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genetics and fertility

Understanding How Genetics Play a Major Part in Fertility & Reproduction

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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

Fertility and Google

Fertility- “When your google search is just not going to cut it”

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I always have a little bit of a chuckle to myself when people call my clinic and try to tell my staff that they know everything there is to know about fertility and that they don’t need to have any other investigations etc, because they have had them all done.

Then when I check, not only have they not had them all done, but the person actually only knows the bare basics about fertility. It is perception versus reality and a degree is doctor google, does not make one an expert.  I often have to say to these people that if they really did know everything, then why aren’t they falling pregnant, the truth is generally a reason why.

The truth is, there is generally a reason why, and it is because they don’t know and they actually need help from someone who does not, and someone who is an expert in reproduction.

There is no easy way when it comes to fertility

I wish it was that easy, because that way I would not have had to study to obtain a Master Degree in Reproductive Medicine, done countless hours of clinical research, and  done hands on experience over the last 20 or more years to know what I know now.

The truth is, unless you are a fertility specialist, have extra post graduate training in fertility, and actually work in the field of fertility and reproduction, you just cannot know all there is to know about fertility. It would be like me doing a google search on astrophysics, or any other field I am not qualified in, and then saying that I am now an expert because I have done a few google searches.  We really need to put all of this into perspective and be real about this. I am all for people being educated, but really, you cannot be an expert without years of study, training, ongoing research and hands on experience.

Doctor Google does not have all the answers

I also know that not everyone in the fertility profession is well qualified either and this is due to the lack of regulation in this profession. But, even so, you cannot just do a google search, or do a few IVF cycles, or get advice from some support page, and then call yourself and expert.  Just remember that a lot of the information on Dr Google is actually wrong, or only partially true and that support groups often contain members of the general public, who have no medical experience what so ever. Yet these days, many are taking the medical advice given on these pages and that is absolutely dangerous. I don’t mean for this to sound harsh, because support groups are a great thing, but we need to be real about who and where we get our medical advice from, especially when it comes to fertility.

Fertility is complex with multiple variants

Fertility is not just about putting and egg and a sperm together and it just works. Let’s be real about this. Making a baby is not as easy as our parents and teachers used to tell us. There is a science behind it and it requires the right timing the right conditions and also optimum health of the parents physically, mentally and also genetically.

Age is one of the biggest factors with fertility

Age is also a huge factor. The older we are, the more issues we have with sperm and eggs and the more random genetic and chromosomal errors we get with embryos.

Genetics is very important when it comes to fertility

Genetics is also something many do not understand and something that many overlook. At present I test couples for 180 different genetic mutations , genetic variants and genetic issues that could be affecting a couples chances of pregnancy.

Not to mention Karyotyping to see if the couple is in fact male and female, or don’t have translocation issues on their X & Y chromosome, or other genetic issues such Turners syndrome, Kleinfelters syndrome etc. Then there is cystic fibrosis screening and many other genetic screenings that most people have never had tested and without proper training would not be able to understand how to interpret them either.

Assisted Reproduction

Then we have IVF and Assisted reproduction, which is not as simple as giving someone some hormones, and putting a sperm and an egg together. I wish it was that simple. There are many variants with the whole IVF process that the general public just do not understand and if you don’t know what these are, things can go wrong very quickly. Let’s face it, if you don’t get hormones and everything right, women have died on IVF cycles, or become very critically ill in the process.

The science of embryology takes years of study

We also have scientists who have done years of study to understand embryology and the very intricate details of what it takes to create an embryo. Even when an embryo is created, it does not mean it will go on to become a baby and there are many reasons behind this. This sort of stuff the general public just do not understand and cannot understand with a mere google search.

When an embryo is created, it is then a mixture on egg, sperm and all the chromosomal and genetic variants from the male and female. Many things can go wrong. There can be random errors, there can be arresting of the embryo growth process and then there are also nutrients and so many other factors that are needed for an embryo to just making it to day 5 ( which is called a blastocyst). That is if it actually makes it that far, which many don’t. Regardless of the classification system and grading system for embryos, it does not mean that the embryo is chromosomally viable, nor does it mean it will go on to become a baby.

