Speaker 1: Thanks for tuning in to the Fertility Health Podcast, hosted by renowned fertility specialist, Mark Trolice, MD. Each episode features firsthand advice and potential treatment news, tips, and strategies listeners can use on their fertility journey. And now here’s your host, Dr. Trolice.
Dr. Trolice: Hi, and welcome to the Fertility Health Podcast. I’m your host, Dr. Mark Trolice. And I’d like to talk with you all today about something that we probably don’t stress enough as physicians, as reproductive specialists, but also probably in the literature, reading articles online, and blogs, and all different sources of fertility, and it has to do with the environment. Patients always ask me, “What else can I do to optimize my fertility?” And traditionally we talk about, “Well, we need ovulation, we need to make sure your fallopian tubes are open, and we need meet to make sure there’s adequate amounts of sperm.” But we are learning more and more today about things in the environment that are, lack of a better term, toxic to your ability to conceive. And so I’ve thought about what we can do and who we could bring on, and we have an expert in that area. Her name is Dr. Lora Shahine.
Dr. Trolice: She is the director of the recurrent pregnancy program at… recurrent pregnancy loss program at Pacific Northwest Fertility, over there in Seattle, and she’s clinical faculty at the University of Washington in Seattle. She’s completed her residency in OBGYN at the University of California in San Francisco, and fellowship in reproductive endocrinology at Stanford University. It sounds like somebody really likes California, or at least the West Coast. She is dedicated to educating and advocating for increased awareness of the impact on environmental toxins on health through an active social media presence, teaching clinical research, and authors multiple blogs and books including Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss. And with that, Dr. Shahine, welcome to the Fertility Health Podcast.
Dr. Shahine: Oh, thank you so much for having me, Dr. Trolice. I’m really happy to be here.
Dr. Trolice: Oh, it’s my pleasure and I’m thankful that you are here. And I really want to share with the audience how we met. It was through social media. I have followed and stalked Dr. Shahine for a while because she is such an inspiring poster that I am so jealous about how she’s able to engage so many people with very, very powerful posts. And so, she is a mentor of mine on social media and I just brought her on, actually for selfish reasons, to learn more from me on how she does what she does, but no, not selfishly, it’s really for all of you out there to listen. Dr. Shahine, I know your expertise is obviously in recurrent pregnancy loss, but speak to us a little bit about what we’re not getting, what patients are not realizing is out there in the environment that we just take for granted and it’s really impairing fertility.
Dr. Shahine: Absolutely. First of all, thank you so much for those wonderful comments. I love following you on social media as well, so the feelings are mutual.
Dr. Trolice: Oh, thank you.
Dr. Shahine: I learned a lot in researching my books on miscarriage. I too was trying to help my patients answer the questions, “What can I do to decrease my risk of miscarriage, increase my chances of conceiving?” And in the research, I kept finding lots and lots of information about environmental toxins and their impact on our reproductive health.
Dr. Trolice: Okay, excellent. So would you say in general that these toxins are more toward miscarrying, or they’re really making it difficult for people to conceive, or both?
Dr. Shahine: It’s both. It is both. These environmental toxins are impacting egg quality, they’re impacting sperm quality, they’re impacting success rate with IVF and fertility treatments, and they are impacting risk of miscarriage. It’s across the board. It’s quite overwhelming.
Dr. Trolice: Yeah. So the most common one that comes to mind with me is tobacco, cigarette smoking, and now even with vaping, there’s studies in mice to show that it impairs fertility as well. So bring us up to date on probably the most ubiquitous, prevalent toxin that we know as specialists that really hurt chances for men and women for fertility.
Dr. Shahine: Yeah. I think of when I’m trying to organize my thoughts around it, and especially talking to patients, I talk to people about how we are already counseling on certain endocrine disruptors, or environmental toxins. These are chemicals that we’re putting into our bodies that are impacting the way our hormones function and the way our genetics are being read. We’re familiar with tobacco, and the harms of cigarette smoking, and now the harms of vaping are really coming to the forefront. We’re also aware of high levels of alcohol being associated with miscarriage and fetal alcohol syndrome, and there are studies showing regular alcohol heavy use can decrease chances of success with fertility treatment and increase time it takes to conceive, so that’s a comfortable place to be. That’s something we’re familiar with and that’s something that we can control our exposure to. But there are other toxins that we might not be very aware of, things like, BPA, and phthalates, and things that are in plastics, and common household materials.
Dr. Trolice: Yeah, so let’s get into a little bit longer, but the thing about alcohol is somewhat confusing to me. So we know that once a woman’s pregnant, any alcohol, there’s no level of alcohol that is considered safe to prevent, unfortunately, the complications of fetal alcohol syndrome and mental retardation. And I remember coming across a New England Journal of Medicine article that any alcohol use could impair fertility as well, which what I tell my patient is tongue in cheek is that, “I can’t tell you to completely abstain from alcohol because probably most children were a result of having a little bit of alcohol, at least to conceive.” So what are you counseling patients on, particularly women, because it seems to be less of an effect on men, but what are you counseling your patients on in terms of alcohol uses before pregnancy?
Dr. Shahine: Sure. So there is some evidence that regular alcohol use will impact fertility in both men and women, and I do realize it’s a huge part of our culture. It’s a huge part of celebration, enjoying yourself out at a restaurant, and it’s a part of everyday life, and it’s actually socially awkward for someone who’s regularly drinking wine to be at a party and then all of a sudden not have something to drink, and that leads to questions and you’re already struggling to conceive. It’s a lot to kind of walk through. But I do go through the evidence and I talk about, “Let’s just keep everything in moderation. Let’s not have alcohol every day. Let’s not have it all the time, let’s have it in moderation.” And another thing I really try to emphasize with people is that the wine industry and the alcohol industry are extremely unregulated, and it may not necessarily be that wine or some alcohol that we’re drinking is necessarily bad, it’s the toxins, the pesticides and some of the additives that are put into these alcoholic beverages that might be the true culprit.
Dr. Trolice: Interesting, I had never thought about it from that perspective, but that makes a lot of sense. So what we’re saying is that some moderation, clearly before pregnancy, is probably acceptable, but certainly avoiding completely once pregnancy occurs. I wanted to go into more detail about the cigarette smoking because, unfortunately, I just don’t think it’s out there enough on the dangers, the harm of cigarette smoking in terms of infertility, miscarriage, ectopic pregnancy. So speak to us a little bit more on on what harm this actually is causing, and also what type of recovery is necessary once cigarette smoking has stopped.
Dr. Shahine: Sure, that’s great. It’s funny, I have been on the West Coast now for over a decade, but I actually grew up in North Carolina, which is pretty close to you I Florida. So I am very familiar with cigarette smoking and tobacco use being a part of someone’s everyday life, and the evidence is overwhelming. Cigarette smoking and tobacco use decreases blood supply to the uterus, it decreases sperm parameters on semen analysis, it’s associated with earlier menopause and poor egg quality. So you can pick each incident that you want to look at apart, but it’s absolutely just like we know cigarette smoking impacts lots of other health issues like cardiovascular disease, increased risk of lung cancer, it’s absolutely associated with infertility and miscarriage.
Dr. Shahine: And I think that when we’re trying to counsel patients about decreasing exposures to toxins that is socially acceptable, like alcohol or cigarettes, people often look at their friends who are smoking twice as much, or drinking twice as much, and they’re having multiple children, and it’s frustrating, they say, “Well, look at this other person enjoying their life.” Why are they not infertile, and I am?” And, “Why are you taking this thing that really gives me pleasure away from me?” And I just have to remind people that every person is different. Everybody’s genetics are different and you can’t say that smoking and drinking alcohol are safe for you, so just everything in moderation.
