What over-the counter medications can impact fertility--both for women and men? What non-prescription drugs should you avoid when in fertility treatment or pregnant? Host Dawn Davenport, Executive Director of Creating a Family, the national infertility education and support nonprofit interviews Dr. Kathleen Tucker, an embryologist and reproductive physiologist with 25 years of experience.
Please leave us a rating or review RateThisPodcast.com/creatingafamily
What over-the counter medications can impact fertility--both for women and men? What non-prescription drugs should you avoid when in fertility treatment or pregnant? Host Dawn Davenport, Executive Director of Creating a Family, the national infertility education and support nonprofit interviews Dr. Kathleen Tucker, an embryologist and reproductive physiologist with 25 years of experience.
Please leave us a rating or review RateThisPodcast.com/creatingafamily
Welcome to creating a family talk about infertility. Today we're going to be talking about the impact of over the counter medications on fertility and pregnancy. You know, we tend to think that over the counter medications are no big deal. I mean anybody can buy them, right, so they must be totally safe. Well, we're going to find, I'm going to dig a little deeper on that. Today. We're going to be talking with Dr. Kathleen Tucker. She is an embryologist with a doctorate and reproductive physiology and over 25 years experience as a professor and an IVF laboratory director. She now has her own consulting business, k e Tucker Consulting. Welcome Dr. Tucker to creating a family. I can't wait to dive in on the topic.
Speaker 2:Thanks done. I'm really excited to talk to you about this too.
Speaker 1:I am a person who really loves to dig into the research and I found some interesting research cited three reasons why the over the, the impact of over the counter medication on fertility was becoming an increasing issue and one that that health care providers as well as patients need to be thinking more about. One they know that, that, that people in general are taking more medication now than people in the past. Also, people are waiting longer to start a family, uh, than, than previously, which is associated with greater medication use just because of age. Also, people who are experiencing in general more chronic disease at earlier ages. Uh, and, and, uh, taking both, both more prescription and nonprescription medication. So taken together, these factors have increased the number of prescribed and over the counter drugs that people are men and women are taking at the time when they are considering or trying to conceive or are or are pregnant. So is, is that fit, I know that you spoke at a, on this topic at the large American Society of Reproductive Medicine Meeting, uh, did this, this what I was just telling you, does that fit with the research that you have seen as well?
Speaker 2:Oh yeah, absolutely. Especially the part of, Oh, you know, they're over the counter medications. It's not big deal. That's actually when I was thinking of an introduction to this topic. That's exactly what I was thinking. Oh, we take them for granted. Um, and it, you know, over the years are our intake has increased substantially. Like for instance in the u s talking about men right now, men undergoing infertility, 68% of men, 18 to 44 years of age and over 80% of men, 45 and older are taking some kind of prescription or over the counter medication. And what's interesting is that coincidentally 26% of these men, 40 that are over 45 years old are becoming patients or parents for the first time. And so they're taking all these medications and they're trying to start a family. So you know, that's where the, there's the rub as they say. Um, so in eh, for women, the statistics of how much they're taking in a nonpregnant state is not real clear probably as much as you and I are taking on. For those women who are, for instance, pregnant, I have a statistic that it was quite a, um, an eye opener. Him, depending on who you read, it can be anywhere from 90 to 94% of all pregnant women are taking some kind of medication. And I don't even, and this doesn't count via vitamins or herbal supplements. So that's a, that's a very high confounding amount of um, people taking drugs at a time when you think that that could be very detrimental.
Speaker 1:And so what we're going to do now is, is trying to dig into what we know and then what we don't know about how these medications, uh, are impacting, um, uh, both the attempts to get pregnant as well as, uh, as pregnancy. And let me just stop and point out that, uh, for the patients, uh, as always talk with your doctor about any concerns you have regarding both prescription and nonprescription medication. However, for the, uh, healthcare providers, I think that the, um, the, the take home message is going to be too come to an understand, find out what medications your including herbal supplements, but your patients are taking that it's going to be vitally important. And we'll circle back to that at the, uh, at the end. Uh, because I think that we're going to learn more about which specific type of medications we need to be worried about. Now we're going to be talking about classes of medications. We're going to be focusing on over the counter, but then some of these classes there will also be prescriptions and, and, and when we have the, and when that research is given us information about the impact from prescriptions, we will talk about that as well. And we're going to be talking about the impact in four different time periods. One, the impact on fertility general, both female and male, uh, for people who have taken the medication in the past, uh, now impact also impact when these medications are taken during treatment. Uh, and third impact, uh, when the medications are taken in pregnancy. And then fourth, impact on the child. If the mother took the medication during pregnancy, again, we won't have a information. There's not research, uh, our definitive research one, uh, all of the, all four of these potential impacts for each class of medication. But that's the general approach we're going to take and we're going to share what we know now from the research. All right, let's start by talking about nonsteroidal anti inflammatory drugs. INSETS, they are a popular, a pain reliever, antiinflammatory obviously. And we've got I think five basic categories. One aspirin to Ibuprofen, three neproxin for uh, Celecoxib and five Acetaminophen. So, uh, let's talk in general about those. And I know, uh, that aspirin, I'm going to let's say aspirin to the end because aspirin is a bit of a outlier and has some really interesting research about that. All right, so what do we know about, uh, starting in that first time period? People who have taken these medications in the past, let's say the, uh, the non non Ashburn once, but the others, uh, is any research indicating that they can impact a female fertility,
Speaker 2:the, um, the nonsteroidal antiinflammatory medications. So the, at least the research I came across for healthy premenopausal women is that what if you follow the manufacturer's recommendations, there isn't a direct effect on, on anything that would affect your fertility, doesn't affect regulation or aid, it doesn't affect, um, your menstrual cycle lengths, uh, things like that. It doesn't affect your fertilization rates. Just if you're healthy and you have no big no, no conditions, you are of normal body weight. Also very important, um, and not taking a myriad of other medications that can conflict, then it should have absolutely no effect. And so, uh, quite the contrary is if you are having an indication where you need to take one of these ad sets, then you're probably, it's better for you in the long run to go ahead and, and handle that fever and take care of that inflammation and reduce that pain then whatever minor impact it might have on, um, on, uh, your fertility rate after that, because these injury conditions can cause much more damage than the amount of medication you're a healthy woman would be taking.
