Preseed.com Blog

This preview has an interesting story on my Fallopian Tube research, looking at sperm cell storage.  (CLICK HERE for a preview)

The show details the journey sperm undergo to reach the egg.  It has several Reproductive Physiologists discussing their research, as well as helping to explain how fertilization occurs.  It is a fun way to learn about this topic for most age groups!

Blessings ~
Dr. E

A new study by Sanchez et al (Fertility  & Sterility, Jan 2010) showed how high levels of reactive oxygen species (“oxidative stress”) can decrease the ability of sperm to swim towards the follicular fluid which surrounds the egg at ovulation.  Normally sperm can “smell” or orient their movement towards this follicular fluid, to make sure they get to the egg at the right time to fertilize it. This is called chemotaxis.  It isn’t really “smelling” but it is a chemical beckoning of the sperm toward the fluid which bathes the egg in the ovary and which is released with the egg into the Fallopian Tube at ovulation. 

Sperm can be exposed to high levels of reactive oxygen species (ROS), in men with low grade (often unnoticed) genital infections and men that have some kinds of infertility. For most men, semen contains antioxidants that protect sperm from excess ROS damage.  Infertile men have statistically lower levels of antioxidants in their semen, and thus can have higher levels of ROS. 

Although the clinical impact of this study’s finding haven’t been proven yet, it suggests that sperm from men with high levels of ROS in their semen, may lose the ability to “smell” and swim specifically towards the egg, as well as sperm from men with normal ROS levels in their semen.

What can you do to optimize your fertility?

Rule out any subclinical genital infections if you are having trouble conceiving. This includes making sure any semen analysis specifically stains for and counts white blood cell presence. 

Try antioxidant fertility vitamins (such as FertilAid) when trying to conceive.  Laboratory studies have also shown that arabinogalactan (part of Pre-Seed’s© patented formula) can limit oxidative stress (or ROS) damage of sperm.

Dr. E

“Sizing Up Sperm” airs on March 14th at 9 pm on the National Geographic Channel.   It is an amazing documentary of the journey sperm go through to fertilize an egg.  Dr. E was invited to help tell the story, where she introduced the concept of “gourmet” sex for TTC couples to Canadian and  UK audiences when the show aired there last year.

It is an entertaining and educational show, and is also appropriate for most middle school children or older. 

Please let your community know about this special event!  To learn more you CLICK HERE to review the NGC press release.

A recent study from the Cleveland Clinic found that Reactive Oxygen Species (ROS) were 7 fold higher in 54 men with male factor infertility versus 51 men with normal sperm.  ROS are highly reactive, free radical chemicals (consisting of one or more unpaired electrons).  They are made by sperm as part of normal function, but can also be made by white blood cells or abnormal sperm in higher, damaging levels, which if present cause “ oxidative stress”.  Most of us think about free radical or oxidative stress regarding aging of our faces and concerns with how we look as we age.

However, oxidative stress is a big problem for sperm as it can cause damage to the sperm’s ability to swim, its  normal shape and most importantly to the sperm DNA or genetic material.  All of these changes can impact fertility and pregnancy outcomes.  Several factors can increase ROS in semen including smoking, varicoceles, and genital tract infection.  Some studies suggest that low grade genital tract infections are very under diagnosed in men, and I happen to agree with this.

Normal men have fairly high levels of antioxidants in their semen to keep ROS and oxidative stress at the right levels.  However, between 25 and 88% of infertile men (study dependant) have elevated ROS in their semen, which can lead to loss in ability to swim (motility), loss of normal shapes (changes in morphology) and breakage in the DNA structure (leading to fertilization failure, pregnancy losses, and even childhood diseases). 

The new study by Desai et al., (Fert &Ster Nov 2009) found that the level of ROS in a semen sample could be used to predict over 75% of the infertile men, with ROS levels being much, much higher for these men than for the men with normal sperm parameters. 

Why is this important?  Because having ROS measured in sperm samples from couples with infertility could: a) help identify if there is a male factor involved in the infertility and b) help identify men for whom further diagnostics and therapies may be helpful. These would include, low grade infections which may need special antibiotics, such as men with ureaplasma or mycoplasma infections.  Also, identifying men with high ROS could increase compliance with antioxidant vitamin therapy, such as those found in fertility supplements (e.g. FertilAid).

In general, couples planning on assisted reproduction may be able to improve outcomes by decreasing semen ROS values prior to treatment. Of course, those trying naturally could also benefit from lowered oxidative stress.  I suggest anyone who is TTC at least try fertility vitamins with antioxidants for 6 months.

To have an ROS assay done, couples in the Northwest could contact Dr. Muller at University of Washington.  The Cleveland Clinic can also perform this assay, as well as other referral clinics with an andrologist on board. 

For our part, we know that minimizing sperm ROS damage is important. The bioactive plant sugar, arabinogalactan, became part of Pre-Seed’s patented formula after finding that it decreased sperm ROS production.  This protective effect on sperm, echoes a larger body of literature which has found an antioxidant effect of arabinogalactan on many other cell types as well. 

Hope your New Year is going well!

