Fertility in women is dependent on ovarian follicles that contain immature oocytes. All follicles are formed during fetal development and should last for the reproductive lifespan of the woman. At most, there are a few million non-growing follicles in the ovaries of the female fetus during mid-gestation, and thereafter, the numbers decrease.

At the onset of puberty, a few hundred thousand follicles remain. Menopause commences when the number of follicles has decreased to a level that cannot sustain the hormonal secretion required for menstrual cycle. On average, the age at the onset of natural menopause is around 50 years. Cessation of menstrual cycles before the age of 40 years is classified as premature ovarian insufficiency.

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There are no direct ways of counting the numbers of non-growing follicles present in ovaries in vivo, and therefore, several surrogate markers are used instead. For example, antral follicle count (AFC), serum levels of follicle stimulating hormone (FSH), estradiol and anti-Müllerian hormone (AMH) are commonly used to estimate ovarian reserve although all these markers relate more directly to growing follicles.

AMH is a growth factor secreted by primary, secondary and small antral follicles up to about 4 mm in diameter. It has become an established biomarker of ovarian reserve due to several advantages over other methods: serum AMH can be easily measured from a single blood sample and the levels do not significantly fluctuate during ovarian cycle. However, AMH also has its limitations. It may fluctuate during the course of pregnancy. While it is mostly used in fertility investigations, AMH does not predict fecundability or other outcomes in the general population. The value of AMH as a biomarker of ovarian reserve in healthy women, and factors affecting its level, still needs more research.

Several reviews have raised concerns about the effects of pervasive exposure to industrial chemicals on reproductive health in women. Major international organizations highlight the need to study chemical disruption of female reproductive system in more detail, including the Endocrine Society, World Health Organization and International Pollutants Elimination Network and the International Federation of Gynecology and Obstetrics.

The study cohort consisted of women who underwent elective caesarean section at the Karolinska University Hospital Huddinge. During the period 2015 –2018, there were 145 women who participated in the study. The scientists wanted to focus specifically on fertility in women and investigated associations between chemical exposures and ovarian reserve. Using a cohort of pregnant women undergoing caesarean section, they had a unique opportunity to measure the size of ovarian reserve in two ways: directly by counting the numbers of follicles in biopsied ovarian tissue samples, and indirectly by measuring the level of AMH in serum by retrieving biobanked samples collected during routine first visit for antenatal care.

Concentrations of 31 persistent organic pollutants (POPs) were measured in the same serum samples. Collectively, their results confirm the often-reported association of POPs with higher odds for infertility time-to-pregnancy (TTP >12 months) and further suggest that exposure to lipophilic POPs associates with lower ovarian reserve. Although the cohort was relatively small, this encourages to pursue studies on chemicals and germ cell quantity in women in more detail, a topic that has been studied for decades in men.

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Endometriosis is an estrogen-dependent chronic gynecologic disorder that significantly reduces the quality of life of affected women. Characterized by adhesions of endometrial fragments in extra-uterine sites (predominantly in the peritoneal cavity and ovary but occasionally on the diaphragm, liver, and abdominal wall), the condition occurs in ~10% of the general population and is associated with infertility, pelvic pain, and increased risks for ovarian and other cancers.

Our understanding of its etiology and complex, multi-factorial origins remains inadequate. Moreover, its asymptomatic nature at the early stages can significantly delay clinical diagnosis. Treatment options are currently limited to hormonal therapy or surgical management; however, these methods are non-curative, may not align with women’s reproductive goals, and frequently lead to recurrence after cessation of treatment. Delineating the factors that contribute to lesion development and progression is key to providing opportunities for prevention and more efficacious therapeutic interventions.

Diet is a leading risk factor for many chronic diseases. The linkage between diet and endometriosis, summarized in a recent review, underscores the ability of anti-inflammatory components present in foods to mitigate endometriosis. Nevertheless, there are certain caveats to consider. Read more:

What do you think about “stop eating red meat”?

