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Deborah Howell: You know, one in eight couples will have trouble conceiving or sustaining a pregnancy. While many are surprised by this, they're certainly not alone. The good news is there are now treatments available to help almost everyone conceive. Dr. Elie Hobeika, a reproductive endocrinology and infertility specialist here at FCI is with us today to help us better understand what we need to know about fertility and infertility.

This is the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Hobeika, it's so nice to have you back on with us again today.

Dr. Elie Hobeika: Thank you for having me back, Deborah. I'm very happy to be here.

Deborah Howell: Yeah, you're most welcome. I've asked you this question before, but for our new listeners, just what is infertility?

Dr. Elie Hobeika: So, infertility has historically been defined as the inability to conceive with intercourse after trying for 12 months in heterosexual couples. However, we recommend now doing a diagnostic evaluation after 12 months if the female partner is younger than 35 years of age and six months if the female partner is 35 years of age or older. We do a workup as well in the setting of known factors that will prevent the ability of someone to conceive naturally, such as a tubal ligation, a vasectomy procedure or in the presence of irregular periods or others.

Deborah Howell: Okay. That's fair enough. How prevalent is infertility?

Dr. Elie Hobeika: Infertility is pretty common and, as you mentioned in your introduction, it affects one in eight couples. However, it's important to note that its incidence has been on the rise in both developed and underdeveloped countries recently.

Deborah Howell: Wow, that's incredible. So, what are some of the common causes of infertility for women?

Dr. Elie Hobeika: The most common cause of infertility in women are disorders of ovulation, which manifest as irregular periods. Other causes include occlusions of the fallopian tubes, anatomical lesions affecting the uterus, such as polyps, fibroids. And, in other cases, the cause remains unknown.

Deborah Howell: Okay. And how about men?

Dr. Elie Hobeika: A decreased number of sperm is the main cause of infertility in men, and this could result from exogenous administration of testosterone, certain hormonal disorders and medical conditions that could affect men, and in addition as well to vasectomy procedures.

Deborah Howell: Okay. And are there any other causes of infertility that are maybe less common?

Dr. Elie Hobeika: Yeah, there are some rare conditions in men and women that lead to the inability to conceive. Some of them are genetic, such as cystic fibrosis, for example, and others occur for reasons that we still do not fully understand yet.

Deborah Howell: Okay. How about age? You spoke earlier about, you know, under 35 and over 35. How does age affect fertility?

Dr. Elie Hobeika: Yeah, it is the age of the female partner that affects fertility the most. The eggs are present in the ovaries before the female is born. So with time, certain proteins in those eggs get denatured plus the reproductive potential and performance of those eggs when mixed with sperm worsens with time making pregnancy less likely to occur. There's also an increase in errors in development, and that's why there's a higher chance of miscarriage with an older age.

Deborah Howell: Okay. Are there tests that determine your fertility potential?

Dr. Elie Hobeika: Unfortunately not. Patients come all the time asking for a fertility checkup, and I tell them that the best way to see if a patient can conceive is to have her try and see if she gets pregnant or not. What we can do is that we can check her ovarian reserve. We can check some hormones that may affect pregnancy. We can make sure tubes are open. We can check that the uterus is a safe place for the embryo to attach. We can make sure that there's a good number of sperm in the ejaculate of the male. But that does not mean that all of these components will work when put to action. So, we cannot guarantee that a pregnancy will occur. We will do the evaluation in the setting where they tried and they have been unable to conceive to try to understand the reason why it has not worked yet.

Deborah Howell: Sure. Understandable. Now, what types of treatments are available for those struggling with infertility?

Dr. Elie Hobeika: Treatments for infertility vary based on etiology. The most common treatments include inducing ovulation with oral medication, followed by intrauterine insemination. And this is a fancy word for washing sperm and putting it inside the uterus or in vitro fertilization or IVF. And this is where eggs and sperm are mixed together in our lab to create an embryo, that is then transferred back inside the uterus. However, one should not forget that treatments for fertility could be surgical. They could involve the use of somebody else's egg, such as a donor egg or somebody else's sperm, such as donor sperm or the use of a gestational carrier. And lastly, treatment may involve medication to treat hormonal conditions purely either in males or the females.

