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.

[Marmaladecat1]

I would also like to repeat Rufus's first question!

[Gumblossom]

Is it true that taking NSAID's (anti-inflammatories) around ovulation time may suppress ovulation as there needs to be inflammation for the egg to be released?

[Gumblossom]

Does the quality/quantity of sperm deteriorate as men age? I have had 4 miscarriages in my 40's and often wonder if it is all down to my "old" eggs, or whether the aging sperm might be a contributing factor. My husband is in his early 50's.

[TheCheckerdyHorse]

I'm pretty sure it does, Gumblossom - which is why I asked my question, right at the top, namely: can a young man with no existing health problems freeze his "young, healthy" sperm, thus safeguarding some before it deteriorates or is damaged by illness or environmental factors?

[FizzyFeet]

Are there any supplements etc that can actually have a negative effect on your chances of conceiving? I'm thinking of herbal ones like agnus castus which seem to have a powerful effect. In my experience, HCPs can be very non-committal on the subject. Is the vagueness just because of lack of evidence, or because most things are genuinely 'harmless'?

[RidgyTipper]

Gunblossom have you been tested for MTHFR?

[MoreTeaPenguin]

I hadn't heard of Sense about Science before, what a good idea! And there is so much anecdotal stuff around conception and fertility, so what a good topic!

Do you agree that a big breakfast can help with fertility in PCOS? www.nhs.uk/news/2013/10October/Pages/Big-breakfast-boosts-fertility-for-some-women.aspx. Are there other things that help with PCOS conception?

Is there evidence that any or all of charting temperature, cervical mucus, lh pee sticks, cervical position etc are helpful to conception?

Is there any evidence that www.duofertility.com is more effective than placebo?

How about guaifenesin for lack of cervical mucus? Is there evidence that it helps with conception? Are there any side effects? I ended up with a sore throat, but that might just be because I caught a bug! I also ended up pregnant, but that also might be coincidence!

[beakybeak]

Is there a natural way to improve your thyroid activity i.e. through food/diet or supplements. What should your TSH be for conception?

Is there a reason for bleeding at different times of your cycle when you shouldn't be and how can this be resolved. Is this ever harmless?

[Gumblossom]

Ridgy yes I have had all the testing done after my second miscarriage. Unfortunately nothing much showed up. My first miscarriage was due to trisomy 13. I didn't find out what caused the others . It's been put down to being older. I was 43,43,45 and 47 so not surprising but still sad. I should have ivf with donor eggs but my dh is not open to it. I still hope I might have one decent egg left.

[BoodleDoo]

Good question, Beaky - I'd like to know about TSH levels too!

[joycep]

There are so many stories out there of people who tried for years and years and then they properly gave up and they then got pregnant. Stress is known to contribute to infertility. But what about worry and negativity? Is there any evidence to suggest that it can prevent a pregnancy. It just astounds me that there are so many of these stories out there. It is almost like some women become so het up by not getting pregnant, their bodies refuse to do until they relax about it.

[Tranquilitybaby]

Why aren't progesterone levels tested as standard as soon as a woman gets a positive pregnancy test result and if deemed low, a progesterone supplement given as they do in the US?

Would this approach help to prevent the relatively high number of miscarriages that occur?

[squizita]

Tranquility we have very similar MC rates to the USA. Low progesterone is a marker of a problem in the vast majority of cases: not a cause. MC is a slightly different area to fertility and their conflation can cause delays in treatment for women with specific MC (as opposed to fertility) issues - have heard many stories.
In the USA or under a UK Dr who mixes up the two it is likely my own issues (which are not that unusual) would have gone undiagnosed as they wrote "implantation issue... Give progesterone" again and again.

[Unsureif]

My questions:

1.
How much does sperm count fluctuate? We had ICSI three years ago (successfully). All sperm counts were >4 million and the morphology averaged around 2% normal with motility being 30% at the best. I had a natural pregnancy last year resulting in baby girl. So how likely is it that it was either a) a super sperm or b) my husband's sperm count has greatly impoved (diet etc is exactly the same).

We'd like to have a third eventually and I'm curious as to whether we could have another natural pregnancy.

1. I have an increased risk of breast cancer due to a slight family history (mother only, no obvious genetic link to cancer identified). I also suffered OHSS during IVF. Due to all the drugs etc am I at increased risk of breast and ovarian cancer now? Are people who have used these drugs generally at greater risk? What can counter act this?
   

1. Is our icsi conceived son more likely to have sperm issues himself?
   

1. Where do you see treatments going over the next couple of decades?

[EffinIneffable]

What is the evidence about how alcohol consumption affects conception?

It's well documented that alcohol has an adverse effect on fetal development, which is why many women don't drink in the tww. But at this point there is no shared blood supply between the mother and the fetus.

What is known about how alcohol affects ovulation and implantation and would it actually make more sense to abstain in the period leading up to and around ovulation and potential fertilisation?
And what is known about how alcohol consumption affects risk of early miscarriage?

The official advice is to abstain completely while ttc, and I'm not suggesting drinking a bottle of wine every night, but total abstention for a year or more while ttc can itself contribute to the stress. I am wondering whether the official advice is more 'precautionary' because they think if they say you can drink at all we'll all be getting plastered every night or whether it's based on scientific evidence of how alcohol actually affects the process of conception?

So if you're going to have an occasional drink - what period in your cycle is less risky and what period should you really avoid?

[LucilleMumsnet]

This Q&A is now closed. Thank you to everyone who took part, we have sent the questions over to the experts and will be posting up their answers next week.