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Sperm cells moving their long tail to swim through the body in search of an egg is a familiar image, but a fully ‘powered’ tail may not be the key to success, according to a new UK study which could be crucial for improving the outcomes of assisted fertility treatments.

Propulsion of sperm and how the cell uses its tail to move through the thick fluids of the reproductive tract to reach and fertilise an egg has been well studied. However, the role of the specific parts of the tail, including the inactive area at the very tip, which it is thought, lacks the structure needed to generate motor activity, remains unclear.

A multi-disciplinary team of mathematicians and scientists from the University of Birmingham used mathematical simulations to analyse the effect that this inactive region has on the overall movement of the sperm and how this contributes to the speed and efficiency of the cell’s motility. The study is the first modelling simulation study to investigate the detailed effects of this area, which measures just 3 microns – or 25 times smaller than the width of a human hair.

Results showed that instead of hindering the cell, the inactive region at the end of the tail actually enables faster and more efficient swimming. Simulations showed as much as a 430% increase in efficiency and a 70% increase in velocity in sperm cells with an inactive end region of the tail compared with cells where the tail was fully active. It is thought that the research could offer key insights into what enables a sperm cell to function.

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In human populations, there are strong seasonal patterns of births that vary across geographic regions and time periods. However, previous studies of seasonality and fecundity are limited because they examine season of birth rather than season of conception and therefore neglect to account for seasonal variation in initiating attempts to conceive or pregnancy loss or differences in gestational length.

The scientists conducted a preconception cohort study of 14.331 women residing in North America. Participants were attempting to conceive without fertility treatment and had been attempting pregnancy for ≤6 menstrual cycles at enrolment. They collected information on season of each pregnancy attempt using last menstrual period dates over the study period. Pregnancy was reported on female bi-monthly follow-up questionnaires. They fit log-binomial models with trigonometric regression to examine periodic variation in fecundability. They accounted for seasonal variation in initiation of pregnancy attempts by including indicator variables for menstrual cycle of attempt in the regression models.

According to the results the initiation of pregnancy attempts peaked in September, with stronger seasonality in North America than in Denmark (48 vs. 16% higher probability initiating attempts in September compared with March). After accounting for seasonal variation in initiation of pregnancy attempts, they observed modest seasonal variation in fecundability, with a peak in the late fall and early winter in both cohorts, but stronger peak/low ratios in North America (1.16; 95% confidence interval [CI]: 1.05, 1.28) than in Denmark (1.08; 95% CI: 1.00, 1.16). When they stratified the North American data by latitude, they observed the strongest seasonal variation in the southern USA (peak/low ratio of 1.45 [95% CI: 1.14, 1.84]), with peak fecundability in late November.

An understanding of how fecundability varies across seasons could help identify factors that can impair reproductive function. Neglecting to account for seasonal variation in initiation of pregnancy attempts could bias estimates of seasonal patterns in fecundability. This is the first preconception cohort study to examine seasonal variation in fecundability after accounting for seasonality in initiation of pregnancy attempts. Fecundability was highest in the fall and lowest in the spring, with stronger effects in southern latitudes of North America, suggesting that seasonal exposures may affect fecundity.

What do you think about “Trying a different season to conceive”?

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Dangerous levels of microwave radiation from Wi-Fi and other devices were discovered in school classrooms in Ontario as measured by students from Peel District School Board. The radiation levels found were strong enough to cause infertility problems.

The students organized an open meeting in order to inform all school students about the dangers they are exposed to due to the radiation levels and that they can actually be harmed by this. They were determined to find ways to protect themselves in case the school Board was not willing to, since students are more exposed to wireless devices than any other group. The Peel Board announced that classroom microwave levels are lower than federal safety limits.  But recently these limits were questioned by the Parliamentary Standing Committee on Health indicating that these amounts of radiation could possibly cause a series of health issues including cancer and infertility.

