Consequences of PCOS

The Serious Health Complications Of Unmanaged PCOS

Just like endometriosis, there is a lot of the information about PCOS, but it is more about the symptoms, time to diagnosis and future fertility outcomes.

While it is necessary to educate people about these things, nobody is really talking about the serious health complications of unmanaged PCOS.

There have been some big changes to the diagnosis of PCOS, but still it can often take up to 3 years or more to get a proper diagnosis. While it may not take as long as endometriosis to be diagnosed, it still means that many women are being missed and dismissed in those year before they are finally diagnosed.

Like Endometriosis, some women with PCOS are never diagnosed and some women do not have any symptoms and can have very regular cycles etc. Women can have PCOS and endometriosis together, alongside other issues such as adenomyosis as well.

There are serious health consequences with unmanaged PCOS

The main thing I am trying to bring to everyone’s attention is that it doesn’t matter what disease you have, if it is left unmanaged, or not managed properly, it can have some pretty serious consequences of ones fertility, and mental and physical health.

PCOS is not exception. While the symptoms of PCOS are not as bad as those suffered with endometriosis, or adenomyosis, women can still suffer in many other ways. The long-term consequences of unmanaged PCOS can be very serious and can also lead to early death (cardiovascular disease, stroke etc.) and also lead to certain cancers.

Risk factors

PCOS is thought to have a genetic component. People who have a mother or sister with PCOS are more likely to develop PCOS than someone whose relatives do not have the condition. This family link is the main risk factor.

Then there is the insulin resistance factor with PCOS as well. Insulin resistance is a primary driver of PCOS and there is now evidence to show that most, if not all, women with PCOS have insulin resistance by default. Again this appears to be through genetic or family links of someone having PCOS, or having diabetes in the family tree etc.

Excess insulin is thought to affect a woman’s ability to ovulate because of its effect on androgen production. Research has shown that women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens.

This is why diet and lifestyle interventions are so important in the overall management of PCOS. It is because these changes help with the insulin resistance.

There are other risk factors such as obesity, stress, nutritional deficiencies and sedentary lifestyle. Have a look at my page about more information on PCOS and risk factors etc (Click Here)

The Common Symptoms of PCOS

It is important to know what the common symptoms of PCOS are, so that women and healthcare professionals alike know what to look for.

The common symptoms of PCOS include:

  • irregular menses
  • excess androgen levels
  • acne, oily skin, and dandruff
  • excessive facial and body hair growth, known as Hirsutism
  • female pattern balding
  • skin tags
  • acanthosis nigricans, or dark patches of skin
  • sleep apnea
  • high stress levels
  • depression and anxiety
  • high blood pressure
  • infertility
  • Increased risk of miscarriage
  • decreased libido
  • high cholesterol and triglycerides
  • fatigue
  • insulin resistance
  • type 2 diabetes
  • pelvic pain
  • weight management difficulties including weight gain or difficulty losing weight

Early Intervention and management is crucial

The causes of PCOS are unclear, but early intervention, early diagnosis and early management, can help relieve symptoms and reduce the risk of complications. Anyone who may have symptoms of PCOS should see their healthcare provider, women’s healthcare specialist, or PCOS expert.

Coping with the symptoms of PCOS and managing the treatments can be demanding ands sometimes stressful. But, to then learn there can be serious complications and added risks to your health from PCOS not being managed properly can be distressing.

Be educated and get proper help

Just like any disease state just being aware, and being educated there are added risks is an important first step. Once you have the common symptoms of PCOS under control then you can turn your mind to thinking about ways to prevent further complications.  The good news is that many of the treatments and management strategies you will use for your PCOS will also help to prevent many of the serious complications. A qualified healthcare professional, or a healthcare practitioner who is an expert in PCOS should be managing anyone with PCOS. Nobody should be trying to manage PCOS on their own without some form of professional help.

The serious complications of PCOS

Women with PCOS are thought to be at higher risk of having future heart disease or stroke. They are also at higher risk of diabetes, endometrial cancer and other cancers too.

What are the serious complications of unmanaged PCOS?

Besides the risk factors already mentioned, the serious complications of unmanaged PCOS are as follows:

  • Weight gain or obesity
  • Prediabetes
  • Type 2 diabetes
  • Cardiovascular disease
  • Metabolic syndrome (generally having at least two of high blood pressure, high cholesterol, obesity, high fasting blood glucose)
  • Endometrial cancer
  • Other cancers (breast, ovarian)
  • Sleep apnoea
  • Inflammation of the liver
  • Infertility
  • Increased Pregnancy induced hypertension and pre-eclampsia
  • Increased gestational diabetes
  • Increased risk of stroke
  • Increased risk of sudden death
  • Atherosclerosis
  • Psychological disorders
  • Mood disorders (anxiety, depression)

What you can do

If you are worried about the serious complications of unmanaged PCOS it is helpful to:

  • Get your symptoms of PCOS under control as a first step
  • Discuss any concerns with your healthcare practitioner, or women’s health/PCOS expert.
  • Learn about and understand your risks
  • Learn that early intervention and early healthcare management is the key to assisting any disease state.
  • Have your blood pressure, blood glucose and cholesterol checked regularly
  • Seek guidance and support to help with weight management and dietary and lifestyle management.
  • Remember that all body types can have PCOS, not just those who are overweight.
  • Do not try to manage the symptoms of PCOS on your own.

Final word

If you do need assistance with PCOS and would like my help, please call my friendly staff and found out how I may be able to assist you. There are options for online consultations and consultations in person.