Speaker 1:So what about during treatment? Um, a woman has come in to treatment, uh, and is, uh, beginning the treatment and she is, let's say both just a periodic or, or a, a routine. Either one of these medications safe for her.
Speaker 2:Yeah. As far as I know, yes. It's not a big deal in, in our experience, again, we'd rather have, she's taking a lot of hormones. She's, you know, she's pretty much, she's menopausal one day and then a hyper stimulated the next, she's estrogen poisoned her, her system is going all over the place. Estrogen isn't an inflammation modulators, so, Eh, you know, she can, she'll have headache, she'll have body aches, it's everything. So she can take, you know, some Tylenol to reduce that. It would calm her down and that will help a lot, um, in this period of time. Um, and as if she's not smoking, smoking is a big one, but we're not talking about that today. But in a healthy woman, beginning infertility treatment, her, her biggest adversary is stress. Anything she can do to minimize physical and emotional stress, she should try and do. Now we're not talking handfuls of Tylenol or Ibuprofen or anything like that, following the manufacturer's recommendation, recommended dosages, Try News as little as possible. And, um, I'm going to mention Acetaminophen because that is the one that is considered the most safe. It has a v a lower
Speaker 1:mmm.
Speaker 2:Blood thinning component to it. So that's usually the first line of defense for any kind of inflammation or pain or Analgesia. So
Speaker 1:would that be the same that we were talking in treatment? Would that also be the same as it pregnant pregnancy as well?
Speaker 2:Yes, yes. Um, that's the most highly recommended, um, analgesic for during pregnancy. And I think I have a statistic for you on that one. Somewhere around 65% of pregnant women take Acetaminophen.
Speaker 1:Gotcha. Okay. So we've had a long time, a lot of research on a Acetaminophen and as far as the others, if you have been taking it in the past, obviously you check with your doctor, but if you have been taking that in the past, uh, Ibuprofen, Naproxen, Celebrex, any of those than the, there would be you check with your doctor, but you might well be fine if your doctor says it's okay. Taking as prescribed Mri as a direction, say on the bottle.
Speaker 2:Absolutely. These, um, the Ibuprofen is still, the jury's a little bit on that as far as during pregnancy. It has a, an SDA categorization of c or d and they do recommend not taking it. And the third trimester of pregnancy, for some reason I could not find that study. Um, so it might be that if you, if you were a headache, can be alleviated by Tylenol, which is more highly recommended. And that's a category B medication, which means that it, there's no,
Speaker 1:okay,
Speaker 2:mmm, well known studies in humans, but animal studies show no adverse effects on the fetus. Uh, risks, I mean the benefits outweigh the risks. It's considered safe during pregnancy. Um, Ibuprofen is still considered safe during pregnancy. If that's the only thing that's helping you with, with fever, with headache, with Migraine. Um, if, if you're getting relief that at the normal dosages, the FDA will still say if the benefits outweigh the risk, it's safe to take. It hasn't, it's not a category X, which means, you know, put this, what the skull and crossbones on that bottle.
Speaker 1:And let us, I think that people probably know this, but when we speak of Ibuprofen, the brand names would be Advil and Motrin. When we speak of Neproxin, the brand names would be a leave and a proxin. Uh, how do I say that in the process? That person, Naprosyn, Naprosyn and uh, Celecoxib is Celebrex. And then of course, Acetaminophen Tylenol. So those are the brand names for people to, to clear them in. All right. So what about these have been around for a while, particularly, uh, Ibuprofen and Acetaminophen had been around for quite awhile. Any indication from the studies you've seen that there is an impact on the child? If the mother took any of these medications during pregnancy?
Speaker 2:It's been no followups on childhood health from a women taking these particular insets. Nothing that stands out.
Speaker 1:Okay. All right, so now what about men? Uh, anything again, we're going to, we're saving ash and we're going to be talking about that in a minute. What about men with this other name?
Speaker 2:Insets? Interestingly, their biggest problem tends to be with Tylenol where it's quite reversed in the women. There's been some studies that shown, um, it can affect seminiferous tubule morphology or the sperm are produced. This is of course an animals in rats. It's hard to see that in men. Um, but they, you see, they have shown more significantly more abnormal forms and more sperm DNA fragmentation in humans, in humans. Um, um, taking Tylenol can lower the motility already an infertility, infertility patients. Plus, this is, seems to be a significant time to pregnancy lag period for men who have been taking chronic, um, Tylenol or Acetaminophen. So, and they think that it might have something to do with testosterone synthesis. So it, it has, um, it's, uh, in a normal healthy male that produces a million sperm per ejaculate, not going to be an issue if you are, if you're undergoing infertility treatment because you have a male factor issue, yes, it's important to pay attention to these things.
Speaker 1:So for a normal a man flight impact on the, uh, motility would probably not matter because there are so many sperm, but, but for someone who are for unexplained are four, actually it seems to me coming into treatment. So what is the preferred, uh, medic, uh, inset for men? For Women? You said it's Acetaminophen, but what about for men?
