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Infertility and Contributing Factors

Here are basic factors influencing fertility:

1) Weight (underweight or underweight)

2) Smoking

3) Alcohol

4) Drugs

5) Stress

6) STI’s (Sexually transmitted infections)

7) Anovulation

8 ) Age over 35

9) Uterine fibroids and polyps

10) Inaccurate timing of intercourse

Endometriosis Basics

Endometriosis is a painful condition

associated with tissue

from the lining of the uterus

(endometrium) in other areas

of the body, such as ovaries,

tubes, behind the uterus, even

distant areas as lungs or kidneys.

It is likely due to heredity,

immune system, lymphatic or

vascular system.

These areas cause cramps,

severe pain, painful intercourse,

pelvic and lower back pain,

heavy menses, irregular menses,

painful bowel movements or

pain during urination.

It is estimated that 5.5 million

women in the US have this


It is one of the most common

causes of infertility.

35% of women with endometriosis

have infertility.

Treatment is medical and surgical.


Most common reasons for infertility

are related to the dynamics of

ovulation, ovum pick-up, fertilization,

transport and implantation.

If after one year of unprotected

intercourse pregnancy fails to

occur, infertility is a concern.

The chances of conception during a

month of regular intercourse is

about 20 %.

Infertility could be due

to the failure of the egg (ovum)

to be released from the ovaries.

This is called anovulation and is

treated medically.

If the Fallopian tubes are blocked

or interrupted, this requires intervention.

If fibroids are present, these can be removed.

If there are autoimmune,

infectious or hormonal issues these

can be addressed.


 By Joseph Hazan,M.D., FACOG


Overweight, smoking, alcohol, drugs,

caffeine, stress are

shown to be related to infertility.

While lifestyle factors alone

do not entirely explain or account

every case of infertility, they are

significant nevertheless.

Stress reduction for instance has

been shown to relate to

normalized levels of GnRh, FSH, LH,

estrogen and progesterone,

blood pressure and improved

pregnancy rates.

Overweight and related increased

levels are associated with

increased testosterone and lack

of ovulation.

Also the elevated levels of insulin

and leptin associated with

overweight lead to increase in LH but

no increase in FSH .

This and elevated androgens will

stimulate unripe follicles

that fail to ovulate.

Positive changes in lifestyle factors

are proven to improve fertility.

Vitamin and Mineral Supplements

 By Joseph Hazan,M.D., FACOG

It is very important to have adequate

intake of vitamins and minerals especially

 during pregnancy.

The main ingredients required as building

blocks are essential aminoacids

along with the following vitamins and

minerals which must be taken as supplements

even though foods contain these nutrients

 to some extent.

FOLIC ACID is highly important in the formation

of cells and neurological development.

Deficiency leads to neural tube defects and

low-birth weight. 800 mg daily required.

It is also found in oranges, green leafy

vegetables, pinto beans and asparagus.

It is absolutely necessary for the prevention

of neural tube defects and low-birth weight.

IRON is essential in blood formation.

Helps prevent anemia.

27 mg daily are required.

It is found in lean red meat, tofu

and chickpeas.

CALCIUM is essential in bone formation.

1000mg daily required.

Helps prevent leg cramps and preeclampsia.

It is found in milk, yogurt and cheese.

MAGNESIUM is essential for bones.

Helps prevent leg cramps and

headaches. It is found in almonds and


340 mg daily required.

ZINC is essential for the immune system,

vision and normal growth.

It is found in pumpkin seeds and meat.

15 mg daily required.

VITAMIN A is essential for skin,

eyes and immune system.

It is found in carrots and spinach.

800 micrograms ( less than 1 mg) required.

High doses can be harmful

to the baby during pregnancy.

VITAMIN B1 is essential for the nervous

system and brain.

Helps growth and energy production.

1.4 mg daily required.

It is found in peas and beans.

VITAMIN B2 is essential for energy

production and blood formation.

It is found in beans and dairy products.

1.4 mg daily required.

VITAMIN B3 is essential for growth

and development.

It is found in fruits and bran.

17 mg daily required.

VITAMIN B6 is essential for the brain.

2 mg daily is required.

It is found in bell peppers and bananas

VITAMIN B12 is essential for blood

and the nervous system.

It is found in dairy products and eggs.

2.4 mg daily required.

VITAMIN C is essential for healing and bones.

It is found in

onions, broccoli,papaya and oranges.

70 mg daily required.

VITAMIN K is essential for blood,

liver and bones.