As mentioned before the key to any disease is early intervention and early healthcare management and you taking the first steps to get the help you need. PCOS also needs a multimodality approach. There are many facets to it. Don’t put off your health. Just pick up the phone and make that appointment today. There can be some very serious consequences if you do, especially for some conditions such and PCOS.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicines

-The PCOS Experts

References
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  2. Meyer C et al. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. J Clin Endocrinol Metab. 2005 Oct;90(10):5711-6
  3. McCartney CR, Marshall JC. Polycystic Ovary Syndrome. N Engl J Med 2016;375:54-64
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fertility 1

Fertility- Before you go any further, you are forgetting one thing…….. The Male

In this video blog I explains how I often get emails from patients and practitioners, needing assistance with fertility issues. The only thing is, it is often only from the female perspective and I have to then explain this to people, or these practitioners. So often, as I am hearing their case study, or patients telling their story, I have to politely stop them and explain “Fertility Before you go any further, I can see what the issue is, you are forgetting one thing…… The Male”

Being completely honest, 95% of the time it is the full female history I am hearing and absolutely no mention of the male. The male is always 50% of the fertility picture, unless there is absolute infertility with the female (medically diagnosed infertility)

Fertility issues require proper evaluation of both the male and female, otherwise crucial things get overlooked. It takes a sperm and an egg to make a baby, not just an egg. Besides that it is a legal and ethical requirement to investigate the female and male. You cannot just investigate and treat the female. Have a listen to the latest video (below) of this very important subject.

If you do need assistance with fertility and reproductive issues, please give my staff a call and find out how my fertility program may be able to assist you and your partner.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

 

Fertility and a piece of string

Explaining The Facts of Fertility- “How long is a piece of string?”

When people ask me about what is the cause of most couples issues trying to conceive, I always say ” How long is a piece of string?”

There can be so many factors involved and there is never just one clear answer. Many times people are focussing completely on the wrong thing too.

In this video blog below,  I have an honest discussion about fertility on every level. I discuss diet, lifestyle, preconception care, supplements, natural medicines, western medicines, investigations, genetic issues, stress, IVF procedures, Natural killer cells, unrealistic expectations, self sabotage, weight issues and much much more.

So again, when anyone asks what the cause of fertility issues are, I will always answer “How long is piece of string?”

Because in reality, there are so many factors that couple are unaware of, and need to be aware of too.

Regards

Andrew Orr

-Master of Reproductive Medicine

-No Stone Left Unturned

-The International Fertility Experts

Fertility

Let’s Talk About The Facts Of Fertility & The Fertility Profession

Wouldn’t you love to sit down for 2-3 hours with a fertility expert and cover everything you need to know for your fertility and journey to become a parent?

Wouldn’t you love to have a fertility expert that can not only talk to you about all the medical investigations, medical protocols, genetics and genetic testing, hormones and medications etc, but can also talk you about preconception care, nutrition, diet, lifestyle changes, nutritional supplements, complementary medicines, acupuncture, counselling and other modalities?

Wouldn’t you just love it if someone could listen to your individual needs, listen to your full history, be empathetic to your journey so far, be there to guide you every step of way, and then make sure you are looked after on every level possible?

Well, you can have this, but before I talk about how, let’s talk about the facts about fertility and the fertility profession first.

Let’s talk about the facts

I never hold back from telling people the cold hard facts on any health topic I talk about. It may, or may not upset some people, but the truth is that it needs to be said all the same. People deserve to know the reality about every health condition and their reproductive system. For this post I am going to talk about the cold hard facts of the fertility profession and facts around fertility.

The fact is that many people are lucky to get half hour with a fertility specialist/expert when they decide that need help in having a baby. Some may only get a 15-minute appointment with a fertility specialist/expert and are lucky to get a few questions answered. Then at each of your next 15 minutes appointments, people are trying to cram in as many questions as they can before they are escorted to the door, because the next patient has arrived.

Many medical fertility specialists/experts have no idea about diet, lifestyle advice, preconception care etc, and the one subject that they did learn years ago at college is now a lost and distant memory. Basically it becomes a case of not my area, not my concern.

People then go home and arm themselves with a degree in ‘doctor google’ and then desperately search for answers themselves. They then end up on all manner of sites and support groups with a plethora of misinformation and angst. Have read of my post about Fertility and Dr Google 

This then leads to people searching for a local naturopath, nutritionist, Chinese medicine practitioner etc, trying to cover off on all the complementary medicines, nutrition, dietary advice and nutritional and herbal supplements.

Then this can lead to the case of too many cooks spoiling the broth, too many with differing ideas, or no idea at all, and the turf war on fertility begins.

The medical specialist damns the complementary medicines. The complementary medicine practitioner damns the medical specialist and the couple, or individual, is then caught in the middle. Dazed and confused, the couple/individual has to make a choice of whom they are going to believe and whom they are going to continue to see. But does it have to be this way?

Health professionals should be working together, for the greater good of the patient, not working against each other. Nobody has all the answer and a symbiotic relationship can greatly increase a couples success of having a child.

No wonder many couples/individuals don’t know where to turn to, who to believe and then end up searching for answers themselves. Worst still, while all this confusion and mud slinging continues, the couple/individual still have not get the answers they need, let alone the baby they are desperately wanting.

The fertility profession is largely unregulated

1.The medical side of things

What many are unaware of, especially here in Australia, is that the fertility profession is largely unregulated. Anyone can say they do fertility work and yet not have the qualifications to back it up. Only one state here is regulated, where you have to have what we call a CREI (Certificate of Reproductive Endocrinology and Infertility).

But let’s face it, it is a certificate, not a postgraduate degree and they are very easy to get. But now, many have to have a Masters in Reproductive Medicine as well. But this is only in one state mind you. In all other states, there is nothing stopping anyone doing fertility.