Speaker 2:Um, well, again, quite the opposite of women. Ibuprofen has probably the least studies that show any detriment and in, in humans. And there's only one animal study. And otherwise it's, there's nothing done in humans. There's no, there's nothing adverse about Ibuprofen. So it's probably the safest for men.
Speaker 1:Fascinating. Okay. Just keep in mind that what we're speaking of is taking it as prescribed because Ibuprofen does have an impact on other parts of your body. Uh, were speaking only about, I mean liver and others. So we're only speaking about the impact on, um, on fertility.
Speaker 2:Correct.
Speaker 1:Taken as directed. And keep in mind that a lot of times what people don't realize is some of the, uh, cold medicines and other even headache medicines are actually a combination of, of, of insets. And so you need to read the ingredients on anything you're taking to see the quantity you're getting because you may be thinking, well, I'm, I'm, I'm taking Tylenol, I'm taking a et Cetera, and actually et cetera. Um, I believe has Tylenol in it, so. Exactly right. All right, so now let's talk about aspirin. We saved aspirin because aspirin is special. So what do we know about aspirin? It's probably not probably it is the oldest, uh, of, of all of the insets.
Speaker 2:Yeah. It's a subtle, silly, salycilic acid. Um, I guess we all know Bayer Aspirin. I mean that's been around since I was a child. So Lord knows that's a long time ago and it has, um, it has two main effects, one as an inhibitor of platelet aggregation, so it increases blood flow and circulation. So people who have had any kind of arterial disease, blood flow disease, they will take aspirin now and uh, and that will help with, with circulation to their extremities. Um, it also is an antiinflammatory, so if you have an injury or a headache or pain or swelling, aspirin is very effective in reducing the inflammation. Um, but what's come to light recently, and it's sort of stems from the work with cardiac patients who have had, who have chronic cardiac disease, they have a higher level of inflammation due to their cardiac issues. And they found that low dose aspirin, which is like a baby aspirin, 81 milligrams a day as little Lissa can substantially reduce their chance for any kind of major cardiac event. And so going with this, there's been some really nice research looking at low dose aspirin, both on the circulatory side and on the, uh, on the antiinflammatories side.
Speaker 1:But most, but, but let me stop because most women, although we are a waiting later to start families, most women have not waited so late. We're in cardiovascular issues, are relatively rare in the reproductive age, childbearing female population.
Speaker 2:Let me tell you some other causes of chronic inflammation in women that will affect their child bearing issues and for instance, um, it can impact to write a genesis. So, um, the making of your, of Estrodial, it can affect a my Attica and cytoplasmic maturation of the ost site resulting in low fertilization rates. It's um, and of and low ovulation rates. Overactive inflammation, um, has contributed to preterm birth, pregnancy or spontaneous early pregnancy, loss of gestational diabetes and Preeclampsia. These are all inflammation and inflammatory states that we live with all the time. Pregnancy is a low level inflammatory state. Um, but the reason I bring up the cardiac patient is because they found that um, there is a marker for the level of inflammation that you're undergoing and that is the high sensitivity. C, Maria c reactive protein. It's a biomarker of the level of inflammation, inflammation. If this marker is high, your level of inflammation is high. If, and, and you will get the most benefit from a low a dose aspirin therapy if you're inflammation marker is low, not such a big effect. And, and this is done in patients as well and we see some, some okay improvements, significant improvement in clinical pregnancy rate in live birth rate in these patients that have this, this high serum marker. So it's, um, we learned something from our cardiac patients that does affect human reproduction and other sources of, of inflammation or, or any of the autoimmune diseases, Lupus, for instance, rheumatoid arthritis. That, and you know that, that you can get that as a child and you're living with a, um, a low, a chronic level of inflammation all your life. And if this level of inflammation is elevated for some, some reason that can even lead to certain cancers. So it's important that the load was, aspirin therapy is kind of a big deal. I was a, I was convinced.
Speaker 1:Yeah. Although there's been some recent in the news anyway, a discussion about it not being used, uh, over the bore of just across the board because the benefits necessarily cause there was some risk associated with the course. Yeah. But the, I, I've read some interesting research, um, a year or two ago about increase it's success and it seemed like it was fairly significant, um, with frozen embryo, a frozen fets frozen embryo transfers, uh, where the woman was not going through a egg retrieval cycle, but, uh, was coming back after the exit already been retrieved and, and embryos have been created and there were being transferred into her uterus and that a low dose aspirin, uh, was effective. And I, uh, are you familiar with the research and talking?
Speaker 2:It was a very nice study. Uh, actually there is a double blind study, constantly know about it and they, this was, yeah, doing their fee, their frozen embryo transfer. So they did have some, a hormonal stimulation beforehand, but mostly just to synchronize the uterus, Eh, with the stage of the ember that's being transferred and they showed a significant improvement in live birth rates. Not just a implantation rates, but in live birth rates over patients who did not receive this low dose aspirin treatment. And they would have started right at the month that they were being considering the transfer. Um, that was very compelling and this would probably catered more to ask. They believe that this effect of the aspirin had to do with increasing the local circulation of the uterus. There has been in historically, and I know people who've done this, patients who have difficulty conceiving, not conceiving. MMM MMM. Um, having an implanted embryo and carrying a pregnancy, um, they would be, um, prescribed injectable Heparin and Heparin, as we all know, is a potent blood thinner and this has some positive effects. So though there is some basis to this thought process that it isn't just out there, oh, let's try some aspirin. And for these particular patients, this seemed to help quite a lot. Um, another study that was done earlier that they did the same thing only with fresh embryo transfer and they saw no results. Um, but then later a Meta analysis, which is an analysis of several studies altogether, it increases the power. So there are more, there are more patients included, there was significance in the clinical pregnancy rate, not necessarily in the live birth rate. They're starting to see it. The more patients they get, the more you start to see maybe there's something to it. Also in the fresh transfer, the problem with a fresh transfer is these women are really poisoned by hormones. So you're counteracting estrodiol and that's your biggest inflammation modulator as I mentioned before. And that's a hard one to overcome. So it's, it might be that you need more patients to an effect and you know, it's, it's interesting and it at least they've showed that it doesn't hurt if it might help, why not? And it's, it beats getting heparin injections.
