It has been known for quite some time that many lubricants used to facilitate intercourse or as an aid in masturbation for sperm collection may actually be toxic to sperm. A new study presented at the American Society for Reproductive Medicine 2005 conference confirmed this through a more rigorous study analyzing sperm motility and DNA damage after exposure to four brands: FemGlide, Replens, Astroglide and Pre-Seed.

Although no single product left the sperm completely free of damage, the research identified the Pre-Seed product as causing considerably less motility and DNA damage than the others.

The company that distributes this product claims that Pre-Seed is of the same osmolarity (salt density) and pH as seminal fluid. They further claim that it contains a plant sugar that acts as an anti-oxidant.

The study was jointly conducted without funding from any of the lubricant companies by researchers at Cleveland Clinic Foundation in Cleveland, Ohio; South Dakota State University in Brookings, South Dakota; and Washington State University in Spokane, Washington.

In the first experiment, sperm from 13 different donors was analyzed for progressive motility after 30 minutes of exposure to each lubricant while compared to a control batch from the same sperm donors with no lubricant exposure.

The results showed that sperm activity ranged from a high of 66 percent in untreated sperm, followed by 64 percent with sperm treated with Pre-Seed, followed by 51 percent with FemGlide and 25 percent with Replens. The lowest reported sperm motility was 2 percent in a solution containing Astroglide.

In a second experiment, spermatozoa was exposed for 4 hours and then evaluated for sperm chromatin integrity and then analyzed for percentage of DNA fragmentation, and then compared to non-exposed sperm. Again, the results indicated that Pre-Seed was associated with the smallest amount of sperm DNA damage at 7 percent more than untreated sperm, followed by KY at 10 percent and FemGlide at 15 percent.

Besides the brands tested, it is also thought that KY Jelly, Vaseline, and even saliva can have a negative impact on sperm. (One of the least toxic substances is pure mineral oil but it is generally not advised that women use lipid-based products in the vagina. Mineral oil remains an excellent choice for lubrication for masturbation.)

We welcome the news that a product that is backed by independent laboratory analysis is now available that can make vaginal intercourse more comfortable as well as acting as a promoter of fertility.

– Carolyn Givens, MD

In the last ten years or so in the U.S., we have seen an explosion in the number of over-the-counter dietary supplements for all manner of ailments as well as for the promotion of general health. Some are vitamins with well-known beneficial properties. Some are herbal supplements with a history of traditional Chinese medicine yet with little in the way of Western scientific studies to substantiate their use. Many other supplements contain elements and substances with very little known benefit.

Now there are several preparations being marketed to promote fertility. In this article, I chose to review three of the major products being actively marketed for the purposes of improving sperm.

The oldest supplement is ProXeed™. ProXeed™ is a citrus-flavored powder and can be dissolved in juice or other cold beverages. It is recommended by the manufacturer to be taken twice a day. The active ingredients in Proxeed™ are L-carnitine, L-acetyl carnitine and fructose. The cost is approximately $335.00 per 3-month supply.

Fertile One® is a pill that contains L-carnitine, anti-oxidant vitamins (ferulic acid, vitamins C and E, garlic, co-enzyme Q10 and selenium), ginseng root, zinc and B-complex vitamins (B-6, B-12, B-9 and folic acid). Cost is approximately $273.00 per 3-month supply.

FertilityBlend® for Men is a supplement containing L-carnitine, ferulic acid, vitamins E, B6, B12, and the elements selenium and zinc. The cost is only about $80.00 per 3-month supply.

Several studies have shown that the amino acid L-carnitine may promote sperm development. In a recent clinical trial¹, 102 men with low sperm motility were treated with L-carnitine and acetyl L-carnitine. There was a significant correlation between higher levels of carnitine in the seminal (sperm) fluid and better sperm concentration, total sperm count, sperm total motility, rapid forward progression, live sperm count, membrane function, nuclear DNA integrity, capacity for cervical mucus penetration, linearity of spermatic movement, and amplitude of lateral sperm head movement after 3 and 6 months of L-carnitine/acetyl L-carnitine treatment. Another high quality study, a randomized, placebo-controlled trial of L-carnitine and acetyl L-carnitine showed that after 6 months of treatment increases were seen in all sperm parameters and the most significant improvement in sperm motility was present in patients who had lower initial absolute values of motile sperm (<4 million forward or <5 million total motile spermatozoa per ejaculate)². There are no published randomized controlled trials looking at pregnancy rates on L-carnitine.

Several studies on the B Vitamins have been published showing anti-oxidant effects and virtually all find some benefit to the addition of this group to a daily vitamin regimen.

