On a day-to-day basis, our focus at Coastal Fertility is on reproductive physiology and its impact on couples trying to build a family. During our evaluation, we often see how an individual’s health can impact the reproductive potential. However, it is also important to understand that problems found during the infertility evaluation can impact the long term health of the individual. Today, we will look at general health and infertility in women. A common diagnosis at our center is Diminished Ovarian Reserve, which implies a reduced number of normal eggs. This can occur naturally thru aging, genetically, chemically induced (smoking, chemotherapy/ radiation), medically induced (diabetes, cardiovascular disease) and surgically (cystectomy, oophorectomy). These women are at increased risk for miscarriage and birth defects due to an increased presence of an abnormal number of chromosomes in a cell.
A 2001 study demonstrated a 2.7 fold increase in Down’s Syndrome in women, regardless of age, with a modestly elevated FSH (elevated FSH indicates poor ovarian reserve/quality). Remember FSH fluctuates, so that a single normal level does not mean there will be a reduced risk. Although it has not been published, an AMH of < 1.0 ng/ml is likely to carry a similar risk to the modestly elevated FSH. Women with premature ovarian failure have been associated with an increased number of CGG repeats in the FMR-1gene (Fragile X). In simple terms, these women have been associated with an increased risk for carrying the Fragile X gene, which is a common case of mental retardation. Young women with significantly diminished ovarian reserve (FSH 12+, AMH < 0.8), are likely to end up with premature ovarian failure and thus are also likely to be at increased risk for Fragile X issues and testing should be offered.
Two common disorders that can impact reproductive function for both women and men are diabetes and hypertension. Control of each of these is important prior to attaining pregnancy as well as for long term health. In addition, both can have a detrimental impact on ovarian reserve long term. For women with diabetes, there is an increased risk of miscarriage, birth defects, fetal growth issues, pre-term delivery and perinatal mortality. The goal of these women is normal glucose control and can be achieved with insulin, glyburide or metformin along with weight loss and an appropriate diet. The goal in controlling hypertension is to moderate the blood pressure to help maintain adequate circulation and nutrition to the baby.
Autoimmune diseases are a series of over 80 disorders where the immune system attacks normal tissues. About 75% of the individuals affected by autoimmune disorders are women, many of reproductive age. In autoimmune diseases, the connective tissue is often affected, but all tissues can be affected including the endocrine system. In addition, many of the treatments can be detrimental to reproductive function. Women with autoimmune disorders should have their infertility evaluation sooner, and in particular, a close look given to their ovarian reserve testing. Many can do well in pregnancy if they receive treatment early.
If you have any of the conditions discussed in this blog, there is hope! Coastal Fertility offers all types treatments which can help you realize your dream of starting your own family, from IVF, Donor Egg and Sperm to Surrogacy. There are also screenings that can be done on an embryo’s before implantation to ensure it is healthy.
For more information on these conditions are their associated risks, please contact Coastal Fertility Specialists at 843-883-5800 for a consultation and testing.