Speaker 1:Well that's for sure. So again, this is something from a patient standpoint to talk with your doctor about[inaudible] your reproductive endocrinologist about, and if you know him for the medical professionals, it's certainly worth researching further the research. Yeah. To see how that, whether or not it's something that you want to recommend for you.
Speaker 2:Yeah, absolutely. We need more, we need more carefully controlled studies and maybe, you know, try to repeat the frozen transfer studies perhaps. And, and um, in our clinic in Holland where I used to work in many m a few years back, we used natural cycle. I'm frozen embryo transfers. So these patients they would avi late and then we would synchronized from there. And this would really be the type of patients you'd want it, you know, carry on this study. Yeah.
Speaker 1:Yeah. Interesting. All right. So now we've talked about women with, uh, impact of fertility on women with aspirin. What about men? Anything we know about the impact, what aspirin does for the fertility of them?
Speaker 2:Male. Heavy. There's one study that showed a decrease in testosterone production by the Leydig cells. MMM. And um, and another, uh, another hormone, uh, reduction by the Sertoli cells. These are the two cells that line the seminiferous tubules and produce testosterone and nurture sperm production. And so there is a moderate disruption in the normal endocrine profile at the level of the seminiferous tubules. Again, for a healthy male, not an issue. If he likes aspirin, he can take an aspirin once in a while. If you have five sperm, maybe an issue, you know, if we're reducing your numbers even further and if even if we're going for the procedure called ECC, which is intracytoplasmic sperm injection, you need to have a few to choose from. And um, and then at least in and Europe, or at least in Holland, these from had to be modal, not just alive because you can have livings from that don't move. But these from have to be modal. So anything that will disrupt motility or numbers and sperm, especially in like a system, these highly infertile patients, you'll just say, stop taking them. Absolutely. Find an alternative or have a headache.
Speaker 1:Yeah, it's, it's worth for the, uh, for the short term a figure from the man's standpoint. Okay. Excellent. Let me pause here to tell you about this. The show is underwritten by ferring pharmaceuticals and they want you to know about an APP called Verticam. It's an app for your phone, either apple or Android, developed by reproductive psychologist, Dr Ali Domar and Dr Elizabeth wrote, uh, both have been on this show. They are, I like them both so much. Uh, and they designed this specifically to help women address that challenging emotional situations that infertility can enduring. And, uh, they've, they use cognitive, cognitive, behavioral and relaxation technique. It's a great app. It is free. You can get more information about it@firsttocalmapp.com f e r t, I c a l m app.com. Alright. Yeah, I want to talk now. Let's move to talking about a different class of drug. Uh, let's talk about antacids in general and, and I also would include in that Proton pump inhibitors. Uh, so, uh, um, which are again, both over the counter as well as, uh, prescription. So antacids, let's talk about what they're for and then, um, let's go through the four, uh, areas that we're looking at impact. Uh, first of all, so what is, I think most people probably know, but, uh, what are the different types of classes of antacids?
Speaker 2:Well, you sort of mentioned that there's the, um, the histamine blocker, these, um, medications act by binding to the histamine two receptor as opposed to the anthill, normal end histamines like for allergic rhinitis and, and hives and the life this binds to the h two receptor. And basically what it does is it prevents gastric acid production foot by the front, by the gastric Mucosa of the stomach. And um, that's, those are the histamine blockers and common ones are Tagamet, Zantac, Pepcid. And then the other type you mentioned the Proton pump inhibitors. These act a little more downstream inhibiting the, the um, potassium proton up pumped also participates in the secretion of gastric juices in the stomach. And uh, these are considered to be slightly more effective. And some of these you might've heard of is priceless. Sac or Prilosec, OTC, Nexium, and privacy.
Speaker 1:Okay. No, let's start with how these might affect the general fertility of women.
Speaker 2:Well, very honestly, as far as in the nonpregnant state, there is no significant impact on ovulation, fertilization, anything like that that I seen in the, in the literature. The big impact is during pregnancy, if there isn't impact, um, basically they are considered safe to use and, but there are some, and it, there, there were no big differences between whether they were the histamine receptor blockers or the Proton pump inhibitors.
Speaker 1:Okay. So you're saying that from a fertility standpoint, research really has not found that the either of the Histamine blockers are the Proton pump inhibitors, the two classes of an acid, so really isn't an impact. Female fertility and during pregnancy they're considered safe.
Speaker 2:Yes. I'm actually, especially the, the h two receptor inhibitors, so Tagamet Santek Pepsi, they're considered category bees very safe. Um, but interestingly, um, a few studies showed that there are no differences between the, the receptor blockers or the Proton pump inhibitors on during pregnancy. So even though their categorization is a tiny bit different, uh, they're still considered safe and that the benefits outweigh the risks during pregnancy. If I may interject, there's actually one study where they were concerned that in older adults, um, the use of anti what they call antireflux agents, which is essentially what we're talking about here, um, it could contribute to osteoporosis or fragility fractures later in life. And so there's, there was a study done, not necessarily on the woman but on her child. And they found that these antireflux agents not only did not contribute to a higher incidence of fractures, but that there was actually significantly fewer fractures in these children when compared with controlled patients who did not take into reflects agents. So when you go,
Speaker 1:well, that's a shocker. I would not have, I would not happen.
