Creating a Family: Talk about Adoption & Foster Care

Impact of OTC Drugs on Fertility

May 07, 2021 Creating a Family Season 15 Episode 19
Creating a Family: Talk about Adoption & Foster Care
Impact of OTC Drugs on Fertility
Show Notes Transcript

Do you worry that the over the counter medications you take for a headache or allergies could impact your fertility? What about CBD or melatonin? We talk with Dr. Kathleen Tucker, a scientific director for various IVF labs; and with K.E. Tucker Consulting, and Dr. Angie Beltos, CEO and Chief Medical Officer of Vios Fertility Institute.

In this episode, we include:

  • Research has found three reasons why the impact of OTC medication on fertility has become an increasing issue.
    • We are taking more medications now that people in the past. 
    • People are waiting longer to start a family and age is associated with greater medication use.
    • People are experiencing more chronic disease at earlier ages.
  • Taken together, these factors have increased the number of prescribed and over-the-counter (OTC) drugs being taken by women and men attempting to get pregnant with or without fertility treatment.
  • As always, talk to your doctor about any concerns you have regarding both prescription and non-prescription medications.
  • Impact of OTC drugs on fertility - female and male fertility.
    • Impact on natural conception.
    • Impact when taken during fertility treatment.
    • Impact on pregnancy.
  • Impact of NSAID (non-steroidal anti-inflammatory drug) on fertility.
    • Aspirin (brand names include Bayer, Bufferin, Ecotrin, St. Joseph)
    • Ibuprofen (Advil, Motrin)
    • Excedrin (acetaminophen, aspirin and caffeine)
    • Naproxen (Aleve, Anaprox DS, Naprosyn)
    • Celecoxib (Celebrex)-prescription only
    • Acetaminophen (Tylenol)
  • Antacids-histamine blockers and proton pump inhibitors
  • Antihistamines B-both types? 1st generation, 2nd generation
  • Sleep aids
  • CBD
  • Other common over-the-counter (OTC) medications
  • Skin and hair care products
  • Herbal supplements?
  • As always, talk to your doctor about any concerns you have regarding both prescription and non-prescription.

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Please pardon the errors.  This is an automatic transcription.

Welcome to creating a family. Let's talk about infertility. I'm Dawn Davenport. I am the host as well as the director of creating a family. You can find lots of resources on infertility at our website creating a Today we're going to be talking about the impact of over the counter drugs or medications on fertility. Not only is the use of over the counter medications in general increasing, but many more over the counter versions of formerly prescription only medications are becoming available. And it's vital to understand the potential influences of these potentially seemingly benign drugs on human fertility. Today we're going to be talking with Dr. Kathleen Tucker. She has been working as a lab Scientific Director of Human IVF laboratories for almost 30 years, and she was the scientific director for one of the largest programs in the Netherlands. Were interested in the effects of over the counter medication on semen and eggs first began. She currently acts as an advisor for egg chain and she has her own consulting business, k d Tucker consulting. We will also be talking with Dr. angelyn belts. She is the CEO and Chief Medical Officer of BIOS fertility Institute. She is board certified in obstetrics and gynecology and reproductive endocrinology and infertility and she has been practicing since 1991. She was formerly on the board of creating a family where we greatly benefited from her guidance. So welcome, Dr. belts, oh and Dr. Tucker, to creating a family.

Nice to be here. Yeah, so excited to be with you today. All right. The research has found that the impact of over the counter medications, OTC meds, one fertility has increased, it's becoming increasingly more of an issue. And there, there are three reasons that the research has found one, people are taking more medications now, in general than in the past. Two people are waiting longer to start a family and age is associated with greater medication use whether we like it or not. And three people are experiencing more chronic diseases at earlier ages and chronic diseases, thus lend themselves to to people taking more medication. So Taken together, these factors have increased the number of prescribed and over the counter drugs being taken by women and men attempting to get pregnant with or without fertility treatment. So at the beginning, let me just point out to everyone that talk to your doctor with any concerns you have regarding both prescription and non prescription medications. It's important that you talked with somebody who knows your specific situation, and not rely just on what we are saying here today. Alright, so let's talk about we're going to start by talking about the impact on we're going to work our way down various common over the counter medications. And I want to talk about how each of those may impact natural conception, impact of conception through fertility treatment, as well as the impact on pregnancy. And let's start with the insets non steroidal anti inflammatory drugs. They are one of the most common probably if not the most common over the counter medication taken. They would include things such as aspirin, which be brand names like bear bufferin, St. Joseph, things like that. ibuprofen brand names Advil, Motrin, excedrin, which is a brand name and which is a combination of acetaminophen, aspirin and caffeine, naproxen, which is brand names, Aleve, and approx DS, and there's some others. Celebrex is a brand name for and I'll probably mess up celecoxib as they say, Oh gosh, I got it good. And acetaminophen and the brand name or one of the more common brand names would be Tylenol. So let's start with talking about these non steroidal anti inflammatory drugs. Dr. Tucker, what impact do we know that these type of medications have on natural conception?