Frank Clegg CEO of Canadians for Safe Technology, one of the speakers in the students’ meeting, claimed that” the Board is misleading its students because the high levels of radiation were measured with only four Wi-Fi devices operating while there are normally 50 devices in use. The students have also invited an international expert on cancer, Dr. Anthony Miller who would give them a lecture on the risks of cancer from common wireless devices like cell phones and Wi-Fi.

In 2011 the W.H.O. declared microwave radiation from Wi-Fi and cell phones to be a “possible carcinogen“, along with formaldehyde and car exhaust. Infertility is also a serious effect that cannot be ignored. Therefore, a thorough investigation on the matter and the development of a policy to substantially reduce wireless exposures to students and staff are of high importance.

A simple way to reduce the radiation dose and exposure time for children and staff is by turning off the Wi-Fi devices when not in use since they are constantly emitting radiation even when no one is using the internet.

What is now advisable is to post in every classroom the Instructions for “Best Practices”  which include:

1. The safest solution is to provide wired connections
2. Avoid prolonged, close contact with wireless routers
3. If students are not using the internet, make sure they de-activate the WiFi
4. Find out if the router has an easily accessible power switch that can be
   turned off when you don’t need access to the Internet

As a parent, would you be against Wi-Fi use in school?

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Does male age affect embryo growth or quality in couples undergoing IVF treatment?

Literature shows that Advanced paternal age (APA) is associated with decreased sperm quality and fecundity. However, the effect of male age on embryo growth in an IVF setting remains inconclusive. Literature concerning male influences on IVF success is scarce and approaches used to analyse embryo outcomes differ by study.

This study was part of the longitudinal Epigenetic Legacy of Paternal Obesity (ELPO) study for which fathers and mothers were followed from pre-pregnancy until the birth of their child. Couples were recruited from April 2015 to September 2017. A total of 1057 embryos from 87 couples were studied.

Dutch-speaking couples planning to undergo an IVF treatment were recruited at the Leuven University Fertility Center in Flanders, Belgium. Anthropometrics were documented and compared to the general Flemish population. Semen characteristics, pregnancy rates and the following embryo characteristics were recorded: number of blastomeres, symmetry and percentage fragmentation.

The scientists observed a significant inverse association between APA and a key determinant for scoring of embryo quality: older men were less likely to produce an embryo of eight blastomeres at Day 3, compared to younger fathers.

Because of the study’s small sample size and its monocentric nature, a larger study is warranted to confirm the results. The scientists suggest a heightened need for future research into male age and its potential effects on embryo growth, embryo quality and ART outcomes. Clinical decision-making and preventative public health programmes would benefit from a better understanding of the role of men, carried forward by the Paternal Origins of Health and Disease (POHaD) paradigm.

What would you comment on the age of men in relation to the above article?

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To explore the possible influence of sperm quality, as assessed by prewash total sperm count (TSC), on cumulative success rates in assisted reproduction cycles.

Methods: Retrospective study carried out in private IVF centre. Seven hundred sixty-five couples undergoing complete ICSI cycles, i.e. whose all embryos were transferred or disposed of. Couples were characterised by male infertility and female age younger than 36 years. Couples with a combination of female and male infertility factors were excluded. The primary outcome measure was cumulative live birth rate. Secondary outcomes were cumulative pregnancy and miscarriage rates. No specific interventions were made.

Results: Higher TSC values have a positive impact on cumulative success rates in cycles characterised by few retrieved oocytes (1 to 5), while does not influence the outcome of cycles with a normal (6 to 10) or high (> 10) number of retrieved oocytes.

Conclusions: The study highlights the importance of sperm quality for the efficacy of assisted reproduction treatments. This influence may remain relatively cryptic in association with normal or high ovarian response, but emerge decisively in cases of reduced ovarian response, suggesting a relationship between ovarian response and oocyte ability to compensate for paternal-derived deficiencies.