Speaker 2:What not either. That was like really? And why? And I'm thinking of the mechanism of action, but that's for another time.
Speaker 1:Yeah. Well that's what I'm thinking too. I was trying to figure out why, but we should point out that Oh, one study does not a uh, conclusion necessarily make. So, uh, we, we, uh, find it interesting, but whenever, whenever I see a study like that, I am dying to see it repeated because, and it with larger groups of course, just because I that's fascinating. And, and uh, yeah, so I'm, I'm keeping my fingers crossed that somebody is doing the research on that
Speaker 2:well, and also that the patients have been conscientious enough to, to keep up with it and to stay in touch and to continue to send feedback and information because that's the hardest thing with these longterm studies and associates, sociology studies is that they are, you lose touch with their patients, they just lose interest. And, and there are quite a lot of, um, patients included in these studies. So there's something, there's something going on that's worth another look. But as you said, you're absolutely right. One study does not a dogma make. But the other thing too is that the point is it's not, it's actually, it's not only is it not detrimental, it may even be helpful on some level. So that's how we have to look at it.
Speaker 1:All right. Let's talk about the men then, uh, impact on fertility for men. And we'll talk both about the histamine blockers as well as the Proton pump inhibitors, which are the two classes. And then I have to,
Speaker 2:I don't have information on the, on the Proton pump inhibitors, but I do have it on the h two receptor antagonists and it's very much medication dependent. Um, here we looked at Tagamet, Santek and Pepcid, and the one with the biggest problem. So as Tagamet and I've heard, um, there was some that was some, some reports many, many years ago, 30 years ago that Tagament at least the, uh, the prescription form, um, caused erectile dysfunction. So there is something to the, some of these studies, um, more recently just looking at the effects on sperm, we see things and decreased number, um, decreased, um, um, qualities, uh, a lower viability, lower testosterone, more DNA damage. Um, quite a lot of of work and half of it's done in it. These are studies in humans as well, not just animals. So this is, um, this was one of those mmm medications when you would say, you know what, let's take something else. Let's take maybe some pepto bismol instead of this stuff because this is very detrimental to squirm. I see this and I would actually recommend to my patients, don't take this.
Speaker 1:So that's Tagamet Zantac, our Pepcid. MMM. MMM. Would be,
Speaker 2:and both of them, um, yeah. Nothing real substantial. So you know, the conflicting data and nothing where you can say, oh yeah, that's a real problem. And so again, it's one of those situations where benefits outweigh the risks. Um, those two would be perfectly fine if you're undergoing infertility treatment. If you're not entanglement works for you, we'll then of course, okay. Again, in high dosages, you know, that whole erectile dysfunction issue could be a big problem.
Speaker 1:Yeah. Rick down to function can impact fertility obviously. Um, the, uh, all right. So now we've talked about the antacids. Let's talk about, and I histamines, um, what, uh, there are different classes of those, if you could explain what the different classes are and, uh, and, and how they differ as far as her of working. And then,
Speaker 2:and then let's talk about the impact starting with female fertility. Okay. Any histamines work by binding to the h one histamine receptor and blocking histamine release, uh, and histamine function. And histamine is a, is is a modulator of inflammation. So anytime you can, and, and, and the results of the inflammation can be anything from a runny nose, itchy eyes to, you know, and Filactic shocks. So it's, it's, it's a very broad range of effects by histamine. So, um, we have two generations of h one receptor antagonists, and the first one is called generation. The first generation and the first generation include, um, uh, medications like color, try mutton or Benadryl. And these molecules can cross the blood brain barrier and resulting in sometimes somewhat adverse reaction, such as drowsiness. So, yeah, and some, some people like it if you're flying and they'll take a Benadryl and go to sleep, um, or, or in Advil pm or any pm medications you were talking about combinations and then will be diphenhydramine makes in with your analgesics. So you, you, your headache is gone and you want to go to sleep. So, um, but they are both considered category B by the FDA. So seemingly, um, uneventful during pregnancies. So, uh, not a lot of results, not a lot of research if you're trying to get pregnant and taking in Histamines, again, I keep this going to be, this is going to be my mantra that the benefits outweigh the risks. So the next group is something we're much more con I'm interested in. And those are the second generation and histamines and these are the quote unquote non-drowsy things like Alegra, Xyzal, Zyrtec, Claritin. And they are, the ones that are most often recommended would be, um, Claritin, insurtech, these are both class B and um, they, they're, both of them have shown no adverse affects for the fetus or the mother before pregnancy, during pregnancy. And I've found one, there's a paper and I've, for some reason I couldn't, I couldn't access the whole thing. But there's been a lot of mentioned that Lizard Tech actually helps with the nausea and vomiting during pregnancy, during the four m morning sickness. Yeah. And that was the one I, when I went into this chat room, I was curious because they were talking about it and one woman said, are you sure it's not something else? And No, no sir. Check, you know, for Sneezy, you know, for this easiest runny eyes, ashes, it works like a charm. And, and I read this in a few, um, peer review publications and they also mentioned this and I thought, well that's something to, and there's a paper written that was written 2000. And um, they, they don't, the online you could just get a little snippet of it, but not much on the mechanism of action. So I, I have to try and persuade them to let me buy it, giving me some trouble with it. But it's, um, but those are most long story short, they end Histamines as a group, whether they're first or second generation are safe.
Speaker 1:Alright. So then let's talk about, and then I'm assuming that there has been, um, we've talked about pregnancy, but there has a, I would've assuming that there's no research would indicate that children born of mothers who took either Gen one our gin to histamines have had any adverse reports.
Speaker 2:No, I have seen nothing that mentions anything that affected the child.
