Melanie Cole, MS (Host): As marijuana is becoming legal in more states, many people are looking to it as a way to wind down and de-stress. But if you're thinking about getting pregnant, what is the effect on fertility if you're using marijuana? Well, we're going to talk about that today on this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey.

I'm Melanie Cole. And joining me is Dr. William Ziegler. He's a specialist in Reproductive Endocrinology and Infertility. He's also the Medical Director of the Reproductive Science Center of New Jersey.

Intro: 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. Here's Melanie Cole.

Melanie Cole, MS: Dr. Ziegler, I'm so glad to have you joining us today. As I said in my intro, more and more states are legalizing marijuana and people are using CBD as well to kind of de stress and help with some of the anxiety that so many of us are feeling. Can you speak to these? And tell us a little bit about how these vices affect fertility for both men and women?

Dr. William Ziegler: I think we really need to look at the number of people or individuals in which are using just marijuana. We know that in 2019, there was only 18% of Americans using marijuana. And in 2022, it has increased to 28%. So, this increase we are seeing because of the increased legalization of cannabis, some feel it's less risky, that it's not as harmful as smoking and alcohol and painkillers. It's also less harmful. You don't hear about individuals that are overdosing on cannabis. And in over 50% of Americans feel it is socially acceptable. So now, we're seeing this big increase in marijuana use. And we have to really think about how it is impacting the medical field. And with regard to our field, it has to do with reproduction.

So, we then look at the two compounds, which are in cannabis. You have CBD and you have THC. We know that THC has a higher concentration in marijuana itself, as opposed to CBD, which has a higher concentration in hemp. And hemp is used to make textiles, to make rope, those type of things. Even though both compounds are very similar, their properties are markedly different. We know there's cannabinoid receptors in the hypothalamus, pituitary gland, as well as in the reproductive system, in the testicle. We know it is in the uterus, the fallopian tubes. So, how does this all impact fertility?

So, we now look at studies that have looked at mainly THC. That CBD has been looked at and there does appear to be an impact on fertility. However, there's more of an impact on THC and that is what gives you your euphoria. CBD is mainly used for, as you were mentioning before, for relaxation. It takes away anxiety. It helps to treat insomnia, inflammation. But now when we look at THC and how it affects men and women in reproduction, we look at what does it do in the brain. It actually decreases luteinizing hormone. Luteinizing hormone is needed in female infertility to recruit eggs. We know that women who smoke or vape, they have a longer time to conception. It was shown that women who smoke one cigarette a day or vape one time a day, their success rates in conceiving in six months are much lower than non-users. It's 42% versus 66%. So, it is a dramatic decrease. We also know that it can affect implantation that by decreasing LH in a woman, it decreases progesterone. Progesterone is needed to hold onto a pregnancy. If you decrease progesterone, what are you going to see? An increase in miscarriages. And that's exactly what we see. We see that the miscarriage rate in smokers are double those that are non-smokers. Also, it increases the rate of stillbirths. So, we know it has a significant impact on a woman's reproduction. Also, it throws off ovulation. There are reports that show that it delays ovulation for around four days. And some of those cycles are anovulatory, meaning a woman is not ovulating. So, how can you get pregnant if you're not ovulating? So, those are some things that we have to share with our patients of what cannabis can do to their body to affect them in reproduction.

But it's not just in women. It's also in men. Studies have shown that if a man has one vape or one cigarette a week, it can decrease sperm concentration and count by at least 30%. And that can last up to three months. So, that it's not short lived, that it is prolonged. But we also know that sperm from those that smoke cannabis or do edibles, what they can do is it can affect the viability of the sperm, how the sperm moves and we have low fertilization in those that are active smokers. So again, it can affect both men and women. In men, also decreases testosterone. So, it can decrease their ability to perform. And there was a study out that showed that it can decrease testicular size. So, we really need to bring this to the forefront. It's not a benign substance. So we really need to be aware of how it impacts the fertility on both men and women.

Melanie Cole, MS: Well, thanks for telling us, Dr. Ziegler, about the many different forms because I was going to ask you about vaping versus smoking versus gummies. There's so many ways now. And I know that we're talking about marijuana. But while we're talking about sort of vices, can you just touch on alcohol as well, Dr. Ziegler, and its effect on motility, sperm count, hormonal production, any of those things?