Well, there's a few reviews out there that mentioned that stem analgesic use during the follicular phase can result in in sporadic copulation mainly because of the mechanism of action. These are either Cox one or Cox two inhibitors, which is its cyclooxygenase inhibitor which is important in prostaglandin production, both prosple types, the prostaglandins that affect your uterine motility and your uterine contractility and, and the prostaglandins that are responsible for the transmission of pain. So if you interrupt the production of prostaglandin, you're the pain level is reduced. So that's where it can probably, and prostaglandins very important in monitoring or manipulating, shall we say, your menstrual cycle. So if you disrupt prostaglandins, you

Can you can in high doses disrupt your follicular cycle? You mentioned Salah kuebix Celebrex, which is actually at this point still only available by prescription that is has been shown quite readily to disrupt menstrual cycles. Okay, I should have mentioned that that was not a over the counter Got it? All right. Okay. So, Dr. Belt so when you have patients that are coming in before they start treatment, is there any What do you recommend as far as the use of insets?

So this is a very interesting question of, you know, so many patients and people using medications over the counter for pain relief, like for example, when a woman might get her period, it might be really uncomfortable. So a lot of women might take a non steroidal, like an Advil or Motrin for their menstrual pain, or even headaches and things like that, that might be beyond a menstrual discomfort. So when you're trying to get pregnant, we do recommend that you during your menstrual cycle, you can take what works for you. And around the time a woman might be ovulating to limit a little bit more. The use of the non steroidal anti inflammatory, more using Tylenol would be better than an ibuprofen, for example. There are some limited studies as Dr. Tucker reviewed that may when people are trying naturally or with some of the fertility medications that could affect the ability of the egg to oscillate. And so when the egg is ready to oscillate, it could block that from happening. Okay, now let's move into let's say people have not been your patients have not been able to conceive naturally timed intercourse, and they are considering fertility treatment. So Dr. Belt says how do you approach the use of insets for your patients who are then moving into either IU eyes or IVF, or any other form of treatment.

So we when we're looking at couples who are trying to get pregnant, and they might be doing fertility medicine to help them articulate or enhance ovulation, we would recommend less use of the the medications that might be in a non steroidal like endo Matheson or ibuprofen. And the reason for this again, maybe that as this egg is trying to isolate, these could suppress the good inflammation that's needed for the egg to be able to come out of the ovary and release. And so if you're taking medication, for example, like Clomid, or letrozole, and doing timed intercourse or intra uterine insemination, those during that time, it would be helpful to I think, hold on to use especially higher dose uses of those medications. There was a study that showed that those high doses significantly delayed ovulation but as Dr. Tucker said, it's not an all or none thing. I was going to ask one question, would you recommend is acetaminophen a safer alternative for pain relief during that during conception? That's a great dawn. Yeah, acetaminophen is something else that if you do need pain relief, or something, going to acetaminophen, which for the brand name would be an example like Tylenol would be better than something like ibuprofen that might be on your counter is Advil or Motrin are examples of that kind of medication. Okay, got it. And what about IVF, there was an interesting study that, you know, using IVF, we actually don't want the egg to obsolete, because, you know, we want to be able to get the egg directly from the ovary. So there was a study looking that using the non steroidal anti inflammatory again, like Motrin may prevent early ambulation. And they were actually helpful, and they prevented IVF cycles from being canceled. What we find on is that for women as we age, the ovaries are sometimes a little more delicate, and, and it's not always listening to all of the medications were giving, giving the ovary to not oscillate too soon, but women you know, as we approach 40, they do tend to ovulate faster and and if the egg populates the cycle would be canceled. So interestingly enough, in that case, it might have been helpful, you know, in that study, okay, so we've talked about female fertility, let's talk about the use of inserts with male fertility. Dr. Tucker, what is known about

