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Monday, August 30, 2010
Updated: Friday, April 18, 2014
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by Fiona McCulloch, ND
Top Fertility tests : A Quick Reference for Women from an Integrative Medicine Perspective
FSH – Follicle Stimulating Hormone
Day 3 FSH can indicate how hard the pituitary is working to stimulate the ovaries. Though traditionally a higher FSH is given a poor prognosis, I don’t always see it this way clinically. The FSH can very much change depending on the quality of the antral follicles, which depends on ovarian health over the previous months as well as ovarian reserve. The poorer the quality of the eggs, the more free radical damage they have accumulated and the poorer ovarian blood flow is, the more FSH the pituitary will have to put out in order to stimulate the antral follicles. Healthy follicles are responsive to lower amounts of FSH. If treatments are started to enhance ovarian health over 120 days of folliculogenesis prior to ovulation, the lowered FSH that can result can indeed indicate that the quality of the eggs in the ovaries has increased. Please keep in mind that I have seen many women with high FSH become pregnant when egg quality and ovarian health is worked on so having a high FSH is not untreatable.
|FSH Levels (Day 3)
||less than 6 mIU/mL
||above 13 mIU/mL
LH – Luteinizing Hormone
This is a test which is often done on day 3 of the cycle. If higher than the FSH, especially if higher than a 2:1 ratio, it can indicate polycystic ovarian syndrome. Having a high LH level will result in increased ovarian testosterone production, altered estrogen production, and abnormalities with ovulation. Normal day 3 range : <7 mIU/mL
Measured on day 3 of the cycle. If elevated, estradiol can lower the fsh, thereby masking elevated fsh levels. This can happen in cases of low ovarian reserve or functional cysts. Estradiol can be low in conditions of low ovarian reserve. Women who have estradiol over 294 pmol/L (or 80 pg/ml) have a lower chance of success with an IVF cycle since they will not respond to stimulation as well.
This is often measured on day 21. This is used to determine whether ovulation has occurred as a healthy corpus luteum produces progesterone. It is important to measure progesterone 7 days after your ovulation, measuring on day 21 only applies to women who ovulate on day 14. Levels higher than 16 nmol/L strongly suggest an ovulatory cycle.
Often measured in the morning can indicate the impact of stress on the reproductive system. Elevated cortisol can affect ovarian circulation and function. Normal levels : 250 – 850 nmol/L taken between 6-8am. Low cortisol can be found in congenital adrenal hyperplasia. Normal levels for am cortisol 101-536 nmol/L
The total level of testosterone in the system. If elevated this can indicate polycystic ovarian syndrome. High testosterone can interfere with normal ovulation often causing delayed ovulation or anovulation. Levels can also be low around which can negatively affect ovarian function. Normal levels for females 0.3- 4.0 nmol/L
The amount of testosterone that is not bound to carriers and is available to stimulate tissues. The higher this is, the more androgenic effect on the tissues. This can be elevated in PCOS and specific adrenal conditions such as non-classical congenital adrenal hyperplasia (non classical CAH). Normal levels for females 0.1-8.9 pmol/L
A hormone normally elevated in nursing and pregnancy. If elevated in other situations it can interfere with ovulation and fertility. It can be elevated due to stress, medications such as antidepressants or painkillers, thyroid disease, or pituitary conditions such as microadenomas. normal levels in women 3.3 – 26.7 ug/l.
DHT – Dihydrotestosterone
A form of testosterone which is very potent. DHT Can be elevated in pcos or enzyme conversion disorders resulting in androgen excess signs and symptoms. Serum testing for DHT is often unreliable.
Sex hormone binding globulin
Can be low in patients with androgen excess conditions such as pcos or in hypothyroidism. Can be high in non classical CAH, hyperthyroidism. Normal levels : Follicular phase 24 – 200 nmol/L, Luteal phase 48 – 185 nmol/L
A long termarker of insulin resistance and blood glucose control. Can be elevated in pcos. Marks the previous 3 months of blood glucose control. Normal levels 0.040 – 0.060
DHEA – S
A precursor to hormones, most especially androgens. DHEA is made by the adrenal gland. Levels tend to reduce with age and can be reduced in low ovarian reserve. Levels can be elevated in PCOS. Normal range for women 0-11 µmol/liter
A marker for stored iron. Levels can be low in patients with infertility. I recommend patients to achieve ferritin levels of above 50.
