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.

@onelubeonelife

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?

AP: We know that some lubricants used by couples during intercourse can be bad for sperm when ejaculated sperm are incubated with those lubricants in the laboratory. This also includes human saliva which is also used by some couples as a lubricant. However, there is no epidemiological evidence to suggest that these actually reduce the chances of conceiving, although it is a reasonable assumption. There are some sperm-friendly lubricants available on the market and under laboratory conditions these do not appear to be detrimental to sperm survival. However, to my knowledge they have never been tested in couples to see if they enhance conception, but it would seem reasonable to assume they do not do any harm if they are used according to the manufacturers instructions.

@SenseAboutScience

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?

GL: Inofolic (a combination of inositol and folic acid) is a new product specifically formulated to assist the fertility prospects of women with polycycstic ovary syndrome (PCOS) whether they are trying to conceive spontaneously or with IVF. Taken as a nutritional supplement, there are good clinical trials suggesting that it improves cycle regulation and reduces the hyperandrogenism (raised testosterone) that causes some of the distressing features of PCOS such as excess facial hair, acne and obesity. Taken in conjunction with Clomid, it improves the ovulation rate in women with PCOS.

@joycep

When I had ivf, I was given steroids and ivig treatment because my immune results showed I had an over active immune system. The clinic had excellent results with this treatment, with many women finally having a successful pregnancy after multiple failed treatments elsewhere. Many top private clinics use this treatment and does many places in the USA as well.

Yet it is not accepted by NHS doctors and most are not even willing to have a conversation about it. Is this because there just isn't enough evidence for this treatment at this time? And is it possible that one day the evidence will show that women's immune system can play a role in recurrent miscarriage and unexplained infertility?

SA: There is a lack of real scientific evidence for this type of immune therapy, and certainly in the NHS we are concerned about offering expensive treatment, for which patients would have to pay, about which we remain unconvinced. It is true that some very successful private clinics offer this treatment, get very good results and believe in this treatment. It is arguable that they would have achieved these results without IVIG, but very difficult to prove. In the world of fertility treatment there is a great deal of criticism of the use of unproven treatment for which patients have to pay, while there is also a great deal of frustration for patients who are unable to access treatments that they have been lead to believe will help them. We would rather offer treatment supported by evidence and we hope our patients understand that we do this in their best interests as we see them.

@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?

SA: The majority of centres automatically give progesterone (so there is no need to do a progesterone level test) following embryo transfer and the NICE Guidelines recommend this.

@Magda37

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?!

AP: Unless there is a disability or an anatomical reason to prefer one sexual position over another, I cannot see the rationale for this affecting the probability of conception. When sperm are ejaculated into the woman's body, we think that the sperm that pass through the cervix quickly are the ones that will find and fertilise an egg. Any sperm remaining in the vagina probably die quickly and are lost. There is at least one study showing that after a fertility treatment called IUI, a 10 or 15 minute bed rest can improve pregnancy rates slightly, but I don't think sexual position matters as long as the male is able to ejaculate into the vagina.

@ballsballsballs

A lot of people on the fertility forum I used to frequent were convinced that acupuncture would help the success of IVF. Is this true?

SA: In 2010 the British Fertility Society published a review of the existing data/publications and found no evidence that acupuncture has a positive effect on the outcome of IVF. Another review published in 2012 saw no clear benefit, but found that the type of clinical trial influenced the outcome. In any case it is difficult to say with any conviction that acupuncture has a direct influence on the outcome of IVF.

@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.

SA: Most women are aware that stress can affect their menstrual cycles, just as it can affect so many aspects of our physiology. A relaxed state is a healthier state to be in, and worry/negativity are really aspects of the conditions we call stress/depression. It is certainly possible that these conditions may inhibit conception, and their removal may improve the chances of achieving a pregnancy. However, a positive attitude is not a cure for infertility where there is identified pathology. We would always encourage a positive attitude, and as relaxed a state of mind as possible for the sake of general health.

