VO: The Reproductive Science Center of New Jersey combines a commitment to sensitive care with a state-of-the-art program. We proudly present Fertility Talk with RSCNJ. Here's melanie Cole.

Melanie Cole: Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. Joining me is Dr. William Ziegler. He's a specialist in reproductive endocrinology and infertility, and he's the Medical Director of the Reproductive Science Center of New Jersey. And today, we're talking about marijuana and its effect on fertility treatments.

Dr. Ziegler, thank you so much. And as we get into this topic, I want you to first kind of give us a broad overview of some of the unhealthy habits that you have identified in your many expert years in this field that we need to avoid that could potentially reduce fertility.

Dr. William Ziegler: Well, we do know the impact that cigarette smoking has on male infertility, as well as female infertility. We do know that the nicotine, which is within the cigarettes, can actually affect sperm production. It can also affect motility as well as morphology, the shape of the sperm. We also know that the eggs within the ovaries, they don't like nicotine either. And we do know that the eggs we get from active smokers are brown in color. And the fluid around them has nicotine in it. Those eggs don't fertilize well, nor do they result in good embryos. And there was a study that was actually done in women who worked in smoking bars, those that were non-smokers and those that were smokers. And they did find those that were smokers and again, worked in a smoking bar, they had a higher incidence of ectopic pregnancies and miscarriages, and we do know that it can play a role.

We also know that third-hand smoke can affect babies, that there's some research out there that even though you may not smoke around an infant or a baby, because it's in your clothes and the baby is snuggling up against your clothes, that third-hand smoke can actually increase the incidence of sudden infant death syndrome. So we know smoking is really not beneficial to do. I'm still trying to find the one good thing that smoking does for you. And I'm just having a hard time finding that.

But when we talk about even illicit street drugs with, you know, cocaine, the effect of cocaine can actually last for two years and it could really affect male infertility as opposed to other recreational drugs. And we are now getting into a new environment where marijuana is now legal. And we now know that marijuana use has actually increased by 60% within the last decade. And probably, it's going to increase even further. And it's not just the marijuana itself, but it's the active ingredient that is in marijuana, which is the which basically produces the mind-altering results that gives that person that high experience. But also, those things bind to specific receptors in the central nervous system. And what it can do is it can alter hormone profiles. We know that in men who smoke marijuana more than once a week have a 30% reduction in sperm count as well as the concentration. And this can last up to five to six weeks even after stopping using marijuana. We also know that it can affect the way the sperm penetrates the egg, that the acrosome reaction or the way that it penetrates, it doesn't work the way it's supposed to. And therefore, this could actually be a cause for infertility.

Now, there was also a study that looked at sperm quality in current users, past users compared to non-smokers. And current and past users, they had a decline in sperm quality compared to non-smokers. And we really don't know the amount of marijuana that would need to be ingested or inhaled to cause a problem with sperm. But we also know in females, it could affect the hormone profile to the point that one study showed that there was a 40% less likelihood in conceiving non-users.

There's a study that looked at women who are smoking for six months and found that they had a 62% pregnancy rate at six months versus 66% in the non-users. And the evidence does come from an altered release of what's called gonadotropin-releasing hormone, that because this is affected, you have a reduction in estrogen, as well as progesterone production. And some of these cycles that women have are what are called anovulatory, they are not producing an egg. So we know from that standpoint, it does affect male infertility, it could affect female infertility. But also, after a woman gets pregnant, what do we know about marijuana? Well, we know that it does increase the risk of miscarriage even in those that are using assisted reproductive technology, that the miscarriage rate is actually doubled, as well as there's a higher rate of stillbirth. You get pregnant, you're carrying throughout the pregnancy, you're still smoking, you do have a higher risk of losing the pregnancy, but it can also have effects on the baby, that it can cause low-birth-weight infants. It can cause developmental delay and defects. It can cause poor executive functioning. So at this point in time, we kind of recommend our patients if they are smoking marijuana, that we do recommend them stopping. Because again, it does affect fertility and it can affect the wellbeing in that of a child.

