Q&A about fertility claims with Sense About Science -ANSWERS BACK

[LucilleMumsnet]

This week we're running a Q&A with Sense About Science about fertility. Sense about Science has teamed up with Progress Educational Trust and the British Fertility Society to help people Ask for Evidence behind fertility claims. If you’ve seen claims for products, diets or policies about fertility then send us your questions and we will put them to the scientists.

Superfoods to promote your chances of conceiving, home-made energy bars to ward off infertility, and even fertility astrologers. Fertility is a global industry and there are hundreds of claims out there. But which ones are based on evidence that they work? Sense About Science tackles claims that aren’t backed by evidence and regularly hear from people about the emotional cost of chasing false hope.

The experts answering the Q&A will be:

Dr Allan Pacey, senior lecturer in andrology and chairman of the British Fertility Society - His research interests cover the biology of human spermatozoa and aspects of semen quality and fertility in males including occupational and environmental influences on semen quality.

Dr Gillian Lockwood, medical director of Midland Fertility - She has a special interest in age-related infertility, Polycystic Ovary Syndrome and nutrition.

Dr Sue Avery, director of assisted conception at Birmingham Women's Hospital - She has been working in the field of infertility for 30 years, as a clinical embryologist.

Post your questions to the thread before 10am on Monday 16th June and we'll post up the experts' answers the following Monday 23rd June.

I've had a few questions emailed to me directly at Sense About Science:

1. Is there evidence that Folic Acid and Inistol together assist fertility and chances of IVF increasing?

1. Is there evidence that acupuncture and Reflexology do assist your chances of getting pregnant?

1. Is it correct that your maternal age is a reason you will not get pregnant or a high BMI?

Hello - great chat idea, thanks for your time people. Here's my Qs:

1. Do you think there a problem with IVF being overused? This BMJ article says so: www.bmj.com/content/348/bmj.g252 (not a full-text link)

1. What do you think about women identifying their "fertile window" each month by checking their cervical fluid and waking temperature and using pee sticks?

I'm interested into the claims around sperm-friendly lubricants.

6 months ago Mumsnet ran a competition thread so that one of these products (Balance Activ) could gain information on contributors experiences with using these products.

I'd done quite a lot of research in our TTC efforts and couldn't find much evidence to back up that they were more effective than normal lubricants. So I asked the following question on that board. Surprise, surprise the company never answered the question, and to be honest I've been miffed ever since that Mumsnet didn't push them on it:

I'm also a scientific-type bod and have done some cursory searching of the scientific literature to read the evidence. I haven't found anything about Balance-Activ specifically and studies seem to be quite thin on the ground and old (late 90s). The most recent study (Agarwal et al, 2008) says that Pre-seed didn't decrease sperm motility like other general lubes. It doesn't say the sperm motility is increased. Perhaps Mumsnet could ask Balanc-activ to provide the studies mentioned above and on their website that 'Balance Activ Conceive formula can aid the motility of poor quality sperm'? This would aid couples to make evidence-based decisions on using fertility-aid lubricants. Conception is a very emotive subject. Providing the hard evidence rather than airy-fairy references to 'studies' would help couples analyse whether they want to add yet another cost and hope to the rollercoaster of conception.

Dr Pacey, would you mind commenting on the evidence or otherwise for using sperm-friendly lubricants when trying to conceive?

And for Mumsnet directly do you not think that when product advertisers contact you to mine information from, and advertise to, people in the emotionally difficult time of trying to conceive you should check the veracity of the product claims? And further…to ask the companies to provide the evidence for their claims so that Mumsnetters can make up their own minds separate from the advertising blurb?

Me and my husband have been classed as infertile as he has 100% antisperm antibodies. I was surprised to find out that many labs don't routinely test for this and maybe could explain some of the unexplained cases of infertility. I've read that taking high doses of vitamin C and a supplement called TribulusTerrestris could help unbind the antibodies and give us a chance of conception. Can this do him any harm to try?

I have no fertility issues but due to a blood condition miscarry 90% of pregnancies eventually if not on medication. I have always conceived easily and am now in my mid 30s, pregnant with my first because I have the correct medication finally.

I find it fascinating that some women are told they will not conceive and the rate of miscarriage will rise suddenly after 35 by some private fertility clinics, but recurrent miscarriage clinics say conception takes longer but there's no significant rise in miscarriage until later in the 30s.

There seem to be different specialists saying different things.
Where is the most reliable source of information? As other posters have noted, there's scaremongering in the media and it does not balance what I see in real life: most women i know do have a child - be it their 1st or their last - aged 34-40. Whilst it may not be wise to wait (if you have the luxury of not having that wait thrust upon you by another medical issue... ) I see far more anxiety about conception aged 34-40 in women with a history of good fertility than I think is realistic (thinking pfb will be an only child if they don't conceive by 34 1/2 for example).

LadyIsabella the risks for miscarriage, according to specialists in miscarriage (a different area from fertility) have the risk rise significantly at 38-42. Not before. At 35 you have a 75-80% chance of success, pretty similar to a 25 year old. Later it sinks to 65 and eventually down to 50% when you are over 42. These are proven stats from EPUs over the years.

It's actually something which has delayed recurrent miscarriers from being tested (GP ignorance about such matters).

Does sexual position affect chance of conceiving? I'd always assumed it best to take advantage of gravity (during and for a little time afterwards) but saw a documentary where a scientist (?) said we had evolved (for want of a better word) for quickies in case a predator/threat turned up halfway through?!!!!!1111!

Great questions, can't wait to read the answers :)
I'm going to be cheeky and ask another one if I may. Is there any evidence that imsi or picsi increase success with ivf for severe male factor infertility? We've had two rounds (6 day 2 embryo transfers) but no positive result and our clinic are now suggesting we try PICSI but we have to pay extra for this and I don't know if it's worth it.