Ferulic acid is found in various medicinal herbs, has recently been shown to scavenge oxygen free radicals and increase the intracellular cAMP and cGMP (energy molecules). The only published article on ferulic acid involved adding this substance to previously ejaculated sperm specimens where it was shown to improve sperm motility³. A medline search did not reveal any studies on sperm after ingestion of ferulic acid.

It is interesting that Fertile One® contains garlic; at least one study has reported an inhibitory effect on garlic on sperm motility and survival in human and mouse sperm⁴ and crude extracts of garlic bulbs have been shown to immobilize ram sperm and are being investigated as a potential male contraceptive⁵.

Selenium is a trace mineral that is incorporated into several anti-oxidant proteins. It has been shown to improve human sperm parameters⁶ and fertility improved slightly when selenium-deficient mice were treated with it ⁷. What is not clear is whether most men with a normal diet would be selenium-deficient.

Folic acid supplementation may also be beneficial, especially for men who smoke Cigarettes⁸. Treatment of men with folic acid and 5 mg zinc improved sperm counts by 60% and also improved morphology (shape)⁹. Vitamin E has also been shown to improve sperm parameters and sperm-egg binding¹⁰. Co-enzyme Q10 has been shown in one small uncontrolled study to improve sperm motility in males¹¹ but studies of men with a varicocele (dilated scrotal veins) suggest that high levels of seminal fluid Co-enzyme Q10 are found with men with the lowest sperm motility, suggesting that Co-enzyme Q10 would not be beneficial for men with a varicocele¹².

Considering all these studies, there does seem to be a beneficial role for dietary supplementation for men with low sperm counts and low motility. The supplement marketed as FertilityBlend® for Men has almost all of the most well studied ingredients and is considerably less expensive than the others. Avoidance of garlic extracts and further supplementation with folic acid may also be beneficial.

– Carolyn Givens, MD

References:
1. Correlation between seminal carnitine and functional spermatozoal characteristics in men with semen dysfunction of various origins. De Rosa M, Boggia B, Amalfi B, Zarrilli S, Vita A, Colao A, Lombardi G. Drugs R D. 2005;6(1):1-9.

2. A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia. Lenzi A, Sgro P, Salacone P, Paoli D, Gilio B, Lombardo F, Santulli M, Agarwal A, Gandini L. Fertil Steril. 2004 Jun;81(6):1578-84.

3. Effects of ferulic acid on fertile and asthenozoospermic infertile human sperm motility, viability, lipid peroxidation, and cyclic nucleotides. Zheng RL, Zhang H. Free Radic Biol Med. 1997;22(4):581-6.

4. Spermicidal effect in vitro by the active principle of garlic. Qian YX, Shen PJ, Xu RY, Liu GM, Yang HQ, Lu YS, Sun P, Zhang RW, Qi LM, Lu QH. Contraception. 1986 Sep;34(3):295-302.

5. Sperm immobilization activity of Allium sativum L. and other plant extracts. Chakrabarti K, Pal S, Bhattacharyya AK. Asian J Androl. 2003 Sep;5(3):230.

6. Male fertility is linked to the selenoprotein phospholipid hydroperoxide glutathione peroxidase. Foresta C, Flohe L, Garolla A, Roveri A, Ursini F, Maiorino M. Biol Reprod. 2002 Sep;67(3):967-71.

7. Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men. Keskes-Ammar L, Feki-Chakroun N, Rebai T, Sahnoun Z, Ghozzi H, Hammami S, Zghal K, Fki H, Damak J, Bahloul A. Arch Androl. 2003 Mar-Apr;49(2):83-94.

8. Low seminal plasma folate concentrations are associated with low sperm density and count in male smokers and nonsmokers. Wallock LM, Tamura T, Mayr CA, Johnston KE, Ames BN, Jacob RA. Fertil Steril. 2001 Feb;75(2):252-9.

9. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Wong WY, Merkus HM, Thomas CM, Menkveld R, Zielhuis GA, Steegers-Theunissen RP. Fertil Steril. 2002 Mar;77(3):491-8.

10. A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility. Kessopoulou E, Powers HJ, Sharma KK, Pearson MJ, Russell JM, Cooke ID, Barratt CL. Fertil Steril. 1995 Oct;64(4):825-31.

11. Coenzyme Q(10) supplementation in infertile men with idiopathic asthenozoospermia: an open, uncontrolled pilot study. Balercia G, Mosca F, Mantero F, Boscaro M, Mancini A, Ricciardo-Lamonica G, Littarru G. Fertil Steril. 2004 Jan;81(1):93-8.