Dr. Trolice: Thanks for tuning in to the Fertility Health Podcast. I’m your host, Dr. Mark Trolice, and I wanted to take a few seconds and share some exciting news with you. My new book, The Fertility Doctor’s Guide to Overcoming Infertility, Discovering Your Reproductive Potential and Maximizing Your Odds of Having a Baby is now available for preorder on Amazon. It’s a long title, but I assure you that’s because there is so much great information and insight packed within the only general guide to infertility written by a medical doctor who specializes in the subject, that’s me. This book has been a labor of love and I can’t wait to share it with you all, so give yourself the best possible odds for getting pregnant and having a baby with this concise and encouraging companion available on Amazon for preorder today. Now back to the episode.
Dr. Trolice: Yeah, I do. You know, that that’s a credo that I’ve lived by about everything in moderation, but I think that it needs to be revised, of course, for tobacco use is that really, unfortunately, if pregnancy is desired, I paint a very profound and chilling picture when I talk about cigarette smoke with my patients I say, “You really have to think about what you’d rather be holding.” And they’re either going to be holding a cigarette or a baby. Now, they’re not mutually exclusive. And of course, you know the stories, and I do as well, particularly for a patient who is frustrated, firstly, when they’re trying to conceive the whole world looks pregnant. And then, when they see somebody who is able to conceive readily and smokes, that’s a very difficult thing for them.
Dr. Trolice: But even more difficult, at least for me, is people who are smoking pregnant because there are significant risks known to baby with the decreasing blood flow to the baby, and what’s called placental insufficiency, and risk of low birth weight and complications even later once the baby’s born. So I’ve also seen that there are some genetic alterations of the sperm and the egg that are impairing the ability to conceive. Tobacco use is really not good. We don’t know yet enough about vaping but animal studies in mice are showing that it is probably just as harmful. Dr. Shahine, the issue of stopping smoking, are you seeing… Now, the guidelines that I have read are about a year after stopping their fertility should resume. Are you seeing that or can you speak to that much?
Dr. Shahine: No, I am not aware of a lot of longterm studies in quitting smoking and seeing resolution of fertility issues. But I think that I would just try to encourage people to quit as soon as they can for, not only their fertility, but for their overall health.
Dr. Trolice: Absolutely. Absolutely. So let’s switch over to something that is very troubling to me and that has to do with, what you had described at the outset, is the endocrine disruptors, these are plastics and the categories that are so much a part of our lives that it’s frightening to know how damaging they can be. So give us some more information about that so our listeners could really understand the effects and maybe make some modifications to help them.
Dr. Shahine: Sure. The two chemicals that I’ve researched the most, as far as their impact on the reproductive health, are BPA, which is bisphenol A and phthalates. So BPA is a chemical that was actually synthesized in the late 1800s to be used as an estrogen substitute. It was used as a pharmaceutical chemical to help women going through estrogen withdrawal. It was even used for some maternal issues like to prevent miscarriage and early labor until it was taken off the shelf and replaced by a chemical that you’re going to be very familiar with. Dr. Trolice, which is DES.
Dr. Trolice: Sure.
Dr. Shahine: So as a gynecologist you will know that DES was used as a pseudo estrogen and given to women to prevent miscarriage and preterm labor, but it was removed from the market in 1971 because it was associated with birth defects, vaginal clear cell carcinoma in babies that were born from moms that took it in pregnancy. So anybody that’s familiar with that is usually pretty shocked when I bring up that BPA was used in a very similar fashion.
Dr. Shahine: The chemical industry realized that BPA could be used in a totally different way. It’s not used as a pharmaceutical anymore, but it’s used in plastics in many household products to make the plastics flexible, lighter weight, and easier to use. It can be found in anything from water bottles, a lot of food packaging materials, it’s in a lot of medical supplies, it’s in a lot of fast food wrappers. It’s in thermal receipts, so when you take a receipt from somebody from a cash register, or an airplane ticket, or something like that, the BPA will rub off into your hands. So it is in so much of what we are exposed to phthalates are a totally different chemical.
Dr. Trolice: Okay, let’s stay with the plastic for a second. So, it’s obvious that it doesn’t necessarily have to be ingested. I mean, this is topical, this is where they can actually get effects from touching. Is that what you’ve seen?
