In general, many women are able to use Pre~Seed that develop irritation, or an infection after using other lubricants. This is most often due to the fact that other lubricants do not have the same ion concentrations as your body fluids. For example, body fluids are at about 270 mOsmo ions, but Astroglide is at about 3,500 mOsmo, so you can see VERY high. It is basically like getting salt water in your eyes!

I myself, had terrible vulvar/vaginal pain when I was young, and didn't realize that the lubricants I was using were actually causing a lot of the irritation. We have had several vulvodynia (pain) clinics use our products as well. Finally, in clinical testing using slugs (yes slugs)... our formula was the least irritating product tested on the slugs (kind of like the old salt in the garden thing)... in fact in contrast Astroglide caused severe damage to the slugs in this study, and FemGlide actually caused a loss of mucus in the slugs.

All that said, a very, very low percent of women do have some irritation after use of Pre~Seed or Pre'. The rate is about 1/2 of 1%, based on the calls we've received.

Reactions can be associated with:
1)  Early pregnancy (for some reason soon after conception) in about 25% of women that have a reaction. If you have a reaction you may want to assume you are pregnant until you know you are not!;

2)  Women having the wrong pH of their cervical mucus. Normally your CM should go from a low pH of about 4-5 to a pH of 7-8 at ovulation ( the same pH as semen and as our products). This is controlled by hormones. If you don't have the right hormone changes, your CM may not make this change on a monthly basis. Therefore, your CM could cause harm to sperm. But also, the normal bacteria in your vagina do not go thru the changes that the pH shift can cause. Therefore, the sudden change in pH with an introduction of Pre~Seed can cause a sudden change in bacteria and a yeast infection to occur; or

3) An allergic reaction to the ingredients in our products. Again, we have tested this product for hypersensitivity in rabbits (applied daily for 10 days) and in people (wearing pre-seed under a patch for 30 days), with no allergies or irritation seen. However, of course some people will still have reactions.

We will always gladly refund your purchase price if you have any problems with our products. I have had enough women go on to try using the products again, just externally (in their non-ovulatory time)- to see if they can use it that way, and then some going on to using it again internally without any problems... that I do want to suggest that you could try that.

At any rate, it is always helpful to us if you can email us at info@ingfertility.com if you have any problems so we can get more details on your situation, and refund your product costs if you prefer.

Thank you-

Dr. E

Picking a doctor for male fertility

Men's Health Best Life- from March, 2006 had a GREAT quote from some of my dancing buddies in American Society of Andrology . This magazine has done a two part series on fertility geared to men that is actually pretty good! The article states and I quote--

"In other fields (of medicine), fundamental expertise is relatively easy to gauge. A cardiologist can't treat heart patients unless he is board certified in cardiology; a doctor can't go by the title "oncologist" unless he's trained to treat various forms of cancer. But many urologists can and do treat male infertility without ever having received specialized training in reproductive medicine. "Make sure your doctor has that extra fellowship training" says Jon Pryor, MD chair of urology at University of Minnesota School of Medicine. "After all, who's better at fixing a Volvo- a dealer or the mechanic down the street?"

Ask your doctor what percentage of his practice is infertility related. "It should be at least 1/3", says Jay Sandlow, MD, vice chair of urology at Medical College of Wisconsin. Also ask him what societies he belongs to. If "andrology" "infertility" or "sexual" isn't in the title, then he's not active in the field and probably doesn't keep up with the latest advances."...

Another alternative to a Urologist as noted in my other FAQ on Andrologists vs REs, is the Clinical Andrologists. These are often PhDs (such as myself) that study sperm physiology and male reproduction. You should always ask if your RE clinic has a Clinical Andrologist on staff, what level of education they have (a Master is not so great vs a PhD) and if they belong to the American Society of Andrology. Also, confirm that any clinic you work with adheres to World Health Organization guidelines for sperm analysis... if they don't, shop elsewhere or ask for a referral specifically for DH elsewhere.

Dr. E

Purchasing Pre~Seed

Q. I went to my pharmacy and they did not carry Pre~Seed. Where can I find it and why is it so hard to locate?

A. Pre~Seed and/or Pre' is carried in around 210 pharmacies, sexuality centers and medical clinics in the US and Canada. You can find locations near you by going to PreSeed.com/PlacesToBuy/index.php. Our products are made with unique ingredients, in a very detailed and controlled manufacturing process. They are also the only vaginal dryness relief product that has each lot tested with human sperm to ensure there is no sperm damage. I also personally try a sample of each lot prior to its sale, to ensure that the product is mild and non-irritating (I am very sensitive to other lubricant products). Taken together, we have found that independent pharmacies and medical clinics tend to understand the unique properties of our products better than the large chains, and have provided better service for product distribution for us. Someday I am sure we will be more easily found!