TSH - thyroid stimulating hormone
I like to achieve levels of approximately 2 – 2.5. Levels above this can put the patient at risk for early miscarriage. Normal Ranges are : 0.4 – 4 mIU/L. If levels are above 3, and especially if thyroid antibodies such as antithyroglobulin and anti-thyroid peroxidase are present with signs and symptoms of hypothyroidism, this and may present risks for fertility.
Important for overall health, hormone balance, and stress levels. Normal levels of 1, 25 Hydroxy Vitamin D 40 -150 pmol/L
A marker of inflammation and circulatory health. This test is only recently being found to be important for ovarian health. Elevated levels can be found in autoimmune conditions, ovarian aging and endometriosis. Normal range : 4.7 – 14.1 umol/L
A measure of blood clotting. Blood which clots excessively may interfere with implantation. Can also elevated in endometriosis or fibroids. Normal value for INR 0.9 – 1.2
Anti sperm antibodies
The presence of anti- sperm antibodies in women can destroy or damage the sperm before they have the chance to fertilize the egg. Around 5% of infertile women have these antibodies in their bloodstreams.
Anti thyroid antibodies
These include antithyroid peroxidase and antithyroglobulin. These antibodies, if present will reduce fertility by 13%, even if thyroid function is normal. These antibodies can cause alterations in thyroid function and also can be cross reactive with ovarian tissue. Women with PCOS who don’t respond to clomid have a higher liklihood of having antithyroid antibodies.
Anti nuclear antibodies
These antibodies are present in autoimmune disease such as Lupus and Sjogrens syndrome.
Special Ovarian Reserve Markers:
Antimullerian hormone is produced by growing follicles and prevents premature recruitment of primordial follicles. This value generally correlates with the number of functional primordial and antral follicles remaining in the ovary. Generally, the higher the AMH, the more healthy follicles are in the ovary. Antimullerian hormone can predict the age of onset of menopause with some degree of accuracy. Low AMH often does not give a good prognosis for IVF because IVF is based on the stimulation of multiple follicles – women with lower AMH tend to get fewer follicles during IVF stimulation. However, even if AMH is low, conception is possible. Even if there are not many follicles remaining in the ovary, their quality can be improved with treatments including antioxidants and circulatory enhancing therapies. Natural conception with low AMH can and does happen. Normal ranges :
||28.6 pmol/L – 48.5 pmol/L or over 1.0 ng/ml
||15.7 pmol/L – 28.6 pmol/L or over 1.0 ng/ml
||2.2 pmol/L – 15.7 pmol/L or 0.3 – 0.9 ng/ml
||0.0 pmol/L – 2.2 pmol/L or less than 0.3 ng/ml
|High Level found in PCOS
||> 48.5 pmol/L or over 3 ng/ml
A marker of ovarian function and reserve, this protein is secreted by small developing follicles and works to inhibit FSH levels, hence the name inhibin. This test is completed on day 3 of the cycle. As inhibin is secreted by the follicles, it can indicate the number of and function of the remaining folliciles. This test is not widely available. Normal = above 45 pg/ml Low = below 45 pg/mL Inhibin B is a spectrum however, and this line is a general guideline not a strict cutoff. Like with AMH even if inhibin B is low, conception is possible if the health of the remaining follicles is enhanced.
Mosby’s Manual of Diagnostic and Laboratory Tests. 4th Ed. 2010
Speroff, Clinical Gynecologic Endocrinology and Infertility. 7th Edition 2005.
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Tuesday, July 27, 2010
Updated: Friday, April 18, 2014
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by Hyla Cass, MD
Our mothers once called them "women's problems." Now we know that these mood swings and physical changes, from PMS to menopause, are all part of a delicate balance among our various hormones. In my years of practicing integrative medicine, I have helped hundreds of women overcome PMS and menopausal symptoms naturally, and here's how.
Let's start by defining hormones. They are chemical messengers secreted by any one of the body's endocrine (ductless) glands. They travel through the bloodstream, telling various systems what to do. Besides reproductive functions, hormones affect virtually every body system from digestion to metabolism to hair growth.
All women have the same hormones but in varying quantities, making your own hormonal profile as unique as your fingerprint. When your hormones are in harmony, you will have predictable menstrual cycles --and moods. When out of balance, you will have irregular cycles and a host of symptoms, from bloating, cramps, weight gain and acne to food cravings, irritability and depression. Perimenopause, the transition to menopause, which can start as early as your late 30's, often causes an increase in PMS. In fact, many women report experiencing PMS for the first time at that point. Also common in peri-menopausal women, is a loss of libido, due to a dip in testosterone which governs sexual desire, and of course, those hot flashes and night sweats, which make sex the last thing on your mind!
For a full picture of your hormonal status, we need to check levels of estrogen, progesterone, DHEA-S and testosterone in blood, saliva, or urine, taken on day 19-21 of the cycle. For perimenopausal women, I also order FSH (follicule stimulating hormone) and LH (luteinizing hormone) blood tests to assess ovarian function. I will check cortisol levels (saliva test) and thyroid hormones (blood test), too, since they are a part of the overall hormone symphony.
You can find home testing kits online. Take these tests on days 19-21 of your cycle, with day one being the first day of your period. If you are post-menopausal, it won't matter when you take the tests. If you're irregular, do your best to estimate the appropriate date.
If testing reveals that your hormone levels to be below the normal range, it may be due to perimenopause or other physiological factors. Faced with fluctuating hormones, doctors have traditionally prescribed synthetic hormone replacement therapy (HRT), such as Premarin (from pregnant mares' urine) and Prempro (Premarin plus synthetic progesterone), to correct imbalances. The recent Women's Health Initiative study showed that women taking this form of HRT had 27 percent more heart attacks, a higher rate of breast cancer, 38 percent more strokes and double the number of blood clots. There are safer ways to balance hormones successfully, ranging from supplements and herbs to bio-identical hormone therapy.
Natural Ways to Balance Sex Hormones
The first step to balancing your hormones is a clean diet:
• Eat fewer animal products, with lots of vegetables, including raw broccoli and other
• Reduce or eliminate caffeine, alcohol, nicotine and sugar.
• Reduce or eliminate high-fat dairy products.
• Eliminate as much processed food as possible
• Reduce salt intake.
• Eat small, regular meals.
Yoga and meditation are helpful for PMS sufferers because they work on the nervous system to help balance hormones.
Supplements for PMS:
I give my patients magnesium (100 mg two to three times daily) and vitamin B6 (25-100 mg) to relieve irritability and tight muscles as well as premenstrual water retention.
Another important nutrient is GLA, an omega-6 fatty acid which also helps reduce the water retention, breast tenderness and moodiness associated with PMS, likely by it's action on the hormone prolactin. GLA is found in borage oil (1500 mg of borage twice daily), black currant seed or evening primrose oils.
The herb, Chasteberry (Vitus Agnus Castus), helps to balance the hormone, progesterone, relieving symptoms of PMS and heavy or irregular periods as well. Dose is 50-200 mg daily depending on symptoms. Do not take if you're pregnant.
The herb, Dong Quai, helps to balance the hormone estrogen. Like Vitex, the dose is 50-200 mg daily depending on symptoms and also do not take if you're pregnant.
Another useful nutrient is the amino acid, 5-HTP (5-hydroxytryptophan) 500-200 mg daily, depending on your individual needs. It helps to raise levels of the feel-good and calming brain chemical, serotonin, which is often low in PMS sufferers.
These nutrients plus wild yam a source of natural hormone production, can all be found in the formulation, PMS Balance. I have had many women report almost immediate relief upon taking this or a similar formula. Others may take a month or two to feel the full effects.