But we also address other social issues such as obesity. And we know that women who are over a body mass index of 30. They can have some oscillatory problems and that's mainly because of peripheral conversion of hormones is higher in those that have more adipose tissue or peripheral tissue. So we do try to counsel our patients to get below the body mass index of 30 to basically optimize their fertility treatment.

Melanie Cole: Wow. That was a wealth of information right there, Dr. Ziegler. So as marijuana is becoming legal, and as you said, this is complicating things for couples trying to get pregnant and can, and even CBD. Since THC is what you were discussing, does it matter the way that it's used, whether it's gummies or candy or smoking it or using various CBD creams or even THC creams? It's the THC that's affecting fertility, not the way that it's ingested, right? Because there's so now.

Dr. William Ziegler: There are so many ways now. And the other thing is that, if you're using, the active ingredient is in something you are either swallowing, chewing, or applying to your skin, you have to think that's getting absorbed. It's getting into your bloodstream. And if it does get into your bloodstream, that could affect your ovulation, it could affect your ability to conceive.

As I mentioned before, we don't know how much affects somebody and it may be weight determined, we don't know, or whether eating it or chewing it or smoking it or inhaling it, which one is better, which one is worse. And I don't think there's enough data out at this point in time. What we have is we have all users, and I think there needs to be some more studies to kind of break out to say, okay, which one has more of an effect on fertility or even pregnancy outcomes, but that would be very hard to construct.

Melanie Cole: I would think so. And as far as other things, alcohol, and you talked in detail about smoking cigarettes and nicotine. There are a lot of vices. So speak a little bit to alcohol and what we know. And Dr. Ziegler then say, if a person has these vices, how can they find alternative ways to whether it's reduce their stress or behavioral, whatever it is, what do you counsel them on every single day when you come across couples with these vices?

Dr. William Ziegler: Well, when we talk about alcohol, alcohol usually does not affect fertility unless they're more of like an alcoholic or if they're ingesting quite a bit of alcohol that could actually affect them mentally, because it can affect the metabolism of hormones. However, in pregnancy, we do know that women who drink in pregnancy, they have an increased incidence for fetal alcohol syndrome, which affects the baby. So again, we do recommend patients to avoid drinking alcohol when they are proceeding through treatment and of course, just during pregnancy. When we talk about vices and people use these to escape maybe the stress of life or to maybe deal with other things within their lives. And I think that's where getting an individual involved with a counselor to kind of address where are these issues in which they're trying to mask or trying to address with smoking or with alcohol, and try to find another way around that. And it could be working out at a gym or maybe it is going for a massage, doing something else that could replace something that's harming them and affecting their fertility and maybe pregnancy outcome.

Melanie Cole: So, this is a really good topic. And I think not everybody really realizes these effects, but there's environmental effects and then there's behavioral and things that we do. As we wrap up, I'd like you to speak about stress levels, things people use these vices for. You can even mention medications, if you would like to. I mean, people are on anti-anxiety medication, depression medication. Do we know anything about stress, the medications we might use, the vices we might use? Any of these unhealthy habits that could potentially reduce fertility for couples that are trying to have babies?

Dr. William Ziegler: Well, stress in itself is really not something healthy to have. And anything that you can do to reduce stress is going to be beneficial, okay? And that's a plus we really don't know the effect that stress has on fertility. There was a study out that showed that women that saw their doctor more frequent in early pregnancy reduced their stress and also reduced the risk of miscarriage. So we have that information, but that was a very small study.

With regard to other things that people may be doing to relieve stress, again, it's one of those things that if they need medication, there are some medications that are safe in pregnancy. But it all depends on what they're trying to address, whether it is anxiety, whether it's depression, what else is going on. And I think counseling really helps. There are safe medications to use. But it all depends on what are we actually addressing. And that's where I leave it up to the mental health professionals.

Melanie Cole: One-hundred percent great information. Very informative. Dr. Ziegler, thank you again as always. You're an excellent guest. And for more information, you can always visit fertilitynj.com to get connected with one of our providers. That concludes this episode of Fertility talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole.