Reposted from the New York Times.

Can Foods Contribute to Infertility?

By THE NEW YORK TIMES

Robert Stolarik for The New York Times People sensitive to the gluten in bread, pasta and other foods may face fertility problems.

Dr. Sheila Crowe, a professor in the division of gastroenterology and hepatology in the department of medicine at the University of Virginia, recently joined the Consults blog to answer reader questions about celiac disease, an often overlooked digestive disorder that causes damage to the small intestine when gluten, a protein found in wheat, barley and rye, is eaten. Millions of people have celiac disease, but most don’t know they have it, in part because symptoms can be so varied. Here, Dr. Crowe responds to a reader concerned about the links between celiac disease and infertility.

Celiac Disease, Infertility and Miscarriages

Q.

Can you explain the link between celiac and infertility? Are you more likely to be infertile if you have celiac?
Melanie

 

A.

Dr. Crowe responds: Yes, infertility, or the inability get pregnant, seems to be more common in women with untreated celiac disease, based on a variety of studies in different countries. Other gynecological and obstetrical problems may also be more common, including miscarriages and preterm births. Men with untreated disease may also face fertility issues. Although these problems were not always recognized as being related to celiac disease by doctors and other health professionals, this situation is starting to change.

Women with celiac disease are reported to start having periods later and stop menstruating earlier than average. They also suffer more often from secondary amenorrhea, a condition in which menses start but then stop. Together, these menstrual disorders lead to fewer ovulations, which results in less of a chance to get pregnant. Hormonal factors and poor nutrition are thought to play a role in causing these problems.

For men, problems can include abnormal sperm – such as lower sperm numbers, altered shape, and reduced function. Men with untreated celiac disease may also have lower testosterone levels.

Of course, for both men and women, how often a couple has intercourse affects fertility. If someone feels lousy from untreated celiac disease, infrequent sexual activity may be contributing to the problem. One study from Italy suggests that sexual relations occurred less often when one partner had active celiac disease compared with couples in which the partner’s celiac disease was being treated.

Once a woman with active celiac disease does conceive, other problems that can arise during the pregnancy include miscarriages and smaller babies because of preterm delivery or delayed growth in the uterus. These conditions are reported to be more common in women with untreated celiac disease, though miscarriages have many causes and occur in up to one-fourth of all pregnancies. Nonetheless, I would recommend that if a woman has repeated miscarriages or is unable to conceive, consideration should be given to screening her for celiac disease by antibody testing (see my earlier posting, “Confirming a Diagnosis of Celiac Disease”).

Indeed, there are many causes of infertility, miscarriages and small babies besides unrecognized celiac disease, and some studies have failed to show that the risks of these problems are actually increased by untreated celiac disease. Larger and better-devised studies are needed.

Still, my own clinical experience suggests that infertility and smaller or preterm babies are more common in women with untreated celiac disease than those without. I am sure some of our readers can share their own experiences in this regard. And the good news is that with proper treatment with a gluten-free diet and correction of nutritional deficiencies, the prognosis for future pregnancies is much improved.

To learn more about celiac disease, visit The Times Health Guide: Celiac Disease, and see Dr. Crowe’s additonal responses:

        

SIDS Linked to Low Levels of Serotonin
NIH-Funded Study Finds Abnormalities in Brain Region That Regulates Breathing, Sleep

The brains of infants who die of sudden infant death syndrome (SIDS) produce low levels of serotonin, a brain chemical that conveys messages between cells and plays a vital role in regulating breathing, heart rate, and sleep, reported researchers funded by the National Institutes of Health.

SIDS is the death of an infant before his or her first birthday that cannot be explained after a complete autopsy, an investigation of the scene and circumstances of the death, and a review of the medical history of the infant and of his or her family. According to the National Center for Health Statistics, SIDS is the third leading cause of infant death (PDF - 1.71 MB), claiming more than 2,300 lives in 2006.

The researchers theorize that this newly discovered serotonin abnormality may reduce infants’ capacity to respond to breathing challenges, such as low oxygen levels or high levels of carbon dioxide. These high levels may result from re-breathing exhaled carbon dioxide that accumulates in bedding while sleeping face down. The findings appear in the Feb. 3 issue of The Journal of the American Medical Association.