Sometimes science cannot explain everything

Some technology surrounding embryo quality and viability we just do not have yet.  So in essence, one an embryo is formed; it compacts and grows, and then makes it to transfer. What happens after this really is up to chance. Sure, there is a science behind it all, and that science is very intricate and precise, but there is also an element that is “left up to the gods”, so to speak

The same actually goes for natural conception too. It is exactly the same processes really, except it is all done in the body. The only difference is that we do not know if the sperm and egg are actually meeting and forming an embryo month after month. It is a waiting game to see what happens just the same as it is for those doing IVF who also have to wait to see if a transfer is successful.

You need a real degree, not a google degree to understand reproduction fully

There is so much to fertility and conception that many will never be able to comprehend, unless they undertake the study to do so. Even then you need to be doing the actual hands on work on this profession too. There is a huge difference between what one reads in a text book, to what actually happens in practice. It is a marriage of theory, study, research and practical experience that is needed to actually call one an expert in reproduction and fertility.

Education is important, but be careful who your source is

When I say all this, this is not to discourage people from being educated, asking questions and finding out as much as they can on their journey to become parents. Education is important and this is why I do my fertility program, so that couples are educated on everything they need to know about fertility and what is needed to have a baby.

My fertility program covers what no google search every will

In my fertility program and education for couples,  I go through everything from medical procedures, genetics, pathology, chromosomes, egg quality, sperm quality, male and female health, gynaecological issues, male fertility issues, surgical interventions, counselling, supplements, dietary and lifestyle changes, diet plans, IVF and assisted reproduction, hormones, medications, complementary medicines, scientific procedures (andrology, embryology, ICSI etc) and so much more that can only be given to couples by multiple degrees, post graduate degrees in Reproductive medicine, and over 20 years’ experience in helping couples have babies.

The importance of seeing a reproductive medicine expert

As I have tried to explain, there really many things that are needed to ensure optimum fertility and better chances of a successful pregnancy outcome. I wish it was as easy as doing a google search and that all answers could be provided. There are lots of underlying reasons that couples are not falling pregnant and this is why it is important to see someone who knows what they are talking about and who is an expert in reproductive medicine. They also need to be appropriately qualified and certified, because the fertility profession is largely unregulated. Like any profession, there are lots of bad practitioners out there too. This is in both the medical and complementary medicine.

Do you your homework, but don’t rely on google

Do your homework on whom you are thinking about going to see, but please remember that your google search does not make you an expert. Google does not have all the answers when it come to the very complex and intricate details of the world of fertility and reproduction. Please see someone who is trained properly, who has years of experience, who is caring, who does listen, and who can guide you through every step of the process in your journey to having a baby.

Final word about fertility and reproduction

Last but not least, when it comes to treating a couple for fertility, both the male and female need to be investigated and managed as part of legal and ethical requirement for fertility services. We cannot just see the female as males are 50% of the fertility equation. If a male is not on board, then females need to be asking some big questions of their partner, not the fertility clinics they are trying to go to. Biology 101 tells us that it takes a sperm and egg to make a baby, and not just an egg and this is something that I talk about often.

If you do need help and assistance with having a baby, and need to find out all the proper information and answers regarding reproduction, please give my friendly staff a call and enquire how I may be able to assist you in your journey to becoming parents as part of my fertility program.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

Fertility Facts Ovulation does not occur mid cycle for every woman.

Ovulation Does Not Occur Mid-Cycle For Every Woman

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Ovulation can happen at anytime in a cycle and research has shown that more than 70% of women are ovulating outside the traditional view that ovulation occurs mid-cycle.

Too many couples are focussing on this small window period, when in fact ovulation may be occurring before, or after.

Many are also unaware of when they are actually ovulating and some women may in fact not be ovulating at all. This is why it is important to find out by proper monitoring by a trained professional.

Once an egg is release it has but 24 hours to be fertilised, otherwise it will die.

The egg also needs one vital ingredient during this time…… sperm. This is why men need to be evaluated properly, to see that their swimmers can actually swim and fertilise the egg.

This is why couples need to be trying to have sex as much as possible when trying to conceive. Miss having sex in that 24 hours period and then there is no chance until the next cycle.

If you are trying for a baby and not having any success, then it is time to get some real help and some proper evaluations and management around your fertility.