are his male fertility impacted through any of the non steroidal anti inflammatories? Yes, it is. The thing that's interesting with men is that it's reversible 99% of the time, if they take something and it has a negative effect, then you can wait three months and it will be essentially gone unless it's something really detrimental to the germ cells. But guys have a bigger problem. There are some negative results, at least in rats. In man taking paracetamol or acetaminophen, which is Tylenol, they see lower fertility, you know, overall, you see more abnormal forms and infertility patients as well. It is an increased time to pregnancy. So there is some deleterious effect to the fertilizing ability of the sperm. And the thinking the thinking is that it reduces prostaglandin and testosterone synthesis, so that's paracetamol. Okay. So then Dr. Bell says, when you have a couple that comes in, do you recommend that the male the man also avoid use of insets? Yes, that's a really interesting question. Because not only may it be a problem, as we're talking about, for women, it may cause some fertility issues and looking at some of these smaller clinical trials, they did show that if someone was taking a fair amount, even for a couple of weeks, that their testosterone went down, and that it may decrease sperm counts. So although a little bit occasional use of this is fine, we really want to think about the prolonged exposure and use less is more so that the basic idea is that less is more got it. So we want to avoid, and it sounds like from what you're saying, The that it's the excessive use are the greater use that causes the most problem. Yeah, or, or continuous use, you know, you've got, you know, I have some of my patients are professional athletes. And their job is to work out for hours a day, and they tend to, at times, you know, have strained muscles, etc, in they might be using, you know, this is a frequent level, whether it's a high dose for a short amount of time, but even that continuous use two could have an impact. It's such a good point that yeah, it's not just the quantity, it's also the period of time that one is is taking it, that's a really good point.

This show would not happen without the generous support of our partners, and these are organizations who believe in our mission of providing unbiased medically accurate information to the patient community. One such partner is cryo international sperm and egg bank. They are dedicated to providing a wide variety of high quality, extensively screened frozen donor sperm or eggs from all races, ethnicities and phenotypes. And they do it for both home insemination and fertility treatment. Crisis international is the world's largest sperm bank and the first freestanding independent egg bank in the United States.

All right, now I would like to talk about the impact on pregnancy that this point somebody has gotten pregnant, do we need to and we're, of course wanting this pregnancy to carry to term and a healthy baby, but at the end of nine months. So what is the impact of the non steroidal anti inflammatories, Dr. Belt so on pregnancy? Interestingly, in the first trimester, there were some concerns about using nonsteroidals and the risk of miscarriage. And the FDA recently has come out that halfway through the pregnancy at around 20 weeks, they recommend the FDA recommends not using any of the advils or motions. One of the concerns is that it may affect the kidney function even of the baby. And if the kidneys aren't working as well, the baby's amniotic fluid can go down. And that can be very concerning. Another thing is that at the third trimester as the you're rounding the bend, using a nonsteroidal can also interfere with how the hurt of the baby functions. And it can make one of the blood vessels in the baby's heart closed before it should. And baby's hearts function a little differently when they're in mom. And then when they're born just because of how the oxygen flows through the their body. And you don't want to switch off that system by using nonsteroidals in the third trimester because that can cause issues for the baby too. So you know, once you are pregnant, I think you have to be real careful with