With menopausal symptoms, I may also add black cohosh and red clover extract. While there was a recent study that claimed that black cohosh didn't work, it was in fact, flawed, and contradicted numerous well-done studies that found it to be very effective. I have also discovered a remarkable new product called FemmePhase. Even the majority of my hard-core hot flashers have found relief with it.
When the nutrients aren't quite doing the job, you can add over-the-counter natural progesterone cream (up to 30 mg daily) for one week prior to your period. This is a maximum of 3 percent progesterone, or 30 mg per 1 gram dose.
I may also prescribe higher dose bio-identical hormones for my patients. The progesterone is often 10 percent, which is three times as strong as the over-the counter dose. Made from highly purified derivatives of soy and wild yams, these formulas are carbon copies of your own natural hormones. Prescription strength bio-identical hormones are available only from compounding pharmacies, and are prescribed by your doctor. Doses are based on your individual hormonal needs as determined by your lab tests.
As I say repeatedly - "you don't have to live with PMS/peri-menopausal symptoms." This applies to both the woman herself and her long-suffering loved ones. This information should help you take care of most cases of PMS and peri-menopausal symptoms. I have many grateful women, and their partners, for whom PMS has truly become a thing of the past.
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Friday, July 2, 2010
Updated: Friday, April 18, 2014
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by Fiona McCulloch, ND
Polycystic ovarian syndrome is the number one reproductive disease in women. This disease disrupts normal ovulatory cycles which can result in heartbreaking infertility for millions of women. Known hormonal changes in PCOS include excess androgens (ie: testosterone), and insulin resistance. Most thought now is leaning towards insulin resistance being the primary cause of PCOS, with genetic factors playing a role, but once the cycle of anovulation begins it feeds back on itself, causing the condition to remain in a vicious cycle. Women with PCOS have not only insulin resistance, but also have neuroendocrine imbalances, resulting in elevated LH (lutenizing hormone) levels. Having a high LH to FSH ratio is one of the hallmarks of polycystic ovarian syndrome or persistent anovulation. In response to a combination of high LH and insulin resistance, the follicles in the ovary will begin to secrete too many male hormones (androgens) which then inhibit the hormonal pathways that are needed to stimulate ovulation.
Various medications are traditionally used to induce ovulation in women with PCOS. A growing body of evidence now exists indicating that low-frequency electroacupuncture is as effective as commonly used medications in inducing ovulation. Furthermore, this form of acupuncture can benefit many of the hormonal imbalances seen in polycystic ovarian syndrome. Thousands of women worldwide use acupuncture therapy for PCOS and so I’d like to discuss how it works, and why it is so beneficial to induce ovulation.
General principles of how electroacupuncture stimulates the ovaries through the nervous system
Electroacupuncture has been found to profoundly effect the reproductive organs, through mechanisms in the sympathetic nervous system, endocrine system, and neuroendocrine system. When needles are inserted into certain points and stimulated in a specific manner, this produces a neurological reflex transmitted to the organ correlated with that nerve pathway. For example, needles inserted into the leg muscles below the knee, lower back, or abdomen in specific regions cause a response which measurably affects the ovary. In addition, the nervous system will transmit a signal to the brain, and the brain then emits a response which affects the organ from a central mechanism. These effects have been investigated through measurements of hormones, neuropeptides, and circulatory changes on both animals and humans receiving this specific type of electroacupuncture.