Speaker 1:Okay. Now let's turn to the men. Yes. Anti-Histamines either. Let's start with generation one, which again, that we think of of that being the drowsy ones, which been a drill was the one that comes to mind.
Speaker 2:Okay. There is some effect about some, there was some research on Benadryl, so there was Benadryl can affect viability of sperm am and viabilities. So you would have more deaths from,
Speaker 1:yeah. Hmm.
Speaker 2:And um, and that's it. I'm color try mutton. There was no research on that whatsoever. So the, the, the, the first gens, that's terrible, you know, but there are other options available for the second Gen z. The only one that, um, that actually had a positive effect was Zyrtec. And they show that a stenosis from, yeah. MMM. Oh actually no. What time saying it incorrectly. So their tech, once they stopped taking it, there's their semen analysis improved. So it did have some effect on the number of sperm available and they think that it has something to do with the Sertoli cell itself, that it affects the cell, that, that nurtures the sperm during its development and these, that these cells start to die when you're taking a Zyrtec.
Speaker 1:And it'd be close to me from the, from the healthcare provider's standpoint, that what this tells us is the importance of getting not only the information on the, the woman, um, but also the information on what type of medications then the man is taken.
Speaker 2:Absolutely. Especially if he's a, if he's the culprit, if he's the Pr, if the, the, the infertility situation lies with him then, then absolutely. But even if he's just, you know, middle of the road, you don't want to, you don't want to set him up to fail and anything that affects the DNA of the sperm, we would, even if it was just an animal work, we would recommend that they stop taking that particular medication switch to something else. Because we do have, especially with Deanna has means there are others to choose from and, and let them and, and then wait three months because three months is approximately once per regenesis for metagenics cycle. And at the end of the three months, you have a whole new set of sperm that don't have that DNA, um, degradation because they're their procedures where, well, we don't need a lot of sperm in the, and they don't have to be super model as long as they're still alive. If there's something wrong with the DNA, then, uh, that then injecting this from it does serves no purpose. You're, you're taking an abnormal sperm and creating an abnormal embryo with it. So,
Speaker 1:and the chances of that embryo implanting and growing into a healthy baby are very small. So, yes, exactly. So, and so going back, did I understand you that the, the only, uh, the only one that showed that researches has said you would choose, you should not use, would be Zyrtec.
Speaker 2:That's the, has the biggest effect. Um, as far as I can tell, yeah, the others don't, the, the research is, is, is sparse. If there, if there's anything at all, I'm the one that has absolutely no information on it. Does Alegra so then I, you know, you have a patient who has terrible allergies. I would just say to Allegron for three miles and, and you know, there are other options. Now the one thing that we didn't discuss with, with women that's is important with men are what they call mass cell inhibitors. And these are also an anti histamines by blocking the source of Histamines, which is a mass cells and they can actually have a, a restorative effect on sperm. So in men who have, it does seem to promote better spermatic genesis.
Speaker 1:What are some of the brand names of the mass cell inhibitors?
Speaker 2:The, um, these are actually not over the counter yet, but they might be eventually. But for instance, one is trend lasts. Another one is called Zedek door. I think that's in um, it might be available here but it's available also in Canada and um, and those two are the biggest ones. So it's a terribly many of those because they're, they work well but they're not as fast acting as the, uh,
Speaker 1:as the Histamine blockers are. Let me pause now to remind you that this show is brought to you by the support of our partners
Speaker 3:and these are organizations and clinics who believe in our mission of providing unbiased, medically accurate information to the patient community. And some of our wonderful partners include Schrafft's 2.0 they are a specialty farts, fertility pharmacy that beliefs pharmacy care can and should be remarkable. All employees from their pharmacist to their shipping coordinators understand the stress of fertility treatments and are trained to treat customers with dignity, empathy and respect. And we also have crafts international, both sperm and egg bank. They are dedicated to providing a wide selection of
Speaker 1:polity, extensively screen frozen donor sperm. And Egg from all races, ethnicities and phenotypes for both home insemination as well as fertility treatment. They are the world's largest sperm bank and the first freestanding independent egg bank in the United States. All right. I want to talk now about some dermatology dermatological products. Now that's an interesting one because I think that oftentimes we think of over the counter medications as being that a pill that we take. Um, and, uh, so when we're, we're now we're moving into talking about a dermatological products. Is that anything that we need to worry about? Is that considered over the counter?
Speaker 2:Yeah, there are only over the counter at these concentrations. What I've, what I've read, and, um, it doesn't, the biggest concern was not prior to pregnancy, but during pregnancy that certain ingredients need to be, um, you need to be cautious about them. And there is, um, an organization called the American College of obstetricians and gynecologists and they have a website that outlines which products are safe and which products I should be avoided during pregnancy. Like, okay, here's, um, and I, and I read a couple, there a couple of articles. One was, um, an article that was trying to raise awareness to warning labels on these creams. For instance, there, um, there is, um, well some women have problems with what they call Melasma or getting dark spots during pregnancy. And so they will use these skin bleaching products and one of these creams, um, that's available. It has something called hydroquinone in it and hydroquinone. And this of course it's right now, studies in animal studies is highly carcinogenic. And um, there's been some, okay. Not Studies necessarily, but investigations in humans and the results are kind of inconclusive. But if you can avoid using a cream that's carcinogenic while you were pregnant and talking carcinogenic effects on the fetus, by the way, not just to the mother and that maybe you would avoid taking these, these medications. And in addition, misses, we were talking about category acts. There's something here that actually could probably be included in category x. You know, there are many creams available now that have vitamin a precursors in them, you know, retinoids retina like acid, mmm. And to wrinkle cream, for instance, some women and some women like it for stretch marks. And stuff while the red noise are actually very, um, um, detrimental to the fetus. And there's one form of a called ISO wreck retina knowing, and this is, this results in severe birth defects in fetuses, mostly neurological, so at least to intellectual and brain disabilities in defects. So this is a big one that even the FDA says avoid at all costs. Do not use this and this is over the counter. Yeah, yeah. Wow. Yeah. No I didn't, didn't get that far. I'm sorry to say. But again it's, it's what you mentioned earlier. Read the label. There are list of, of of ingredients that are perfectly safe. Um, Benzo peroxide as a celiac acid. I'm not sure what that is. Salycilic acid topically also not a problem. And glycollic acid, these, these are all things that well, so we help each skin, you know, get rid of some of those dark spots. But those are, those are safe to use.