The use of nonsteroidals. Let me ask a question. You mentioned specifically problems associated with ibuprofen. Is that do we need to is that is it just ibuprofen that they are concerned about after the week? 20? Or is yes. Okay, so it's just ibuprofen. So if, again, if you again, check with your doctor, obviously, but in general, if you're needing pain relief, when pregnant, it's best to avoid ibuprofen and use one of the others is, am I hearing you correctly? Yeah. Now, interestingly, acetaminophen might be it let's say someone has a headache or some pain, Tylenol or acetaminophen might be the way to go. Another thing that's very important to come in on Dawn is the use of baby aspirin. And baby aspirin might be categorized in non steroidal anti inflammatory drugs. However, baby aspirin is often used in women who are at risk for having issues with blood flow. So if they might have risk for a blood clot, or having good circulation, we do use baby aspirin. And the second use of baby aspirin that some of the listeners might know that they're on is to prevent or lower the chance that they would have preeclampsia. So there's some really interesting studies as well that your doctor might have you on a baby aspirin for those as two examples where we do use a non steroidal it Yeah, but it's a it's a lower dose. Dr. Tucker, before we move off of non steroidal anti inflammatories, any thoughts on research that you have found as it relates to pregnancy, our conception? Well, the the comments about low dose aspirin is very, very important. And and I agree that with Angie, that the that the use of it, we would only recommend Tylenol if you really have a headache, take some Tylenol that seems to have the fewest side effects, but the low dose aspirin is can actually be quite beneficial, especially if you're also trying to become pregnant it it seems to help the micro vascularity of the uterus, it can help with implantation, it can help with fertilization. There. See there's some positive effects after frozen embryo transfer to prepare the uterus, shall we say for implantation. And a couple things. One other thing is that you can do prophylactic use of low dose aspirin at this age in our age, especially but start early because if you're pregnant, there's been some really nice work that shows that it helps with previous losses with previous miscarriages and also with the prevention of preeclampsia, just but you can start taking that ahead of time. And it's it's really quite an amazing thing. It helps if you are specifically also patients who have I think it's called high sensitivity c reactive protein issues, and they tend to be more prone to preeclampsia and this will help the inflammation of those particular proteins. So it's or if you have you know, heart disease, rheumatoid arthritis, endometriosis, any of these other issues, low dose aspirin therapy is is quite amazing. And, oddly enough, doesn't seem to help guys that much but for women, it's very important. All right, now let's move on to to talking about another common over the counter medication antacids, Dr. Tucker First, if you could give us a brief intro as to the different types of antacids that exist, because they're not they're not all made the same? No, no, not at all. There are two types of antacids. There's the histamine, two blockers, and those are things like tagamet, Zantac, Pepcid, and these work by blocking the histamine receptors, thereby ultimately lowering into more indirectly lowering hydrochloric acid secretions in the gastric mucosa. And you see these receptors throughout.

And what is the other type of antacids that's commonly available over the counter. Other types are the protein pump inhibitors, and these block gastric potassium hydrogen sensitive hpas which is located on the surface of the gastric mucosa. And it directly inhibits gastric secretion. And the most common that I I've heard is like pi lowsec, and Nexium, and those are fairly effective as well. Okay, so Dr. Bell says, What do you recommend for your patients about taking antacids, either when they first come to you or even before they come to you and they're trying to conceive naturally or when they move into infertility treatment

when people have an upset stomach, and sometimes that can be

Like you said, before you're pregnant and while you're pregnant, so something that's real easy to take that I think can be very helpful for GERD or heartburn, acid reflux are Tom's as an example, those are really great to consider before after, and most people get really nice, good relief, you know, from that, on the other hand, some of this, you just have to be careful. The other interesting thing too, is, is modifications of behavior. So for example, eating let's say you're pregnant and you're taking your Tom's The other thing to do is to sit up after you eat, don't lie down and try to eat and then walk around a bit, don't eat and then go straight to bed, getting that out of your, you know, the food past the stomach. And being able to do some of that is really important. Another thing is some of these medications can also have calcium, which supplementing calcium just need to be thoughtful as well because it can worsen stones like kidney stones, for example. And, you know, these things that we can add into our into our system, you just have to be thoughtful about that too.

