Does Stress Affect Your Fertility?

Additional Info

• Segment Number: 3
• Audio File: healthy_talk/1514ht4c.mp3
• Featured Speaker: Jamie Grifo, MD, PhD
• Book Title: The Whole Life Fertility Plan: Understanding What Affects Your Fertility To Help You Get Pregnant When You Want To
• Guest Website: Jamie Grifo
• Guest Bio: Jamie Grifo, MD, PhD, is Program Director of the New York University (NYU) Fertility Center. He is also Director of Reproductive Endocrinology and Professor of Obstetrics and Gynecology at the NYU Langone Medical Center.
  
  As Co-Directorof the NYU Egg Freezing Division, his team has created one of the largest egg preservation programs and is currently developing a new generation of embryo screening. Dr. Grifo's research in pre-implantation genetic diagnosis/screening (PGD/PGS) led to the delivery of the first healthy baby in the U.S. using the embryo biopsy procedure he developed.
  
  He has appeared on CBS This Morning, NBC's Today Show, Good Morning America, Oprah and has been interviewed and featured in countless print media outlets including the New Yorker, New York Times, Newsweek, and Wall Street Journal.
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: April 2, 2015
  Host: Michael Smith, MD
  
  Healthy Talk with Dr. Michael Smith, MD. And now, here's the country doctor with the city education, Dr. Mike:
  
  DR MIKE: So, my guest is Dr. Jamie Grifo. He is the program director of the New York University Fertility Center and he co-authored a book, The Whole Life Fertility Plan.Dr. Grifo, welcome to Healthy Talk.
  
  DR GRIFO: Thank you.
  
  DR. MIKE: So, we started, at the end of the last segment, talking a little bit about stress and how that affects conception, so I'm going to come back to that. But before we do, in my first segment today, I was talking about the genome wide association studies and genetic testing and the power of prevention. Before we started your first segment, that seemed to spark an interest in you, so I wanted to give you an opportunity to talk a little bit about what are we doing in terms of testing with conception?
  
  DR GRIFO: Well, there are two elements to that. One is, we all have our own individual risk of passing on recessive genetic diseases to babies and now we have the ability to find out if we're carriers and if we both carry a particular mutation, say, for instance, for cystic fibrosis and both the husband and wife carry it, 25% of the babies will have a very serious medical problem. You can prevent patients from conceiving a baby with such a serious illness. We have the technology now to test embryos for these diseases and avoid having an embryo transferred that has a lifelong disease ahead of them.
  
  So, we can prevent things and, as you said, prevention is really one of the best things we can do in medicine and we have to leverage technology to do it. We have those options for the people that choose it. On top of that, one of the things that we've learned is that the age-related decline in fertility that we see with women is because as eggs get older, they make embryos that are more likely to be chromosomally abnormal. We have found that the biggest cause of failure to conceive, failure of IVF cycles, is that embryos that look good under the microscope are chromosomally abnormal and don't make babies, they make miscarriages, sometimes. Usually they just don't make a pregnancy. Sometimes, they make a baby with Down's syndrome.
  
  Now, we have the tools we can test every embryo before we put it back. By leveraging that tool, we're now testing all of our embryos, putting back a single chromosomally normal embryo, getting pregnancy rates that are age-independent and low miscarriage rates and not having to tell somebody at 16 weeks, they have a baby with Down's syndrome. So, the world is changing in the world of IVF. Now, in the United States, 2% of the babies born are through in vitro fertilization. So, this is mainstream. This is happening every day.
  
  DR. MIKE: When you say that, though, I understand. But, you're the specialist so when you say that you're testing embryos and, to you, it's mainstream, but how often is an everyday couple getting genetic testing like this in small town, USA?
  
  DR GRIFO: Well--and that's a problem. I recommend when you're ready to go get pregnant, you go see your obstetrician and you do preventative measures like genetic screening to find out your risk and, mainly, you'll be reassured that your chance of having a baby with disease is very, very low, but you may find out that you both carry a significant recessive gene. For instance, cystic fibrosis, Tay-Sachs, Gaucher, Canavan. There are hundreds of these diseases. They're found out, mainly, by the baby being born and we now have technology that's not expensive to do these tests, simple blood tests to find out your risk and minimize your risk so that babies can be born that are healthy and not suffer. Most people find out they carry recessive genes by having a baby with the disease.
  