So what this means is that anyone can go and work in a fertility clinic, without the proper extra training to do so. We see obstetricians often do the change to fertility, without having to do extra training, and are basically learning on the job as they go along. The patients then become the guinea pigs and test cases while they are learning on the job. It really should not happen. Sure, they have some reproductive training, back when they studied, but fertility is a very different area to obstetrics and pregnant women.

We also are now even see some GP’s do the sea change to some of these bulk bill IVF clinics and then are consulting with people are their fertility. Many of these couples are then led to believe they are seeing a fertility specialist, when in fact they are just seeing a GP, without any formal training in fertility and reproductive. For many of these, the last time they did any study on fertility, was back in university, and it was probably one subject, if that.

2. The complementary medicine side

But, at the same time, this is not just an issue that is related to the medical side of things. There is just as many complementary medicine practitioners saying that they do fertility, when in fact they have had no formal training, and many often have no idea. They are doing the same thing of learning at they go along, and the patients are the guinea pigs.

Many of these complementary medicine practitioners are lucky to have studied one subject in fertility and reproduction. Many of their lecturers have no formal qualification in fertility and reproduction either. They are then leaving college, or university, and then setting themselves up as experts in fertility.

Many are literally setting up overnight, with no clinical experience, or post graduate certification in fertility, and then trying to say that they do fertility. Daily, I see some of these practitioners not even knowing the basics, yet are out there trying to treat people for fertility issues. I often comment on how some of these practitioners are out there trying to have a crack at it with no idea what so ever. This should not be happening.

There needs to be better regulation

It is a big issue for couples trying to wade their way through the murky waters of the fertility profession. It really should not be allowed to happen. But again, it is all due to lack of regulation and laws preventing it from happening.

As I said, it is on both sides and not just related to one profession. There desperately needs to be more tougher and tighter regulation with the fertility profession, so that couple know that when they are seeing a fertility expert, they actually do have the post graduation training and degree, as well as the clinical experience too. The only good thing here in Australia, is that nobody can advertise that they are a specialist, unless they have a specialisation. If they are caught advertising they are something that they are not, there are harsh penalties around this.

But seriously, this would not happen in any other profession. You would not see a backyard mechanic, or a backyard hairdresser, or someone without the appropriate levels of training?
Yet, why are people not checking who they are seeing for fertility, and just presuming on face value. Your fertility and reproduction is far more important than your car, or your hair. I hope people get what I am trying to say here.

So how do you know whom to see?

This is the million-dollar question and why I always say to patients to be careful. It really is a case of buyer beware.

What you need to do is ask the big questions and do not see someone unless they can answer all the questions and tick all the boxes.

  • Here are some of the things you need to ask:
  • Does you fertility practitioner have a post graduate degree in Reproductive Medicine?
  • Can you please see a copy of their degree?
  • What is their official academic title?
  • What extra study have they done in fertility and reproductive medicine?
  • How long have they been practicing for?
  • Is the practitioner a recent graduate (medical, or complementary medicine)
  • How many fertility patients have they helped?
  • What experience has the practitioner had, and who has mentored them, or trained them?
  • What was their motivation for getting in this area of healthcare?
  • Do they work in with a fertility/IVF clinic?
  • Do they have a symbiotic relationship with a fertility/IVF clinic?
  • Does the practitioner know all the fertility investigations, fertility terms, drugs, hormones, procedures, and all things related to fertility?

These questions are just some of the important questions someone should be asking any practitioner, medical or complementary medicine, before they decide to seek their help to assist them having a baby.

See someone who specialises in fertility and reproductive medicine

I also generally tell people that when seeing someone for fertility, the practitioner should specialise in that area and not have their hands in too many pies so to speak. If seeing a medical specialist, you should try and see someone who just does fertility work on, and who isn’t trying to juggle a busy obstetrics practice at the same time. I see this happen often, where patients are left waiting while a specialist is off delivering babies and the couples are left waiting for hours. Someone like this cannot give you his or her full attention and why I believe you need to see someone whom just does fertility work only.

But again, you just need to do your homework with whomever you see. This goes for complementary medicine practitioners as well. Find out if their primary focus is fertility and not trying to be someone who does a bit of everything. Remember, don’t forget to check that they have post graduate training and experience in reproductive medicine and fertility.

Many couples are having the basics missed

Many couples I see, are often at the point of desperation, and some are also at the point of giving up. I feel sorry for those who get to this point, when in fact it is because some of the basics just have not been investigated.

Being desperate can also lead to bad decisions and also for couples to be exploited by big fertility clinics and the hard sell on offering a solution to their fertility. The fact is that nobody has all the answers, there is no magic pill, and IVF is not a cure for infertility, and we need to start being real about this.

There is often the case of expectation versus reality and many are exploited because they are desperate. We need to be very real that while IVF etc, can help couples have a baby, it really is not a cure for infertility, and it cannot help everyone.

But at the same time many couples issue really are that they have not have the basics done, or proper evaluations done, purely because the person they are seeing is a properly trained in fertility and reproductive medicine. That is a fact.

Males are not exempt from fertility issues

I’ve talked about this often and it is one of my biggest annoyances with the whole fertility profession and men who do not need to be part of the fertility journey. Have a look at my previous posts on this (click here) 

The fact is that many men are not evaluated properly and are not having the basics done with regards to fertility testing. Women are being focussed on and the male is often almost excluded from the process. Let’s face it, some men are literally in denial and excluding themselves as well. I honestly do not know why some women chose to be with men who refuse to be part of the process. Their actions speak volumes.

The long and short of it is that men are often the biggest part of the reason why a couple is not conceiving. Up to 50% -60% of fertility issues are related to men and up to 85% of miscarriage and fertilisation issues are related to chromosomal and DNA factors related to men. Yet many men are under-investigated, or not investigated at all. I see it so often where couples have literally been trying for years and years, and then we find out it is the man who is the issue. Yet all along both the fertility practitioner, and the woman’s partner alike have blamed the woman as being the primary issue. I see this so often and it actual disgusts me. Why should women be blamed for all fertility issues, when men are an equal, and often greater part?