Okay, Dr. Tucker, anything else on the impact of antacids when trying to get pregnant either naturally or through fertility treatment? Not Not that I came across, okay. Again, you know, it's one of those things, you know, you overdose maybe, but now it really doesn't seem to have an effect even during pregnancy. The evidence is sketchy. Mostly the research has been on the the fetus or on the child, those effects but as far as actually affecting the pregnancy is very little that's that you can, you know, take to the bank type of thing. So, okay, well, Tucker, what do we know about the impact of antacids on male fertility? Now, that's a little different. And you asked about like a map resolve, that's also something else that you can take, if you're having some of those concerns. It seems that that appears to be safe. What what's the brand name for that? What's the brand name for Microsoft? map results project pile a sec. Okay, so taking private sec seems to have less impact. Yeah, okay. And it's, it's one that if you're on, you know, people have studied that as well. But as you had mentioned, in the beginning, make sure that you talk to your doctor specifically about what medications your body might need to while you're pregnant, and what things you should, you know, exactly try to switch and be off. Because, you know, different people have different situations and they might need something beyond what we're talking about here. Okay, excellent. Dr. Tucker. Anything on male impact of male fertility? Yeah, there's there's quite a bit to be honest, the worst. Let's just say the worst medication out there is tagamet, which is sometta Dean that has that can lead to decrease number of ejaculated sperm. If it has negative effects on morphology motility, it also can increase intracellular calcium in sperm which can lead to sperm death. It lower testosterone levels, you see more DNA damage on the sperm, it can be reversible. It's It's so as I said, it's the joy of spermatogenesis is that it's it affects the sperm that are developing, it doesn't affect the germ cells. And I know that there were some, some studies years years years ago that high doses of tagamet can lead to erectile disorders, and impotence. So

don't take tagamet if you're trying to get pregnant, but are others other antacids are safe for men who are trying to conceive? There are a couple there's Zantac, which is Ranitidine. And that's right now there's there's very, there's conflicting data on it, but it's it's not as bad as tagamet famotidine, which is Pepcid is probably the least of the evils. And if there were any negative effects seen, it also affects intracellular calcium, it can affect but it's one of those things, you know, don't if you use it, occasionally, it's not going to be an issue. Okay, it's just long term use or chronic use, as we've mentioned before.

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All right now moving to another over the counter drug and histamines. Dr. Tucker, why don't you lay out the difference between first generation and second generation for us? Okay. And histamines, one of my favorite medications, sometimes an allergy girl. Yeah.

appreciate those. Oh my gosh, sing the praises. Yeah, I'm right there with you. Go ahead. So it's a it's a very big issue. So we have two main types of histamines. They're both. There's Well, they're they're generally history. They're h1 receptor blockers. Those are the main ones there's there's mast cell inhibitor, but those are prescription only. So the the first generation h1 receptor agonist are the ones that have more of a sedative effect, like chlorpheniramine color try metallic or Benadryl, Benadryl being the most widely known. And then they're the second generation switch they've developed to minimize drowsiness or eradicate the drowsiness and these are the ones we all know a leg Mazar tech clarinex Claritin tattooist. The most common would be fexofenadine, which is Allegra and loratadine. This is Claritin and cetirizine, which is cert tech. Okay, now, Dr. Bell. So let's talk about the impact of anti histamines on conception, either natural or through treatment. Yeah, I think these anti histamines which especially as we come into the spring and summer times that so many people are using these to help them, you know, get through the breathing times. Interestingly, the anti histamines are something that you want to think about because the uterus also has histamine receptors, and the embryo itself makes a little histamine. So one study said it may decrease the blood flow to the uterus. And so do we want to be careful Overall, we do let people use anti histamine medications that they're using. It's not something we say that you shouldn't do, because there's no current evidence that they they reduce fertility. And in some interesting protocols, there may be some questions that it might be helpful for implantation, and increasing blood flow to the uterus, for example, with these medications, to sometimes calm the immune system down. But we don't say that they need per se to stop taking it, but maybe, overall limiting it to the medications that will keep your body functioning, if you will, and your nose and your nose open and your body functioning. Yes, exactly. Yeah, for sure. Dr. Tucker, what do we know about the impact of anti histamines on male fertility?

This is something that was very interesting to me when I was in Holland. Because we if you have somebody who has, it has wonderful sperm, it doesn't really make such a big difference what he's taking unless again, it's something very chronic, and then he's got other issues. But with but if they're borderline and especially if they're trying to do normal IVF or or in intrauterine insemination, we do recommend that they limit their use of anti histamines because these can have a negative effect on sperm. Okay, well, that's that sounds good that we just know that they have a potential to have a negative influence, particularly if you are born again, this is all it's all reversible. That's the joy you can say listen, your you know, your your semen analysis is great. What have you been taking? We always question our patients. What you know, give me a list of medications, even especially over the counter medications, because you disregard them you think, oh, medications means what my doctor is prescribing? Oh, yes, I had a really bad cold or I've had I'm having terrible allergies. I go, Yeah, what are you taking? And then they give me a list and some of them are less bad than others. But if we say listen, can you get off it for a little while or try something different? Get a prescription massell inhibitor, which actually can be beneficial to sperm, as opposed to these regular anti histamines which can be detrimental if he's just taking it constantly because he's just everything's running. So you know, there are options. Sometimes I just have to be sneezy. And until we get a good sperm sample and then they can go back to their estimates Yeah, that they don't have to live with the pregnancy either. So I mean, they don't have to do it. So that's a little bit different. But you know, it's it's a way of managing everybody said that they're not losing their mind.

So that leads us into the impact of anti histamines on pregnancy. Dr. belta Yes. So you know some of these medications we say, Claritin is okay. But trying to avoid you know, Allegra is important. antihistamines like Zyrtec, Benadryl, those are also seem to be safe during pregnancy. So when you're talking about your particular thing their overall again safe, but just make sure you talk to your doctor if you're on any of these anti histamines once you are pregnant and tried to stick with the ones that we just mentioned, most of the end of histamines in my in my research that came up that very few had what they call an FDA category worse than C. So which basically means that either there was no studies that are negative or no animal studies, or if it's a category see that there are some negative effects in animals but no human studies. So I always say it's okay to use, just use with caution. Okay, now moving to another common over the counter medication, sleep aids, which is a general category, obviously, and includes things that are actually medications, but it also includes supplements that people take to help sleep doctor belt. So what are some of the common sleep aids that you see your patients using? And how do they impact conception?

These are some people use the supplements like melatonin, that one is a popular medication. And interestingly, with melatonin, it also may help. There's some studies looking at some of these supplementations to help get pregnant through improving egg quality. So these micronutrients and then again, it may be something that also seems to help sleep. Wouldn't that feed on each other? I mean, I'm sorry to interrupt, but I'm trying to understand. So melatonin you're saying could actually improve air quality generally. But it also is the reason people most people are taking it is to improve their sleep and we know improved sleep can have an impact on air quality. So not to be

Yeah, not to make a pun. But what comes first the chicken or the egg? No, really, yeah, it's so funny. But that's really important, I think, for us to think about how important sleep is. And we know that that is incredibly important for sperm production. It also is very important for the body to rest in a woman. And of course, while someone's pregnant, on the other hand, it can cross the placenta. And in one animal study, adding too much melatonin can negatively affect how much the mom weighs, the baby weighs and you know, its ability to keep the baby safe. So don't use what you don't need. And just be careful using things. Again, that could be concerning. Like for example, another one is NyQuil. And that one can make us it's a product that can also make us sleepy, so it can help with sleep, but it's not safe for the pregnancy.

Okay, I did want to move into talking about the sleep aids that are non supplemental, non natural, and they would include things like the Tylenol PM, but we've already talked about the Tylenol part. But they also over the counter have just the p m part. Or we've already talked about Benadryl or NyQuil, which we've we've talked about the impact there, but what about some of the ones that are the the sleep aid part of those? Dr. Tucker, do we have any indication that they impact either conception or pregnancy in women and then we're going to move to talking about men?

Well, in a real quick review, there's another sleep aid unisom and the active ingredient that is doxylamine succinate. And interesting, Lee, there was no negative effect on pregnancy and if taken as directed and taken only when needed, of course, and it might even help with nausea and vomiting during pregnancy. So you know, sleeping and not vomiting. What about magnesium, which is also a common supplement that people take to aid sleep. Dr. belta

think magnesium and pregnancy especially when some people are deficient, you know, people wonder if they should supplement in without it. They might be at higher risk of having issues like high blood pressure and

premature labor. So it, it can be something that you can take it again depends on how much you do take the recommendation for pregnancy is around 350 milligrams per day and depending on how old the woman is, but you also people ask if they should avoid it during certain times and magnesium is also in for example, antacids, and they say that you should avoid that towards the end of pregnancy because it might interfere with uterine contractions. So, you know, I think you have to think about that. And then of course, sometimes in labor and delivery, we use magnesium sulfate to help prevent complications from preeclampsia. Alright, so with magnesium, check with your doctor, if that is a sleep aid that you are utilizing. Dr. Tucker, what about any of the sleep aids either they melatonin they magnesium, or any of the unit calm or any of the pm part of the painkiller part? So the Tylenol pm the NyQuil or whatever? What is the impact on male fertility? Well, I looked at the effects of diphenhydramine or Benadryl, Aleve, PMS and essentially unisom melatonin and Valerian we haven't touched on Valerian, which is a strictly herbal supplement. And as far as what I could find is that diphenhydramine and doxylamine succinate, which is yunusov. They actually are beneficial, slightly beneficial to sperm.