Nervous system alterations in PCOS
Evidence indicates that women with pcos have abnormal circulating levels of a neurohormone called β-endorphin. β-endorphin is known to increase insulin production and reduce insulin excretion by the liver, which is very much implicated in PCOS. It has also been found that women with PCOS have unusually high amounts of sympathetic nerve fibres in their ovaries. These nerve fibres cause unusual stimulation of the ovary by the sympathetic nervous system (the part of the nervous system associated with “flight or fight” responses in the body, among other processes). Stimulation of these nerve fibres can cause the ovaries to produce androgens, which then impair normal ovulation. Women with PCOS have also been found to have high amounts of nerve growth factors in their ovaries, something which is associated with high levels of sympathetic nervous system activity. Disturbances in central and peripheral β-endorphin release, high androgens, insulin resistance, abdominal obesity, and cardiovascular disease are associated with increased sympathetic nervous system activity, and all of these are also associated with the pathology of PCOS. In a recent study by Elizabet Stener-Vitorin in Sweden, direct intraneural testing found a strong correlation between levels of sympathetic nervous system activity and testosterone levels in women with PCOS. Those who had the highest amounts of sympathetic nervous system activity were found to have the highest testosterone levels and the most severe PCOS conditions.
What evidence exists for acupuncture inducing ovulation?
Several studies exist on low frequency electroacupuncture and ovulation induction. In one trial, the effect of a series of 14 electroacupuncture treatments on 24 anovulatory women with pcos was investigated. In 38% of these women, regular ovulation was induced. Three months after the last treatment, LH/FSH ratios and testosterone levels were significantly decreased, a sign of improvement in PCOS pathology. In another study done on a group of women given human menopausal gonadotrophin (a commonly used drug in the treatment of infertility), acupuncture was compared to hCG injections in order to assess its effect on ovulation. Traditionally hCG is given to stimulate ovulation during medicated cycles at fertility clinics. It was found that a single acupuncture treatment induced ovulation as effectively as the as the hCG injection and reduced the incidence of ovarian hyperstimulation syndrome, a painful side effect of medicated cycles. Other studies have also indicated enhanced ovarian response when acupuncture is added to medicated cycles. Female rats with PCOS induced by chronic exposure to DHT (a form of testosterone) were given low frequency electroacupuncture and physical exercise. The treatment increased the amount of healthy follicles in the ovaries, and significantly normalized cycles.
Effects of electroacupuncture on nervous system changes in PCOS
It has also been found that electro-acupuncture can regulate parts of the central nervous system related to dysfunction in PCOS. Specifically, beneficial effects on neurohormones such as GnRH(Gonadotropin releasing hormone) and androgen receptor proteins, indicate that electro-acupuncture significantly benefits the hypothalamic-pituitary-ovarian axis and through this can help to restore normal cycling. Electroacupuncture was also found in 3 recent studies to increase ovarian blood flow through effects on sympathetic nervous system pathways. In addition, it has been found in two studies to reduce high peripheral circulating β-endorphins in women with PCOS, and thereby improve insulin resistance. As sympathetic nerve activity appears to contribute to the development and maintenance of PCOS, the beneficial effects of electroacupuncture, and also exercise, may be mediated by nervous system modulation to the ovaries.
Electro-acupuncture appears to work through multiple pathways to disrupt the “vicious cycle” of PCOS. Even though much more research needs to be done to determine all of the mechanisms involved, its safety and low incidence of side effects makes it an excellent therapy to stimulate ovulation naturally for the many women who suffer with this disease.
Andersson, S., Lundeberg, T., 1995. Acupuncture — from empiricism to science:functional background to acupuncture effects in pain and disease. Med. Hypotheses 45, 271–281.
Cai, X., 1997. Substitution of acupuncture for HCG in ovulation induction. J. Tradit. Chin. Med. 17, 119–121.
Carmina, E., Ditkoff, E.C., Malizia, G., Vijod, A.G., Janni, A., Lobo, R.A., 1992. Increased circulating levels of immunoreactive beta-endorphin in polycystic ovary syndrome is not caused by increased pituitary secretion. Am. J. Obstet. Gynecol. 167,
Chen, B.Y., Yu, J., 1991. Relationship between blood radioimmunoreactive beta-endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupunct. Electrother.
Lobo, R.A., Granger, L. R., Paul, W.L., Goebelsmann, U., Mishell Jr., D.R., 1983. Psychological stress and increases in urinary norepinephrine metabolites, platelet serotonin, and adrenal androgens in women with polycystic ovary syndrome. Am. J. Obstet. Gynecol. 145, 496–503.
