After interviewing Dr. Samuel Wood, a leading endocrinologist and fertility expert who also serves as medical director at the San Diego-based Reproductive Sciences Center, a few months ago about post-pill amenorrhea, I was simply fascinated with the amount of knowledge that this man was carrying around in his noggin’. (Particularly as it applies to, well, me since I’m trying to get pregnant myself.)
So, naturally, I picked his brain about all things Fertile Myrtle. From how to boost fertility to his opinion on whether or not more women are having infertility issues these days due to environmental reasons, read on for the fertility facts straight from Dr. Wood!
Fertility Facts: An Interview with Dr. Samuel Wood
- FBM: Are fertility issues becoming more common? Are you seeing younger patients come in with fertility issues?
- SW: Despite many breathless claims about an ever-worsening “infertility epidemic” strewn across popular media, not only does it appear that the incidence of infertility has not risen over the past 30 years, based on data from the CDC, it actually seems to have fallen somewhat (in the U.S. at least). At first this may seem surprising because it is clear that, in general, women are delaying childbearing, and age is the most important factor influencing a woman’s fertility. Counterbalancing this effect, however, has been a dramatic drop in new cases of pelvic inflammatory disease (PID), which is associated with infertility due to fallopian tube damage or obstruction. Although there may have been a modest reduction in the incidence of infertility, it remains a significant public health problem, the gravity of which is heightened by a paucity of insurance coverage for needed fertility treatments. Infertility affects between 1 in 7 to 1 in 10 couples of reproductive age, a staggering figure when one realizes that means that at least 5 million couples in the United States alone suffer from this. As the public’s awareness of the effects of age on infertility has increased, I have noticed that more younger couples are seeking advice and assistance. Sadly, lack of available insurance coverage for infertility and the recent worldwide economic decline has placed necessary infertility treatments out of the reach of many couples who would benefit from it.
- FBM: In general, how much of our fertility is within our control?
- SW: This is a fascinating but difficult to answer question because so many different genetic and environmental factors contribute to any given woman’s fertility. (This includes choice of partner—a “subfertile” person who chooses to mate with a “hyperfertile” partner may well be able to complete their family without ever finding out that he or she has a “fertility problem.”) If one includes age as a “lifestyle choice,” then certainly fertility is largely under our control. The now classic study of fertility rates in the Hutterites, a conservative religious sect that eschews contraception, conducted some 60 years ago, revealed an infertility rate of only 3.5 percent in couples under 25. Even in this insular group, however, infertility was almost 10 times higher (33 percent) by the age of 35 to 39. Many other controllable lifestyle choices (e.g., cigarette smoking, obesity) also contribute to the risk of infertility.
- FBM: How does our environment affect our fertility—and what can we do to improve it?
- SW: It is unclear just how much effect our environment has on fertility. Over the years, several so-called “endocrine disrupting compounds” (EDCs) have been implicated as causing infertility. For example, estrogen-like compounds found in soy products have been accused of contributing to the reduction in sperm counts that have been seen globally over the past 50 years. Research in this area is controversial and at this stage it’s difficult to determine the magnitude of the effects of these substances, if any, on infertility rates in humans. One environmental toxin that’s readily avoidable is secondhand-cigarette smoke, which may lead to an earlier menopause.
- FBM: What role does stress play in fertility?
- SW: It is universally accepted that stress plays an important role in female infertility since both physical (e.g., anorexia/bulimia and prolonged strenuous exercise) and psychological stress can disrupt normal ovulation. But what hasn’t been appreciated until recently is that significant levels of stress may also have a detrimental effect on sperm. What isn’t clear, though, is what effect male stress has on fertility (apart from not wanting to have sex at all!), given the excess of sperm produced in an average ejaculate. For example, a male whose baseline sperm count is 160M/ml would still be within the normal range for sperm counts (>20M/ml), even if stress reduces his sperm count by 75 percent. Because the woman generally releases only one egg per month, there is much less “room for error.”
- FBM: How long should a couple try to become pregnant before seeking help?
- SW: The conventional advice is for women under 35 to wait a year before seeking help with infertility, while those 35 and over should seek a consultation with a fertility specialist after only six months, given that there is much more time urgency in the latter situation. It is important to remember, however, that this advice only holds true for couples who do not have a history of medical conditions that may affect fertility (e.g., PID) and for women who have no obvious menstrual abnormalities. For example, it would make no sense for a woman who is not having periods to wait a year before being seen, no matter what her age.
- FBM: What are the most common fertility issues you see in your practice?
- SW: The two most common causes of infertility that I encounter are advanced reproductive age (the average age of my female patients is 39) and severe sperm deficits. Other commonly seen problems include anovulation and andendometriosis.
- FBM: What are three things every woman can do to improve her chances of becoming pregnant and having a healthy baby?
- SW: The most important thing is to avoid delaying childbearing once conditions are acceptable to have a baby. Waiting until things are “perfect” as opposed to “good” may well mean that becoming pregnant and having a healthy baby will be much more difficult or, in some cases, not possible. I’ll always remember a couple that came to me for consultation and said, “Okay, everything’s perfect, we’re ready to have a baby. We have a beautiful house in a great neighborhood, we both have lucrative careers—we will be able to send our child to the finest schools.” Because they looked considerably older than couples usually do for initial infertility consultation, I immediately asked their ages. The woman told me she was 51 and an FSH confirmed that she was perimenopausal. Although they were able to have a child through egg donation, their dream of having a biological child was lost. Because obesity is strongly associated with subfertility in both men and women, staying fit is an important way to maintain one’s fertility. From a fertility standpoint, practicing safe sex is particularly important for women since STDs like gonorrhea and chlamydia can be precursors to PID, which can profoundly increase the chance of infertility.
- FBM: What are three things every man can do to improve his fertility?
- SW: It’s common to see substantial improvements in sperm counts with lifestyle changes. For obese males, losing weight both improves sperm counts as well as sexual function. While their partner is attempting to become pregnant, men should avoid or minimize exposure to excessive heat (e.g., hot tubs), alcohol, marijuana, tobacco and exposure to potentially toxic chemicals like pesticides. Men who live healthy lifestyles may be able to improve their sperm counts by taking supplements containing ingredients like l-carnitine, zinc, vitamin C, which have been shown, in animal studies at least, to beneficial for sperm (e.g., Proxeed and the product I created, FertileMax).
- FBM: Any other tips, thoughts or advice on this issue?
- SW: No matter what your age, if you’re concerned about your fertility, you should see a fertility specialist to learn what your reproductive potential is and to find out what you can do to maintain your fertility. As an example, many women in their late 20s and early 30s who have not yet found a partner they wish to have a baby with are now freezing their eggs because in doing, so they also freeze their biological clocks. Having young eggs “in the bank” can reduce the pressure some women feel to compromise in their choice of men or careers.
Yet another reason to work out and eat a healthy diet! As usual, thanks for the insight, Dr. Wood! How have you boosted your fertility and gotten pregnant? Inquiring minds want to know! —Jenn