Blessings-

Dr. E

The WHO has published new reference guidelines for semen parameters.  These were generated by evaluating 4,500 men in 14 countries whose partners had less than or equal to 12 months time to pregnancy (TTP).  The WHO authors found that with a 95% confidence,  men whose partners had TTP of 12 or fewer months had NO LESS than the following:

• Semen volume:  1.5 ml
• Total sperm in the ejaculate:  39 million
• Sperm per ml:  15 million/ml
• Vitality:  58% live
• Progressive motility:  32%
• Total Motility:  40%
• Morphologically Normal:  4%

(There was a typing error here on 12.15, the values are correct now).

This group of fathers had significantly better semen quality than semen samples tested in the general population.  It is important to note that falling below these levels does not mean that a male factor is causing a couples infertility, but rather that male infertility is a possible factor in the couple’s failing to conceive.

It is IMPERATIVE that any clinic performing a semen analysis for a couple use WHO guidelines to evaluate and interpret the sample.  There is NO excuse to not be performing up to date analysis methods on something this important.

Your physician can find the entire study at Human Reproduction Update Advance Access Nov 24,2009.

Blessings ~ Dr. E

A new paper by El-Chaar et al (Fert Ster Nov 2009) found a 1.55 fold increase in birth defects (2.91%) for children conceived by assisted reproduction (including ovulation induction, IUI, and IVF) versus  natural conceptions (1.86%). This was highest for in vitro fertilization (3.45%) and intrauterine insemination (2.89%).

No one can doubt the blessing that assisted reproduction has been for many couples.  Currently, 2-3% of all European and 1.5% of all US births are a result of these technologies.  However, they should be entered into with a full understanding of potential risks included with the technology, such as preterm labor, lower birth weights and an increased incidence of birth defects.  Assisted reproduction should be saved for couples that REQUIRE this technology, and not rushed into by couples who could conceive naturally if more was done to optimize people’s own fertility.  For example, couples who are lucky enough to have insurance to help with infertility, may find the companies do not want to pay for the time honored medical approaches of problem oriented medicine, where testing is done to identify a problem and time and treatment are done to correct problems.  I firmly believe, that a substantial proportion of male infertility cases have a low grade infectious component that usually goes uncorrected.

Assisted reproduction can be quicker, makes many people involved more money and helps the couple feel that they have done “everything”.  But ALL the outcomes need to be considered in this course of action.

In order to optimize your own fertility, be sure to read the ASRM Best Practice Guidelines “Optimizing Natural Fertility”, which I am proud to say mentions Pre-Seed! There are also several great resources to provide you with the best knowledge to do all that you can when trying to conceive.  These include books like: Taking Charge of Your Fertility, Perfect Hormone Balance for Fertility and Making Babies.  At the very least, you need to know if and when you are ovulating, and be sure to time intercourse appropriately.   Also, make sure his sperm are of a good quality. Fertility vitamins are beneficial for everyone too!  And of course Pre-Seed can also help make for slippery fun and provide an optimal environment, without harming sperm, fertilization or embryo development. 

Blessings-
Dr. E

Merhi (Fertility&Sterility, Nov 2009) concludes that “…bariatric surgery seems to improve fertility status, sexuality, pregnancy outcomes, and reproductive hormone profile…”.  Although, the author also cautions that the surgery may be linked to contraceptive failure with “the pill”.  Hmmmm…. More enjoyable sex…an easier time becoming pregnant and a healthier pregnancy??  I think most of women who needed this surgery would gladly trade having to use an alternative method of contraception for the above!

Be healthy!
Dr. E

One of the “god-fathers” of Andrology (male reproduction) Dr. Amann has a very valuable series of articles this month in the Journal of Andrology.  Some of it is very complicated and will likely not be adopted by the physician community, without patient driven demand.  If you are a TTC geek and are struggling with potential male factor infertility I would suggest you wade through the articles. 

For the rest of you, the key points when it is time for sperm sample are:

1. Never accept a diagnosis on one sample! Total sperm count in one sample will be within -16% to +30% of the true value in only 50% of the men.  Meaning a single ejaculate is almost worthless to evaluate if you have low sperm count or not.  Three samples, will be -20% to +30% of the true value in 80% of the men.  It simply isn’t that expensive overall (even at ~$200/sample) to KNOW for sure if low count is an issue or not.
2. Have the correct abstinence period. To maximize detection of men with truly low sperm production, abstinence of 42-54 hrs should be the case, with NO MORE than 64 hrs. Many physicians recommend much too long a time for abstinence for a diagnostic semen sample. In contrast, when producing a sample for a procedure for men with diagnosed low sperm numbers, wait 7 days.  Men with normal sperm counts, should produce samples for procedures (such as IUI or IVF) after 3-4 days of abstinence.   
3. Make sure your lab adheres to WHO guidelines, if they don’t, find another lab.  There is no excuse for not using the globally accepted standards.
4. Make sure they give you a volume (in mls) of the ejaculate and a total number of sperm in the ejaculate (not just sperm per ml).  This tells you the total number of sperm made at that ejaculation.
5. A useful parameter is total number of sperm in an ejaculate divided by the hours of abstinence (since the man last ejaculated)- this gives a value for testes production or output, and be compared across the three samples, even if the abstinence time is slightly different for the three samples.