“We have known for many years that placing infants to sleep on their backs is the single most effective way to reduce the risk of SIDS,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the research. “The current findings provide important clues to the biological basis of SIDS and may ultimately lead to ways to identify infants most at risk as well as additional strategies for reducing the risk of SIDS for all infants.”

NICHD’s Back to Sleep campaign urges parents and caregivers to place infants to sleep on their backs. Following the campaign’s launch in 1994, the rate of SIDS dropped by more than 50 percent. Widespread adoption of back sleeping appears to have reduced the occurrence of SIDS, but has not eliminated it.

For this study, senior author Hannah C. Kinney, M.D., of Harvard Medical School and Children’s Hospital Boston, and her colleagues examined small samples of tissue from the medulla, a region at the base of the brain that regulates basic functions such as body temperature, breathing, blood pressure, and heart rate. The researchers analyzed brain tissue from infants who died from SIDS and controls who died of other causes. Included in the analysis were 35 infants who died of SIDS, 5 infants who died unexpectedly of other causes, and 5 infants who were hospitalized and died for reasons associated with a lack of oxygen.

The researchers found that serotonin levels were 26 percent lower in tissue from infants who died of SIDS than in tissue from the group of infants who had otherwise died unexpectedly. Measurements of tryptophan hydroxylase, an enzyme needed to make serotonin, also were 22 percent lower.

In earlier work comparing SIDS cases with other infant deaths, Kinney and her coauthors showed that the brains of infants who died of SIDS had higher concentrations of cells that use serotonin in the medulla oblongata, a region of the brain stem. For the current study, the researchers set out to see if this meant the SIDS infants’ brains in fact had altered levels of the brain chemical.

This abnormality appears to fit into the triple-risk model of SIDS, which holds that SIDS occurs only when three elements come together: an infant with an underlying vulnerability, a critical period of development, and an external stressor. The researchers speculate in this case that the low serotonin level would cause the underlying vulnerability. The first year of life is the critical period of development for stabilizing vital functions such as breathing. The final element of the model, sleeping face down, might provide the external stressor.

“Our research suggests that sleep unmasks the brain defect,” Dr. Kinney said. “When the infant is breathing in the face-down position, he or she may not get enough oxygen. An infant with a normal brainstem would turn his or her head and wake up in response. But a baby with an intrinsic abnormality is unable to respond to the stressor.”

“It’s no one single factor but a culmination of abnormalities that result in the death,” Dr. Kinney said. In fact, in 88 percent of the SIDS cases they examined, the researchers found two or more risk factors, such as the infant’s sleep position, an illness, or exposure to cigarette smoke.

Kinney hopes these findings will one day lead to a test that measures infants’ serotonin levels in the blood or other tissues that reflect brain serotonin levels. Such a test might make it possible to identify those at the highest risk for SIDS so that additional steps could be taken to protect them. In the near term, the findings will provide the basis for the development of animal models with serotonin deficiencies, to mimic what occurs in SIDS in human beings.

        

According to a Danish study small increases in cancer risk from certain fertility drugs used for longer duration.  The research group identified higher uterine cancer risk among women who had used follicle-stimulating hormone and human menopausal gonadotropin (hMG) for duration longer than 10 years. Similar risk was seen among women who at any point took six or more cycles of clomiphene(treatment for women not ovulating normally) or when clomiphene didn’t work when women were injected with six or more cycles of human chorionic gonadotropin (hCG). Uterine cancer risk seemed about two times the usual risk in each of these scenarios though the absolute risk of developing uterine cancer is still not very high.

The study was based on 16 years of research on a group of 54,362 women who underwent fertility treatment between 1965 and 1998. The team compared the use of fertility drugs among 83 who developed uterine cancer and 1,241 of similar age who did not develop cancer of the uterus. 51 and 50 percent of the women who did and did not develop uterine cancer, respectively, used fertility drugs. Differences in risk became clear in investigations of specific fertility drugs used and the length of use. These risks weren’t ruled out when the investigators further allowed for use of a single or multiple fertility drugs, number of births, causes of infertility, and any history of oral contraceptives.