Dr. Shahine: Yeah, you can get it from rubbing or holding a thermal receipt. But the highest exposure to BPA is usually through food. It’s food that’s heated up in plastic containers and the plastic, the BPA, that’s there in the plastics will leach into the food or into the water, and that’s how most humans will ingest it.
Dr. Trolice: And so humans are touching water bottles and they’re drinking out of water bottles. So it’s a setup right there for problems with fertility and miscarriage. Yes?
Dr. Shahine: Yes.
Dr. Trolice: Yeah. So amazing. Absolutely. You know, who doesn’t have a water bottle when you see them? It’s just so ubiquitous, it’s right there. Okay. So we’ve got the issues very, very important, so you were just ready to talk about the phthalates.
Dr. Shahine: Yeah, phthalates, they’re also found in plastics as well, so you’re going to get exposed to them in that way as well. But I think about them mostly in household products like beauty products, cleaning supplies, candles, they are often used as a way to stabilize fragrance in materials, so like a fragrant candle, they stabilize makeup, so it has a longer shelf life. It stabilizes the smell that you have in your shampoo or your laundry detergent, and so phthalates, as well as BPA, are just ubiquitous throughout our households, and we’re exposed to them every day.
Dr. Trolice: Right. So what is a couple, or what is a woman to do?
Dr. Shahine: Sure. So, it’s overwhelming. I just want to say, when I started really learning about this, and researching it, and writing in my books, I really shut down for awhile. The evidence is overwhelming. It’s mainly in animal models because they’re honestly just easier to test, but Europe especially has really paid a lot attention to these chemicals, has much more regulation than the United States, and they have a lot of human research as well. And so the evidence is there, but the positive is that the most harm are from patients and people that have the highest levels of exposure in their systems, and so if you can take active and small measures to decrease your exposure to these chemicals, you are going to drastically improve the levels in your system, and you actually can make small changes that have a huge impact.
Dr. Trolice: Fantastic. Fantastic. Just briefly, I hear patients talking about soy products. How much of an impact, if at all, do you see with with these over the counter products that may contain soy and should patients be reducing their intake of soy because it’s an estrogen like compound?
Dr. Shahine: That’s a really complicated question because in general soy, in and of itself, is not a bad thing. It’s the type of soy that people have, and there’s even some really interesting evidence that people who have high levels of soy in their system have lower levels of BPA. And the way I put that together is that people who are eating soy are often eating [inaudible 00:21:18], they’re often eating less meat. And one of the highest ways that we can be exposed to BPA is how our meat and dairy is processed because it’s just put in through so much plastic containers as it’s being processed.
Dr. Trolice: Packaged as well, yeah.
Dr. Shahine: So I don’t think in and of itself soy is necessarily a bad thing, but you’re going to find so many different conflicting evidence surrounding that because of where the story is coming from, and which supplement, and there’s so many confounders, it’s hard to narrow that down.
Dr. Trolice: Well, you’ve made a very confusing topic much more clear, Dr. Shahine. I thank you so much. I was looking forward to this and I hope the readers, I know that the readers will enjoy this as much as I because this is just a topic that doesn’t get the play, it doesn’t get the press and notoriety that it needs to. There’s things out there that are harming your fertility even if everything is great for you all, even if tubes are good, and sperm analysis is good, and you’re and you’re ovulating, so fabulous, and thank you so much for spending time with us today, Dr. Shahine. I really appreciate it.
Dr. Shahine: Thank you for the opportunity.
Dr. Trolice: So if you are in the Seattle area, please don’t hesitate to find Dr. Lora Shahine, she is the director of the recurrent pregnancy loss program at Pacific Northwest Fertility and the clinical faculty at the University of Washington in Seattle. She is also a very, very avid user of Instagram. What is your handle, Dr. Shahine?
Dr. Shahine: @drlorashahine.
Dr. Trolice: Well, there you go. Okay. Well, I’m @drmarktrolice, so we were both of the same mindset in that as well.
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