But for now, check for stores at your location at our website. Or you can easily order on line or by phone! Our packages come to you and are charged to your credit card with no description of contents (under the name ING).

Thanks!
Dr. E

REs versus Andrologists

Subfertility (which is now the preferred term over "infertility") is a medical problem that must be investigated based on the couple, not either partner in isolation. Subfertility is frequently multi-factorial, i.e. involving more than one contributory factor, and frequently contributory factors that are present in both the man and the woman at the same time (about half of all subfertile couples, based on the most recent research). Moreover, there are many aspects to the whole process of getting sperm from the site of insemination in the upper vagina to the site of fertilization in the ampulla of the Fallopian tube (oviduct), as well as in the complex sequence of events whereby the sperm and egg interact and fertilization takes place, that cannot be evaluated by currently available medical or laboratory tests. Indeed, the process of gamete transport and interaction is still not fully understood, and it should be no surprise that we still have many situations where the cause of a couple's infertility cannot be identified: this is called "unexplained" or "idiopathic" subfertility, and can affect as many as 30% of couples who seek medical advice for perceived subfertility.

Fellowship training in reproductive endocrinology typically takes place in departments of obstetrics & gynecology where there is frequently very limited expertise in examining the man and investigating male factors that contribute to, or cause, subfertility. Also, the great majority of urologists have not specialized in this area, their medical specialty being defined as "that part of medical science that deals with diseases and abnormalities of the urinary tract and their treatment". For this reason, thorough subfertility work-up should include someone trained in investigating the male reproductive system, an "andrologist", who has knowledge and expertise complementary to that of a gynaecologist trained in reproductive endocrinology and infertility.

Since the advent of intra-cytoplasmic sperm injection ("ICSI"), whereby fertilization can be achieved in vitro by injecting a single sperm cell into an egg, many subfertility doctors simply look at the man as being a source of sperm, and have the couple undergo assisted reproductive technology treatment ("ART") without worrying about diagnosing or attempting to treat cases of "male factor subfertility" directly. While this can certainly be seen as a quick way to achieve a pregnancy, it might not be the cheapest, or safest, means of doing so. However, such medical management decisions must always be taken by a physician fully trained in all aspects of subfertility diagnosis and treatment, and specific advice cannot be provided outside of such a patient-doctor relationship. Nonetheless, from a scientific perspective, it is clear that many "infertility doctors" could benefit from more extensive, or more recent, training in male reproductive biology and medicine. This opinion is based on the many patients who have received advice that is contrary to the recommendations of the World Health Organization's Manual for the Standardized Investigation, Diagnosis and Management of the Infertile Male, which is intended as a "lowest common denominator " approach to investigating and managing subfertile couples with a male factor, that can be applied everywhere, including Third World countries.

Unfortunately, there is no simple way for a couple to verify that their managing physician has proper expertise in clinical andrology, but patients must never be afraid to ask questions, perhaps especially about the nature of their doctor's training and expertise in clinical andrology, and about what options other than ICSI have been considered and might be available to them. As a generalization, based on experience from centres where andrology is integrated into their operation, only 35 to 40% of ART treatment cycles actually need ICSI.

Dr. E

Safe Lubricant Use While Trying to Conceive

Q:  My doctor said Replens® was OK for us to use while trying to conceive. Is this true?

A:  At least six million couples in the US have medically defined infertility (about 15%), meaning they have had unprotected intercourse for over one year without a successful pregnancy. A common complication for these trying-to-conceive couples (“TTC”) is vaginal dryness in the female partner, with 75% of these couples reporting increased incidence of vaginal dryness due to: the stress of being infertile; having to have timed intercourse; and/ or fertility medications they are taking. Enjoying intercourse can become difficult during daily sexual activity when vaginal dryness and pain become an issue. In fact, over 25% of TTC couples “always” use lubricants while having intercourse (e.g. an estimated 2.25 million Americans).

Vaginal dryness is routinely treated with vaginal lubricant products, of which there are several hundred products marketed in the US. However, three decades of peer reviewed, published research has shown that all existing vaginal lubricants studied to date harm sperm, resulting in rapid losses in their viability (% live) and motility (% swimming). Specifically, there have been at least 11 studies on this topic conducted in Medical school settings, reviewing the effect of 16 different lubricants on sperm, including all of the top selling brands, such as KY, Astroglide and Replens. In each study, sperm motility and viability were dramatically reduced after exposure to even small concentrations (<10%) of these products.