My Fertility Program has helped over 12,500 (plus) babies into the world and it could be the answer to assisting you having your baby as well.

For more information and to book in for the program, please contact my friendly staff on +61 07 38328369, or email info@drandreworr.com.au, or contact by the online form on the website.

You can also book a meet and greet appointment prior to joining the program (to find out more information) and we do see couples locally, interstate and from overseas.

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Lycopene Helps Improve Sperm Quality

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A new research study conducted by the university of Sheffield has shown that supplementation of Lycopene, a compound found in cooked tomatoes, has helped improve the sperm quality in a group of men.

Many studies have examined the role of dietary factors, antioxidants and amino acids and data from randomized controlled trials suggest that antioxidant therapy can improve sperm quality.

Health benefits of lycopene supplementation have been proposed for a variety of health conditions. This recent study examines whether 14mg of daily lycopene supplementation, for 12 weeks, can help improve sperm motility and sperm morphology in men.

Poor sperm quality

Poor sperm quality is a major contributor to infertility in heterosexual couples, but men are often overlooked and often are unwilling participants in the journey to have a baby. There is no doubt that sperm quality is declining and many couples inability to have a baby is actually coming from the male side of things, not the female side.

It is generally recognized that 50% of fertility issues are related to male sub-fertility and poor quality sperm. Typically, fertility problems in the male manifest themselves as ejaculates containing too few sperm (oligozoospermia), or sperm that swim poorly (asthenozoospermia), or sperm with poor size and shape (teratozoospermia) or a combination of all three.

Factors Affects Sperm Quality

Known factors that affect sperm are – Poor diet, obesity, alcohol, smoking, recreational drugs, steroids, medications, chemicals and environmental factors. There are also genetic and hereditary issues that affect sperm as well.

Women are often driving force behind fertility health

Women are often the ones being very proactive in whatever it takes to have a baby and will take supplements, improve their diet, and look at any way they can to help with conceiving. Unfortunately, getting men to do the same can be like pulling teeth and we need to start educating men of the importance of preconception care prior to having a baby.

Men offered very little advice about sperm health

Unfortunately many fertility clinics and healthcare practitioners in general, are giving very little advice and information around what men can do to improve their sperm. Many healthcare professionals are also only focussing on delivering general advice to highlight the known lifestyle risks for poor sperm quality. More advice around preconception care is needed.

Preconception care for men is a must

There is now lots of research about the importance of preconception care for men and lots of research on the importance of a healthy diet, lifestyle changes and the role of antioxidants and amino acids for sperm health and sperm quality.

This recent study could add to the ways that men can improve their sperm quality and help with the outlook for men with known sperm issues. This recent study could also add to existing research and could also lead to better ways to reduce the damaging impact of modern living on reproductive health. We really do need for all couples to know, that of all infertility cases, at least 50 per cent of the issue is due to male factors and poor quality sperm.

Lycopene increases sperm quality

This is the first ever double-blind randomised controlled trial to assess the impact of giving men a bio-enhanced form of lycopene (called LactoLycopene) to see if it helped with sperm quality. The team from the university of Sheffield discovered that the lycopene supplementation made no significant difference to sperm count and concentrations. However the rapid progressive motile sperm and the sperm with normal morphology increase by around 40% in response to the lactolycopene intervention. Rapid progressive sperm and morphology are the two most important parameters for sperm quality and for increasing chances of fertilisation and pregnancy.

During the 12-week trial half the recipients took LactoLycopene supplements and the other half took identical placebo (dummy pills) every day for 12 weeks. Neither the researchers nor the volunteers knew who was receiving the LactoLycopene treatment and who was receiving the placebo. Sperm and blood samples were collected at the beginning and end of the trial. The researchers were surprised by the improvement in the sperm quality shown by the results. The improvement in morphology and rapid progressive sperm was dramatic after lycopene supplementation.

What are Lycopenes?

Lycopene can be found in some fruits and vegetables, but the main source in the diet is from tomatoes. However, the bioavailability of lycopene from fresh tomatoes is low, but this is enhanced by a special natural processing technique of heating and infusing tomatoes with oil. As such, this study used lactolycopene, the main ingredient of which lycopene is embedded in a special protein mix for enhanced intestinal absorption.