Proper fertility evaluation and testing

I’ve spoken about this in previous posts and it is so important that couples are evaluated properly. Personally I believe that everything that should be done is done up front and at the beginning. So many couples end up finding issues years later, which should have been found in the beginning.

Proper testing should involve at least the following:

  • Full blood testing and screening
  • Hormone assay
  • Scans and imaging
  • Surgical intervention (Laparoscopy, hysteroscopy and dye studies)
  • STI screening
  • Semen analysis
  • Sperm chromatin Assay (SCAT)
  • Full genetic screening
  • Advanced genetic carrier screening
  • Others

I make sure that all my patients have been screened and investigated properly on all levels, for both the man and the woman, not just the man.

You can also see my previous post about the importance of proper genetic screening as well (click here) 

We do have same sex couples and single women seeking help now, and it is still equally important that all concerned are screened properly. Sometimes one of the partners in a same sex relationship may have an issue which prevents them from conceiving, so you have to screen the other partner just in case. It is all about screening and proper evaluations and investigations.

Expectation versus reality

While we have talked about the fertility profession, we also need couples to be real about their chances too. As mentioned before, couples do need to be aware that IVF is not a cure for infertility and that is cannot help everyone. It can help many couples that would never have been able to conceive naturally too.

Age 

We also need for couples to be real about age related fertility, as that is the biggest issue as far as fertility and conception is concerned. The older you are, the harder it is going to be to fall pregnant. No matter is you are doing IVF, or not, age is a big factor in couples being unsuccessful. The older you are, the poorer quality your eggs and sperm are, and the more random chromosomal/DNA errors you get in embryos.

Preconception care

There are other issues with diet and lifestyle that need to be addressed too. Couples that are overweight are going to struggle more with being able to conceive. This is why proper pre-conception care is so important and why I have talked about it often before. We need for couples to look at their diet, their lifestyle, their alcohol intake, their stress levels etc. All these things in combination can affect ones fertility and chances of having a baby. Have a look at my post about the importance of preconception care 

Not everyone will be able to have a baby

There are also those couples, that despite the best medical interventions and help, that they may not be able to fall pregnant. This is really sad, but it is a harsh reality that some will have to face. You can read my post about why IVF cycles fail

But now they are more ways to have a baby then ever, with donor eggs, donor sperm, donor embryos and even surrogates.

Final word

There is a lot to know about fertility and many couples are unaware of the lack of regulation around the fertility profession. Many are literally at breaking point and for many of these it is really through lack of proper investigations, or seeing someone who is not properly qualified to be doing fertility work.

We also need couples to take responsibility for their own health and lifestyle and also be real about age related infertility too. It is all really overwhelming for couples, but the fact is that we still need to talk about it.

Lastly, you need to do your homework, when going to see someone for help with fertility. As mentioned previously the fertility profession is largely unregulated and there are a lot of practitioners out there, medical and complementary medicine, who really are dabbling, or who are not adequately qualified to be assisting you.

How I can help?

If you do need assistance with fertility issues, and do want to see someone with a masters of reproductive medicine and years of clinical experience, please give my staff a call and find out how my fertility program may be able to assist you. You can also look at some of my posts about my fertility program on my website too.  You can do our full fertility program or you can now do our new 3 phase fertility program too. There are also meet and greet appointments before joining the fertility program. Again for more information, speak to my friendly staff, or drop us an email.

I hope this helps those trying to have a baby better understand the fertility profession on all levels and seek the best help possible.

Regards

Andrew Orr

-Master of Reproductive Medicine

-Fertility Expert

-The International Fertility Experts

-No Stone Left Unturned

 

 

 

 

 

genetics and fertility

Understanding How Genetics Play a Major Part in Fertility & Reproduction

Understanding how genetics plays a major part in fertility and reproduction is very important. Many couples are completely unaware that their fertility issues and inability to conceive may in fact be from genetic, or hereditary issues that have not been screened for.

When it comes to fertility and being able to conceive more and more couples are now struggling. Some of this is due to increased stress levels, poor diet and lifestyle, increase alcohol consumption, lack of preconception care and many other factors. However, one key area that is not often talked about, or even known to many is genetic factors, chromosomal factors and DNA issues passed on through our sperm and eggs.

Fertility and reproduction is one of the hardest areas of medicine to understand. I am sure many people think that they understand it, but even with years of study and clinical experience, some questions just cannot be answered at this present time. No amount of “Dr Google” searching is going to bring answers for many couples and this is something that needs to be discussed more. Unless you have done years of study and clinical research into fertility and reproduction, you cannot understand the finer details and intricacies of conception. Even then, some answers are just not available to anyone at this present time.

The Reality of Fertility and Reproduction

The reality of fertility and reproduction is that just because an egg and sperm are put together, it does not mean that an embryo will be formed. Even if an embryo is formed, it does not mean that it will become a baby. Even if an embryo meets scientific grading categories (grade 1-4 etc), it still does not mean that the inner make up of that embryo is chromosomally viable. Even if the embryo is tested to be chromosomally viable (via PGD/PGS testing), it still does not mean that the embryo will go on to become a baby. This is the hardest thing for people to get their heads around and why we need to discuss this more. Quite simply, something that is supposed to seem easy really isn’t that easy at all. Reproduction and having babies is not as easy as many have led us to believe.