  DR. MIKE: At that point, it's devastating to them, right? It's almost a little too late.
  
  DR GRIFO: It changes their life.
  
  DR. MIKE: Dr. Grifo, the last question on this and we'll move into the stress part. How far are we away from taking an embryo we have identified with cystic fibrosis or Tay-Sach, whatever it is, and doing gene therapy at the embryo level?
  
  DR GRIFO: We're very far away from that. It's interesting. I did the first embryo biopsy in the United States in 1992. We were the second in the world to do it, mainly because we couldn't get permission from the regulators to do it until the Brits were successful. So, we've been doing this a long time. Everybody's fear was that we were going to use this to select traits and we just, number one, don't have the technology to do that, nor the desire. We're about helping babies be born that are healthy and that's really what this technology is. There are lots of fears about how it is used and potentially misused. But, we're using it to help people have healthy, good outcomes.
  
  DR. MIKE: I just find gene therapy, to me, is just a fascinating field and the concept is pretty straightforward. Replacing a bad gene with a good gene. I know we're able to replicate that and do that in certain laboratory settings and stuff. So, I think that that is an exciting field and I'm glad to see that you're on top of that.
  
  Let's move the conversation. We have maybe a couple minutes left. Let's move the conversation over, though, to, I think, something's that's more relevant for most of my listeners right now: the stress in our lives. Here you have maybe a couple trying to conceive, but the lives that we're living today; I mean, this constant 24-hour information cycle, this "go, go, go" attitude in this country. What is that doing to us and what are some of the things you can tell a couple to de-stress a little bit so they can conceive?
  
  DR GRIFO: Well, you know, it's very clear that the fight or flight response which we're all exposed to multiple times a day has an impact on ovulation and also on the environment for an embryo to develop. While it's not contraception, per se, it's not an absolute reason not to get pregnant, but what it can do is lower your chances. There are studies that suggest that you manage your stress well—not take it away, because no one can, but manage it—that you might get better outcomes. But, on top of that, the real problem is, when you're an infertility patient, that alone is a huge stress and, you know, on top of that, you have the pressure of not being stressed when you're probably going through one of the most stressful things in your life. So, just managing it to help you get through it is more important than whether it has an effect on outcomes.
  
  So, there are lots of things that one can do to manage their stress and make it better. Some of those are simple things. Things you do by yourself. You figure out on your own. You know, things like acupuncture can work for some, if they find it relaxing and helpful; meditation; yoga. Just taking yourself out of the environment. Just breathing and managing and recognizing your stress and trying to minimize your exposure to it can have an impact. So, don't stress about stress. You're going to be stressed going through fertility treatment. You can't take it away, but manage it.
  
  DR. MIKE: So, let me shift gears here. When should a couple go and see a specialist like yourself? At what point do they say, "Okay. Something's not right here."
  
  DR GRIFO: Infertility is defined as a year of trying and not getting pregnant. But if you're under 30, you could wait that long unless it's bothering you. If it's bothering you, you should get a workup because it's oftentimes a simple correction or a simple thing that we find that we can fix that makes a difference. Certainly, women over 30, and especially over 35, should not wait a year to come see a doctor.
  
  They should, with 3-6 months of trying, be in getting evaluated, getting tested and making sure there are no obstacles. Treatment starts with simple stuff that's not that involved, not that invasive, not that expensive and often very efficient. Then, ultimately, there are much more sophisticated, technology driven, but highly efficient, techniques like in vitro fertilization as well as in vitro fertilization with genetic testing of embryos, which turns out to be one of the biggest problems. Most people are making embryos that are abnormal. You've got to find the one good one.
  
  DR. MIKE: So, when a couple needs to go see someone like you, are insurances covering visits to a specialist like yourself?
  D
  R GRIFO: In our area, in New York, they cover the diagnosis and they may not cover treatment, although more and more, they're covering treatment, but diagnostic aspects of this generally are covered by insurance. But you have to check and see your policy. Every policy is different.
  
  DR. MIKE: Alright. Dr. Grifo, we're going to have to leave it there. The website, if you want to learn more about what Dr. Grifo is doing, it's JamieGrifoMD.com.
  
  This is Healthy Talk on RadioMD. I'm Dr. Mike. Stay well.
• Length (mins): 10
• Waiver Received: No
• Host: Mike Smith, MD