Posts Tagged ‘infertility’

Conception is a complex process that depends on everything working properly at a number of stages. Firstly, your hormone balance must be correct so that the egg develops normally. Secondly, you must be ovulating so that the egg is released. Thirdly, you must have sex at the right time in your cycle (there may be only two or three days a month when you are fertile). In addition, your partner must have a good sperm count and possess healthy sperm, which are capable of penetrating your cervical mucus to reach the egg. Then the egg has to be captured by the fallopian tube and be fertilised. Finally, once the egg has been fertilised, the embryo has to implant securely in the lining of the womb, which needs the right levels of the hormone progesterone to maintain the pregnancy. No wonder they talk about the miracle of life!
It’s daunting to think about the number of things that can go wrong. But, as we have seen, there are many simple ways in which you can dramatically improve your chances of getting pregnant.
In this section of the book I outline all the different factors that can undermine your fertility.The list may seem long but it is important to identify the particular combination of factors that may be undermining your and your partner’s health and wellbeing.
You may have been given the impression that there is no medical reason – and therefore no Solution – for your problem. But when you read this section you will realise that nothing could be further from the truth.

Nutrition
You are what you eat. Or, to put it another way, if you put poor-quality petrol in a high-performance car, like a Rolls-Royce or a Porsche, it may run for a while but eventually it will become less productive and less efficient. It is exactly the same with the human body.You need top-grade `fuel’ to function properly, and to produce healthy eggs or sperm. To a very large extent, your fertility depends on what you eat.
Food Isn’t What it Used to Be
One of the problems is that nowadays we eat a lot of convenience and refined foods that have been stripped of essential nutrients during manufacturing. For example, 80 per cent of zinc is removed from wheat during the milling process to ensure that a loaf of bread has a longer shelf life.’
The soil our food is grown on is so lacking in nutrients due to overuse and commercial farming methods, that even what we regard as ‘healthy’ foods — vegetables, for instance — may not contain the amounts of minerals we expect to get from them. If you have been dieting for a number of years (either restricting your food intake or trying different diet drinks or pills), you could well be deficient in a number of vitamins and minerals.
The well-balanced diet is a myth. We simply do not get all the nutrients we need from our food. This was confirmed by a National Food Survey conducted in 1995 which found that the average person in Britain was grossly deficient in six out of the eight vitamins and minerals surveyed. Fewer than one in ten people received the RDA (Recommended Daily Allowance) for zinc, which is the most important mineral for both male and female fertility.

Put this lack of nutrients together with all the additives, preservatives and pesticides (see Chapters 4 and 5) in your food and you can see that your fertility may well be compromised on a daily basis. Chemicals like pesticides are known to affect fertility, others will affect your general health, and this in turn can reduce your ability to conceive. Scientists may know the toxic effects of one particular chemical but what they don’t and can’t know for certain is the effect of being exposed to a cocktail of these substances.
Balancing the Scales
Your weight is crucial for your fertility. Being very underweight or very overweight can make conception difficult or impossible. So it’s important that your weight is within a certain range in order to give you the best chance of conceiving.
Nature gave women proportionately more body fat for a specific purpose, in order to reproduce and then feed our young. That is why fat accounts for 27 per cent of an average woman’s body weight, while it is only 15 per cent for a man.
Fat is essential to fertility and it is necessary in order to ovulate.Young girls do not begin to menstruate until their bodies are composed of at least 17 per cent fat.
Underweight
If a woman’s body fat drops too low, then her periods can stop. This low level of body fat may be caused by excessive exercise, as sometimes happens with ballet dancers or athletes who have very tough physical regimes.’
Infertility can also be caused by excessive dieting. When a woman is anorexic, for instance, her periods stop.’ With so much publicity about anorexia and an increasing number of young women falling victim to the ,slimmer’s disease’, the long-term damage to fertility caused by drastic weight loss is well-known. But not so many people realise that being overweight can also affect fertility.
Overweight
If a woman is overweight it can stop her ovulating. Studies have shown that just losing a small amount of weight, 10 per cent, for instance, can be enough to increase fertility by stimulating ovulation, improving hormone balance and making periods more regular.”‘
In another study, on women who previously did not ovulate, 11 out of 12 conceived naturally after exercising and dieting over a period of six months to get their weight down.”
Fortunately your dietary intake is fully within your control, and eating the right food may be the single most important thing you can do to achieve a successful pregnancy. Later (in Chapter 7) I will explain how the right  fertility. -Ig it nutrition can give you and your partner optinitini health and fertility.

Alcohol, Smoking and Drugs
Most of us know that smoking and drinking alcohol when pregnant can be very harmful to the baby. But what most couples don’t realise is that smoking and alcohol could actually be stopping them conceiving a baby because it reduces their fertility. The good news is that the negative effects are not permanent and simply stopping will dramatically improve your chances.
Alcohol
Research has shown that drinking alcohol causes a decrease in sperm count, an increase in abnormal sperm and a lower proportion of motile
sperm.12
Alcohol also affects a man’s fertility by changing his hormone levels because it can alter the way testosterone is produced and then released.” Because alcohol affects the liver (the organ which normally clears out any excess hormones), a man who drinks alcohol may accumulate small amounts of female hormones (men produce `female’ hormones, just as women produce testosterone). These female hormones can lower sperm production and potency.
In addition, alcohol stops absorption of nutrients like zinc which is one of the most important minerals for male fertility. Zinc is found in high concentrations in the sperm. Adequate levels of zinc are needed to make the outer layer and tail and are therefore essential for healthy sperm. If you reduce the amount of zinc in a man’s diet, his sperm count goes down.”
Finally, alcoliol reduces fertility in nianirrials, and studies show that women who drink heavily may stop ovulating and menstruating, and take longer to conceive.”

How Much is Too Much?
A study of 430 women demonstrated that drinking more than 5 units of alcohol (equal to five glasses of wine) a week could stop women conceiving. Researchers discovered that the women in the survey who drank less than 5 units a week were twice as likely to get pregnant within six months compared with those who drank more. A study published in the British !Medical Journal concluded that women should be ‘warned to avoid alcohol when trying to conceive’.”
The fact is that drinking any alcohol can reduce your fertility by half— and the more you drink, the worse the impact on your chances of conception.”
Studies have also shown a strong relationship between alcohol and miscarriages. Women who have a drink every day have a much higher risk of miscarriage (2.5 times more) than non-drinkers.” The same study found that if the woman was a drinker and a smoker her chance of a miscarriage was four times higher.
Smoking
There is so much information available nowadays about the risks of lung cancer, emphysema and other life-threatening conditions and most people are aware of the detrimental effects of smoking when pregnant. I know how shocked many of us feel when we see a heavily pregnant woman standing with a cigarette in her hand.Yet most people are not aware of the impact smoking can have on a couple’s fertility. It’s not surprising that tobacco has such an effect — it contains more than 4,000 compounds, including carbon monoxide, oxide of nitrogen, ammonia, aromatic hydrocarbons, hydrogen cyanide, vinylchloride, nicotine, lead and cadmium.
Although many women smokers resolve to give up when they get pregnant, they don’t realise that by smoking they are reducing their chances of getting pregnant in the first place. Not only that but you don’t usually know that you are pregnant for the first couple of weeks and the baby will be taking in all that tobacco smoke in the meantime.
The man’s fertility is also affected by smoking — it decreases his sperm Count, makes his sperm more sluggish, increases the number of abnormal sperm and reduces his testosterone levels.
In addition, smoking reduces the level of vitamin C in the bloodstream. Lack of vitamin C encourages sperm to clump together (a process known Alcohol, Smoking and Dru
as agglutination) instead of moving forward to fertilise the egg. One study showed how male fertility was improved by giving men 500mg of vitamin C twice a day.”
Smoking has definitely been linked with infertility in women.” It can even bring on an early menopause, which is an especially important consideration for older women trying to conceive who may be racing against time.” If you are a smoker, you should ask yourself why you are taking something into your body that is bringing you nearer to the menopause
—and infertility?
Recreational Drugs
The use of marijuana and cocaine has increased steadily over the years to the point where, for some people, it is part of everyday life. Although still illegal, recreational drug use is increasingly socially acceptable. That does not mean it is healthy or safe. The fact is that these drugs can compromise both your and your partner’s fertility. But, as with alcohol and tobacco, you can stop using recreational drugs and negate the damage to your fertility in a relatively short space of time.
If you continue to use them during a pregnancy, of course, it can have disastrous effects on your developing baby.
The Effects of Some Common Recreational Drugs
•    Marijuana can lower a man’s levels of FSH and LH, two hormones needed to produce sperm. It can also lower his libido.” For the woman, marijuana can lead to irregular periods, reducing fertility and sometimes even stopping ovulation.”
•    Cocaine users will have a lower sperm count, poorly moving sperm and a high rate of abnormal sperm.21
•    Heroin can cause a decrease in testosterone levels.2`
•    Cocaine and heroin, taken together, will make it harder for a woman to conceive and she is more likely to have a miscarriage, a stillbirth or a baby born with a malformation.21

Medicines
If you or your partner are taking medication while you are trying to conceive you should speak to your doctor about which drugs are medically essential and which are not. Some drugs have a direct effect on fertility and you do need to discuss this with your GR
Many drugs can affect not only the man’s sperm but also his ejaculatory function and libido. Some medicines may even cause impotence. These drugs can include sulphasalazine (used to treat irritable bowel), nitrofti•antoln, tetracyclines, cimetidine, ketoconazole, tricyclic antidepressants, monoamine oxidase inhibitors and propranol.”
In addition, medication given for conditions like gout or high blood
pressur can interfere with fertility. And non-steroidal anti-infianiniatory drugs (often used for arthritis) can stop ovulation.”

mepacrine A synthetic antimalarial. Now replaced by chloroquine and other powerful drugs. It is used occasionally in the treatment for Giardia laynblia infections. Dose: 300 mg daily for 5-8 days.
tmeprobamate A mild tranquillizer used Ili anxiety and tension states, but its extended use may lead to dependence. Dose: 1.2-2.4 g daily. Side-effects are drowsiness, headache, gastrointestinal and visual disturbances. It has been largely replaced by benzodiazepine anxiolytics. (Equallil).
meptazinol An analgesic for the relief of moderate to severe pain. It has a more rapid and extended action than morphine, and is less likely to cause respiratory depression or induce dependence.
Dose: 800-1600 nig orally daily. In severe pain, 50-100nig by injection, repeated as required; in obstetric analgesia, 2 nig/kg. The action can be partly antagonized by naloxone. Side-effects include dizziness and nausea. (IMeptid).
rinequitisizine An antihistamine used for the symptomatic relief of allergic states such as haytever and urticaria. It is less likely to Cause sedation than sonic other antihistamines.
Dose: 10 mg daily. Side-effects may include dry mouth and blurred vision. (Prinialan). See page 110 and Table 2.
mercaptopurine A cytotoxic agent used in the treatment of acute leukaemia.
Dose: 2.5 niWkg daily. Close haernatologi,al control is essential, as the drug has .1 marked niyelosuppressive action. \.lercaptopurine is also hepatotoxic, and should be withdrawn if jaundice occurs. (Puri-Nethol). See page 122 and Table 8.
meropenem An antibiotic similar to imipenem. but more resistant to breakdown by renal enzymes, so combined use with an enzyme inhibitor is unnecessary. Dose: given by i.v. infusion in doses of 500 mg-2 g 8-hourly according to the severity of the infection. Care is necessary in hepatic disease. (Meronem).
mesalazine The active metabolite of sulphasalazine. It is not suitable for oral
use as such, but can be given as a resin-drug complex, so that the drug reaches and is released in the colon unchanged. It is used both for the acute attack and for the maintenance of remission of ulcerative colitis, particularly in patients unable to tolerate sulphasalazine.
Dose: 1.2-2.4 g daily. Side-effects include gastrointestinal disturbances, and care is necessary in patients hypersensitive to salicylates. Patients should be advised to report an), bruising, bleeding or malaise. If .a blood dyscrasia is suspected, a [)food count should be done and the drug withdrawn. Lactulose should not be used as a laxative, as it may hinder the release of the active drug. Also used as enema and suppositories. (Asacol; Pentasa; Salofalk). See page 172 and Table 32.
mesna A compound used to prevent the liaemorrhagic cystitis caused by the cytotoxic drugs cyclophosphamide and ifosfamide. The reaction is caused by the metabolite acrolein, and mesna reduces the toxicity by combining with acrolein in the urinary tract.