Chromosomal Errors

One of the biggest factors in embryos not developing, or IVF cycles failing, or even natural conception not working is chromosomal errors at the embryo stage. Even if both parents have normal karyoptype (46XX and 46XY) it does not mean that they cannot produce random chromosomal and genetic errors in their sperm and eggs. The thing is, the older we get, the more these errors occur and the harder it is to fall pregnant. An abnormal embryo with and abnormal number is cells is called aneuploidy. When an embryo has the correct number of cells it is called euploidy. Unfortunately, many couples are producing high numbers of aneuploidy embryos and this is why they are struggling to conceive. As mentioned before, just because the outer features of the embryo look fine, it does not mean the inner workings (chromosomes and DNA) are fine.

The Important of Genetic Screening

Speaking about chromosomal and genetics, when couples are struggling with fertility and being able to conceive, one of the biggest factors I see is that couples are not being screened properly. This is screening on all aspects, not just the standard blood tests and fertility investigations. Many couples that come to see me for help for fertility often believe that they have had everything done, yet most times I am finding that they have only had the basics done. Many couples have not even had basic genetic screening for karyoptype and genetic issues such as cystic fibrosis.

Understanding the Coding on DNA

Understanding the coding on the DNA is now having a profound practical impact on the practice of medicine today. This is particularly important in the area of infertility. There is increasing knowledge that there is frequently a major genetic component both from nuclear and mitochondrial DNA in couples with infertility or subfertility.

Significant examples include:

  • The demonstration of microdeletions on the Y chromosome in men with low sperm count (oligozoospermia)
  • The identifications of mutations in the Cystic Fibriosis gene in those with congenital bilateral absence of the vas deferens
  • The high rate of aneuploidy in normally dividing embryos after fertilisation in older infertile couples
  • The presence of an expanded triplet repeat in the androgen receptor in some men with low sperm counts.

Without seeing someone who has all this  knowledge of the molecular and genetic basis  of fertility many couples will continually have troubles trying to fall pregnant and may possible end up with repeated failed cycles in IVF too. There is so much to genetics and it is often overlooked in all areas of fertility these days. No amount of “Dr Google” is going to give you this information, nor will it give you understanding, unless you have a degree in reproductive medicine, or genetics. I do understand that people get desperate for answers, but unfortunately, sometimes these answers cannot be found by an internet search.

Other Genetic Factors Affecting Fertility

There are also other genetic conditions and chromosomal errors such as balanced translocations, reciprocal translocations, Robertsonian translocations, Turner’s syndrome, Kleinfelter’s syndrome, fragile X syndrome and many more. Again, many who are struggling with fertility issues and struggling to have a baby may not have even had some of these genetic screening done.

When I see couples, I also recommend advanced genetic carrier screening which tests for several hundred more genetically inherited mutations. Many fertility clinics do not recommend couples to do advanced carrier screening. Given that 1 in 22 couples are at risk of a hereditary gene mutation, it is really important to screen couples properly and not just do the basics.

Mutations in Genes

A mutation is a change in the information encoded in the DNA sequence. Such a change may result in the production of an abnormal protein, produce a truncated protein, reduce the levels of that protein, or cause it not to be made at all.

A single gene genetic disorder is one where an alteration in the DNA sequence of only one of the genomes 40,000 genes has resulted in significant pathology and disorders that affect the human body.

Such disorders include cystic fibrosis, Duchenne muscular dystrophy, Huntington disease and familial breast cancer. Although individually these disorders are rare, as a group, they are numerous and therefore important.

Cystic fibrosis, one of the most common autosomal recessive conditions affecting people of Northern European decent has a population incidence of 1 in 2,500.

To date up to 6,000 single gene disorders have been characterized and it is estimated that 14 per 1,000 people suffer from one of these conditions. A person who inherits a mutation in a single gene will carry that mutation in every cell of their body.

Mutations occur when a cell is dividing. The task of correctly copying 6 billion “bits” of information, the number of base pairs in the human genome, is huge and mistakes do occur. It has been established experimentally that these mistakes occur and are uncorrected in one in one billion base-pairs copied (or about 6 errors per cell division).

When a mutation occurs in the coding DNA sequence of a gene it may be a polymorphism with no effect or it may significantly impair the gene function. All mutations are thereafter inherited. Inherited or germ line mutations must be present in the egg or sperm. They are twice as common in sperm as eggs.

 Male Sperm Quality is a Big Part of Fertility Issues

Before everyone jumps to the conclusion that all failed cycles are related to women’s egg quality, I need to make it absolutely clear that men are half of the fertility equation. They are not exempt when conception does not take place, or an IVF cycle fails. As mentioned above many genetic mutations are twice more likely to be present in sperm than eggs. Up to 85% of miscarriage and chromosomally defective embryos are related to chromosomal errors that men have passed through their sperm.

Women’s eggs do have more errors as they get older, and eggs are not as viable as they get older, but men’s sperm are exactly the same. If men are not having their sperm quality managed while trying to fall pregnant, there is half your problem then and there. This is why all men are treated and managed on all levels of their health when doing my fertility program.

Sperm quality is variable and each time a man ejaculates the quality of that sperm can vary by as much as 20% at a given time. This is why men need to be continually looking after their health and sperm health while trying to conceive. Men are actually the bigger part of conception not taking place and we need to talk about this more. Men are not exempt when it comes to making babies.

Creating Life

Life does not begin with conception, but is simply a continuum from living cell to living cell with genetic information being transmitted through the genome from one generation to the next. A failure to achieve this is recognised as infertility.

At conception we are a single fertilized cell resulting from the fertilization of the egg by the sperm. The sperm contributes one copy of nuclear DNA, the egg the other copy and the mitochondrial DNA. That cell proceeds to divide, and over the course of 9 months (32 cell divisions) billions of cells are created, with specialized functions, forming complex tissues and organs that constitute the working human body. That first cell therefore must contain all the information necessary for embryological development, growth from fetus and then growth through to adult life. Without all the right coding and necessary information, life does not get created. This is also the answer to why so many couples are having problems trying to conceive.