Speaker 1:And could you please say the, the of the website again that lists the dermatological products?
Speaker 2:Yeah. If you, if your line and search for the American College of obstetrics, obstetricians and gynecologists, they will have their frequently asked questions and it's frequently asked questions, number one, six, nine, and uh, it will tell, uh, give a list of things that are safe and unsafe during pregnancy and the creams are, or one of them. And that, um, uh, but, uh, um, a study led me to that website. So that's how I found this. I don't know. Well, let me see what else they have in there. So it was very informative. You know, these little things are, it can be very helpful to patients as well. And as also this is something that maybe, um, the healthcare provider can have maybe on a pamphlet and say, Hey, do you have any more questions? Just go ahead and click onto this website. And this has been fairly well shown by not just by government officials, but by people who deal with, um, pregnant women all the time.
Speaker 1:It's also a word of warning to healthcare providers to suggest creams that they, that their patients may be using. Because honestly, most people don't think of of their anti wrinkle cream and uh, uh, as, as being a over the counter medication or nor do they think of of a, of a bleaching substance for a pregnancy dark spots as a, uh, so it behooves the medical profession to be, to ask, you know, d two s specifically asked to help the trigger ideas whether or not that matters. All right. So, uh, before we move on to talking about herbal supplements and vitamins, um, are there any other medications that we need to know about that would impact fertility before or during treatment or lets us focus on those states?
Speaker 2:The one thing we, um, we could spend hours discussing as well as if we started talking about prescription medications or list is we'll go to the moon and back again with all, with any of these medications. I know for a fact a certain, um, certain antidepressants in men will cause their sperm membrane to be altered in such a way that they don't find normally to, to the egg. This is a problem. It can be alleviated by the[inaudible] procedure because it doesn't seem to affect the DNA of this firm, but they will. If you're trying to do normal insemination or regular IVF, you need to know what kind of antidepressant your husband is on. If he's on any and if he can get off it for a short term because it is reversible, that's the joy, then he can stop it. There's also same situation with certain Beta blockers in men. That's the biggest problem we find is that it's an men. Um, it does have an immediate effect on the actual binding of sperm and which you can test. Again, maybe they can go to an Alpha blocker or some other kind of hypertensive medication that doesn't affect their sperm and for three months and you know, but if in the case that that they're on a specific medication and they cannot change it, there are doctors as you cannot just switch like that, then we can offer them something that where instead of regular IVF we might do half regular IVF and half injection and that way they will end up with something fertilized. At the end of the day. And it's also very diagnostic for us that tells us, okay, whatever hypertensive medication you're on, this one does not affect sperm binding. So you have very good for realization or maybe it does. And then we have the injection side, um, where we can, we can choose embryos, Trump. So it's, um, again, as you said before, you know, you have to take a lot of these reasons, a lot of the research with a grain of salt because it's not 100% for every patient. Some patients are very sensitive and this is how it manifests itself. And patients, you see no, no effects whatsoever. But do you want to risk an IVF cycle just to say, so this, that was our answer for the, the medications that he couldn't change and that might be risky and that worked out extraordinarily well for us.
Speaker 1:Okay. Um, and like you say with men, if a man has a normal semen analysis, it becomes less of an issue. Um, unless it's effecting the DNA and then that would, that would
Speaker 2:correct. But usually if there's a problem with the DNA, you see other issues, you'll see morphology. They don't look right, they don't swim, right? Thoughts, a double heads, things like that. You know, it, they're there. There are other flags that fly around. It's, it's not like, Ooh, they're so pretty, but their DNA is garbage. And that's very rare.
Speaker 1:Okay. All right. Now let's talk about something that a lot of people don't think at all is a over the counter. They don't think of it in terms of medication because they're not necessarily taking it for medication. Um, and that's, uh, let's start with herbal supplements, but I'd also add, but let's include vitamins.
Speaker 2:Well, vitamins, um, that's a, um, a sticky, wicked a little bit. Generally, most multis are pretty good. Well, test formulations and when in doubt, I would say to my male patients, if there's, and, well, what do you think if I take this? Or what do you think? If I take that and I'll say, well, that's fine, but I would recommend a man's multivitamin and make sure that those ingredients are in there because they'll be in there at the right percentage.
Speaker 1:You're saying you're making a distinction, if I'm understanding you correctly about rather than taking the vitamins individually to get a multivitamin that combines a number of vitamins, the name and then they are doing that. But that the combination is in the proper percentages.
