Anti-Mullerian Hormone and Fertility

    There are several markers of a women’s reproductive health when it comes to making a baby.   Many are familiar with common hormone tests such as estrogen, progesterone and the follicle stimulating hormone (FSH).  New research is showing that the anti-mullerian hormone (AMH) might be a better predictor for those looking to undergo invitro fertilization (IVF) however it may also be advantageous to check this marker when looking to become pregnant in general.

    To compare, the FSH test is essentially a marker of communication between the anterior pituitary in the brain down to the ovaries.  When the FSH begins to rise on day 2 or 3 of the cycle, it stimulates the growth and development of the follicles such that a dominant follicle is formed  and with the trigger of luteinizing hormone  an egg can be released for pregnancy.  As a woman becomes older, her FSH levels rise as there are fewer and fewer follicles left in the ovary yet the pituitary continues to produce the hormone .  The higher the FSH levels (typically above 10), the less fertile a woman has become.

    Working with FSH is the anti-mullerian hormone that is produced directly by the ovaries in order to help with follicular development as well by controlling excessive follicle stimulation by FSH.  Those with lower AMH are thought to have lower levels of follicles therefore the potential for egg development is a lot less.  Unlike the FSH marker which should be drawn on day 2 or 3 of the menstrual cycle, the AMH can be checked any day as it does not typically vary throughout the month. 

    Research in the February 2013 Journal of Clinical Endocrinology and Metabolism suggests that AMH is a good predictive marker for those women looking to undergo IVF as it can predict the oocyte yield and oocyte quality which is important for a successful transfer.  The higher the AMH level (typically between 3-7 ng/mL depending on the lab and fertility center), translates to a better outcome for IVF which means a successful pregnancy.  Levels above 7ng/mL are indicative of polycystic ovarian syndrome.  Levels less than 2 ng/mL are indicative of lower fertility chances. 

    If you are currently trying to become pregnant, are having difficulty becoming pregnant or are thinking about it in the future, remember that you are more than a number.  There are several factors that contribute to the health of your body, ovaries and eggs however these tests may be powerful indicators of what’s to come.  Talk with your health care provider about getting a work-up and remember to be as healthy as you can be when it comes to making a baby.

References:

1)      Hand, L.  Antimullerian Hormone Levels Predict IVF Success.  Web.  20 February, 2013.

http://www.medscape.com/viewarticle/779410

2)      Jabbour, S., and Griffing, G.  Follicle Stimulating Hormone Abnormalities Workup.  Web.  20 February, 2013.

http://emedicine.medscape.com/article/118810-workup

5 Facts About the Vagina You Probably Did Not Know

Besides the Chinese New Year on February 10^th, this month is also well known for that happy love day for couples also known as Valentine’s Day.  Millions will be spent on flowers, chocolate, cards, stuffed animals, dinner and jewelry in an attempt to celebrate a relationship and for many, the night will end (or start) with sex.  Therefore, it is important to understand the ins and outs of the vagina.  Here are five facts you may not have known.

First (and not very sexy), the vagina is its own little ecosystem and has a particular pH that is easily influenced by outside sources.  A healthy pH is on the acidic side as normal is between 3.5 and 4.5.  If the pH of the vagina changes then symptoms often occur.  For example, blood, semen, most lubricants, spermicides, douching, and bacterial vaginosis (BV) increases the pH making it more basic.  The pH also becomes more basic around ovulation in order to NOT kill any incoming sperm in hopes of becoming pregnant (remember, it is the way the body is designed, not necessarily what you want).  This can cause women to have itching, burning and abnormal discharge this time of the month.  Yeast/Candida more often causes the pH to drop into a more acidic level but not always.

Second, the ecosystem relies heavily on good bacteria much like the intestines to help things run smoothly.  Lactobacillus is the most predominant bacteria in there which is why women can help control any negative symptoms by eating yogurt with live active cultures or taking the supplement probiotics with lactobacillus in it.  This also helps when an infection occurs after a round of antibiotics as they kill all bacteria, including the good kind in the intestines and vagina.

Third, the vagina is made up of very strong muscles – obviously as it needs to withstand different types of penetration and be able to birth a baby.  Abdominal surgeries, hysterectomies, child births, hormone decline, age and certain medical conditions can all lead to lax muscles making kegel exercises and muscle training with weighted balls or cones and/or biofeedback with a pelvic floor physical therapist very important.  This can help the sensation of sex and improve symptoms of incontinence as well.