The Importance of Seeing a Reproductive Medicine Expert

There are many factors to fertility and reproduction and why it is important that couples see someone who is a fertility expert. The fertility profession is largely unregulated and many who are now practicing in that profession are not experts at all. Many actually do not have further training and qualifications in reproductive medicine and are some of the reason why people are struggling to fall pregnant.

Final Word

Lastly, while we cannot change our chromosomes, or change genetic mutations, we can do things to change and improve our cellular DNA. This is why proper preconception care and preconception programs are so important. Everything we do, we ingest, we think etc, can be passed on to our future offspring via sperm and eggs. Health parents produce healthy sperm and eggs, thus producing healthy babies.

If you need help with being able to conceive, give my friendly staff a call and find out how my fertility program may be able to assist you. I use a ‘No Stone Left Unturned’ approach to assisting couples with fertility issues and will look at every aspect of a couples lives, including genetic and hereditary issues, to help them have the best chance of having a baby.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

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Being Overweight, or Underweight, Can Adversely Affect Fertility

As mentioned in previous posts about fertility and weight, it is important to have healthy weight and waist size when trying to conceive. It is important to address dietary and lifestyle issues in order to be in health weight and waist range before trying to conceive.

Healthy Waist Size

Healthy waist range for a woman is 80cm (from the belly button around)

Healthy waist range for a man is 94cm (from the belly button around)

If a woman’s waist size is about 88cm and a man’s waist size if above 102cm then they are in what we call “metabolic syndrome”

This increases their chances of diabetes, heart disease, depression, gynaecological conditions (PCOS, endometriosis etc), sperm issues, egg quality issues, reproductive issues, increased miscarriage, increased risk of certain cancers and of course…. infertility.

Body fat and how it affects fertility

Excess body fat (now known as obestrogens) can disrupt hormones and fertility and can have a negative effect on egg and sperm quality.

Similarly being underweight and low body fat can affect fertility outcomes too. Body fat has a regulatory role in reproduction and a moderate loss of fat, from 10% to 15% below normal weight for height, may delay the menstrual cycle, completely stop the menses altogether and inhibit ovulation. Both dieting and excessive exercise can reduce body fat below the minimum amount and lead to infertility. But this is reversible with weight gain, increased body fat and reduction of intensive exercise, or both.

A moderate reduction in body fat, not just weight, for those overweight, can increase fertility and chances of pregnancy exponentially. Similarly an increase in body fat for those that are underweight, and who don’t have enough body fat, can increase their fertility and chances of pregnancy as well.

This goes for men too. Increased body fat, or not enough body fat can affect hormone production and fertility and can affect sperm quality and sperm production.

This is why preconception care and healthy screening and weight and waist management is so important before trying to conceive. This should also be a part of any fertility program and is definitely part of my fertility program for all couples.

Are you in healthy waist range?

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicine

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr 1

IVF cover image

Let’s Talk About Why IVF Cycles Fail

Let’s talk about why IVF cycles fail because it is a very common question that is asked when a cycle fails. Often there will be no conclusive answer and often when I am asked this, I have to say the old saying “How long is piece of string?”

The reason I say this is that there are so many factors involved with a cycle failing. It could be from following

  • poor egg quality
  • poor sperm quality
  • age of the couple
  • genetic factors (diagnosed, or undiagnosed)
  • hereditary issues
  • DNA and chromosomal issues
  • a non-receptive endometrium
  • dietary and lifestyle factors
  • weight factors (excess or too little weight)
  • emotional factors, or mood disorders
  • stress
  • incorrect hormone therapy
  • medications
  • human error
  • lab errors
  • many other factors in the IVF process.

I wish it was as easy as putting a sperm and an egg together and it just happening. I know many couples do look at it this way, but there is so much more to the whole process of conception. I know it is often hard to understand, but no google search is going to tell you all of this and you would need years of study to completely understand the whole process. Plus IVF is still only a young form of medicine and it still evolving.

This is why IVFsuccess rates are still relatively low. We just do not have the technology yet to tell us which embryo will go on to become a baby. If we had that, then there would be a much higher, if not near 100% success rate. The reality is that type of technology may never be available, or would be many many years off. We can only hope.

The other thing I explain to couple is that sometimes it is literally the IVF process hindering a couples chances of success, by not having the right protocol, or right team helping them.  I could go on and on because there are so many factors that could affect a cycle and someones chances of conceiving. This is why I use the term “How long is a piece of string?”

This is why I do what I do and explain all of this and more to all my patients as part of my fertility program. I am literally there to hold their hands every step of the way and explain everything in detail each step of the way as well. I will always make sure everything is done properly and even go into bat for them and step on toes if I have too. My patient’s come first always.

What is required for a successful pregnancy?

At least three things are required for a successful pregnancy during in an vitro fertilization (IVF) cycle:

  • a healthy embryo
  • a receptive endometrium
  • careful transfer at the proper time in the cycle

There are things other things such as the right diet and right nutrients and right emotional state for the couples and proper preconception care, but for now I am just talking about a successful embryo transfer on a medical level. Firstly I will discuss the IVF process.

IVF has improved significantly in its almost 40-year history. Different types of hormone and fertility drugs have been developed that are easier to administer and are associated with an improved safety profile. In addition, numerous stimulation protocols are available that allow us to individually tailor treatments. For example, ultrasound-guided embryo transfer using soft catheters and embryo glue (enzyme to assist implantation) has also helped with ensuring better placement of the embryo, without trauma to the endometrium, but very few clinics are actually doing this. Tests can also be used to evaluate the receptivity of the endometrium in order to determine the best time to schedule the transfer.