Dr. William Ziegler: Well, in reality, that casual or social outpoll use doesn't appear to affect fertility. It's when somebody is imbibing quite a lot, then it can actually affect the hormone profile because alcohol is broken down within the liver. The liver can also break down hormones. So even though they're making the hormones, they're being broken down quicker; and therefore, that can also affect sperm concentration because if you're breaking down the hormones quicker, then the hormones are not getting to the organs which are needed. So yes, that can also affect fertility. However, you do need to consume quite a bit of it to actually have an impact.

Melanie Cole, MS: Now, in my intro, Dr. Ziegler, I mentioned stress and winding down. And certainly in this day and age, we're all looking for a way to wind down and de-stress. Tell us a little bit about that, the role that stress has in fertility or infertility. And as we're looking to some of these vices, whether it's alcohol or marijuana, how that all ties together because stress in and of itself can affect our fertility, yes?

Dr. William Ziegler: Yes. That stress can. You know, that in times when women are in college and if they're studying for a test, their cycle may be thrown off, mainly because of the stress of studying. Because stress does increase opioids within our body and opioids again affect LH and affect the FSH levels. Stress we know is not good in any form. And there was a study out that showed that stress could also be related to having miscarriages. There was a study that looked at women who had repetitive pregnancy losses. And they were seen by their obstetrician every single week as soon as they signed up for their office. And they compared it to those that had the standard care, where they were seen every four weeks within the first trimester, two weeks, second trimester. And they found those that were seen more often had reduced stress. And they also had a better live birth outcome. So, we know stress is not good. And we know that even CBD is used to reduce stress. It's not really used to get the high, but it does help reduce inflammation. It reduces stress. It helps individuals sleep. So again, we're getting full circle back to the marijuana issue. And we know that CBD, that it can affect sperm production. We just don't know how much.

Melanie Cole, MS: So, what are we to do if someone, if a couple really wants to start trying to get pregnant and these are the things that help them de-stress and we know that fertility treatments in and of themselves can also be stressful? What is your best advice, Dr. Ziegler, for the vices that we can look to if I, if vices is the word that I should use, to help de-stress, to help bring down that level of anxiety If we're not going to be able to use marijuana, CBD, have to have a drink, what's your best advice?

Dr. William Ziegler: I think the best thing to do is to find a way to let out the anxiety. Whether it is through joining a gym, whether it's doing yoga, whether it's acupuncture. Those things are beneficial. Anything that can reduce stress. When you start to use outside influences such as marijuana and alcohol and painkillers and that type of thing, now you start to disturb the apple cart. Now, you're actually affecting fertility. And I know we didn't touch on female infertility too much with marijuana, but even that, they have prolonged menstrual cycles. They have anovulation. We have to inform them of what marijuana can do to their fertility as well as some women use marijuana in the first trimester of pregnancy to help avoid nausea and vomiting. However, it has been shown that children that are exposed to marijuana or cannabis in utero have a higher incidence of being admitted to the neonatal intensive care unit. There's a lower birth weight. There's also been an association with autism. So even there, you try to bring everything together and say, "Okay. What you are doing, it may be beneficial for you now. But in the long run, it's really not going to be a good thing for you, for conceiving as well as for a baby."

Melanie Cole, MS: So for couples together, finding that alternative way to let out the stress and for women and hormone production, these are things you just don't recommend, yes? Do you have any final thoughts for us, Dr. Ziegler?

Dr. William Ziegler: Well, I think when a couple are trying to get pregnant, they need to kind of take a look at their whole lifestyle. And yes, that if you have a cough and you go into your family practice doctor's office, you're concentrating then on the cough or the cause of the cough. Here, we're just not focusing on what is causing their infertility, but also what are they doing in their social lives in private that could be affecting their fertility. And we do uncover those that are taking steroids for bodybuilding or doing some other extracurricular activities in which could affect a couple's ability to conceive. So within our practice, we try to pull everything together and give them enough information that they can make that choice and know what the impact is of what they're doing so we can better treat them.

Melanie Cole, MS: Well, it certainly is all about education and you're so good at that, Dr. Ziegler. Thank you so much for joining us again. And for more information, you can 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. Thanks so much for joining us today.