How come science seems to know comparatively little about exactly how fertility works?

As many as a third of infertility cases are given the (non) diagnosis of 'unexplained'. The prices charged by IVF clinics suggest that there is money to be made in this area!!

So why does science still have so few answers?

What is your view on undertaking acupuncture to help with unexplained infertility? This has been suggested to us by the NHS clinic we are attending but I would like to know if the science justifies the cost?

So far, the only diagnosis I have after two years ttc is 'unexplained infertility'. I suspect problems with my luteal phase, but this has not been acknowledged by any of the HCPs I have seen.

My luteal phase is 11 days. I know this because I have been tracking my cycle for two years. I know the NICE guidelines cite research that women cannot reliably pinpoint ovulation. This may be the case statistically for groups studied as a whole, but I don't think this can be applied to individuals. I reliably see a temp rise, I experience ovulation pain, fertile cervical fluid, increased sex drive, and I have used a cbfm to detect the LH surge. I know when I ovulate. And frankly, I'm pretty irritated by HCPs who don't believe me. I may not have a medical degree, but I know my own body.

Rant aside, I have an 11 day luteal phase, I frequently experience mid-luteal spotting, and two day 21 progesterone tests came back 'borderline' at 29 and 31. Of course I have no way of knowing for sure, but it seems to me that this could be a contributing factor to my inability to conceive (all other standard tests, including HSG and dh's sperm analysis have come back fine) and perhaps luteal phase support in the form of progesterone supplementation might help. But because this is not recommended in the NICE guidelines, it's not an option.

The evidence may not exist purely because the right studies haven't been done. But surely, just knowing the biology of fertility, it should be worth considering? I would be interested to know the experts' opinions on this.

What are the chances of conception if there is only one Fallopian tube that is patent/working? How much are the chances reduced compared to if both tubes were normal?

Is it true that you can ovulate from the ovary on the blocked tube side and still conceive as the working tube 'catches' the egg or is this a myth?

Does oral sex and saliva from it kill sperm?

Like Barking and Happy Ambler, I would also like to know more about scientific understanding of the luteal phase. I have used ovulation testing kits and temperature taking, as well as cervical fluid and positioning to estimate my ovulation date. All these signs occur together and suggest a luteal phase of 9 days. So, my questions include:
Why do many doctors and gynaecologists not take this seriously?
Why is it thought that all women have 14 day luteal phases?
Has there been any significant research to investigate luteal phase and impact on conception?
Why is progesterone not used for treatment when Clomid is dished out like sweets?!

Also, I keep hearing things about eliminating wheat to improve fertility and the general heaviness/pain associated with periods. Is there scientific evidence to back this up? If so, why does it help?

Oh, I forgot one! Natural high killer cells always seem to end up in the newspapers (presumably because they sound so terribly dramatic) but I've heard mixed ideas about their impact on conception. If they do have an impact, are there symptoms? For example, I've tried to find out why I have strong allergy symptoms, that are non-responsive to meds, a couple of days before my period comes. I tried googling (dangerous, I know) and the nhk cells and the idea of being 'sensitive to progesterone' came up. Is that even possible?!

Is there any evidence to suggest that some couples are just not compatible when it comes to making babies? You hear of couples who cannot conceive with each other, they split and then go on to conceive perfectly well with other people. Our consultant told us that for some reason, and it's not even a quality issue of egg and sperm, that some couples just produce faulty embryos. Is this really true?

Joycep that's an interesting one because of course you can get 2 people who are less genetically compatible due to both having some high-risk genes which 'clash' (tested by karotyping) and have a higher risk of it not working - but are there things still undiscovered?

I fell pregnant very easily at 43, was I just lucky or could it happen again at 48?

Can we take supplements to improve egg quality or can this not be altered (we are born with all the eggs). If so, what do you recommend. There are so many touted by various fertility experts eg maca, coenzyme 10, dhea, greens etc.

Also i have often heard of greater risk of miscarriage for women with pcos. What is the reason for that?

1. Is it better to have sex every day or every other?

1. How long does sperm live inside the woman? I have heard anything from 24 hours to seven days.

1. Why do I not see fertile mucus every month? Is it a problem if you don't always see it? I don't go "rummaging" to find it but when I do see it is obvious.

1. When should I start to worry about not conceiving? I have been trying for six months.

1. How long after the LH surge should you ovulate? I use the same brand every month (Cleablue Digital) and seem to ovulate anywhere between the day of the surge to two days later.

1. I am nearly 32 and my periods are lighter than in my 20s. Could this be a sign of fertility issues?

Thanks!

thanks for this.

my questions are:

as someone else asked, for thise given an 'unexplained' diagnosis, whst further investigations beyond bloods (fsh, lh, thy, prog, oest) and scans (int ult, ext ult, hycosy) should be conducted?

what may explain this diagnosis? eg is it possible eggs are released into the abdominal cavity and not the fallopian tube? if so how can the underlying causes be identified?

are there any lifestyle factors which demonstrably affec liklihood of conception? (eg alcohol).

what is the prognosis for those with pco, as opposed to pcos?

thanks.

I read an article on nice.org.uk here that was published in 2010. It discussed whether smoking in pregnancy can have an impact on the fertility of offspring. Has there been any further research on this issue?

What advice to you give to normal weight women with PCOS to better regulate hormones and improve ovulation?

What level of AMH pmol/L do you consider an indicator for poor ovarian reserve?

Yes, I'd like to repeat Rufus's first question please - what can normal weight women with PCOS do to improve their fertility/hormone balance?