Feng, Y., Johansson, J., Shao, R., Manneras, L., Fernandez-Rodriguez, J., Billig, H., Stener-Victorin, E., 2009. Hypothalamic neuroendocrine functions in rats with dihydrotestosterone-induced polycystic ovary syndrome: effects of low-frequency electroacupuncture. PLoS ONE 4, e6638. produces skeletal muscle vasodilation following antidromic stimulation of unmyelinated afferents in the dorsal root in rats. Neurosci. Lett. 283, 137–140.
Jin, C.L., Tohya, K., Kuribayashi, K., Kimura, M., Hirao, Y.H., 2009. Increased oocyte production after acupuncture treatment during superovulation process in mice. J. of Reprod. & Conception 20, 35–44.
Manneras, L., Cajander, S., Lonn, M., Stener-Victorin, E., 2009. Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am. J. Physiol. Regul. Integr. Comp. Physiol. 296, R1124–R1131.
Stener-Victorin, E., Wu, X., Effects and mechanisms of acupuncture in the reproductive system, Auton. Neurosci.(2010)
Stener-Victorin, E., Lindholm, C., 2004. Immunity and beta-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol. Reprod. 70, 329–333.
Stener-Victorin, E., Waldenstrom, U., Tagnfors, U., Lundeberg, T., Lindstedt, G., Janson, P.O., 2006. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet. Gynecol. Scand.
Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Manni, L., Aloe, L., Gunnarsson, S., Janson, P.O., 2000a. Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol. Reprod. 63, 1497–1503.
Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Bileviciute-Ljungar, I., Janson, P.O., 2001. Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries. Neuropeptides 35, 227–231.
Stener-Victorin, E., Kobayashi, R., Kurosawa, M., 2003a. Ovarian blood ﬂow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Auton. Neurosci.: Basic and Clin. 108, 50–56.
Stener-Victorin, E., Lundeberg, T., Cajander, S., Aloe, L., Manni, L., Waldenstrom, U., Janson, P.O., 2003b. Steroid-induced polycystic ovaries in rats: effect of electro- acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod. Biol. Endocrinol. 1, 33.
Stener-Victorin, E., Fujisawa, S., Kurosawa, M., 2006. Ovarian blood ﬂow responses to electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats. J. Appl. Physiol. 101, 84–91.
Stener-Victorin, E., Jedel, E., Manneras, L., 2008. Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J. Neuroendocrinol. 20, 290–298.
Stener-Victorin, E., Jedel, E., Janson, P.O., Sverrisdottir, Y.B., 2009. Low-frequency electro-acupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am.J.Physiol.Regul.Integr.Comp.Physiol. 297 (2), R387R395.
Zhao, H., Tian, Z.Z., Chen, B.Y., 2003a. An important role of corticotropin-releasing hormone in electroacupuncture normalizing the subnormal function of hypothalamus–pituitary–ovary axis in ovariectomized rats. Neurosci. Lett. 349, 25–28.
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Thursday, March 4, 2010
Updated: Friday, April 18, 2014
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There is so much controversy about the effect of soy foods on men’s fertility. With each study that is released, a news article follows declaring it to be either safe or harmful for men’s fertility. I would like to go through some of the studies in this area and review the significance of them before drawing a conclusion based on the current evidence. Soy is well-known for its health benefits for men, including the reduction of risk for both cardiovascular disease and prostate cancer. Due to these benefits, it has become a larger part of the North American diet than it ever has been in the past so it is important to fully understand its impact on hormones and fertility.
Effects of Soy on Infants and During Pregnancy on Adult Male Fertility
The following studies investigate reproductive effects on men who were given soy products either through infant formula, or while their mothers were pregnant. This is a very sensitive time of development for the reproductive organs, so much concern remains about the possibility of permanent negative effects.
Soy Formula in Infant Male Marmoset Monkeys causes no Adverse Effects
This study concluded that infant feeding with soy formula has no major adverse reproductive effects in male marmoset monkeys. Although it did not appear to affect fertility, soy infant formula did alter testis size and cell composition.