Specific data from these studies show:

• A spermicidal or sperm killing activity of the leading three brands of lubricants as being equivalent to contraceptive jellies such as Gynol. In these studies, sperm had ZERO motility after 30 minutes of contact with the top three selling lubricant products.
• These effects are concentration dependent and were seen even with low concentrations (1–6%) depending on the lubricant product.
• Critically, the negative effect of lubricants on sperm includes decreasing sperm penetration into the cervix in vivo, as determined by the post-coital test (PCT).

In order for conception to occur, motile sperm must be able to penetrate into cervical mucus and proceed to the Fallopian tubes in adequate numbers. Existing lubricant products rapidly decrease sperm motility, thus possibly decreasing the numbers of sperm penetrating the cervix and being able to participate in fertilization. The following quotes from these lubricant studies highlight the investigators’ deep concerns with the use of vaginal lubricants by TTC couples (see a complete list of these references at www.helpconceive.com).

Dept of ObGyn; University of Texas Southwestern Medical Center “For couples with infertility, the use of vaginal lubricants during intercourse is not recommended.”

Dept of ObGyn; University of Connecticut “We conclude that all traditional vaginal lubricants should be avoided in patients desiring conception.”

Dept of ObGyn; University of Minnesota “The spermicidal effect of the lubricants was statistically significant. The lubricants had a similar effect on both normal and abnormal semen specimens.”

Dept of ObGyn; Uniformed Service University, Bethesda, MD “In vivo (in people) data demonstrated severe impairment to sperm penetration of mid-cycle human cervical mucus by the lubricant.”

Why do lubricants harm sperm? The best pH value for sperm migration and survival in cervical mucus has been established by the World Health Organization at between 7.1 and 8.5. This coincides with the normal rise in pH of cervical mucus found in women at the time of ovulation. In contrast, vaginal lubricants tend to have pH values below 7, and often as much as half of this value. These pH values can cause sperm death. Sperm are also sensitive to both high and low osmolality (concentration of osmotically active particles in solution) because these can cause the cells to either shrink or swell too much. A physiologic osmolality around 320 mOsm/kg (that of semen) is best for sperm function. Sperm motility decreases with exposure to increasing osmolality, with all motion stopping at 600 mOsm or greater. Lubricants have osmolality levels 3-10 times that of semen that causes irreversible damage to sperm motility at contact.

In spite of the numerous publications cited above, there remains a great deal of confusion amongst physicians and lay people alike as to the safety of vaginal lubricant use while trying to become pregnant. In fact, many doctors are inadvertently recommending lubricants that harm sperm to their patients based on inaccurate information. In many cases there is a fundamental disconnect between the published data of the effects of lubricants on sperm function and the physician’s knowledge. This confusion exists in part, because the leading brands state in their marketing material that they “will not kill sperm”, or that they have “no effect on sperm motility” in spite of published literature to the contrary. Additionally, a common misconception is that if a lubricant does not contain a spermicide or if it is water soluble, it will not impair sperm function. Unfortunately, this is completely inaccurate. Water based lubricants often have glycerin (which has been shown to be toxic to sperm) and propylene glycol both of which are highly hyperosmotic. This results in irreversible damage to sperm and a loss in motility after exposure to commercial lubricants. Damage to sperm and subsequent inability of the sperm to penetrate into the cervix following contact with lubricants may prevent conception in some couples, resulting in consequences such as undesired childlessness, or the advancement to more invasive advanced reproduction technologies (all of which carry added economic costs and medical risks). If there is any evidence that a vaginal lubricant can interfere or limit a couple’s fertility, it should carry a warning label to avoid its use while trying to conceive, and testing needs to be established for any products that claim to not harm sperm.

In contrast, Pre~Seed Intimate Moisturizer was developed in response to the need for a product to replenish vaginal moisture without harming sperm while couples were trying to conceive. Pre’ Lubricant also can provide traditional lubrication without harming sperm. Each lot is tested to ensure no sperm damage before it is sold. So if you are trying to conceive, know the facts about vaginal lubricants. They damage sperm and should be avoided (except Pre’). If you need help with dryness, as many couples do, Pre~Seed & Pre’ were developed by a Sperm Physiologist and has several studies presented at National Reproductive Meetings suggesting their “fertility-friendly” nature.

Dr. E