Melatonin is a very powerful antioxidant, and they've it has been used as an additive in in vitro preparations for instance, it tends to improve motility and sperm after thaw. So when you were talking about the chicken and the egg, melatonin would be your chicken I guess it's it does have a direct effect and it doesn't necessarily go via via so I was that was a bit of an eye opener because this is new to add actual melatonin to your cultures, keeping in mind that that was that was not the people the patient was not taking the melatonin and what you're describing that is exactly so it's just a direct effect on the germ cell itself. So also the some of the things I've read about our sites is that it can have a direct effect on any kind of oxidative stress that the site might be undergoing. That's basically its mechanism of action. Okay. And then as I said, with Larian sketchy information, you always want to watch out. For guys, that doesn't seem to be anything very negative, the only one paper I could find that it, it may actually have a beneficial effect on the type of motility that you see because there's different types of motility and this is the one you want to see that that would be more fertilized double.


This show would not happen without the generous support of our partners and these are organizations who believe in our mission of providing unbiased medically accurate information to the patient community. Another partner is Reproductive Medicine associates in New York. They are a full service Fertility Center specializing in in vitro fertilization, egg donation, egg and embryo freezing and LGBTQ i a family building. They also do reproductive surgeries and male reproductive medicine. highly individualized patient care is offered through 13, reproductive endocrinologist and fertility specialists and a urologist and a full service support team.

Alright, so Dr. Bell says what other common over the counter drugs do you see your patients coming in? When I'm sure one of the first things you ask is, what medications are you taking? What are some others that we haven't talked about that are fairly common in your patient population? This is something very interesting, but I would say CBD is something that people are using for a variety of things and sometimes quite frequently. And the use of cannabis can vary between people. You know, you might have one male patient who comes in and uses a small amount and his best friend uses it you know every day and has 10 kids but this particular gentleman may have issues with sperm movement. The motility piece, the sperm is just swimming very slowly, and the count is a little bit compromised. So we you know, continue to see these regulations changing state by state, and the use is quite common. I've seen much more use than ever before, and it has been linked in both human and animal models to reduce

Fertility in men. So if this is something where your sperm count is lower,

and you do use cannabis in some form, and it comes as we are learning in many different forms, smoking and oils, and gummies, and etc, that the use of this, you need to be careful when you're trying to get pregnant.

And happy. You've mentioned men, how about with women, certainly in women, we also recommend limiting that exposure. Obviously, when trying to get pregnant, after you ovulate, we want you to consider yourself pregnant, you know, just because as the blood supply connects to the baby, those early exposures might be compromising. And of course, when you're pregnant to not use this, okay, Dr. Tucker, any other common over the counter medications that we have not covered? Well, one thing that I was interested in as well as

herbal supplements, and I found that they could be quite detrimental if taken alone in high quantities or in conjunction with any other over counter medication. For instance, things like camel, mild phenol or ginger, these can all shorten your gestational age, gestation duration, ginger and high quantities has been shown to lead to smaller skull sizes in the fetus. So there's some growth issues there. interaction is a real problem. Like for instance, again, going back to ginger, that FDA gives it a category C. So there is quite a an abundance of negative animal studies.