Again I would like to mention here that both rats and monkeys produce much higher levels of equol (an estrogen like substance which is much stronger than soy isoflavones) in their intestines than humans in general. The equol is produced through fermentation of isoflavones by bacteria which reside in the intestine. It’s hard to compare humans directly with rats or monkeys especially when it comes to estrogenic effects. Studies investigating the effects of phytoestrogens on the fertility of different animal species have been very inconsistent. This indicates that soy has very species specific effects on fertility and highlights the need for more studies on humans before we can draw definitive conclusions.
Study on Vegetarian Mothers and Hypospadias in Infants
This famous study investigated the difference between vegetarian and omnivorous women and the likelihood of a condition known as hypospadias in their newborns. Hypospadias is a condition (which is currently on the rise) where the urethral opening is in a lower position. This study found that significantly more of the vegetarian mothers had babies with hypospadias. As vegetarians have a greater exposure to phytoestrogens than do omnivores, the researchers concluded that phytoestrogens may have a negative effect on the developing male reproductive system. However, this study was not specific for soy, it only examined whether or not vegetarians tended to have more infants with hypospadias. Other factors cannot be excluded for example, vegetarians could be more likely to be deficient in other vitamins or nutrients such as B12, and could also be consuming a larger amount of estrogenic pesticide residue, and this study did not question participants about consumption of organic foods. It was also found that the vegetarian mothers who did not take iron supplements had more infants with hypospadias. In Japan, there are 1/10th the number of infants born with hypospadias as there are in North America and yet there is a much higher level of phytoestrogen consumption. Therefore, this study is not fully conclusive that phytoestrogens are the cause of this developmental condition since there are too many unaccounted for variables.
Study on Soy Formula in Infants and Reproductive Outcome In Young Adulthood
This study on 811 men and women, who were fed either soy or cow milk formula as infants were assessed in young adulthood for their pubertal maturation, menstrual and reproductive history, height/weight, and current health. It concluded that exposure to soy formula does not appear to lead to different general health or reproductive outcomes than exposure to cow milk formula in infancy. This study did not go into details asking about length of time to conceive. Also, no reproductive health markers were reported for male subjects with the exception of sexual maturation. Although men were questioned about pregnancy outcomes in partners the results were not reported.
In conclusion on the subject of male reproduction and feeding of infant soy formula, it appears that overall there may be a risk for some long-term reproductive developmental changes, however, the full effects of this are unknown and may not go so far as to cause fertility concerns. However, as we know from so much current data, breast milk is a far superior nutrition method for infants, and avoids any of the risks that soy formula may hold.
Studies on Male Adult Animals
Phytoestrogenic Plant given to Adult Male Mice – Some Effects on Reproduction
A phytoestrogenic plant(pueraria mirifica) was given in two doses, one high and one low, to a group of adult male mice. Neither treatment had effect on testicular weight, sperm count, LH, FSH or testosterone. However the high (100mg/kg) dose reduced the weight of epididymis, seminal vesicle and sperm motility. There were no effects on fertility. This effect was seen to be reversible after the phytoestrogen was stopped. However, this plant, though it does contain some of the same components as soy, is not identical to soy.
Acute Exposure of Adult Male Rats to Dietary Phytoestrogens Causes Temporary Reduction in Fertility
This study found that lipid peroxidation damage of sperm was increased in rats fed a high phytoestrogen diet for 3 days. No such changes were noted in low phytoestrogen group. As in the previous study, this effect was temporary, with fertility returning to control levels by day 12. Rats who were fed the phytoestrogens for longer than 6 days did not show this reduction in fertility and in fact showed no change in any reproductive parameters.
Phytoestrogens cause no Negative Effects on Fertility of Rhesus Monkeys
In this study, phytoestrogens were given to rhesus monkeys at the age of puberty. They had no adverse effects on the reproductive systems of male or females as evaluated by hormone concentrations. Cardiovascular benefits were observed in the monkeys receiving the phytoestrogens.