12. Coenzyme Q10: another biochemical alteration linked to infertility in varicocele patients? Mancini A, Milardi D, Conte G, Bianchi A, Balercia G, De Marinis L, Littarru GP. Metabolism. 2003 Apr;52(4):402-

Q.
I sought our physician’s opinion about how my fibroids might impact our desire to get pregnant. Eight doctor opinions later, we are no closer to a decision. About half of the experts advise surgical removal; and the other half tell us to try to get pregnant despite them. Why is the medical community divided on this?

A.
Fibroid(s) of the uterus, also known as leiomyomas or just myomas, are benign growths that may be located on the exterior of or within the muscle layer of the uterus, or may be growing within the lining of the uterus. For the vast majority of women, fibroids do not cause significant health problems.

A few women who desire pregnancy may need to have their fibroids removed (myomectomy) prior to conceiving if the fibroids are very large (greater than 6 cm) and/or if they impinge upon and distort the uterine cavity.

Various surgical approaches to removal are further described on PFC’s web site, along with a more in depth summary of the factors that our physicians consider when counseling a patient to undergo a myomectomy.

You probably received different opinions because the impact of fibroids as related to pregnancy chances depends on the size and location of the fibroids. Other issues to consider are that fibroids are dependent on estrogen to grow, and high levels of estrogen produced during pregnancy can lead to rapid growth of the fibroid(s). If the fibroid is on the outer surface of the uterus, this may present little problem. If the fibroid is located within the uterus muscle wall or nearer the uterine cavity where the fetus is growing, a patient may be at higher risk for various pregnancy complications (miscarriage, preterm labor…).

In rare cases, the fibroid may grow so rapidly during pregnancy that it outgrows its blood supply and starts degenerating, which can be painful and sometimes lead to pregnancy complications. Also uncommon but of significance is the fact that some fibroids may block the lower portion of the uterus, prohibiting the baby’s head to descend into the birth canal, making cesarean delivery necessary. However, it is important to keep in mind that the majority of patients with fibroids experience no problems during pregnancy.

What is the impact of fibroids on pregnancy chances? It is unclear that there is any negative impact, if the fibroids are small and not growing within or distorting the uterine cavity.

The trend towards using more laptop computers in public places and airports will continue to grow as wireless internet access “hot spots” proliferate. This year laptop use in the U.S. is projected to grow to 60 million users. Additionally, laptops are also increasing their heat output with ever-faster processing power. Which begs the question: are we staring at a potential cause of male infertility without even knowing it?

It is well known that healthy sperm are produced ideally at a testicular temperature of 2 – 4 ºC below body temperature. Established studies have revealed a considerable decline in healthy sperm production – up to 40 % – resulting from scrotal or testicular temperature increases as small as 1 ºC. A long-term decline in sperm quality over several decades has also been identified by at least seven research studies, although definitive causes have yet to be determined. Given this, it was only a matter of time before the connection between laptops and infertility would be examined.

As reported in Human Reproduction, Vol.2, 2005, a group of scientists at State University of New York, Stony Brook embarked upon a research study monitoring the scrotal temperature change in 29 healthy male volunteers, median age 24, from laptop computer use. The researchers used two different types of laptop computers and randomly measured their thermal effect on the scrotum by using right and left scrotal temperature gauges in two separate 60 minute sessions.

They recorded scrotal temperature increases averaging 2.6 – 2.8º C.

The heat emitted by the laptops appears to be a factor, but curiously not the solo factor. The researchers also directed the study participants to sit upright without the laptop, but with their knees tightly pressed together. After sitting this way for an hour, researchers recorded their scrotal temperature, which increased on average 2.1 ºC.

This initial study may prompt further research seeking a more definitive link between laptop use and infertility, or it simply may be added to the myriad considerations of exogenous scrotal heat exposure related to lifestyle. In this same category are prolonged driving and sedentary sitting. Naturally this study calls for prudent use of laptops by men trying to become fathers while weighing in on how modern life in all of its ramifications might be boosting scrotal temperature and causing an overall decline in sperm count.

Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research’s relevance to clinical practice.

Same Success for Single Embryo Transfer
Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden’s rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores.

The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC’s patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden’s new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate.

Obesity Reduces Pregnancy Outcome
An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI.

Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients’ BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups.

Progesterone Supplementation Not Needed
A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the “long group” received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the “short group” continued same dose progesterone but only until the pregnancy test.

The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified.

FDA Changes Ahead
Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.

Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC’s medical team is continually evaluating the latest research. Our patients’ welfare is PFC’s first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.

Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research’s relevance to clinical practice.Same Success for Single Embryo Transfer
Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden’s rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores.

The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC’s patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden’s new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate.

Obesity Reduces Pregnancy Outcome
An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI.

Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients’ BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups.

Progesterone Supplementation Not Needed
A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the “long group” received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the “short group” continued same dose progesterone but only until the pregnancy test.

The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified.

FDA Changes Ahead
Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.

Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC’s medical team is continually evaluating the latest research. Our patients’ welfare is PFC’s first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.


Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research’s relevance to clinical practice.Same Success for Single Embryo Transfer
Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden’s rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores.

The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC’s patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden’s new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate.

Obesity Reduces Pregnancy Outcome
An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI.

Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients’ BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups.

Progesterone Supplementation Not Needed
A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the “long group” received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the “short group” continued same dose progesterone but only until the pregnancy test.

The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified.

FDA Changes Ahead
Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.

Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC’s medical team is continually evaluating the latest research. Our patients’ welfare is PFC’s first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.

As fertility care providers, a frequent question we are asked is “Does stress affect my chances of a successful outcome?” This is a difficult question to answer, because few substantial studies have been conducted. However, some viable data is starting to trickle in.

Researchers from the UC San Diego Dept. of Family and Preventive Medicine, working with a number of IVF centers, tried to assess the impact of patient worries on their IVF outcomes Konoff-Cohen et al, Fert Ster: Vol 81, No 4, 982-988). In this prospective study, 151 women completed questionnaires pre and post IVF or GIFT treatment regarding their concerns about medical aspects of their treatment (not achieving desired results, side effects, surgery, anesthesia, not enough information, pain, recovery) and financial aspects (missing work, finances). It is important to note that only the questionnaires completed pre-treatment provided data for this study, since not enough post-treatment questionnaires were returned.

Women who were concerned about the medical aspect of the procedures had 20% fewer eggs retrieved and 19% fewer fertilized, than women who were less inclined to worry about it. Women who were concerned about missing work had 30% fewer eggs fertilized. Those who were very concerned about the financial implications of their treatment cycle had a greater risk of not achieving a live birth. These results were adjusted for different variables that could also affect success rates such as age, race, smoking, type of infertility, previous treatment attempts, and prior live births. However, other important predictors of outcome were not adjusted for, such as FSH and antral follicle count.

While these findings may appear to show dramatic differences, it is important to note that these differences (20-30% fewer eggs, 19% fewer fertilized) clinically represented a decrease of only ONE fewer embryo transferred. The greatest decrease was seen in women > 35 yrs old, and those who had already done a treatment cycle.

This study represents an interesting look at the issues of personal concerns and IVF/GIFT outcomes, and calls for further studies to understand the potential physiological effects that may mediate these outcomes. Other related studies are also worth noting.

For instance, a well-done study (Domar), which we described in the November/December 2003 issue of Fertility Flash, has shown that women participating in support groups while in IVF treatment seem to have increased pregnancy rates. A recently published study (Facchinetti) has looked at changes in physiological markers (heart rate, blood pressure, cortisol levels) in women undergoing IVF treatment and participating in support groups, showing evidence of physiological changes for those in support groups. These physiological changes are consistent with those seem in lower stress situations.

These collective studies suggest that one can best prepare for IVF by being as informed as possible about expectations of one’s treatment cycle (treatment procedures and financial impact). It may also be helpful to consider joining a support group. Fertility clinics can help patients by trying to alleviate patient’s concerns and making the IVF experience as smooth as possible.

Q:
Can vaginal Viagra increase my odds of having a successful IVF cycle?

A:
Some fertility physicians turn to vaginal Viagra as a tool to improve uterine function. However, there is a great deal of skepticism about the use of Viagra for fertility patients.

One of the key parameters we monitor during a fertility treatment cycle is the development of the endometrial lining: both thickness and pattern. Our aim is to achieve a lining with a minimum thickness of >=7mm, and a trilaminar (or triple) pattern of the endometrial layers, by the day of HCG administration. For some patients, we cannot obtain this type of a lining, despite various hormonal manipulations.

For these patients, and even many without endometrial lining issues, we will typically recommend that she take a baby aspirin per day (81 mg) starting with gonadotropin stimulation. The rational for the use of baby aspirin is that on a micro-vascular level, vasodilation and decreased blood platelet aggregation occurs and therefore improves blood flow to the uterine lining, providing a lining with functional improvement. Blood platelets are the blood cells, which promote blood clotting. Two well designed studies confirm the benefit of baby aspirin use in improving pregnancy rates for patients with endometrial linings <8mm. It is important to note that the lining does not necessarily thicken with the use of baby aspirin – this is a qualitative improvement. It is also important to take only a baby aspirin, NOT a full dose aspirin.

Some fertility practitioners have suggested that Viagra vaginal suppositories for women, which are also a vasodilator, may provide improvements in pregnancy rates in the same way baby aspirin does. It needs to be noted however, that Viagra as a vasodilator works via a different mechanism compared to aspirin. While these claims have been made, well designed studies have yet to prove this. In the interim, Viagra should be used with caution.