It is found in okra, cabbage and broccoli.

65 mg daily required.

All of the listed nutrients are essential

and should be supplemented

by daily intake of Prenatal Vitamin Pills.

There are many formulations


 Please start taking them while

planning pregnancy.


 By Joseph Hazan,M.D.,FACOG


The typical US diet has a ratio of 1:20 of

omega-3’s versus omega-6’s.

This ratio should be 1:1 to help

prevent most of the degenerative

diseases such as heart disease,

cancer, arthritis, degenerative brain

diseases and autoimmune disorders.

Also depression and allegies can be

greatly decreased by having the right ratio.

A study in the Journal of the American

Medical Association (JAMA)

has shown that by increasing the omega-3’s

in the diet it is possible

to cut down the risk of heart attack by 50%.

The ideal diet should contain organic,

nutrient dense foods that are high

in vitamins and minerals.


 By Joseph Hazan,M.D.,FACOG


When we say Baby Blues this is not confined

to the postpartum period.

It is known that 20 % of women have depression

during pregnancy.

Pregnancy related stresses added to the

preexisting ones bring new

sets of anxieties and depression.

This can be manifested in appetite and

mood changes. Also irritability,

lingering feeling of sadness, remorse,

guilt, too much  or too little sleep,

lack of joy, energy and concentration

are signs of depression and anxiety.

Antepartum depression, like postpartum

 depression impact the normal

caring for the baby.

It is also known to impact your physical health.

Antepartum depression is found to be related

to preeclampsia, abnormal

weight gain (excessive or inadequate).

It is also known to be related to

alcohol and drug abuse or suicidal thoughts.

Other stresses such as family or relational issues,

job loss, financial

difficulties increase the level of anxiety and


If you have these problems it is best to

talk to your doctor.


 By Joseph Hazan,M.D.,FACOG


Obesity and Smoking cause 40% of

premature deaths in the US.

Obesity and Smoking also are the cause

 of 70% of chronic diseases

like diabetes, emphysema, heart disease

and disabilities.

They cause 75% of the cost of healthcare costs.

It is obviously imperative to prevent and treat

obesity and smoking if we want to lower

healthcare costs.


 By Joseph Hazan,M.D.,FACOG


There are genetic factors associated

with Alzheimer’s disease.

These genetic markers  are identified at

Washington University School of Medicine

by Alison M. Goate and John C. Morris.

The genes recently identified are called

clustrin (APOJ) on chromosome 8 and

PICALM on chromosome 11.

The clustrin gene is thought to be associated

with the tendency to accumulation of amyloid

and plaques.

The PICALM gene is thought to be related to

the breakdown of synapses and could lead to

amyloid deposits.

This research encompassed DNA samples of

19000 individuals and  600,ooo markers.

A gene called APOE4 was found to be related

to the late onset form of the disease.

Association with chronic sleep deprivation

identified as a risk factor.


By Joseph Hazan,M.D., FACOG


Condyloma is also known as genital warts.

Whereas Chlamydia is the most reported STD,

Condyloma is the most common STD.

This is due to the fact that most HPV infections

which are related to Condyloma do not

cause symptoms. This is most common for

those under 25.

 Condyloma is the most

common lesion of HPV

(Human Papilloma Virus),

but many HPV types do not cause


There are over 100 types of HPV and

15 of these types are high risk for

cervical cancer.

The most important hiph risk HPV types

are HPV-16, -18, -31, -33,

-35, -39, -51, -52, -58,  and  61.

One third to one half of women who

have condyloma also have high risk

HPV types.

External genital warts are more common

in women than men.

It is estimated that there are 1 million new

cases of external genital warts every year

and two thirds of these occur in women.

The incidence of HPV is increasing.

Over the past few decades the

incidence has increased and there

was a four-fold rise in reported cases

during the sixties, seventies and eighties.

HPV is sexually transmitted and most lesions

appear within two months after exposure.

Smoking is a risk factor, due to both behavioral

and immune response factors.

There are numerous treatment options that

help eliminate the warts, but there are no

treatments that directly target the virus.

It is important to screen for other STDs when

HPV is detected. There is no evidence that

the partner is at increased risk for being

reinfected by HPV after being exposed or


There are situations in which the

external genital warts clear up without

being treated.

It is important to use safe treatment options

especially during pregnancy since

there are cases of warts that form in the throat

of the baby due to exposure during

labor and delivery.

Some of these warts require several treatments.