Speaker 2:Absolutely. Right. You got to me before I could say it because I was saying I'm on of the school. I take my vitamin separately, but then I pay attention to what I'm taking and I don't overdose on one, but I know that it might fertility patients if a little is good, a lot is a whole lot better. And especially, you know, there's been some, mmm mmm. Press on, on zinc. That sync can help in fertile men. Yes. And, and if you are zinc deficient, sync will help you. If you are not seeing deficient, you only need a small amount of sink because it is a heavy metal. It will build up. It can be toxic. You don't want to take a whole bottle of zinc. If you have a cold, you probably have a system that is zinc deficient, then it will help you, that type of situation. But the best thing for these guys is a multivitamin. And if they're really particularly stressed, and I can, you can tell, take to take what's in the box. Sometimes they, the manufacturer recommends for a day. That's okay because they're in the proper balance and the right proper ratio. So you're not creating an artificial imbalanced something. Uh, and that's the thing we have to watch out the most in May. Okay. So what about with women? Well, it with women is pretty straight forward. Prenatals they're very, very good. Um, you know, folic acid, don't go without it. That's very important. Not even just for pregnancy, but when you're trying to get pregnant, that seems to have some help. Any of the B vitamins are very helpful. They have because they're the first set are depleted in a stressful situation. So, you know, if you get a good prenatal vitamin, um, that tends to check all the boxes. And again, I always tell people, I said, if you feel in particular like you're not eating right, you feel that you're not eating right, tick, tick another one. It's okay. And they usually come back and tell me how great their hair looks.
Speaker 1:You're right. Women for women because we recommended that to take the prenatals.
Speaker 2:They're good, they're good. Generally, they're just a little bit, you know, if you are, if you're stressed, if you're running ragged going here and there, you know the ultimate soccer mom and you're just be prenatal vitamin, so just a little bit more of everything and that's what you know you need because you're not eating it. Balanced meals are our foods these days just don't have the nutrients they did 20 years ago. I'm starting to sound like my mother, but it's true. You know, it's just not how it used to be. It and, and so we do need supplements and, but supplements only really help when there's a deficiency. Otherwise it, you know, you're creating an artificial imbalance and that's what we have to watch out for as far as vitamins are concerned.
Speaker 1:All right. Now let's talk about herbal supplements.
Speaker 2:Yeah, that sounds a little bit of, um, the black box. I, you know, the, the thing that that got me was a herbal supplements by themselves. If you're taking nothing else are probably okay. And I know that women love to take them because they think, oh, they're natural and they're just going to be good for me and they'll, you know, they'll just counteract everything else that I did today. And if I, if I take this tea or this, this green drink or whatever book, you know, um, we know from, for a fact that, you know, certain in most, many of our prescription medications have come from plants down the road. And so we have to take this all with a grain. Um, I found a very interesting paper that just described a list of things that we take on a regular basis. Things like cam a mile or cranberry, ginger, Jensen and sage, and then listed if you're taking other medications, how they can either exacerbate a symptom or counteract the functioning of your prescribed necessary medication. So that was a real, that was a real eyeopener. Um, we're not talking necessarily
Speaker 1:about consuming cranberry eating cranberry cranberry muffins are syncing t or adding sage to you're stuffing our, or we, from my understanding that we're not necessarily talking about consuming this in the proportions when you're eating food.
Speaker 2:No, no, exactly. We're just discussing supplements because if you go to an herbalist, they will put dried these dried herbs in little capsules and you will be taking them in a much higher level than you would normally. And you wouldn't just be taking one a day. You'd maybe take four or five or six a day, a handful. Um, people who like for instance with ginger, you know, people will make tea out of ginger, they will eat ginger and that, you know, you're infusing dry ginger in water and then you're drinking it. And I used that as a, as an example because we all love ginger. But when you take it at higher levels, it's um, exacerbates, if you're taking insulin for instance, it can amplifies the effect of the insulin causing a hypoglycemic situation. So you of these things are in interact. And that's what I was bringing up is like you have to be careful because some people, yeah you have to take insulin, but if you're pregnant and you're taking insulin and then you say, oh my stomach's upset, I'm going to have some, I'm going to have ginger tea and when I take my ginger pills cause you can buy that, um, and we'll make it, it'll settle, my stomach will bay. And then she starts getting the shakes because she's hypoglycemic and you know, you don't want that. That's what you don't want. And so it's just everything you're taking in large doses and concentrated form, you'd be cautious. There are, there is information out there. Your pharmacist might know, I'm a dietician, might know they're even herbalists south there that probably no, what natural products are safe to take with whatever medication you're taking. Or even if you're just taking their aspirin therapy of those things can, can counteract or can increase the blood thinning effects of the aspirin and stuff like that.
Speaker 1:Is there anything for the two would specifically recommend that people avoid? Oh say women or men, uh, avoid when they are trying to get pregnant either in treatment or out.
Speaker 2:Nothing that leaps out. Just, you know, you know something that no, no that wasn't saying, oh my God, don't take this. You will not be late. Um, to be honest, even if you're eating a lot of soy, which has a, you know, the phytoestrogen, um, you'd have to eat so much to really affect your normal estrogen levels. This, this as an as an a healthy normal cycling woman that you can't even and you don't even change the length of your menstrual cycle with, with that. So I really think that that by itself isn't such a big problem during pregnancy. Again, by themselves, these things are, are, are harmless and maybe help you but in combination with what you're taking. And that's really the only point I was making. It's like if you're going to take some of these supplements, these herbal supplements, she was like taking a vitamin supplement or another kind of medication. Be Aware of what else you're taking and see if there's any harmful interaction between the two.
Speaker 1:Okay. Well, this is been so interesting. Thank you so much, Dr Kathleen and Tucker, uh, an embryologist and the reproductive physiologist too for talking with us today about over the counter drugs, the impact and uh, very interesting and I really appreciate it. I think it will be helpful for, for everyone.
Speaker 3:The views expressed in this show are those of the guests and do not necessarily reflect the position of creating a family, our partner, our underwriters, and keep in mind that the information given in this interview is general advice to understand how to apply it to your specific situation.
Speaker 1:You need to work with your infertility. Thank you so much for joining us today and I will see you next week.