficiency Irregular periods? See your doctor Prevent a bigger Problem!
Cancer treatments • Chemotherapy • Radiation • www.fertilehope.org
Men • Steroids/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
Toxins • Sperm 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
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