Age, genetics and birth control: the main causes of infertility

In Invent Health, healthcare leaders and investors discuss why infertility rates are so high

Recently, VatorNews held its latest Invent Health event: these are salon-style tech talks and mixers where valuable lessons and insights are shared by investors, technology pioneers and adopters. It is designed to get a 360 degree view of a particular subject. We hold events in person and online.

For this event, we looked at women’s health, specifically fertility and menopause.

The salon was directed by Dr. Archana Dubey, Chief Medical Officer at UnitedHealthcare and Bambi Francisco Roizen, Founder of Vator. Panelists included: Dr. Jean Gekas (CEO, Genoscience); La Keisha Landrum Pierre (Partner, Emmeline Ventures); Dr. Tammy Mahaney (Venture Partner, Suncoast Ventures); Dr. Jillian Lopiano, Chief Health Officer (Wisp, part of Well Health Technologies); Dr. Tendai Chiware (Director of Third Party Reproductive Programs, GENESIS Fertility and Reproductive Medicine)

One of the first topics raised in the conversation was the root causes of infertility, which is a growing problem: about 11% of women and 9% of men of childbearing age in the United States have infertility problems, and the total rate worldwide fertility declined by nearly 1% per year from 1960 to 2018, which is more than 10% per decade and more than 50% over 50 years. There are a number of reasons why this may be happening, chief among them being that women are having children later, with the average age at which women gave birth in the United States going from 27 in 1990 to 30 in 2019.

The problem with later pregnancies is that women are less fertile. In their 30s, women are almost half as fertile as in their early 20s.

(source: CDC)

Dubey began by bringing up all the “P’s” and “M’s” that happen to women throughout their lives: puberty, prenatal, pregnancy, postpartum, PMS, and then menopause.

“One of the areas that has the most impact for women is infertility because it has the longest footprint in their reproductive years with a lot of it wrapped up in trauma, sadness, hormones, all the treatment pathways, new technology, all of that. .” she said, addressing the question to Dr. Chiware.

“What are you seeing, especially working in the fertility clinic? What are the main causes of infertility that you see most often in the women who come to see you?” Dubey asked, to which Dr. Chiware responded that infertility is “ssomeone who is under 35 and has been trying with regular intercourse for a 12-month period and someone over 35 for a six-month period without any success in conceiving.”

“As a fertility specialist, I see both sides of the coin, where it could be caused by the woman, where it could be a disorder like polycystic ovary syndrome, endometriosis, things like that. It could be something structural, like fibroids, or fallopian tubes. blocked, either by a previous infection or previous sterilization for contraceptive reasons,” she said.

“Also, we see a lot of women who are over 35, or even over 40, who are then looking to start their families at that time and will sometimes have difficulty trying to conceive. And then there are some genetic conditions that also cause infertility, as well as medical disorders where, sometimes, women are taking medications that can result in infertility, especially things like chemotherapy, radiation therapy to treat cancers.”

Dubey then pointed out that it takes women longer to ask the right question about fertility because they feel like they are alone throughout their journey.

“There is a hesitation, and I have seen this time and time again in my practice: when they cannot conceive, they think that the fault is on them. But you are enlightening our viewers and our audience that 35% can be as a result . on the male side And so we have to evaluate both individuals and asking that first question becomes almost the most necessary step to get care from the provider,” she said.

Voluntary sterility or current condition

While most women who are infertile are in their later years, the percentage of women who are infertile due to genetic or other conditions is extremely small in number. For example, ovarian or gynecological conditions, such as POI (primary ovarian insufficiency), affect 0.1% of women under 30 and 1-2% of women under 40.

So Dubey asked what Dr. is seeing. Chiware in her clinic. In other words, what the divide is between voluntary deferral of fertility, which can lead to older women potentially having problems, and what percentage are medical conditions.

Dr. Chiware replied that it is divided between the two. “Being in New York, it’s a pretty fast-paced lifestyle, so a lot of women are in the middle of their careers, so they’re not thinking about starting a family at this time. So they go back to fertility preservation .the good thing is that many organizations and companies are now starting to realize this, and are actually starting to cover it in terms of covering current cycles and paying for it, but we still have a long way to go. it’s about insurance coverage, which I’m sure you’ll dig into as well,” she said.