Not Not a lot in humans, it's hard to have them take something and then looking at the detrimental effects on the fetus, it would just be by accident. So it would be mostly like case studies and things like that. But the one thing that you want to be careful is ginger and aspirin together can exacerbate the effects of aspirin and increase any kind of platelet D aggregation. So it has a blood thinning effect, a greater blood thinning effect. So that those are the things you just want to take. They're not all healthy, great, wonderful. Oh, if I take this and I take all my herbal supplements, I'm just going to be even better. It might have a real deleterious combined effect. So that was one thing that was interesting. The other thing that we didn't talk about was skin creams. Wait just a second before we move there, let me I guess I do want to speak a little more about herbal supplements. Oh, yes. Okay, because it's, as you point out, I think that more and more patients are now and honestly I think patients in particular who are trying to conceive one of the first things everyone does is they go to Dr. Google and they you know, are told what supplements would help potentially help and, you know, supplements it seems natural and and it sure as heck beats going to see you doctor belt. So we have no offense, but we don't want to have to, to receive fertility treatments. So lots and lots of patients are trying herbal supplements before they even come to you. So what are some of the common herbal supplements that that your patients, if they are going to the internet are told to try because it might improve their fertility and and what do you recommend? So for our patients, again, micronutrients and vitamins can be very, very helpful to your body to your fertility, and pregnancy, but everything in moderation. So some things for men are the antioxidants can be very impactful in amino acids like l carnitine, zinc, vitamin C, Vitamin E, and co q 10. And these can help polish the DNA and boost the energy of the sperm and to help the sperm develop. Other things that can be helpful for egg quality is to refuel the mitochondria. And again, that can be done with CO q 10. And there's other studies with an A D, which has been found to be helpful. Once you are pregnant, you want to be mindful of the supplements that you've started you want to make sure you're taking a good prenatal vitamin with folic acid and omega three fatty acids and there are some medications and herbs that you want to avoid once you are pregnant. Because they although they may be good when you're not pregnant, but when you are you have to be careful like Saw Palmetto and golden seal. Don Quaid. These are examples of ones black cohosh, people use sometimes when they're trying to balance out some of these hormones. We do want to be careful so look over the ones that you're buying on the

Internet that are labeled for fertility. And then once you are pregnant, what is safe once you're pregnant and, you know sticking the to be more conservative once you are pregnant? All right now, Dr. Tucker, let's talk about because I agree with you when we're talking over the counter, it's not a medication, but my nightstand is full of creams and my shower is full of hair products. And I'm sure I'm not alone. So what are some of the skin and haircare products? That what are some of the research indicate as far as how that might impact fertility? Let's start with female fertility, fertility on its own, he doesn't want to have a real effect the biggest issues that I found was with the pregnancy and and transgenic effects of creams like

anti acne creams, for instance, that contain ISO red tone and or retinoids. And they can result in severe birth defects. If taken in large quantities. Again, you know, you're slathering yourself, a lot of women break out during pregnancy. So, this this is an issue and there are no warning labels. That was the thing that many of these reviews would say is like these are detrimental for use during pregnancy and nobody says do not use it pregnant. And another interesting point that came out that I read was that during pregnancy there are a lot of women suffer from melasma getting those dark spots, you know, I call them the cow spots. And so, they use products that contain either some kind of bleaching product or a hydro Kwai known, which is, at least in studies in rodents is is is very detrimental to fetal development, and it has rocked and it has carcinogenic effects. So, you know, it's it's not just, it's again, it's like a category c type of thing, but the FDA just doesn't pay attention to something that's topical, even though it is absorbed into the bloodstream mechanics. Yeah, so these are just there are other options out there. You know, that's the thing is like, don't take anything that has these particular ingredients in them because many things are absorbed through the skin. And we don't we don't think about that. Now. Absolutely, Dr. Meltzer, I will give you the last word. What is hair and skincare products? Do you caution your patients on if any, you know this is so important and it's a provocative topic because we do expect that things like you said lotions, and sunscreens and these products that we use for keeping our hands clean, thin and vegetarian bins which are in many products, sunscreen, body lotions, you know, it's in our makeup like mascara, a hand soaps, shampoos, all these have products in them. So if you look for ones that are paraben free, they may not necessarily be safer, but we do know that these products can affect sperm. And they are also endocrine disruptors. And other endocrine disruptors that are in our food. Some of the European Union ban some of these in cosmetics, but the US FDA has not limited the use of these ingredients and yet they could be harmful to your hormones. So being thoughtful about our makeup, and our skin products is something that we cannot take for granted. Perfect I couldn't agree with you more. The interconnection disruptors are a are an issue particularly for someone who is struggling to conceive. Well, thank you so much Dr. ante belt SOS and Dr. Kathleen Tucker for being here. Talk about the impact of over the counter drugs on fertility. And one more time let me remind everybody to keep in mind that the information given in this interview is general advice to understand how it applies to your specific situation you need to work with your infertility professional. Thanks for joining us today and I will see you next week.

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