        

Acupuncture may have significant positive effects on the percentage of motile sperm in infertile men who have severe oligoasthenozoospermia, reports research from Germany. According to two prospective randomized clinical studies (Dieterle et al., 2006; Westergaard et al., 2006) and a systematic
review with meta-analysis (Manheimer et al., 2008), acupuncture has a significant effect on clinical pregnancy and live birth rates when it is conducted at the time of embryo transfer in patients undergoing in vitro fertilization (IVF). The effect of acupuncture on semen parameters has only been evaluated in a small sample of patients, however (Yu Ng et al., 2009). Therefore, the purpose of this study by S. Dieterle and colleagues was to determine the effects of acupuncture on the semen parameters of infertile men with severe oligoasthenozoospermia. "A significantly higher percentage of motile sperm (WHO categories A - C), but no effect on sperm concentration, was found after acupuncture compared with placebo acupuncture," wrote Dieterle et al. ("A Prospective Randomized Placebo-Controlled Study of the Effect of Acupuncture in Infertile Patients with Severe Oligoasthenozoospermia," Fer & Ster, 2009;92(4):1340-1343). The study included 47 infertile men with severe
oligoasthenozoospermia who were randomized to receive either acupuncture (n = 28) or placebo acupuncture (n = 29) twice a week for six weeks. Acupoints were chosen for both groups based on an earlier acupuncture study on sperm morphology in male infertility (Pei et al., 2005). The acupuncture needles,
which were 0.30 x 30 mm, were inserted to a depth of 15 - 30 mm. They were rotated manually to evoke the Deqi sensation; 10 minutes later, they were manipulated again for the same sensation. Non-penetrating needles of the same dimensions were used for placebo acupuncture. Semen samples were
evaluated according to WHO (1999) standards at the following times: ≤ five months prior to intervention, < 3 months prior to intervention, < 2 months after intervention, and ≤ 3 months after intervention. Statistical analysis included Dixon and Mood sign test,

Mann-Whitney U-test, and Wilcoxon matched pairs test. Data are given as mean ± SD. In the group of patients that underwent acupuncture, a significant (P = 0.035) increase occurred in motility A - C after intervention (24.2% ± 17.0 before intervention vs. 33.8% ± 18.2 after intervention). No significant difference was seen in motility A - C after use of non-penetrating needles in the control group. Sperm concentration improved after intervention in the acupuncture group, but not to a significant extent; however, sperm concentration did improve significantly (P = 0.0180) in the control group from 0.016 ± 0.085 million/mL before use of non-penetrating needles to 0.468 ± 1.712 million/mL after placebo acupuncture. Semen volume decreased significantly (P = 0.041) after intervention in the acupuncture group, but no significant difference was noted after placebo acupuncture in the control group. "The decrease in semen volume after acupuncture has to be investigated. There was a significant increase in sperm concentration after placebo acupuncture, but not after acupuncture. These results might be due to the number of patients included in this study," concluded Dieterle et al. "The results of the present study support the significance of acupuncture in male patients with severe oligoasthenozoospermia." Address correspondence to Priv.-Doz Dr. Med. Stefan Dieterle, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Olpe 19, D-44135 Dortmund, Germany; e-mail: dieterle@ivf-dortmund.de.

        

Paul Magarelli, Ph.D., M.D. and Diane Cridennda, L. Ac. (FABORM) - recently Acupuncture/IVF Study published in this month's Fertility and Sterility. We at Reproductive Wellness are proud of them, and the word is getting out. So for those who are interested, feel free to click on the link below to listen to the recorded radio interview about their research and how Acupuncture and IVF are being used to make changes and increase IVF success rates!!!

Creating Families

        

The single best resource for integrating Acupuncture and/or Chinese Herbal Medicine into your fertility treatments is the American Board of Oriental Reproductive Medicine (www.aborm.org). The ABORM Board Certifies Acupuncturists who specialize in the treatment of male and female infertility via a rigorous certification examination that measures their knowledge base in western REI, and Traditional Chinese Medicine as it relates to Infertility. ABORM Fellows are experienced, highly trained, certified, and up-to-date on the very latest in evidence-based CAM treatments for Infertility. They can be an invaluable resource as you go through fertility treatments.

If you are under the care of an Acupuncturist who is not ABORM Certified, it can be a toss-up as to their competency in terms of their experience and training related to Infertility. It’s always best to contact the practitioner and ask a few questions. The fact that they have performed a few pre-transfer and post-transfer acupuncture treatments for IVF patients, does not equal a thorough understanding of western REI, nor a thorough grasp of TCM as it relates to Infertility.  Many newly licensed practitioners say they are specialists in fertility because they like the area but in reality they have no real hands on experience. 
Remember: you are looking for someone to work with who can refer you out if needed!  You dont want some who will keep you as a patient indefinitely.   