Deborah Howell: Oh, so many, many options. How can lifestyle choices affect your fertility?

Dr. Elie Hobeika: Lifestyle choices are very impactful on fertility. I encourage all individuals to maintain a consumption of caffeine that is under 200 milligrams per day. As far as alcohol consumption, it is okay for women to consume two to three servings of alcohol per week preceding the week of ovulation. We are a little bit more lenient with men, and it's okay for them to consume up to six to seven servings per week. It is very clear to us now that smoking is a big toxin and affects fertility in both partners on so many levels, so I urge all couples trying to conceive to quit smoking immediately, and I would do the same for--

Deborah Howell: I just want to stop you there. Is this tobacco or all smoking?

Dr. Elie Hobeika: That's smoking cigarettes. Tobacco, yes. And I would do the same as well for marijuana and illegal drugs. Although the data for marijuana on fertility is not so clear yet, but it's generally a toxin and it may not be the smartest thing to consume marijuana while trying to conceive.

Deborah Howell: Okay. And then, let's go back to coffee again. You mentioned 200 milligrams. How much is that?

Dr. Elie Hobeika: So, 200 milligrams is the equivalent to 16 ounces of coffee. So, one cup eight ounce is equivalent to 100 milligrams and two cups would make it up to 200 milligrams per day.

Deborah Howell: Okay. So, two cups a day or less.

Dr. Elie Hobeika: Or less.

Deborah Howell: Okay.

Dr. Elie Hobeika: But one should also account for the sources of caffeine that could be present, and energy drinks and protein shakes and pre-workouts. I'd like to say Pepsi or soda, I can completely forgot.

Deborah Howell: Yeah. And also, chocolate has a little bit of caffeine in it, right?

Dr. Elie Hobeika: Yeah, very minimal though.

Deborah Howell: Okay. All right. Speaking of chocolate and things, what kind of diet is best to boost fertility?

Dr. Elie Hobeika: I am a big believer that food is medicine, so being on a Mediterranean or a Greek diet has been shown to improve fertility naturally and in couples doing treatment as well. This consists mostly on relying on fish and seafood as main source of your animal proteins and getting most of your fats from plant-based sources such as avocados, olive oils, nuts, peanuts. Eating a lot of fruits and vegetables since those are a good source of fibers and antioxidants and limiting the consumption of red meat and processed foods in general.

Deborah Howell: Okay. Are there supplements you can take to improve fertility and are they different for men and women?

Dr. Elie Hobeika: Yeah, there's very good evidence that coenzyme Q10, which is an antioxidant, is beneficial for both men and women as it improves egg and sperm quality. It is important women take a prenatal vitamin daily containing 800 micrograms of folic acid or more. As far as additional supplements, I would recommend that on a case-to-case basis, and I encourage that couples check with their providers on whether or not they should be taking those additional supplements or not.

Deborah Howell: Okay. What words of wisdom do you have, Dr. Hobeika, for someone who suspects they're struggling with infertility?

Dr. Elie Hobeika: I would like to say here that infertility is a disease. It is not voluntary, it is not a punishment, and definitely not something to be ashamed of. I encourage people to seek help as soon as possible. Talk to a fertility specialist. Seeing me of my colleagues does not necessarily mean that you have to do IVF or even any other treatment. Sometimes all what we do is give guidance and reassurance, and that could be all what you need to conceive.

Deborah Howell: That's well said. It's such great information. It's such a wonderful thing to talk to you every single time, Dr. Hobeika. We learned so much. Anything else you'd like to add at this point?

Dr. Elie Hobeika: For all those struggling with infertility, I want to let you know that you're not alone. We feel you and we are here for you. So, please do not hesitate to reach out to us.

Deborah Howell: Perfect. And, you know, that's such a great idea. Reaching out is the very first step in success. Such great information, Dr. Hobeika. Always so wonderful to have you with us today. Thanks for being with us to share your expertise.

Dr. Elie Hobeika: Thank you, Deborah, and have a very happy New Year.

Deborah Howell: That was Ellie Hobeika, a reproductive endocrinology and infertility specialist here at FCI. Schedule an appointment to talk to a fertility specialist at 877-324-4483 or visit fcionline.com for more information.

And if you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do. This has been the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.