This was the first properly designed and controlled study of the effect of LactoLycopene on semen quality, and it has spurred researchers to want to do more research into lycopene and well as other antioxidants and amino acids that may help with sperm quality. The research also shows the role these antioxidants play in helping inhibit the damaging effects of oxidation and oxidative stress.

Oxidation and Oxidative Stress Damage Sperm

Oxidation and oxidative stress is a known cause of damage to sperm and the sperm DNA. Lycopene is a powerful antioxidant that is potentially inhibiting oxidation and the damage of oxidative stress causes to sperm quality. Researchers believe this antioxidant is the key to improvements in sperm quality seen in this trial and could be an answer to the cause of many male fertility problems. More research is needed and the research team is hoping to embark on a new study as soon as possible.

Final Word

As part of my fertility program all males are educated on the importance of preconception care and about optimum sperm health. All men on my fertility program are given antioxidants and supplements that have been shown to assist with sperm quality and maintain optimum sperm health. Men are 50% of the equation of making a baby and why all men need to be included in any preconception care and any program to assist couples in having a baby.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

 

Journal Reference:

  1. Elizabeth A. Williams, Madeleine Parker, Aisling Robinson, Sophie Pitt, Allan A. Pacey. A randomized placebo-controlled trial to investigate the effect of lactolycopene on semen quality in healthy males. European Journal of Nutrition, 2019; DOI: 1007/s00394-019-02091-5
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Being Overweight, or Underweight, Can Adversely Affect Fertility

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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

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Sperm Quality and How To Took After It

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More often than not, women are often told that is their egg quality, or some gyneacological factor is the cause of not being able to conceive. But, in truth, more often than not, it is actually the sperm quality that is at fault, or in combination. Fertility issues are not just a woman’s cross to bare.

Men are 50% of the fertility equation and up to 85% of miscarriage issues can be related to chromosomal and DNA factors relating to poor quality sperm in men.

To be honest, men often think that they have this inherent right to conceive and often believe there is nothing wrong with their sperm, despite never being tested. Many often avoid being tested and will often make great claims as to why they should not be tested either.

As part of proper fertility assessment, both the man and the woman need to be evaluated, not just the female.
A man will need to have a comprehensive semen analysis done and may also need further testing such as DNA fragmentation analysis, or a sperm chromatin assay. There will also be further genetic testing needed as well.

A semen analysis is really on a basic test that lets us know what the sperm look like and if they have 2 heads, 2 tails and may be swimming in circles. The fact is, that many men’s sperm quality is substandard and their sperm is actually not in a good shape at all. Recent research and statistics have shown that the male sperm quality has fallen by as much as 70% in the last 60-70 years.

There are many things that can affects a male sperm quality such as:
1. Steroids and recreational drugs
2. Alcohol
3. Smoking (including recreational drugs)
4. Chemicals
5. Drugs (pharmaceutical and illegal)
6. Being overweight and too much body fat
7. Age

These are to name just a few. There are also genetic and hereditary issues that need to be checked as part of proper fertility evaluation as well.

More often than not these days, men are the bigger part of the issue when it comes to not being able to have a baby. Men are often also overlooked as part of the issue as well, which is actually not good ethical practice.

Many couples are also quick to tell me, or other healthcare practitioners, that the man’s sperm is fine, or they have been told it is fine, when actual fact it is not. OK, or fine for IVF purposes does not mean that the sperm is fine. It is very rare to see a man that is having troubles conceiving a baby with his partner that has sperm that is fine. That is the truth.

If you have been trying to conceive for a long time (and not being able to conceive) and the male has not been checked properly, or on some kind of lifestyle and preconception care plan, then in might be time you looked into that.

If you do need help with preconception care and getting your eggs and sperm more healthy, then enquire about my fertility program that has helped over 12,500 babies into the world and counting.

In the mean time have a look at this great fact sheet about your sperm and how to look after them at yourfertitity.org.au and put together by Andrology Australia.

Take care

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

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Why Excess Body Fat and Obesity is The Enemy of Fertility

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Excess body fat and obesity is the enemy of fertility and it is something that needs to be talked about. Despite what anyone tells you, being overweight, or being obese significant affect on fertility and it can also affect the future health of offspring. This is a fact and we need to talk about it more and bring more awareness to this subject. This is why I have been focusing on this very important subject a lot more lately.