What do you think about “Improve sperm quality before assisted reproductive cycles”?

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In this study, 3,480 cycles of in vitro fertilization with preimplantation genetic testing for aneuploidy (PGT-A) in the blastocyst stage and euploid embryo transfer were divided into four groups according to patient body mass index (BMI).

The primary outcome was the miscarriage rate, which included both biochemical and clinical miscarriages. Secondary outcomes were implantation, pregnancy, clinical pregnancy, and live birth rates.
Result(s)
Cycles were divided into four groups according to BMI (kg/m 2): underweight (<18.5; n = 155), normal weight (18.5–24.9; n = 2,549), overweight (25–29.9; n = 591), and obese (≥30; n = 185). The number of PGT-A cycles per patient was similar in the four groups. Fertilization rate, day of embryo biopsy, technique of chromosomal analysis, number of euploid embryos, number of transferred embryos, and method of endometrial preparation for embryo transfer were similar in the four BMI groups. Miscarriage rates were significantly higher in women with obesity compared to women with normal weight, mainly due to a significant increase in the clinical miscarriage rates. Live birth rates also were lower in women with obesity. Obesity in women and day 6 trophectoderm biopsy were found to influence the reduced live birth rate.
Conclusion(s)
Women with obesity experience a higher rate of miscarriage after euploid embryo transfer than women with a normal weight, suggesting that other mechanisms than aneuploidy are responsible for this outcome.

What do you think about “Check your BMI before starting a fertility treatment”?

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Unexplained infertility represents about 22–28 percent of infertility causes.
The diagnosis is based on the exclusion of common causes using standard fertility investigation.

Over the years, the causes of unexplained infertility or subfertility have been identified in pre-existing associated pathologies, such as alterations of the immune system, thyroid dysfunctions, and coagulopathies.

Studies regarding the influence of psychological factors on the development of infertility highlighted that spontaneous pregnancies following adoption or the decision to remain childless are absolute exceptions. The link between stress and infertility in humans is still unclear. For many women, the effect of infertility and the subsequent medical therapy represents a considerable emotional stress.

Accordingly, the relationship between the environment and the reproductive capacity has been proved to have a direct correlation.
Previous work demonstrated that stress is associated with changes in eating habits and exercise, resulting in a complicated spectrum of reproductive disorders.

However, the potential impact of the interrelationship between stress and frequency of sexual intercourse on reproductive efficacy was not sufficiently described.

The low frequency of sexual intercourse in the couple is often not mentioned during the anamnestic investigation, mostly because this issue is a source of frustration and shame.

Psychological stress, physical fatigue, lack of adequate time, and geographical distance represent the main determinants of low frequency of sexual intercourse. Therefore, there is a considerable proportion of couples with unexplained infertility that is treated with assisted reproduction techniques, who would have been able to naturally conceive a baby by simply increasing their sexual activity.

On March 10-2020, Italy became the first democratic country since World War II to impose a national lockdown. In few days, the outbreak spread from a northern crisis to a national one. Restriction measures are imposed to stay home and seek permission for essential travel.

Many companies have started smart working for their employees. At the same time, both the most accredited national and European scientific societies for reproductive medicine and the National Transplant Center, the institute that is responsible for the control of the Centres for ART (PMA) in Italy, have arranged to postpone the cycles of ARTs, waiting for the end of the coronavirus pandemic.

In order to assess the potential impact of insufficient sexual activity on infertility, the group studied whether recent COVID-19-releated lockdown in Italy had any effect on conception ability of couples with unexplained infertility. The scientists included in the study 50 couples with unexplained infertility. In these couples, medically assisted procreation techniques were temporarily suspended because of the lockdown, as imposed by the Italian Institute of Health. Interestingly, they found that 14% of the couples conceived naturally after years (average 2 ± 0.7 years) of infertility.