[LucilleMumsnet]

We now have answers back and will be posting them up shortly. Due to the huge interest in this Q&A, Sense About Science and the panel members have agreed to try and get the remaining questions answered in the coming weeks.

[SenseAboutScienceExperts]

[quote raydown]Is there anything that can be done to improve a very low sperm count

[SenseAboutScienceExperts]

@joycep

At my fertility clinic, all ivf ladies were given strict instructions to drink at least a litre of milk per day before and during ivf. They said getting a lot of protein was imperative. Is there any truth behind this? And is milk really the best way to get your protein quickly especially as there are questions marks about whether dairy is actually good for humans?

Susan Avery: Fertility is affected by general health in the same way as every other function of the body, so a healthy diet may help to optimise your chances. If your diet is lacking in protein then you should address this in the interests of general health and a balanced diet. There is no evidence that milk in particular will help. Milk can cause problems for some people, aside from those known to be lactose intolerant, in particular people who suffer from acid reflux. Just aim for a balanced diet in a way that suits you. There's nothing magic about milk.

[SenseAboutScienceExperts]

@Triplespin

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.

Gillian Lockwood: It is unlikely that egg quality can be 'improved', the best we can do is avoid damaging it by smoking, obesity etc. I always recommend a multi-vitamin (with folic acid and iron) for all patients having fertility treatment (or trying to get pregnant naturally). There has been very interesting work published in 'Fertility and Sterility' which found that women on a high carbohydrate diet where less than 25% of their daily calories came from protein, even when they were not overweight, had a significantly lower pregnancy rate and higher miscarriage rate than women on a high protein, low carbohydrate diet.

[SenseAboutScienceExperts]

@joycep

Should people undergoing ivf quit refined sugar? There are claims that it has a negative impact on the way the follicles develop. Is this true?

SA: Everyone should aim for a healthy diet, and that includes reducing refined sugar. There is a huge amount of advice out there – some of it contradictory, and very little of it underpinned by evidence. Aim for a healthy balanced diet rather than focussing on a particular aspect of your diet.

[SenseAboutScienceExperts]

@Bue

I'd also like to know about improving sperm health. What are some concrete, evidence-based actions (if any) you can take to improve motility and morphology? You hear a lot about reducing/eliminating alcohol, but does this really make a difference?

AP: The quality and quality of sperm men ejaculate is a function of many factors such as the size of testicles, the time since last ejaculation as well as aspects of lifestyle, illness, infections and diet. It would be a tall order to devise an intervention to improve sperm health. A better way of looking at it is for the man to remove himself from known harm so that the sperm he ejaculates are the best possible quality. We know that men who work with solvents such as glycol ether or who wear tight underwear generally ejaculate lower numbers of motile sperm. In addition, men who have used cannabis in the last 30 days are more likely to have sperm of poor morphology. Smoking cigarettes is likely to damage sperm DNA. If these risks are removed and the man has a healthy diet, then this is likely to have a positive impact on sperm health, although the exact study to show that has not been done.

[SenseAboutScienceExperts]

@victoria401

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?

AP: Testing for sperm antibodies in the laboratory is a very difficult to perform with any certainty and moreover the national quality control programme was stopped a few years ago because it was almost impossible to provide what we call 'external quality control'. If you combine this with the fact that doctors are uncertain about the role of sperm antibodies in male fertility and it is not clear how to use the data to guide clinical decisions, you can appreciate why many laboratories no longer perform the test. Indeed in 2004 NICE (National Institute for Health and Care Excellence) recommended that the test was not done and as far as the World Health Organisation recommendations are concerned, it has only been an 'optional test' for many years. I am unaware of any supplements or potions that can remove sperm antibodies and would be most cautious about using them for this purpose.

[SenseAboutScienceExperts]

@FizzyFeet

Are there any supplements etc that can actually have a negative effect on your chances of conceiving? I'm thinking of herbal ones like agnus castus which seem to have a powerful effect. In my experience, HCPs can be very non-committal on the subject. Is the vagueness just because of lack of evidence, or because most things are genuinely 'harmless'?

GL: There are two problems with supplements. The most significant is that they can act as 'hormone mimics' and interfere with baseline hormone assessments and monitoring. The best example is soya extract which can be helpful with menopausal symptoms because it acts a little like oestrogen. Agnus castus has been found to help with a wide range of 'female' problems including pre-menstrual dysphoria, lumpy breasts and even 'hyper' sexuality (it is the fruit of the 'chaste' tree, after all). The second problem is the source and purity of the supplements. This is especially relevant for Traditional Chinese Medicine as the practitioner may be treating in good faith but using imported substances of dubious provenance (one pile of powdered bark looks much like another!)

[SenseAboutScienceExperts]

@MoreTeaPenguin

Is there any evidence that www.duofertility.com is more effective than placebo?

GL: A the current crop of 'smart' fertility aids like duofertility, Fertilicare Conception and Kindara fertility tracker are all designed to make measuring bbt (basal body temperature) more accurate (and possibly more fun). I feel that anything that takes the spontaneity out of love-making is more likely to be counter-productive however. Partners often get performance anxiety when told it is the 'right time' and sex can become a chore to make babies rather than a glue to stick couples together.

Sperm works best when 'young' and waiting for the 'right' time can result in a large number of half-dead sperm being delivered. Frequent intercourse (every two to three days) from the end of one period to the start of the next is probably better than anything electronic. For women with very irregular cycles (probably PCOS – polycycstic ovary syndrome), then weight loss (if required) and ovulation induction are likely to be the way forward.