Dose: 20%, of that of the cytotoxic drug, and should be given at the same time by i.v. injection. Subsequent supportive doses may be given orally or by injection il - 8 hours after therapy. (Uromitexan).
mesterolone An orally active androgen with the actions and uses of testosterone. It is used in androgen deficiency and male infertility but, unlike other androgens, it does not inhibit endogenous androgen production, and is less hepatotoxic. Dose: 75-100 mg daily for sonic months. (I'm Viron).
mestranol An orally active oestrogen present in some oral contraceptive products. See page 264.
metaraminol A sympathornimetic agent that increases the blood pressure by a general constriction of the peripheral blood vessels. It is used mainly in the acute hypotension that may occur with spinal anaesthesia. It has also been used in shock, but the use of vasoconstrictors has declined, as in shock the peripheral resistance may be already high, and the use of blood volume expanders and dopamine and dubotamine is now preferred.
Dose: 15-100 mg 1)), i.v. infusion. Side-effects are tachycardia and reduced renal blood How. It is contraindicated in myocardial infarction. (Aramine).
metformin An orally active biguanide hypoglycaemic agent. Its action differs from that of the sulphonylureas, as it acts by increasing the peripheral uptake of glucose. It is used mainly in non-insulindependent diabetes not controlled by diet and sulphonylurea therapy.
Dose: 1.5-3 g daily according to need and response. Side-effects include nausea and transient diarrhoea. 11 may cause lactic acidosis and it should not be used in patients with renal impairment. (Glucophage). See page 131 and Table 13.
tmethadone A morphine-like analgesic with reduced sedative effects. Ofvalue in severe pain, and in the relief of useless cough in terminal disease.
Dose: 5-10 mg orally or by i.m. or s.c. injection, in intervals according to need. Prolonged treatment carries the risk of cumulative effects and overdose.
(Physeptone).
methenamine See hexarnine.
methionine A sulphur-containing amino acid essential for nutrition. It is used mainly in paracetamol poisoning, often with acetyl cysteine, and given within 10-12 hours.
Dose: 2.5 g 4-hourly up to a total of [0 g.
methocarbamol A skeletal muscle relaxant used in muscle injury and spasm.
Dose: 6g daily orally; 1-3 g daily by slow i.v. injection. It may cause drowsiness, dizziness and allergic rash. Contraindicated in epilepsy and myasthenia gravis. (Robaxin).
methohexitone A short-acting i.v. anaesthetic similar to thiopentone. It is used mainly for the induction and maintenance of anaesthesia for short operative procedures, when the quick recovery may be an advantage. (Brietal).
methotrexate A cytotoxic agent that acts by inhibiting the synthesis of purines, and so indirectly interferes with cell proliferation. It is used chiefly for maintenance therapy in the remission of acute lymphoblastic leukaemia in children, but it has been used in choriocarcinoma as well as some lymphomas and solid tumours.
Dose: in children, I5 mg/in' weekly. It is sometimes effective in resistant psoriasis, and is given in oral doses of 10-25 nig weekly under specialist supervision. It is occasionally used in severe rheumatoid arthritis not responding to other treatment in doses of 7.5 mg once weekly. Side-effects are those of gastrointestinal toxicity, niyelodepression, rash and cirrhosis. Blood counts and liver function tests during treatment are essential. Cough and dyspnea may indicate pulmonary toxicity. Aspirin and non-steroidal anti-inflaniniatory drugs (NSAIDs) should be avoided, as they delay the excretion of methotrexate and increase its toxicity. See page 122 and Table 8.
methotrimeprazine An antipsychotic agent of the chlorpromazine type, with similar actions, Uses and side-effects. It is used in schizophrenia when a sedative effect is also required.
Dose: 25 -50 mg daily, but much larger doses, up to 1 g daily, may be required, particularly for bedfast patients. It is of value as an adjunct to other therapy in terminal illness and is sometimes given by continuous s.c. infusion in doses of 25-200 ing over 24 hours. Postural hypotension may occur in elderly ambulant patients. (Nozinan). See page 168 and Table 30.
methoxamine A sympathomimetic agent that increases the blood pressure by constriction of the peripheral vessels. It is used in the hypotension following spinal anaesthesia; to correct an excessive response to antihypertensive drugs; and to arrest supraventricular tachycardia. Dose: 5-20 mg by i.m. injection; 5-10 mg by slow i.v. injection. Care is necessary in preexisting hypertension and cardiov.iwular disease (Vasoxine).
methyl cellulose A derivative of cellulose that is used as an emulsifying agent and bulk laxative.