        

Reproductive Wellness will be hosting its Fertility talk called "The Stork Talk".  This will take place on December 15th, 2009 at 6:30pm in Mission Valley at the Courtyard Marriott.  Anyone who is interested in learning more about Natural Treatments for fertility is welcome to attend.  For more information please contact the clinic at 619-265-0291.

        

How do we diagnose and determine a treatment plan using Chinese Medicine?

 

Chinese Medicine uses an intricate system of pattern differentiation to determine the correct diagnosis.  Each group of signs and symptoms begins to move us through a web of options finally allowing us to determine a pattern of disease.  Simply, each group of symptoms is pulled together to show an underlying cause of disease.  Through a series of questions and answers the pathomechanism (mechanism that caused the disease) is determined.  This allows us to reverse the disease process in the quickest time with the most appropriate treatment.  Once the pattern and mechanism are determined a correct treatment plan can be established.  Each treatment (set of acupuncture points, herbal medicine, nutrition, supplements, etc …) is carefully picked to coincide with the diagnosis that has been established.

Treatment frequency is determined by a patient’s rate of response.  The establishment of a patient’s ability to heal allows our case manager to determine how frequently and for what length of time a patient needs to come in.  A patient’s rate of response is reevaluated by their case manager regularly to measure progress and adjust treatment plans as needed. 

Marc

        

Many patients have recently asked about stress and acupuncture and its affects on the ovaries, so I wrote this out.

Acupuncture originated centuries ago and is the means by which practitioners of Oriental Medicine tap into the vascular systems that enlivens and runs through each person. There are classical entry points (acu-points) along these lines called meridians. The stimulation of a combination of exact points using ultra fine filaments will cause the body to correct the flow of blood and oxygen, sometimes called Qi.  Classic texts describe 365 points located on meridians that are mapped onto the surface of the body.

Simply, acupuncture functions by affecting neural pathways along the body.  When a needle is inserted into the skin a signal is sent from the area of insertion (the peripheral aspect of the body) to the spinal cord.  From the spinal cord a signal is sent to different areas of the brain.  Once these areas of the brain are contacted the body will respond by producing more or less of a certain chemical or hormone.  It may also then send a signal back to the spinal cord or organs that it is trying to influence.  Studies have shown that when needling the point Pericardium 6 (traditionally used for relieving nausea and vomiting) a signal is sent to the brain area that affects vomiting, to inhibit the nausea and vomiting.  Similarly, research has shown that pain is reduced through acupuncture.  Once the signal of the acupuncture needle has reached the spinal cord it sends a signal to the brain to release opiates.  Opiates are our body’s natural painkillers and are released from the pituitary gland. (Pomeranz and Stux: 1988)  It has also been seen, in functional MRI’s that acupuncture stimulates the central nervous system.  (Cho et al.: 1998; Fang and Hayes: 1999) 

These studies are excellent example of how acupuncture works when needling acu-points.  These studies however do not explain what Meridians are.  Most people who have some understanding of Eastern medicine have heard the word Meridian.  The Chinese would describe a meridian as a pathway where qi travels along to bring health to the body.  This abstract explanation makes sense to very few in the west.  Luckily there is research to show that meridians actually do exist.  A research study has demonstrated the map of a meridian pathway.  This study involved the injection of Technitium99, a radioactive tracer, into both true and sham acupoints.  “The scan of the injection sites showed random diffusion of the tracer around the sham point but rapid progression of the tracer along the meridian at a rate that was inconsistent with either lymphatic/vascular flow or nerve conduction.” (Victor S. Sierpina, MD; Moshe A. Frenkel, MD South Med J.  2005; 98)

Acupuncture has several effects on the body.  Some of these effects are:

• Restoring blood, nutrients and air flow
• Restoring visceral (organ) and immune function
• Promoting physiological and autonomic balance – Homeostasis
• Relieving pain
• Promoting the healing of tissue

 

It should be known that unlike the needles used to give standard pharmaceutical injections, the filaments used in acupuncture treatments are extremely fine, only twice the width of a single hair. These filaments are designed to enter the skin with the least resistance and with barely any perceived discomfort.  Most clients are surprised to discover that treatments involve little or no pain, and are usually quite relaxing.

