Unexplained infertility – and pomegranates…

800px-Granadas_-_PomegranatesI’ve had a few queries recently about foods or therapies that might boost your fertility for those who don’t have a proven cause, and it struck me that the important thing to remember about unexplained infertility is that it is only “unexplained” because doctors can’t find a cause – it doesn’t mean that there isn’t one!

Unexplained infertility is a frustrating diagnosis, and it is very tempting to try to find your own cause – is it stress, working too hard, eating the wrong things? Once you start searching, the potential causes are apparently never ending – as is the amount of money you can spend trying to reverse them. The number of fertility “experts” offering all kinds of therapies and support seems to increase daily and it is important to think before you opt for using their services or their expertise and apply the same kind of discretion that you would when purchasing anything else.

As attractive as it may sound, no amount of relaxation or diet change is going to unblock a fallopian tube or reverse an early menopause. Most people are only too aware of that, but it’s those whose fertility is unexplained who are more vulnerable to the idea that the chances of getting pregnant could be influenced by changing the way you think or what you eat.

Changing your diet and lifestyle so that you feel fit and healthy when you’re trying to conceive is an excellent thing to do, but it’s simply not true that eating specific foods will make your fertility treatment succeed. I read an article from a national newspaper this morning with a list of foods to “boost” fertility – in the comments underneath someone had suggested that one of them was traditionally used to terminate pregnancies.

Punica_granatum_3I thought it couldn’t possibly be true, but a bit of googling did find some evidence that perhaps it might not be the top fertility food suggested – for the record, it was pomegranate, which the article had listed as a fertility booster. Although the juice and fruit is thought to be fine, animal studies have found that pomegranate seed extract can stimulate uterine contractions – see this research from the University of Maryland and this from the University of Liverpool. In reality, eating a pomegranate is certainly not going to stop you getting pregnant and there is no evidence to suggest you should avoid pomegranates when you are trying to conceive – but equally, it’s possibly a rather strange choice to list as a “fertility booster”.

This illustrates very clearly the kind of difficulty people face when trying to make sense of the frequently conflicting evidence about how to boost your fertility – and explains why it’s often best to take any such advice with a large pinch of salt…

Juno and unexplained infertility

You may have heard about the exciting discovery by scientists of the protein which helps eggs and sperm to bind together. Named after the Roman fertility goddess Juno, it is found on the surface of female eggs and is essential in order to allow fertilisation to take place.  Apparently the scientists are now starting to investigate whether screening tests for Juno could be an indicator for fertility problems – and the discovery has been widely touted in the press as the “key” to unexplained infertility

It’s obviously a hugely important advance, but whether it explains why so much infertility is unexplained is not at all certain.

Many of those who receive a diagnosis of unexplained infertility are eventually offered IVF treatment, and at this point it is actually quite unusual for eggs not to fertilise even if the treatment doesn’t eventually work.

It is possible that ICSI could by-pass Juno, but for standard IVF treatment, fertilisation can only occur if Juno is present – which would suggest that it is unlikely to be a major cause of unexplained infertility.

If you have unexplained infertility and have been thinking that maybe it’s down to a lack of Juno, this won’t be the case if you’ve ever had a fertilised egg during IVF.

 

 

Are people rushing into IVF?

According to a report out today, we are using IVF too quickly and too often, particularly for those with unexplained infertility.  I was due to go and discuss this on Sky News this morning, but due to hideous traffic ended up missing the slot. I was disappointed, as I did want to raise some important issues from the patient perspective on this.

The report says that 25 – 30% of those who come for IVF currently have unexplained infertility, and that some of them will actually get pregnant naturally. The report talks about natural conception occurring even in couples who have been through two to three years of unexplained infertility.  This is true – we all know it can happen – but that doesn’t mean it will happen for every patient with unexplained infertility.  According to HFEA data, the average fertility patient in the UK has spent four years trying before they have IVF.  I am not sure how much longer the authors of the report would expect them to carry on before fertility treatment would become appropriate.

We also have to remember that there is always a cause for unexplained infertility – the diagnosis just means that doctors haven’t managed to find it.  Our infertility was unexplained, and we have never conceived naturally. Had we waited five or six years before trying IVF (and I assume this is how long we are meant to carry on as four years is seemingly not enough), our treatment would have been far less likely to work as my fertility would have been declining.

I appreciate that clinicians need to debate these issues, but it can be very difficult for patients who are forever facing conflicting information about what they should do and when.  I’d say the best thing is always to take advice from a fertility specialist, and to take newspaper headlines with a pinch of salt.

 

Study finds a third of IVF parents go on to conceive again without medical help

I’m sure you’ve been told about someone who had an IVF baby and then got pregnant again without the need for any more treatment.  I’ve known a few people it has happened to, but hadn’t realised quite how common it can be – according to new research from Australia, a third of couples will go on to conceive naturally after successful fertility treatment.

A research team looked at the pregnancy rates between 18 months and two years after having a first child and found that 33% of women who’d had assisted conception went on to have a second pregnancy without medical help afterwards.  Although some of the couples had been trying to get pregnant again, apparently a quarter of the second pregnancies were just totally unexpected – presumably because couples weren’t using contraception having assumed they couldn’t get pregnant.  The second pregnancies without any further treatment were most often amongst those who had unexplained infertility.

The study is published in the Australian and New Zealand Journal of Obstetrics and Gynaecology and you can read more about it here.

An explanation for unexplained infertility…

I’ve had a really interesting couple of days at the European fertility conference ESHRE which is being held in London this year.  It has been fascinating to meet people from around the world who are involved in the fertility field and to look at different issues from different perspectives – from the lovely Kenyan doctor who is working to set up a fertility support group to the IVF baby who was so inspired by the story of her conception that she’s training to be an embryologist!

One theme that emerged from a number of discussions over the last couple of days was unexplained infertility and sperm DNA damage – last night I was very excited to meet Professor Sheena Lewis, the leading expert in this field, whose research has shown that sperm DNA damage is the key to unexplained infertility.

This morning I met a Danish expert, Preben Christensen,  who is working in a similar area. He said that he had seen lifestyle changes make a real difference to the fertility of men who had been unable to conceive because they’d been drinking large quantities of fizzy caffeinated drinks or eating huge quantities of chocolate every day – and even taking scalding hot baths.  He recommends testing for DNA damage and then not only lifestyle changes but also taking vitamin supplements such as Vitamin D, zinc and selenium all of which can affect sperm.

It does seem that there is increasing evidence that this is a really important factor in fertility – but one that is not yet part of the routine round of tests which are carried out at clinics.

Unexplained infertility – could the cause be found?

Being told that doctors can’t find a reason why you can’t get pregnant can be hugely frustrating – and often means that people end up blaming themselves, making endless lifestyle changes or paying for lots of complementary treatments in an attempt to improve their fertility.

Now, researchers from Belfast claim that they’ve discovered a cause for many fertility problems which have been classified as “unexplained”.  In a study of more than 200 couples, they discovered that there was high sperm DNA damage in 80% of the couples who’d been told their infertility was unexplained.  The research – which has been published in  Reproductive Biomedicine Online – also revealed that the chances of getting pregnant after IVF is linked to the amount of DNA damage in each sperm.  Some DNA damage is normal and is found even in perfectly fertile men, but when levels are high this can reduce the chances of having a baby even with fertility treatment.

You can read more about the research here.  If this is indeed the case, it could herald a huge change in the diagnosis and treatment of many couples with fertility problems.