Fourth, just as the pH can change through the cycle, mucus can change too.  Women often confuse normal mucus with abnormal infections.  Near ovulation which is usually mid-cycle, vaginal mucus becomes more abundant and stretchy awaiting the potential for sperm.  As a result, the excess mucus concerns many who assume they have developed an infection when in fact it is normal.  If you are uncertain though, definitely talk with your health care provider to rule out an infection.

Fifth, yours looks normal.  This is a common question that many women ask and as a result of the concern, a booming business in surgical options for gynecological aesthetic medicine has evolved.  Many believe their labia are too long, too short, or abnormally shaped which is just not true. The vagina comes in all shapes and sizes and again it is normal.

Read more at www.empowher.com

References:

1.      Menendez-Figueroa, H., and Anderson, B.  Vaginal Innate Immunity.  Web. 10 February, 2013.

http://www.medscape.com/viewarticle/752814

2.      Mayo Clinic Staff.  Vagina: What’s Nomal, What’s Not.  Web.  10 February, 2013.

http://www.mayoclinic.com/health/vagina/MY01913

3.      Kim, J., and Iglesia, C.  Designer Genitalia: Fad, Benefit or Mutilation?  Web.  10 February, 2013.

http://www.medscape.com/viewarticle/778067

Avoiding the Flu: it can spread 6 feet!

Chances are this winter season you, your family, your friends, and your co-workers have already contracted the flu and are over the worst of it.  According to the Centers for Disease Control (CDC), this season has been one of the worst in several years as many, even with the flu vaccine, are seeking treatment with their health care provider.  Unfortunately, new research demonstrates that the flu virus can travel up to six feet simply from talking and breathing.

Historically, the flu virus is thought to spread only through short distances and with coughing and sneezing in the release of larger respiratory droplets.  This of course makes it important to wear a mask when sick, cover your nose when you cough or sneeze (preferably with your arm, not your hands), and use tissues.  With this new information that the virus can move more than a foot or two, it becomes critically important that hygiene and health practices take an even larger role.

First, if you are sick, feeling down, experiencing chills and a fever, coughing, sneezing, difficulty swallowing with congested sinuses and ears – please stay home.  Unless you are running to your health care provider’s office for help or the local pharmacy for treatment and tissue - the public does not want to become sick.  Do not try to muster through it because you will end up feeling worse and infecting those around you. 

Second, sanitize yourself.  Wash your hands frequently or use antibacterial germ lotion.  Remember to wipe down everything.  This includes your cell phone, your steering wheel, your desk, your keyboard, your counters, the handles in your house, your iPod and iPad and whatever else your hands come in contact with during the day.  Many grocery stores are offering antibacterial wipes to swipe the handle of the shopping cart before use which can help reduce infection as well. 

Third, take care of yourself.  The flu season usually hits during a stressful time of year (think: holidays) when the weather is colder, darker and wetter and dietary/exercise habits may be more in “hibernation” instead of keeping healthy therefore remember to stay hydrated, minimize sugar and caffeine, get a good solid amount of sleep, say “no” to things that stress you out and laugh often (maybe with your mouth closed so you do not breathe in other people’s respiratory droplets!)

 

Fourth, keep up on your supplements as they may be helpful.  Probiotics, commonly known as the good gut bacteria or live active cultures in yogurt, are helpful at supporting the immune system in the gastrointestinal tract especially after a course of antibiotics, vomiting or diarrhea.  While yogurt may sound good when you are sick, dairy products often thicken mucus which may not be ideal when you have a congested head therefore a capsule daily is recommended.  There are many mixed supplements that contain Vitamin C, Zinc, B vitamins, elderberry, Echinacea, garlic and more in order to strengthen the immune system.  While research is mixed, there is a lot of anecdotal evidence in my practice to show that sick people love their supplements and report less illness overall, shorter duration and easier symptoms.

Fifth, the flu vaccine is probably not going to save you now if you have not yet had your shot.  With the number of people who did receive the vaccine and still got the flu, many in the health field are reporting that the flu vaccine was the wrong strain.  This information is all tracked by the CDC at their Fluview webpage, http://www.cdc.gov/flu/weekly/.  However, talk with your health care provider to determine if the vaccine is a good idea for you at this time.

 

References:

1.Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases.  Situation Update: Summary of Weekly Fluview.  Web.  3 February, 2013.

http://www.cdc.gov/flu/weekly/summary.htm

2. Brown, T. Now Published: Flu Virus can spread up to 6 feet, No Cough or Sneeze Required.  Web.  3 February, 2013. ttp://www.medscape.com/viewarticle/778674

3. Ciorba, M.  A Gastroenterologist’s Guide to Probiotics.  Web.  3 February, 2013.

http://www.medscape.com/viewarticle/770468