Despite all these improvements, however, implantation and pregnancy rates with IVF only slowly increase year after year.

Achieving Implantation-The hardest step

The rate-limiting step of IVF is implantation. It requires the proper interaction of a healthy embryo and a receptive endometrium. It often fails due to problems with the embryos. The genetic health of the embryo depends on both its inherited genetic material and on the errors and repairs during the cell divisions.

A chromosomally abnormal (anuploidy) embryo is unlikely to implant, and when it does it is likely to be lost early on. Many embryos that are transferred have chromosomal abnormalities, even if they look fine on the outside, or are classified as being the best grade prior to transfer. We need people to understand that just because and embryo has reached Blastocyst, or Morella stage and it looks like a good quality embryo from the outside, it does not mean that the inside and the chromosomes inside the embryo are OK. Not every fertilised egg will result in a genetically sound embryo that will go on to become a baby.

DNA & Chromosomal When Sperm and Egg Combine

We also need people to realise that an embryo is made up the genetic material of two people and that requires the sperm to be healthy both outwardly, but also chromosomally, and this can change with each batch of sperm ejaculated. Sperm quality and the viability of sperm changes and just because something was “OK” last cycle, or two years ago, or last month, or last week, does not mean that it is OK now.

Unfortunately people need to face the reality of what happens with the body and reproduction. The health of the sperm is also reflected in the health and lifestyle and age of the male too. Unhealthy males produce unhealthy sperm and higher levels or sperm with chromosomal abnormalities and damage to the DNA. Unless you are testing every batch of sperm for DNA and chromosomal abnormalities, you aren’t going to see this and even then, testing can only see so much.

A healthy embryo (Euploidy embryo) also requires a female to be healthy and her eggs to be health chromosomally and on a DNA level. It also requires a healthy male for his sperm quality to be healthy on a DNA levels as well. Egg and sperm quality is also related to age, diet, lifestyle, environment, and exposure to environmental disruptors, weight, body fat, stress and so many other factors.

We need people to be aware of this. Then when you put two unhealthy people’s genetic and reproductive material together, there is a high likelihood that it will produce higher numbers of abnormal embryos, and sometimes it can be all of them. It all depends on the health of the sperm and health of the eggs at time of fertilisation. Even then we can still have random errors in chromosomes and DNA and this then produces faulty embryos. Again this is a hard process to explain and again Dr Google isn’t going to tell you this.

Pre-implantation Genetic Diagnosis/Screening (PGD/PGS)

Various methods of genetic testing of embryos have been evaluated in past decades. During the early days of PGD/PGD many embryos were lost in this form of screening. Today it is more routine and more perfected.  One can test the chromosome content of the polar bodies, but a cleavage-stage embryo (day 3 of development) or a blastocyst-stage embryo can be evaluated as well. In addition, various techniques  are available for assessing the chromosomes.  There are also new testing and new technologies that have addressed the shortcomings of these earlier tests.

The authors of a recent systematic review concluded that comprehensive genetic screening of embryos using day 5 blastocyst biopsy is associated with increased implantation and pregnancy rates. In addition, this technology appears to be a good tool to limit the number of embryos transferred. But embryos can still be tested early on in their development, with good results, too.

Most experts recommend genetic testing of embryos in women with advanced reproductive age, recurrent implantation failure, recurrent pregnancy loss, or severe male factor infertility/DNA issues. This then gives a greater probability of transferring a chromosomally normal embryo and having a higher chance of implantation and pregnancy occurring. But even a chromosomally normal embryos doesn’t ensure a pregnancy. This is often the hardest thing for people to get their heads around. To be honest, much of this comes down to luck and is really in the hands of the gods. Again this is often not told to people and no google search is going to tell you this either.

Preconception care increases chances of conceiving

But what you can do to ensure healthy egg quality, healthy sperm quality, healthy embryo quality, healthy uterine lining, decreases stress levels, optimal health at time of transfer etc, is doing proper preconception care as part of proper fertility program.  There is now growing evidence that the health of both parents before and at the time of conception influences the chances of conceiving and the short and long term health of the future offspring. (9,10,11,12,13,14,15)

This is why I offer couples a program to go over everything they need to know and everything the need to do prior to trying to conceive or trying to embark on the next IVF cycle. It is about getting the couple as healthy as possible and their bodies as ready as possible to give them the best chances of success. I always explain to people that preparing for an IVF cycle is like preparing for a marathon. If you do the work and get the body ready, it gives you a better chance of making it to the finish line.

If you are having trouble falling pregnant, or are having failed IVF cycle, then give my clinic a call and find out more about how my fertility program may be able to assist you achieving success of having a baby. So far my program has helped over 12,500 plus babies into the world and counting. It doesn’t matter if you are starting the journey, or well on your way into the journey or trying to have a baby. You can also do a meet and greet appointment to find out more about the fertility program before you commit to the whole program.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicine

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr 1

References

  1. Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril. 2010;94:785-790. Abstract
  2. Society for Assisted Reproductive Technology. Clinic Summary Report. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0Accessed April 27, 2015.
  3. Staessen C, Platteau P, Van Assche E, et al. Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial. Hum Reprod. 2004;19:2849-2858. Abstract
  4. Mastenbroek S, Twisk M, van Echten-Arends J, et al. In vitro fertilization with preimplantation genetic screening. N Engl J Med. 2007;357:9-17. Abstract
  5. Yang Z, Liu J, Collins GS, et al. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012;5:24.
  6. Scott RT Jr, Upham KM, Forman EJ, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100:697-703. Abstract
  7. Forman EJ, Tao X, Ferry KM, et al. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27:1217-1222. Abstract
  8. Scott RT Jr, Upham KM, Forman EJ, et al. Cleavage-stage biopsy significantly impairs human embryonic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial. Fertil Steril. 2013;100:624-630. Abstract
  9. Buck Louis, G. M., et al. (2016). Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study. Fertility and Sterility, 106(1), 180-188. doi: 10.1016/j.fertnstert.2016.03.009
  10. Chiu, Y.-H., Chavarro, J. E., & Souter, I. (2018). Diet and female fertility: doctor, what should I eat? Fertility and Sterility, 110(4), 560-569. https://doi.org/10.1016/j.fertnstert.2018.05.027
  11. Day, J., et al. (2016). Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype. American Journal of Stem Cells, 5(1), 11-18
  12. Homan, G. F., Davies, M. J., & Norman, R. J. (2007). The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Human Reproduction Update, 13(3), 209-223.
  13. Nassan, F. L., et al. (2018). Diet and men’s fertility: does diet affect sperm quality? Fertility and Sterility, 110(4), 570-577. https://doi.org/10.1016/j.fertnstert.2018.05.025
  14. Salas-Huetos, A., et al. (2017). Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Human Reproduction Update, 23(4), 371-389. doi: 10.1093/humupd/dmx006
  15. Sharma, R., et al. (2013). Lifestyle factors and reproductive health: taking control of your fertility. [Review]. Reprod Biol Endocrinol, 11(66), 1477-7827.
Dr Andrew Orr Header Slider 03

Let’s Talk About Fertility

Dr Andrew Orr has an honest and open chat about his years of experience dealing with couples with fertility issues.

Much of it gets back to couples not having the proper testing and investigations, being on the same page, preconception planning, getting healthy, doing the work and the expectations versus reality.

Have a listen to Andrew’s open and honest discussion about a very serious topic.

If you do need help and are struggling with fertility and not having a baby, Andrew can assist you in your journey to becoming parents.

To find out how Dr Andrew Orr’s fertility program, please call his friendly staff to find out more.

The Journey of Trying To Have a Baby is Sometimes Like a Marathon 1

The Journey To Have a Baby Can Be Like a Marathon For Many Couples.

The Journey to have a baby can be like a marathon for many couples. It can be physically, emotionally and financially draining on every level.
 
One of the things I teach my patients, struggling with fertility issues, is that the journey often is like trying to run marathon. I also explain that they also need to prepare for the journey, just like preparing for a marathon too. 
 
I teach them that ‘couples’ (meaning two people) not just the woman unless she is doing it alone, need to get into the best shape possible prior to running the marathon, not just think about it half way through, when they are tiring and the finish line is nowhere in sight.
 
Healthy couples create healthy sperm and healthy eggs, which then go onto to being health embryos and then later health babies.
 
When preparing for a marathon you need to get the body into the best shape possible. That means physically and mentally too. Never overlook the mental aspect and this is why counselling and mindfulness is so important for couples struggling to have a baby. Many times this is the most important, but often overlooked aspect to a couple having success. 
 
Then couples need to get their diet in check, their lifestyle in check, get the body investigated and assessed properly and get the body fully ready to be able to make that finish line.
 
Nobody should ever just decide to run a marathon without proper training, good nutrition, mental preparation and getting the body in shape.
Unfortunately many couples try to run the marathon without the proper preparation and preconception care and then try to patch things as they struggle along the journey. This is when I see many of them. They are struggling on every level and exhausted and ready to give up.
One of the things I mention often is that  I wished that I saw every couple before they even started their journey. This way they are less likely to end up at this point of exhaustion and despair and clutching at straws to make it all work.
I see so many out at sea in a leaky boat trying to patch the holes as they go along, when really they should have got the boat sea ready before they head out. Trying to patch things half way through the journey never works. It  just causes desperation and wasted time and money as well. It can also lead to much worse and many couples actually end up breaking up due to the stress of it all.
 
This is why my fertility program is about preparing the couple on every level. Making sure everything is evaluated and properly investigated on a medical front first and then preparing their bodies on a holistic, and physical and emotional level too. It is also teaching the couples the power of intimacy and connection again too. Literally, I make sure “No Stone is Left Unturned” and then I know couples are ready for the journey ahead. For many it is often a short journey afterwards and this is what I hope for everyone trying to have a baby.
 
I always say that the couples that put in the work, get their bodies ready, prepare physically and emotionally, get the right nutrition, change their lifestyles, take all the supplements and nutrients, talk to a counsellor, do mindfulness, get some acupuncture, do some exercise, connect as a couple, have date nights, make love often, and do all the requested investigations and testing etc, they are the one that get that baby they so desperately deserve.
 
I have a special interest in Reproductive and Fertility issues. I have assisted in helping over 12,500 babies into the world and I know what couples need to do to increase their chances of having a baby. I want all couples to experience the joy of being a parent.
If you are having trouble have a baby, or not getting the help you so desperately deserve and need, then give my friendly staff a call and find out how my fertility program may assist you in having a baby. 
Regards
Andrew Orr
-No Stone Left Unturned
-The International Fertility Experts
PCOS Awareness The Facts About PCOS

The Facts About PCOS

These are some of the main Facts about PCOS

Copy of PCOS Awareness Irregular Menses or Absent cycles           PCOS Awareness Obesity and weight gain can be symptoms of PCOS

Copy of PCOS Awareness Hirsutism and PCOS           PCOS Awareness Acne and PCOS

PCOS Awareness Contraceptive Pills do not cure PCOS           PCOS Awareness Depression and anxiety can be a symptom of PCOS 1

PCOS Awareness PCOS does not always cause infertility           PCOS Awareness

Copy of PCOS Awareness You dont have to be overweight to have PCOS           PCOS Awareness Menopause does not cure PCOS

Regards

Andrew Orr

-No Stone Left Unturned

-Women and Men’s Health Advocate

-The PCOS Experts