In short Acupuncture works in 2 fundamental ways; regulating the nervous system and increasing blood circulation.  Research has shown that when a needle is inserted into the muscle it causes the blood vessels to dilate.  This begins the increased circulation of blood, but then we need to direct the blood to the area of the body that has lost function or is in pain (which are the 2 main effects of a reduced amount of blood circulation).  We do this by sending a signal to the brain via the nervous system.  This signal tells the body which area to shunt blood to.  This is like a computer program; you plug in the code by selecting points, and this tells the body what to do.

The adrenal glands are the stress glands of the body.  When the environment is hostile to the body, its reaction is to fight or run.  Both of these reactions cause the secretion of adrenal gland hormones.  These glands are designed to prepare the body for a temporary emergency; they can become exhausted and over reactive with prolonged environmental stresses.

The adrenal glands are 2 almond shaped glands that sit right above the kidneys.  Most noted for secreting adrenaline, they also secret numerous other hormones including cortisol, DHEA and norepinephrine. 

Adrenalin- This hormone causes an immediate burst of energy, makes the heart beat harder, raises up the blood pressure and over time leads to heart disease and vascular problems.

Norepinephrine (Noradrenalin) - This hormone takes blood out of the digestive tract and puts it into the muscles.  This can lead to digestive problems.

Cortisol- This hormone breaks down fat into sugar keeping your energy constant all day.  It also controls sleep, acts as an anti-inflammatory and suppresses the immune system.  Allergies, arthritis, fatigue, sleep and weight issues can be related to problems with this hormone. 

DHEA- This hormone is considered to be the master sex hormone of the body, controlling estrogen, testosterone, and progesterone. Imbalances with this hormone can affect menopause, PMS, infertility, loss of libido, etc… through its connection with the hypothalamus, pituitary, ovaries/gonads. 

These hormones cause the following reactions to prepare you to fight or run:

First, the blood flows toward your muscles, heart and brain, away from the skin, digestive track and reproductive organs; your heart beats rapidly and forcefully, your eyes dilate and glycogen in your liver is converted into glucose for quick energy.  All to help you fight or run.

The connection between stress and heart disease is that prolonged stress causes rapid and forceful heart actions which over a prolonged period of time can lead to heart disease.  Also the extra blood sent to the heart over time has also been found to be destructive. 

Second, as the blood begins to be moved toward your muscles, heart and brain, the first place it gets pulled away from are your ovaries, uterus, testes and your other reproductive organs.  The understanding is that the last thing your body needs to do when it is in a stress response is to reproduce.  The result of long term stress on the reproductive organs can be menstrual pain, pelvic pain, infertility, high FSH, irregular menstrual cycles, anovulation or a decrease in sperm count. 

 

Third, through the secretion of hormones, the digestive track shuts down.  You don’t need to digest when you are being attacked, so your body causes either immediate elimination or stops digestion altogether. The result of long term stress could be constipation, diarrhea or any digestive problems. 

 

Further, more than 50% of your body’s protein, B vitamins and vitamin C are not absorbed when you are under stress.  Because the body under  stress directs its efforts to run or fight; the immune system stops functioning when you are under stress.  Research done by the National Institute of Health (NIH) found that persons under stress are more susceptible to bacteria and viruses.

 

Your hormonal rhythm that leads to sleep is based on the secretion of adrenal hormone cortisol.   With stress, cortisol levels alter which can cause abnormal sleep behavior. 

 

Finally, because these glands secrete DHEA, which has proven to create the estrogen reserves in the body, problems with these glands can be related to PMS, menopausal symptoms and infertility. 

 

As our nervous system is continually hyperfunctioning our body begins to deplete its adrenal glands.  As more cortisol is released patients develop adrenal fatigue.  Because of the adrenal glands connection to the hypothalamus and pituitary glands (and in turn their connection with the ovaries), adrenal fatigue can, and usually does, lead to poor ovarian reserve.  As our skilled practitioners treat our patients they work to boost the adrenal glands and their functioning to minimize the aging process on the ovaries.

 Marc

        

This years sponosrs for the 2009 San Diego Fertility Expo are

Reproductive Wellness
Acacio Fertility Center
Project Baby