Paternal age and obesity diminish fertility

SAN RAMON, CALIFORNIA – Infertility physicians at Reproductive Science Center of the Bay Area have found that their male patients follow the findings of a recent study that indicated sperm quality begins to deteriorate after age 35.

According to the new study reported in the Aug. 1 issue of Obstetrics and Gynecology, sperm quality starts to go downhill after age 35 and indicates that paternal age is a significant risk factor for miscarriage. The study of almost 14,000 pregnancies, conducted by Dr. Karine Kleinhaus of Columbia University, showed that women with partners ages 35 or older had nearly a threefold increase in spontaneous abortions compared with women whose partners were younger than 25.

“Many of the male patients we treat were married later in life or in the course of their second or third marriages found they were unable to conceive–even if they had children from a previous marriage,” says Dr. Kirsten Ivani, IVF lab director of the Reproductive Science Center of the San Francisco Bay Area (RSC). “Sperm quality is clearly impacted as child-bearing is increasingly delayed – for both men and women. It is already well documented that fertility declines because of a limited number and quality of eggs for women as they get older, so this is research should alert men to similar issues.”

It may be that the clock ticks even faster for overweight men. New research from the National Institute of Environmental Health Sciences showed that men with increased body mass index (BMI) were significantly more likely to be infertile than normal-weight men. A 20-pound increase in men’s weight may increase the chance of infertility by about 10 percent. The majority of men who participated in the study were more than 30 years old. Obesity affects nearly one-third of the adult American population (approximately 60 million).

According to the American Obesity Association, the number of overweight and obese Americans has continued to increase since 1960, a trend that is not slowing down. The Columbia research found that the risk of miscarriage of a fetus conceived by a father over age 40 was 60 percent greater than if the father were 25 to 29, irrespective of other factors that have been linked with increased miscarriage risk, such as the mother’s age, maternal diabetes, poor maternal health and smoking during pregnancy. The increased risk of miscarriage does not just apply to fathers in their 40s, however. The miscarriage risk in a pregnancy involving a father aged 35 to 39 was three times higher than the risk if the father were under 25.

Data from the study showed that 1,500 of the women suffered miscarriages, while 12,000 carried their children to term. “This new study provides important information for people – of all ages – who are planning their families,” says Dr. Ivani. “It means that men should be sure to get the medical attention they need to uncover medical problems underlying infertility.”

In fact, the American Society for Reproductive Medicine (ASRM) has set an upper age limit of 40 years old for semen donors because of the increased risk of genetic abnormalities in the offspring of older fathers. According to the ASRM, infertility is a male problem 35 percent of the time; a female problem 35 percent of the time, a combined problem of the couple 20 percent of the time, and the final 10 percent is unexplained.

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“Fertile Awakenings” program one of a handful nationwide interlinking traditional western and alternative fertility care

SAN RAMON, CALIFORNIA – This month the Reproductive Science Center of the Bay Area, one of nation’s oldest IVF practices, launches “Fertile Awakenings,” one of the first programs to provide coordinated care by a team of traditional western fertility specialists and complementary and alternative medical practitioners.

Though the medical community is divided about complementary and alternative medical approaches to infertility, many patients have been using them successfully. However, it is rare for their care to be coordinated between all medical providers.

The program includes a panel of RSC physicians and the Fertile Awakenings team of alternative practitioners, who will review infertility treatment for patients on a case-by-case basis. When appropriate, they will recommend complementary treatment to be offered at RSC clinics as well as other locations, such as acupuncture at RSC’s Orinda clinic, mindfulness training and stress reduction courses at RSC’s San Ramon location, confidential phone coaching, and uterine massage and nutritional counseling at Harmony Acupuncture.

“It is becoming more common for infertility practices to offer a multidisciplinary approach, integrating western and eastern medicine, along with a Mind/Body program. There is some evidence that this combined approach may improve success for some couples,” said Louis Weckstein, M.D., IVF and Medical Director of RSC. “A collaborative program that addresses the stress as well as the medical aspects of infertility care more raises the bar for fertility care,” said Weckstein.

“Helping to manage the brutal stress and emotional rollercoaster of infertility can go a long way in supporting medical treatment for infertility,” he added.

More patients like Lidia Gutierrez, a 39-year-old San Ramon engineering consultant who is completely healthy but having difficulty getting pregnant, are using acupuncture while undergoing in vitro fertilization (IVF). “When Dr. Weckstein showed me the research on superior pregnancy rates for patients who used both methods, my husband and I agreed it was the best way to proceed,” she said. Gutierrez began acupuncture treatments in June in preparation for her first IVF cycle in August. Some studies show acupuncture increases the success of embryo implantation as well as improves relaxation and reduces stress.

Most fertility experts agree that reducing stress is key for many of their patients. Stress signals the pituitary gland that the body is in trouble, which can slow the release of the luteinizing hormone, which in turn triggers ovulation. Even if ovulation occurs, a shortage of the luteinizing hormone could mean a lower level of progesterone, a hormone necessary to nourish and sustain an embryo’s implantation.

Infertility patients who have endured many months or years of frustration may have low emotional reserves and benefit from the emotional support of a professional coach. Research showed that couples who participated in group counseling sessions were more likely to get pregnant than couples who did not. The Fertile Awakenings coaching program also helps patients navigate the stress of decision-making regarding complex treatment options, such as determining which assisted reproductive techniques are appropriate, when to consider use of a donated egg or sperm, a gestational carrier, or cease treatment and consider other choices.

Separate German and Chinese studies of 160 women combined who used assisted reproductive techniques, as reported in the April 2002 issue of Fertility and Sterility, found that 42.5 percent who included acupuncture with their treatment achieved pregnancy compared to 26.3 percent who did not use acupuncture. Other studies have shown that sperm quality benefits from acupuncture treatment as well.