Do birth control pills cause infertility?

birth-control-pills-NJThis is one of the most common questions patients ask their fertility doctors and/ or their OBGYNs. Fortunately the short answer is no and this is backed up by large research studies. While their purpose may be to prevent pregnancy, the contraceptive effect of the pill wears off rather quickly. In some women the return to normal cycles and fertility can take a number of months, but usually there is not much of a delay. In other women, such as those with ovulation disorders such as PCOS, coming off the pill may actually increase the chances for conception. If your cycles have not regulated themselves 6 months after stopping the pill or they are becoming less regular over time after then and you’re trying to get pregnant, it’s probably not the pill, and it’s time to discuss this with your GYN or fertility specialist.

Couples with high cholesterol levels take longer to concieve

statinsA recent study from the NIH suggests that couples who have high cholesterol levels may not just be at higher risk for heart disease, they may also have a harder time getting pregnant. Couples (who were not yet considered infertile) in which both partners or even just the female partner had high cholesterol levels on average took a longer time to conceive. These findings are not so surprising since ovulation disorders such as polycystic ovarian syndrome (PCOS) are among the most common causes for infertility, and many of these patients have underlying metabolic problems that place them at risk for heart disease and diabetes.  So what does this mean? It does not mean couples trying to get pregnant should rush out and go on statins to lower their cholesterol. Cholesterol is the chemical from which sex hormones such as estrogen and testosterone are made from, so these drugs could potentially be harmful to your fertility. However, healthy lifestyle changes such as moderate excercise and avoiding processed high carbohydrate foods may help both cholesterol and fertility.

Lesley Brown, the unsung heroine of IVF

Being that is National Infertility Awareness Month, this week seemed like an appropriate time to share this story. I recently attended a lecture given by one of pioneers in our field and one my personal mentors, Dr. Eli Adashi. The story he shared with the audience moved me and reminded us of our patients’ suffering and why we do what we do. In the history books, when one looks at the breakthroughs in medical infertility treatment, the birth of the first IVF baby does and will stand out as one of the great milestones. The protagonists in the story that everyone knows are, Drs. Steptoe and Edwards, the brilliant gynecologist and scientist team, and of course, baby Louise Brown herself. But the popular narrative leaves out perhaps the most important character in this drama, Lesley Brown, the patient herself.  Lesley was a reserved woman who never wanted attention but her delivery was one of the most famous events of the 20th century. She put up with repetitive surgeries and painful medical procedures knowing there was little chance they would work.  When she did IVF with Drs. Steptoe and Edwards, she was basically (and knowingly) a human guinea pig.  Nobody had any idea as to whether it could work, whether it was safe and if it did whether her child would turn out normal. On top of that she had to put up with moral outrage (and occasionally harassment) of those who opposed the very idea behind IVF. Without her bravery and perseverance, millions of couples would remain childless and millions of babies would never have had a chance at life. Lesley Brown passed away quietly in 2012 but the legacy she left has brought both hope and joy to millions.

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Lesley Brown, the unsung heroine of IVF with her daughter Louise

Aspirin and miscarriages

aspirin-baby-81It is quite common for both OBGYN and Fertility doctors to encourage their patients who have had multiple miscarriages take baby aspirin in order to reduce the risk of future pregnancy losses. The problem with this is that these recommendations were never really backed up by research to see if aspirin is really effective in preventing miscarriages. In order to determine if this common practice was effective, the NIH conducted a large trial to see if taking daily baby aspirin would reduce the risk of subsequent miscarriage in women with 1 or 2 prior miscarriages. Unfortunately, as reported in the journal Lancet,  baby aspirin did not help and these women were no more likely to experience another pregnancy loss than those who took a placebo. The one bright spot in this study: women who took had a single loss early in pregnancy within the last year and took baby aspirin were more likely to actually become pregnant.

New guidelines for PCOS

ImageThe Endocrine Society has issued new guidelines for the diagnosis of Polycystic Ovarian Syndrome (PCOS). These guidelines developed by a special task force are based in part on the Rotterdam criteria and were recently published in the Journal of Clinical Endocrinology and Metabolism.

Women are diagnosed with PCOS when they have 2 out of the 3 following conditions:

  1. Problems with ovulation such as irregular cycles
  2. Excess levels of male hormone levels on bloodwork or based on symptoms such as abnormal hair growth or loss, acne
  3. Large numbers of ovarian follicles or “cysts” on ultrasound

Additionally, doctors will need to rule other hormonal disorders that may mimic PCOS and are advised to screen for medical diseases such as diabetes and hypertension that are more common in women with PCOS. They also issued recommendations for treatment of infertility and irregular cycles in PCOS patients.

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