Your man deserves a high quality fertility evaluation.  Demand it

Dr. E

We recently received this question from a visitor:

Does pre-seed help when low sperm morphology is the factor? Please inform me!

At INGfertility we take our product and our science very seriously.  My reputation as a federally funded Sperm Physiologist, and as a Member in the American Society of Andrology and the Society for Male Reproduction and Urology depends on what I say being accurate and scientifically defensible.  Therefore, we don’t make claims about our products based on one time, small, or preliminary laboratory studies. Nor do we confuse such work with “clinical proof.”  If we can’t defend our claims to regulatory agencies or my peers, we don’t make them.

I will say that we have received some awesome User Stories from couples with challenging male factor problems, such as the notes below.   You can always search our user’s stories blog to find stories relating to your situation, such as search for “sperm” and you will pull up stories that mention DH’s sperm count.

You can also see that 25% of our product users in one survey had male factor issues, as well as the self reporting pregnancies in the group a as whole.  Click Here for these Survey Results.

Blessings -
Dr. E

I’m telling all my fertility challenged friends!
OMG Thanks!  I never write into companies, but this experience is too good to be true. For over six years, we had tried to conceive and we had seen specialist after specialist. We were told my husband has 99% bad sperm and low counts and I have PCOS, so it was very unlikely that we would ever get pregnant together without IVF. The first and only time we used your PreSeed product, much to our surprise we conceived. That was the only change that month. I’m telling all my fertility challenged friends about the magic goop that worked. Thanks again. We’re now 4 months pregnant and are hoping for a healthy baby. Kind regards, ~ K

Pregnant Thanks to Pre-Seed
This stuff is like gold!! I have PCOS and have been going through round after round of Clomid since February this year. We did trigger shots, everything. My husband even has a male factor issue working against him…high count, but VERY low morphology, motility, and rapid linear movement. I did not want to have to go for an IUI so we decided to give Pre-Seed 2 rounds… no need because the FIRST round we got our BFP! I am in complete shock!! I still do not believe  it and still test every morning (I am only 3 weeks, 6 days along!), and they are getting darker. My beta test is Monday. THANK YOU PRE-SEED!!!! Finally, my dream of becoming a mother is real!  ~ JW, TN

The June 2009 Fertility & Sterility Journal has an interesting new paper by Chambers et al (91:2281-2294).  In this they compared economic aspects of assisted reproduction technologies in several countries.   The statistics are good for people to review.  Specifically, the cost per live birth for an IVF baby was the highest in the US at $41,132 (average per cycle cost of $12,513).  This represented 50% of disposable income in the US, and was  the highest percentage of any country.  Meanwhile only 24% of estimated demand for ART was met in North America.  Not surprisingly, given the news stories around this, the US also has the highest  overall multiple birth delivery rate at 33%, as compared to 17% in Scandinavia, Japan or Australia.    

The US media fixates an inordinate amount of attention on assisted reproduction as “the cure” for infertility, when in reality only about 1.5% of all children are born from assisted reproduction and over 95% of infertile couples do not pursue these technologies.  Although these techniques certainly have blessed many couples with children, who otherwise would not have become parents; it is important for us to realize the low success rates (~28% per cycle)and high cost in dollars and in complications for the offspring (especially with multiple births).

Methods to optimize fertility through natural reproduction and less invasive procedures should continue to be developed.  But it is important to remember that the assisted reproduction industry has a strong incentive to push couples to in vitro methods, especially when much of it is paid for out of pocket.

Tracking your cycle and optimizing timing of intercourse by understanding your own cervical mucus production is critical.  I strongly recommend Toni Weschler’s book.  Taking fertility vitamins such as the FertilAid products can help boost cervical mucus production and sperm quality.  Have testing to ensure your Fallopian tubes are open early in the process.  And read a good resource on optimizing the whole process such as Dr. Robert Greene’s book.  I do not sell any of the above products.

We do sell Pre-Seed.  Which we think everyone who is trying to conceive should at least try J.  It doesn’t harm sperm or embryos, so there is nothing to lose, and the amazing Users’ Stories we receive tell of Pre-Seed’s role in assisting folks on their TTC journey.   

Pre-Seed is designed to be INSERTED INTRAVAGINALLY.  This is for a reason.  It mimics fertile cervical mucus in pH, osmolality and thickness making a familiar optimal environment for the ejaculated sperm.

I am always amazed at the stories of women splitting applicators and not using the Pre-Seed internally as it was designed.  I am not quite sure why they would want to use the product other than as it is recommended and as has functioned so well for thousands of other couples.  To save the cost of latte, at the same time they are literally standing on their heads to become pregnant.

Remember our products always carry their “Love it or its Free” guarantee.  Of the approximately 150,000 boxes of Pre-Seed sold last year, less than 0.01% were returned for a refund.  

So the math is in your favor to try Pre-Seed and to use it as recommended.

Blessings ~
Dr. E