@SenseAboutScience

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

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

GL: The evidence is conflicting and rather weak. Some studies have found a benefit but others have found that it is not helpful. One study compared real acupuncture with sham acupuncture and found no benefit of sticking the needles in the right place. Indeed an article published in Human Reproduction in 2009 found that placebo or sham acupuncture had a higher pregnancy rate than real acupuncture. Clearly acupuncture can produce strong placebo effects. The perceived benefit of acupuncture may lie with stress reduction and relaxation it can induce.

@Tinkleybison

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?

GL: Acupuncture aids stress management and stress has been associated with unexplained infertility (via raised prolactin and cortisol levels). The frequency of unexpected pregnancies that occur when couples 'give up' fertility treatment and go on holiday are good evidence for this.

@YouAreMyFavouriteWasteOfTime

i would like to see more scientific information about fertility decline and aging. information in the news appears to be low on statistics and high on scaremongering and unhelpful to people wanting to understand the real changes that will/are taking place in their body.

GL: The science is clear. Ever since Malcolm J Faddy first dissected thousands of ovaries taken from foetuses, babies, girls and women of all ages, we have known that a baby girl is born with every egg she will ever have and that they are lost at a predetermined rate influenced principally by genetics but also by health and lifestyle. Smoking, surgery, endometriosis and infection can all damage the ovary's ability to ovulate fertilisable eggs. The quantity and quality of eggs remains perfectly adequate until the late thirties and then there is, on average, a decline in both from the age of about 37-38. It is at this age that the risk of miscarriage starts to rise along with the risk of chromosomal problems like Down's Syndrome. It is vital to remember that 'biological' age and 'chronological' age can vary by 3 years in either direction, so if you are a life-time smoker and your mother had an early menopause (before 50), then it is likely that at age 35 you will have the ovarian reserve of a 40 year old. Don't forget that ovarian reserve is only one factor in getting pregnant successfully, and that sperm quality, tubal status, general health and uterine factors such as the presence of fibroids and polyps all play a role.

@LadyIsabellaWrotham

There's been a bit of a backlash recently regarding the Daily Mail's favourite scary statistics about declining fertility in 35+ women.

Whilst much of the revisionist data seems well-founded, I do worry that all the "Stop Panicking!" articles concentrate on reassuringly high chances of getting pregnant at older ages, but never seem to factor in the significantly higher risks of miscarriage to give you the odds of an actual baby.

What do you think? Am I being too pessimistic?

GL: Data from Denmark which looked at the outcome of 1.2 million positive pregnancy tests demonstrates conclusively that whereas at age 35 only 15% of positive tests will fail to produce a live birth, by the age of 40, it is 40% and by 45 the miscarriage rate is 75%. Healthy lifestyle (normal weight, no smoking or drinking or caffeine with a low carbohydrate intake) can help a little, but principally the problem is that embryos that are made (in vivo or in vitro) from oocytes that have been stuck half-way through their second meiotic division for 30 years are highly likely to be structurally genetically abnormal. The eggs will fertilise and may implant, but Mother Nature does a ruthless 'quality control' check at about 5-6 weeks and this is when the vast majority of these early pregnancy losses or 'blighted ovum' cases occur. When this tissue is examined cytogenetically, significant chromosomal errors are found in the vast majority of cases.

Is there any evidence for the use of IgG food intolerance testing & infertility? Napro recommend this to all their patients.

In relation to sub clinical hypothyroidism, what evidence is there currently that ideally for fertility purposes, the woman's TSH level should be

Is there any known link between Raynaud's disease & unexplained infertility?

You can now see the answers from the Q&A archived here.

Thanks Lucille. Will the experts still be answering the remaining questions? While I genuinely appreciate you running this Q&A, I'm a bit disappointed that questions about luteal phase and progesterone from me and others have not been answered.

Oh yes, I'd love to see answers for the remaining questions if possible, please! I've been ttc#1 for over a year and I'm really interested in lots of them, particularly thyroid levels.

The panel will be aiming to answer a selection of the remaining questions over the next few weeks. For Q&As we normally only expect the experts to answer up to 20 questions, but due to the huge interest here Sense About Science are keen to answer as many as possible, however need to fit this into the experts' busy schedules!