Dose: 1.5-6g with water, but not at night. It is sometimes given in diarrhoea, with a minimum amount of water.
methyl salicylate A pale yellow liquid with a characteristic odour. It has long been used as wintergreen liniment and ointment for the local relief of muscle pain and rheumatic conditions, but is now less popular.

methylated spirit Alcohol containing 5% of wood naphtha. Used for skin preparation and alcoholic applications. The methylated spirit used domestically differs, and is coloured violet to indicate its unsuitability for medicinal use.
methylcysteine A sputum-liquefier claimed to be of value in respiratory conditions where the sputum is viscid. Dose: 600 ing daily. (Visclair).
! Met
other pressor amines. It is used mainly in the preoperative control of adrenaline-producing tumours (pliaeochrornocytoma), and in the long-term treatment of patients unsuitable for surgery.
Dose: I g daily initially, increased if necessary up t(') 4g daily. An adequate fluid intake is essential. Side-effects include sedation, which may be marked initially, diarrhoea, which maybe severe, depression and confusion. (Dernser).
so
methyidopa A centrally acting antihypertensive drug, usually given together with a diuretic. It has the advantage of being relatively safe in asthma, heart failure and pregnancy.
Dose: 750 ing-3 g daily; 250-500 mg by i.v. infusion. Side-effects are drowsiness, depression and diarrhoea. A systemic lupus crytheinatostis-like syndrome may also occur, and active liver disease is a contraindication. (Alcloinet). See page 148 an(] Table 21.
tmethylphenidate A central stimulant used occasionally under strict supervision for the treatment of hyperactive children. Dose: 5-10 mg daily. Witalin).
metoclopramide A stimulant of gastric and small intestine transport. It is used in the treatment of nausea and vomiting generally, including that induced by drugs or migraine, in non-ulcer dyspepsia, and in accelerating the passage of a barium meal.
Dose: 15-30 ing daily orally or by Lin. or i.v. injection. A single dose of 10-20 mg is given by injection 10 minutes before radiological examination. Side-effects include extra-pyramidal reactions, facial sprints and oculogyric crises, mainly in voting persons, and it is best avoided in patient., under 20 years of age. (Maxolon). Some long-acting products are also available. See page 158 and Table 25.
tmethylphenobarbitone An anticonvulsant with the actions, uses and side-effects of phenobarbitone.
Dose: in epilepsy, 100-600 ing daily. (Prominal). See page 136 and Table 15.
methylprednisolone A corticosteroid with the actions, uses and side-effects of prednisolone, and given in similar doses. (Medrone).
methysergide A synthetic drug related to ergonicirine and used in the prevention of severe and recurrent migraine not responding to other drugs.
Dose: 2-6 ing daily. It is also given fur the symptomatic treatment of the carcinoid syndrome in (loses of 12-20 ing daily. Mcthvsergide has many side-effects, including retroperitoneal and cardiac fibrosis, and its use requires expert supervision. (Des-A-ril)-See page 154 and] able 23.
metipranolol A beta-adrenoceptor blocking agent used as eye drops 0.1-0.6% for the treatment of chronic glaucoma.
metirosine An enzyme inhibitor that interferes with the synthesis of adrenaline and
metolazone A diuretic with the actions, uses and side-effects of bendrofluazide.
Dose: in hypertension, 5 mg daily I p
initially; in oedematous statcs,5-20ingor more daily may be given. The diuresis is increased by combined treatment with a loop diuretic such as ffl,lsemide, but monitoring of the response is necessary. (NIctinex). See page 148 and Table 21.
metoprolol A beta-blocking agent used in the control of angina, but also of value in hypertension and the prophylaxis of migraine.
Dose: in angina, 100-300 mg daily; in hypertension, 100-400 ing daily; in migraine prophylaxis and thyrotoxicosis 200 ing daily. It is occasionally given by slow i.v. injection in acute cardiac arrhythinias; dose 1-2 nighnin tip to a total of 10-15 mg. Care is necessary in heart block, bradycardia and pulmonary disease. (Betaloc; Lopresor). See page 114 and Table 4.
metriphonate An organophosphorus schistosornicide, but used only in infections of the hookworm Schistosonia haemobitim, which is found in the genitourinary veins.