At present up to 70% (or more) of Australians are either overweight, or obese, so we can no longer ignore what the consequences of these statistics mean. We know that excess weight and excess body fat is linked to serious health consequences, but we need to talk about how it affects fertility and decreases the chances of obtaining a live birth.

Overweight, or obese men and women have higher levels of body fat and higher levels of the hormones leptin. As I have mentioned in previous posts, this excess body fat is also now referred to as obestrogens, as they cause the same health consequences as environmental estrogens (known as endocrine disruptors). These excess body fats and higher levels of leptin do impair production of sex hormones and also reduces fertility. It can also lead to poorer sperm quality, poorer egg quality and can also increase the risk of miscarriage. The more excess body fat, the greater the risk of fertility difficulties a couple will have. This is a fact. Despite what your specialist, your doctor, Dr Google, or your own mind tells you, this is a fact and we need to start being real about it. It isn’t about fat shaming either. It is to help people who are struggling with fertility and to help them seek the help they need to have a baby.

Excess body fat, especially excess abdominal fat is also linked to insulin resistance, metabolic syndrome and other health issues. It also interferes with the regulation of sex hormones and sex hormone binding globulin (SHBG).  This can then increase the risk of irregular cycles, PCOS, endometriosis, sperm quality issues, miscarriage and other factors affecting fertility.

While the facts around excess body fat, excess weight and obesity are very real and can often seem overwhelming, there is some good news for couples that are overweight and obese.

Dietary and lifestyle changes and fat loss interventions which also includes exercise, can significantly improve fertility outcomes. It can also help with regular menstrual cycles, PCOS, endometriosis, sperm issues, egg quality, mental health and many other health issues. It definitely improves the chances of pregnancy and lessens the chances of miscarriage.

Research has shown that fat loss of up to 7%, for those that are overweight, achieved by diet, exercise and lifestyle changes, can improve overall health, fertility and improve chances of a successful live birth.

There is no fast track, or easy way to lose excess body fat and people need to face the facts, face reality and just get in a do it. The best ways to do this are as follows:

Seek the help of trained healthcare professionals that can help you with dietary and lifestyle changes and can help monitor you and support you rather than blaming and shaming. It also helps to hold you accountable and keep you motivated.

Do any dietary, exercise or lifestyle changes as a couple. It is much easier if you both do it and can support each other in any changes. You can also hold each other accountable and also see the changes in each other.

Set realistic goals and be realistic about how long things will take. It is no use setting unrealistic goals and having an unrealistic perception of how long things will take to change it your body. This will only set you up for failure and chances of rebounding. It is about one day at a time and one step at a time.

Seek the help of a trained healthcare professional to educate you on what good nutrition, good dietary and lifestyle habits are. The more educated you are about what a good diet is, the better your chances are of eating the right foods and achieving your fat loss goals

You need to exercise as well. Diet changes alone will only help to a point and you do need to do some form of resistance work to help burn fat. While walking is great, it doesn’t burn fat and increase lean muscle like resistance exercise (weights etc) can. You may even need to see a personal trainer to get yourself started and be held accountable.

Have access to fresh foods and means to increase your levels of physical activity. It is important to have access to good fresh foods and stay away from the processed and refined foods. You also need to have ways of exercising and keeping your body active and burning fat.

It is all about perception versus reality. You need to be real about your weight, your body fat and then set realistic goals to lose the excess body fats. Just remember it is about being proactive. Nobody is going to do this for you, but they can help encourage you to be healthy and make better dietary and lifestyle choices.

Lastly, men and women are twice as likely to achieve healthy weight and waist range and proper dietary and lifestyle choices if their partner does it too. The journey to having a baby requires a couple to do it and the same goes for weight loss and achieving healthy body fat and healthy waist range too.

Take care

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

obesity 3247168 1280

Excess Weight and Male Fertility

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It has long been known that for men, being overweight, or obese, is associated with lower fertility and poor sperm quality. We know that excess body fat causes inflammation in the body, but it is also known to cause the following:

  • Hormones Problems
  • Sexual Dysfunction
  • Erectile Dysfunction
  • Type 2 Diabetes
  • Sperm Quality Issues
  • Heart Disease
  • Sleep Apnoea
  • Lower Testosterone
  • Other Health issues.