Studies on Adult Men
Soy Products Related with Slightly Lower Testosterone and Lower Estradiol in Japanese Men
This study on Japanese men investigated the relationship between soy product intake and serum testosterone and estrogen concentrations. The results found that blood levels of estradiol concentration were significantly lower with increased soy product intake, and blood estrone levels were not related to soy intake. Testosterone levels were also lower with increased soy intake but this effect was so slight it did not reach significance in the study. This study also concluded that this may be part of the reason soy reduces risk of prostate cancer in men.
Soymilk Given to Japanese Men Results in Lower Estrogen Concentrations
This second study on Japanese men investigates the effects of drinking 400 mL daily soymilk on serum estrogen and testosterone concentrations. In contrast to the previous study, the results of this study indicate that soymilk consumption is associated with lower levels of the estrone form of estrogen. In this study there was no effect of soymilk on any of the other hormones measured including testosterone, estradiol, and sex hormone binding globulin.
These two studies indicate that soy can affect serum estrogen levels. It is known from other research that estrogen is required for proper formation of sperm, but also, that elevated levels of estrogen can interfere with fertility (especially if testosterone to estrogen ratios are altered). So, what we can say is that a good level of balance of estrogen is required for optimal male fertility, and the real question is, does soy interfere with the balance of estrogen enough to impact actual fertility parameters in males. These two studies do not answer this question, so we need to look more to studies on soy consumption and the end result on adult male fertility.
Soy Food Intake Related to lower Sperm Concentration Among Men from an Infertility Clinic
This very well-known study took a group of men from a fertility clinic and evaluated the relationship between soy food intake and sperm quality and count. It found that there was a relationship between the intake of soy foods and the reduction of sperm concentration. 72% of men in this study were either overweight, or obese according to their BMI levels. The relationship was more pronounced in the men who had the highest sperm concentration and among overweight or obese men. Soy foods did not reduce sperm motility, sperm morphology, or ejaculate volume. This suggests that because androgens are converted into estrogen in fatty tissue, this may increase tissue sensitivity to phytoestrogens in those who have higher amounts of body fat. This study did not consider that those who eat more soy could be exposed to more estrogenic pesticides (it did not ask about consumption of organic versus non organic soy). It also did not account for the addition of soy in many foods that may not have been reported by the participants (such as soy based additives in baked goods, processed foods and so forth). Therefore, although this study is quite interesting, it not conclusive. This study does however, make an important association between elevated body mass index, and effects of soy on fertility in men.
Healthy Adult Men of Normal BMI: Soy Isoflavones have No Negative Effect on Sperm Parameters
This new study from the University of Guelph which involved healthy adult men with a healthy body mass index investigated the effects of isoflavones on sperm parameters. In this study, men were given a daily serving of soy isoflavones in low concentration, high concentration, and then isoflavone free milk protein isolate. The different substrates were given for 57 days each separated by a 28 day ‘break period’. The study showed no significant effect of soy isoflavones on sperm concentration, motility and morphology of the men. This study adds to the evidence that soy has a much lesser effect on semen parameters in men of healthy body mass index.
In summary, more research needs to be done before we can have any conclusive answers about the impact of soy on male fertility. There are many conflicting studies on this subject, which indicates we need to investigate further. There are a few points though that we can learn from the current research which can probably be protective to male fertility, and also allow men to have some of the health benefits that soy foods can provide.
1) Soy can have a temporary, acute effect on adult male reproductive parameters if taken in high quantities, especially if not normally included in the diet. Therefore, it would not be a good idea to consume large amounts of soy directly around the time when your partner is ovulating.
2) Soy appears to reduce sperm concentration in males who are overweight or obese, so if you are overweight, try to achieve a healthy BMI. In cases where BMI is high, soy foods might not be the best staple for the diet while trying to conceive.
3) It is probably likely that small amounts of organic soy have little negative effect on reproduction in males of healthy body mass index and can provide health benefits such as improvement of cardiovascular profiles, and reduction of risk for prostate cancer. More research still needs to be done in order to truly understand the impact of soy fertility of healthy adult males.
- Fiona McCulloch, ND
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