All the seven couples were contacted by phone, and all confirmed a significant increase in sexual activity, from an average of 2/month to two to three times/week (p < 0.001). They all stated that the longer time spent together at home contributed to the increase of their sexual activity.

It has to be noted that the spontaneous pregnancy rate is so significantly close to that in the literature of unexplained infertility (14% vs 15%, p = 0.9).
Therefore, lockdown and smart working during the pandemic have increased the frequency of sexual intercourse and could have unmasked the real cause of infertility or unexplained subfertility in these couples. It seems unlikely that a reduction of psychological stress would have contributed to the success to the natural conception of a baby in these seven couples, because of the extremely high stress levels felt in Italy during these months, in which more than 25,000 deaths due to COVID-19 were reported.

The team observation seems to suggest that insufficient sexual activity should always be ruled out in couples referring to reproductive centers for fertility issues. It is interesting to note that couples confined to home, naturally increase the amount of sexual intercourse.

Clinicians probably should resist to the temptation to begin an active treatment and not immediately propose medical treatments in these couples. The real impact of insufficient sexual activity on unexplained infertility warrants further clarification in larger studies.

What do you think about “Increase the frequency of sexual intercourse”?

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A question that couples very often ask when starting an assisted reproduction program is related to the two most common techniques used to achieve egg fertilization and the coveted pregnancy.

Confirmation of the best technique given through this study based on the highest rates of blastocysts per egg used for the procedure.

In this retrospective study, 62 ICSI/IVF cycles were analyzed with the eggs divided for each technique. Eggs from these cycles were used randomly in ICSI or the classical IVF procedure. Two hundred and thirty-four ICSI cycles and 152 cycles of classical IVF were further analyzed for comparison.

This method of analysis using sibling oocyte split (half oocytes for IVF and other half for ICSI from the same stimulation cycle) showed quite interesting results. In particular, when comparing and calculating the two pronucleus (2PN) in the oocytes between the classical IVF group and the group of ICSI, the quality of blastocysts was clearly higher in the first case (IVF) with a statistically significant degree (p < 0.05).

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Human eggs use chemical signals to attract sperm. New research from Stockholm University and Manchester University NHS Foundation Trust shows that eggs use these chemical signals to choose sperm. Different women’s eggs attract different men’s sperm—and not necessarily their partner’s.

The researchers examined how sperm respond to follicular fluid, which surrounds eggs and contains sperm chemoattractants. The researchers wanted to find out if follicular fluids from different females attracted sperm from some males more than others.

“Follicular fluid from one female was better at attracting sperm from one male, while follicular fluid from another female was better at attracting sperm from a different male,” said Professor Fitzpatrick.
“This shows that interactions between human eggs and sperm depend on the specific identity of the women and men involved.”

The egg does not always agree with the women’s choice of partner.

The researchers found that eggs did not always attract more sperm from their partner compared to sperm from another male.
Ιs this egg or sperm choice? Professor Fitzpatrick explained that sperm have only one job—to fertilize eggs—so it doesn’t make sense for them to be choosy. Eggs on the other hand can benefit by picking high quality or genetically compatible sperm.

“The idea that eggs are choosing sperm is really novel in human fertility,” said Professor Daniel Brison, the scientific director of the Department of Reproductive Medicine at Saint Marys’ Hospital, which is part of MFT, and the senior author of this study.
The University of Manchester Honorary Professor added: “Research on the way eggs and sperm interact will advance fertility treatments and may eventually help us understand some of the currently ‘unexplained’ causes of infertility in couples.”

“I’d like to thank every person who took part in this study and contributed to these findings, which may benefit couples struggling with infertility in future.”
The article “Chemical signals from eggs facilitate cryptic female choice in humans” is published in the scientific journal Proceedings of the Royal Society B.

Australian fertility experts are now testing the technique, which uses artificial intelligence to improve the odds of a successful pregnancy, in the largest trial of its kind in the world.
As part of the international study, led by national fertility provider Virtus Health, 1000 patients will be recruited at five IVF clinics across Australia, alongside sites in Ireland and Denmark.