These are women over 35 years old. But then there are those under 35 who actively want to get pregnant and have difficulty. This begs the question, what is going on?

Consequences of birth control

Enter birth control, which may be part of the problem women are struggling with infertility. Dr. Mahaney pcompetes in women’s health clinics while also conducting medical missions in underdeveloped countries, which responded that she agree with dr. Chiware about the physiological causes, but that she is also seeing many women, especially in her primary care clinic, who want to go off birth control and want more of a natural approach to fertility awareness.

“As we know, there are some types of hormonal birth control that can stop ovulation like Depo-Provera and some hormonal IUDs and that can affect women. I mean, think about it, if some of these girls started birth control at age 14. or 15, and they wait until they’re 35 before they want to start having children and families, there’s been a lot of changes and side effects that have happened in their natural cycle,” Mahaney said.

For example, sometimes birth control can basically trick the body into thinking the body is pregnant, so it keeps the endometrial lining very thin, which is not the natural cycle because the endometrium, as we know, becomes thick and thick and then poured. alignment, which is the natural process. So these types of things can affect fertility.

Mahaney also brought up environmental factors, such as diet, estrogenic chemical exposure, hormone disruptors, which we’re finally starting to see and look at and research is talking about that are also affecting fertility, something that she does not see in developing countries.

“Something that’s very unique about America is even though we’re a very wealthy nation, we’re also a very sick nation, we have a lot of obesity, and insulin resistance is another root cause and factor in infertility. So when we have a morbid obesity situation, I know that even for fertility clinics you have to have a certain BMI before we start any intervention,” said Mahaney.

“So things like that are other root causes that we need to understand and think about and do hormone balance for hormone restorative endocrinology, just balancing those hormones; some women may be progesterone deficient or low in estrogen and there are other things we can do to help empower the body to do better.”

Dubey then brought sstress as a direct contributor to the problem with women and their hormones.

“One thing that we do is ACEs training, which is adverse childhood experience training. That usually carries a woman’s life through all the pieces we talked about: affects puberty, affects PMS, affects pregnancy or fertility. and then also the experience of menopause,” said Dubey.

“That would be a really, really good consideration for people to screen their patients or themselves for an advanced childhood experience that can affect all the hormones that can be at play in the body.”

Francisco reached out to Lopiano to see how Wisp creates awareness on what their users need to know about fertility and infertility.

“Tammy mentioned that there are negative effects of birth control. There are also environmental factors, but there are concerns about being overweight, there are many different things that can affect your fertility,” she said.

“Do you create awareness in your group about what you need to know about fertility and infertility? Not just, ‘here’s your ovulation kit on the go when you want to consider fertility,’ but things to consider throughout your life yours and these are the negative effects of the things you’re taking,” she asked.

Lopiano’s answer was that contraception and preventing unwanted pregnancy is also a really important component of women’s health.

“50% of pregnancies are unplanned and a lot of them are unwanted. And we have really good data at UCSF we just did a beautiful study called the Turn Away Study, looking at the social, emotional and physical impacts of women who had an unplanned pregnancy. and those who wanted to continue the pregnancy and those who did not, and what were the consequences of that,” she said.

“We’re talking about infertility, but ultimately, if we’re talking about women and women’s care, we’re talking about control over your fertility and being able to plan your life, whether you want zero children or 10. ”

As such, one of the things Wisp does is talk about contraception in terms of preventing pregnancy and being able to get pregnant when you want is very important. And that includes side effects from birth control, which will depend on what that specific woman wants.

“One of the things that’s a very important educational piece when you’re talking about contraception is that there’s not a one-size-fits-all approach. When you’re talking about contraception, part of that clinical context has to be, ‘Do you think want to get pregnant When do you think you want to get pregnant?’ Because the return to fertility and ovulation is different for different types of contraception, Depo-Provera takes a little longer, Side effects and return to fertility in the immediate sense is a really important component of the contraception prescription. and then management,” said Lopiano.

Watch the entire panel below:

(Image source: news-medical.net)