It is now known that carrying an extra 10 kilos can reduce male fertility by between 10-50%. This is exactly why all men need to take their health, their body fat and their weight more seriously when trying to conceive.

A review of studies about the effects of paternal obesity on reproductive outcomes found that overweight, or obese men were more likely to experience fertility issues and less likely to have a live birth if they and their partner used assisted reproduction technology (ART) – (IVF, ICSI, IUI etc).

The reason being is because the extra body fats are known to be estrogenic (known as obestrogens) which not only reduce sperm quality, but also changes the DNA, the physical shape and molecular structure of sperm cells.

This is why all men need to look at preconception care and lifestyle changes for trying to have a baby, but also their future health and their future offsprings long term health as well.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicines

-Women’s and Men’s Health Advocate

 

IVF cover image

Let’s Talk About Why IVF Cycles Fail

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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.
Endometriosis Facts Endometriosis does not always cause infertility 1

Endometriosis DOES NOT Always Cause Infertility

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Many women are led to believe that if they are diagnosed with endometriosis, that they will be infertile. The one thing I do want all women to know is that Endometriosis DOES NOT always cause infertility.

Over the years I have helped over 12,500 plus babies into the world and many of the women who went on to have these babies had endometriosis.

I have had women who have been diagnosed with endometriosis being told that they cannot fall pregnant, based on the diagnosis and AMH (Anti-Mullerean Hormone) levels alone, and no other fertility investigations. This is disgusting and should never happen. It is so sad hearing things like this and women believing they are infertile and cannot have a baby, when it fact they actually may be able to.

Endometriosis can make it harder to fall pregnant

While having endometriosis can increase your chances of having fertility issues (about 50%), it does not mean you are infertile. To be honest the word infertility is often wrongly uses. Unless you have absolutely infertility and have been diagnosed with a condition that would render you infertile, then we should really be using the word subfertility. Subfertility is a better word to use for those that may be experiencing difficulty falling pregnant, but may need assistance of some come.

Biology 101 tells us that it takes two people to make a baby

Let’s not forget that just because you have endometriosis, it does not mean that the fertility issue falls solely with you. Men are just as big an issue when it comes to fertility issues and could be the bigger part in you not being able to fall. The problem is that many fertility clinics will solely focus on the women because she has a diagnosed condition and this is wrong. Many times I have seen a women with endometriosis blamed as the main cause of the fertility issue, when in fact it is actually the man’s sperm that is at fault. Please remember this. Biology 101 tells us that it takes a sperm and an egg to have a baby, not just an egg.

Endometriosis can make it harder to fall pregnant and can affect egg quality, fertilisation and implantation, due to the resulting inflammation from the disease. But this is where it gets a bit tricky.

Pregnancy rates are not necessarily related to the extent of the disease

It isn’t always about the amount of the disease either. We know that pain levels and the associated symptoms of endometriosis are not related to the extent of the disease. I will address this in one of the other facts posts sometime in the future. The hard thing is that sometimes stage 4 endometriosis sufferers, with lots of the active disease, will have not issues falling pregnant at all. Meanwhile a woman with stage 1, or minimal disease, may have lots of issues falling.

Then we have the women who are having issues falling pregnant and will not even know that they have endometriosis and then it is found as part of fertility investigations, via a laparoscopy. Just remember that a significant portion of women with endometriosis are asymptomatic (meaning no symptoms).

Like I always say to my patients, Endometriosis can make it harder to fall, but having the disease does not mean that you are automatically infertile, or will have trouble conceiving. This is why it is important to see someone who specialises in Fertility, not just a regular OB/GYN or a GP, and also specialises in the area of endometriosis.

Fertility Program

If you are having issues falling pregnant, please give my clinic a call and find out how my fertility program may be able to assist you. I can help you and assist you in receiving the proper fertility evaluation and investigations you should be getting. This is for the couple, not just the woman. Like I mentioned before, my multi-modality fertility program has helped and assisted over 12,500 babies into the world and it may be able to help you too.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

-The Endometriosis Experts