During each IVF cycle, embryos will be grown in an incubator fitted with time-lapse cameras to assess the embryo during the five-day incubation period.
The embryo ranking system was built by training the artificial intelligence using thousands of images where it was known whether the pregnancy was successful or not.
What the AI tool can do is analyze .all the embryos. The embryo with the highest score can then be selected for transfer by the embryologist with the aim of accelerating the chance to a successful pregnancy

Dr Illingworth said the purpose of the study was to determine whether the technology can shorten the time it takes a woman to fall pregnant, ultimately saving aspiring parents thousands of dollars in fertility treatment.

The novel coronavirus can persist in the semen of men who are recovering following infection, according to a new study.

The preliminary findings of a Chinese study raise the small possibility that the virus could be sexually transmitted.

According to the Authors from The Eighth Medical Center of Chinese People’s Liberation Army General Hospital,  “to avoid contact with the patient’s saliva and blood may not be enough, since the survival of SARS-CoV-2 in a recovering patient’s semen maintains the likelihood to infect others”.

They also added “If it could be proved that SARS-CoV-2 can be transmitted sexually in future studies, sexual transmission might be a critical part of the prevention of transmission, especially considering the fact that SARS-CoV-2 was detected in the semen of recovering patients”. 

Leaving an infant to ‘cry it out’ from birth up to 18 months does not adversely affect their behaviour development or attachment, researchers from the University of Warwick have found, they also discovered that those left to cry cried less and for a shorter duration at 18 months of age.

Researchers from the University of Warwick have today, the 11th of March had the paper ‘Parental use of ‘cry it out’ in infants: No adverse effects on attachment and behavioural development at 18 months’ published in the Journal of Child Psychology and Psychiatry.

In the paper they deal with an issue that is discussed for decades by parent websites and parents without much scientific evidence: Should you always immediately intervene when your baby cries?

The sample with complete longitudinal data comprised 178 infants and their caretakers. Parental use of ‘leaving infant to cry out’ and cry duration were assessed with maternal report at term, 3, 6 and 18 months, and frequency of crying was assessed at term, 3 and 18 months of age. Attachment was measured at 18 months using the strange situation procedure. Behavioural development of the infant was assessed with two observational measures and a parent-report questionnaire at 18 months.

Contemporary practice of some parents in the United Kingdom to occasionally or often ‘leaving infant to cry it out’ during the first 6 months was not associated with adverse behavioural development and attachment at 18 months. Increased use of ‘leaving to cry it out’ with age may indicate differential responding by parents related to infant self-regulation.

What do you think about “leaving infant to cry it out”?

Emerging literature suggests that men’s diets may affect semen quality, but there is little knowledge about the relation between meat intake and male fertility. A new study, currently published in Fertility and Sterility, showed that processed meat intake was negatively associated to fertilization rate in conventional IVF cycles. Even though it was found no link between overall meat consumption and successful fertilization, men who avoided processed meat such as sausage, bacon, and canned meat had a 28 percent higher success rate than those who consumed these foods daily.

Processed meat was associated with lower sperm concentration and morphology, reflecting sperm normality.

These data are in an agreement with findings of another recent study which examined the association between intake of meat and fish in relation to semen quality indicators among men attending a fertility clinic. It appears that just one piece of bacon a day can damage a man’s fertility, while eating a portion of whitefish such as cod or halibut every day can improve it. More specifically processed meat was associated with lower sperm concentration and morphology, reflecting sperm normality. Men who consumed less than a slice of bacon a day had 30% more normal sperm than those who ate higher quantities of processed meats.

On the other hand, foods like poultry and fish have been positively associated with fertilization rates. It is already known that high intake of processed meat is linked to other health issues and so advising men to consume more fish and white meat instead of processed red meats may improve their health generally as well as possibly be good for their fertility.

Would you keep your man away from bacon?