1. Preserving your fertility Laura L. Tatpati, MD Clinical Asst Professor, Obstetrics and Gynecology Live and Learn Lecture Series KU School of Medicine

2. Reproductive Endocrinology and Infertility Obstetrics and Gynecology

3. Preserving - Protecting: Our goals today- The Biological Clock External factors impact on fertility Protecting fertility - old and new

4. Almost 1 in 8 couples

5. www.reproductivefacts.orgInfertility

6. Causes of Female Infertility Egg factors Quality Number Tubal factors/Pelvic scarring Infection Endometriosis Cervical/Uterine factors Genetic Acquired

7. 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

8. Aging

9. 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

10. 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

12. modifiable risks

13. “Goals for a healthier Me and baby-to-be” http://www.cdc.gov/preconception/showyourlove/documents/ Healthier_Baby_Me_Plan.pdf FERTILITY GOALS HEALTH GOALS BE AWARE OF GOALS AND COMMUNICATE THEM TO YOUR DOCTOR

14. 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

15. 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

16. 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

17. Weight

18. 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

19. Obesity/ Elevated BMI Irregular menses Regular menses Still reduced fertility Pregnancy complications Health complications

20. 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*

21. 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.pdfhttp:/www.prhe.ucsf.edu/prhe/pdfs/ToxicMatters.pdf. http://www.marchofdimes.com/pregnancy/stayingsafe_indepth.html

22. 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

23. Health Conditions

24. 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...

25. Gynecologic issues Fibroids Polyps Endometriosis PCOS Primary ovarian insufficiency Irregular periods? See your doctor Prevent a bigger Problem!

26. Chemotherapy Radiation www.fertilehope.org Cancer treatments

27. Cumulative effects Each new issue Builds on the last

28. 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

29. 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 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

30. State of the rt: Egg freezing

31. 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

32. Resources www.asrm.org www.reproductivefacts.org www.cdc.gov www.perinatalweb.org http://www.cdc.gov/preconception/showyourlove/documents/Healthier_Baby_M e_Plan.pdf www.fertilehope.org www.resolve.org