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Ask for Evidence on Fertility claims
Superfoods to boost your chances of conceiving, relaxation CDs, home-made energy bars to ward off infertility, exercise regimes to boost your sperm count and even fertility astrologers. Fertility is a global industry and there are hundreds of claims out there. It can be hard to know if these claims are based on evidence or not.
Having problems conceiving and going through fertility treatment can be a long, stressful experience with no guarantee of a happy ending. After a while without success, couples might be willing to try anything. Having worked with neurological disease charities to help patients make sense of claims and cures for chronic diseases we know the emotional cost of chasing false hope and the dangers of promoting claims and cures that aren’t backed up by evidence.
When confronted by these claims, what you can do is Ask for Evidence. You do not need to be a fertility specialist to ask searching questions about the status of claims - you can talk about peer review, replication, consensus and certainty. On Monday 9th June we teamed up with Mumsnet, Progress Educational Trust and the British Fertility Society to help people Ask for Evidence behind fertility claims. We had over 70 questions asked during the week in what was one of the most popular Mumsnet Q&As of the year.
Our panelists have been busy and you can read a selection of their answers below. Mumsnet published the full Q&A here.
Here's what Mumsnet Founder Justine Roberts had to say:
'Conception difficulties and sub-fertility can be heartbreaking for women and their partners, and it's understandable that some may be tempted to try unproven methods to help them conceive a much-wanted baby. We were very happy to work with Sense About Science to host this Q&A, and hopefully provide a valuable permanent resource for those who want to maximise their chances of pregnancy without being taken in by dubious claims.'
Fertility Q&A - you can read the Q&A on the Mumsnet website (the orginal forum Q&A is here).
Diets and supplements
1. raydown: “Is there anything that can be done to improve a very low sperm count <8 mil total count. Or to improve poor morphology? There are lots of supplements that claim to help but is there any evidence that they do? What about pine bark? When going through IVF [in vitro fertilisations] ICSI [intra-cytoplasmic sperm injection], is there anything the couple should do to prepare themselves? Is there a special diet that should be followed eg high protein?”
Allan Pacey: “There is very little evidence to suggest that specific diets or supplements can improve the sperm count, although there is some evidence that men who have diets which are high in antioxidants on average have better quality sperm. Although many of the supplements aimed to boost male fertility have been formulated on reasonable assumptions, there have been no head-to-head comparisons to recommend one above the other. The best advice anyone can give is to make sure a man has a well-balanced diet and is consuming at least five portions of fruit and veg per day.”
2. joycep: “At my fertility clinic, all IVF ladies were given strict instructions to drink at least a litre of milk per day before and during IVF. They said getting a lot of protein was imperative. Is there any truth behind this? And is milk really the best way to get your protein quickly especially as there are questions marks about whether dairy is actually good for humans?”
Susan Avery: “Fertility is affected by general health in the same way as every other function of the body, so a healthy diet may help to optimise your chances. If your diet is lacking in protein then you should address this in the interests of general health and a balanced diet. There is no evidence that milk in particular will help. Milk can cause problems for some people, aside from those known to be lactose intolerant, in particular people who suffer from acid reflux. Just aim for a balanced diet in a way that suits you. There’s nothing magic about milk.”
3. FizzyFeet: “Are there any supplements etc that can actually have a negative effect on your chances of conceiving? I'm thinking of herbal ones like Agnus castus which seem to have a powerful effect. In my experience, HCPs [Health Care Professionals] can be very non-committal on the subject. Is the vagueness just because of lack of evidence, or because most things are genuinely 'harmless'?”
Gillian Lockwood: “There are two problems with supplements. The most significant is that they can act as ‘hormone mimics’ and interfere with baseline hormone assessments and monitoring. The best example is soya extract which can be helpful with menopausal symptoms because it acts a little like oestrogen. Agnus castus has been found to help with a wide range of ‘female’ problems including pre-menstrual dysphoria, lumpy breasts and even ‘hyper’ sexuality (it is the fruit of the ‘chaste’ tree, after all). The second problem is the source and purity of the supplements. This is especially relevant for Traditional Chinese Medicine as the practitioner may be treating in good faith but using imported substances of dubious provenance (one pile of powdered bark looks much like another!) It is reasonable to assume that if the supplement seems to be having a powerful effect then it is active and women should not take these supplements during active fertility treatment.”
Products and policies and positions
4. MoreTeaPenguin: “Is there any evidence that www.duofertility.com is more effective than placebo?”
GL: “A the current crop of ‘smart’ fertility aids like duofertility, Fertilicare Conception and Kindara fertility tracker are all designed to make measuring bbt (basal body temperature) more accurate (and possibly more fun). I feel that anything that takes the spontaneity out of love-making is more likely to be counter-productive however. Partners often get ‘performance anxiety’ when told it is the ‘right time’ and sex can become a chore to make babies rather than a glue to stick couples together.
Sperm works best when ‘young’ and ‘waiting for the ‘right’ time can result in a large number of half-dead sperm being delivered! Frequent intercourse (every two to three days) from the end of one period to the start of the next is probably better than anything electronic. For women with very irregular cycles (probably PCOS – polycycstic ovary syndrome), then weight loss (if required) and ovulation induction are likely to be the way forward.”
5. onelubelife: “I'm interested into the claims around sperm-friendly lubricants. Would you mind commenting on the evidence or otherwise for using sperm-friendly lubricants when trying to conceive?”
AP: “We know that some lubricants used by couples during intercourse can be bad for sperm when ejaculated sperm are incubated with those lubricants in the laboratory. This also includes human saliva which is also used by some couples as a lubricant. However, there is no epidemiological evidence to suggest that these actually reduce the chances of conceiving, although it is a reasonable assumption. There are some sperm-friendly lubricants available on the market and under laboratory conditions these do not appear to be detrimental to sperm survival. However, to my knowledge they have never been tested in couples to see if they enhance conception, but it would seem reasonable to assume they do not do any harm if they are used according to the manufacturers instructions.”
6. Magda37: “Does sexual position affect chance of conceiving? I'd always assumed it best to take advantage of gravity (during and for a little time afterwards) but saw a documentary where a scientist (?) said we had evolved (for want of a better word) for quickies in case a predator/threat turned up halfway through!”
AP: “Unless there is a disability or an anatomical reason to prefer one sexual position over another, I cannot see the rationale for this affecting the probability of conception. When sperm are ejaculated into the woman’s body, we think that the sperm that pass through the cervix quickly are the ones that will find and fertilise an egg. Any sperm remaining in the vagina probably die quickly and are lost. There is at least one study showing that after a fertility treatment called IUI, a 10 or 15 minute bed rest can improve pregnancy rates slightly, but I don’t think sexual position matters as long as the male is able to ejaculate into the vagina.”
Complementary medicine and state of mind
7. ballsballsballs: “When we were going through fertility tests I was astonished about the number of people around me who told me that a positive attitude was everything. Also, that if we 'just relaxed' and 'stopped thinking about it' a pregnancy would miraculously happen. Or we should go on a holiday. There is no evidence that any of these things could improve sperm quantity and motility. We looked at the figures and decided not to go ahead with IVF.”
SA: “Anything that has a positive effect on your general health may impact on your chances of conception. However, if you have some identified pathology that is responsible for your infertility then no amount of relaxation will give you a pregnancy without treatment. Most people have come across a story of a couple who struggle to conceive, stop thinking about it and then achieve a pregnancy. Stress can impact on hormone levels and other aspects of physiology involved in conception, and reduction in stress might coincide with conception in couples where there is no other cause. By all means relax and have a holiday, but you will still need treatment for infertility.”
8. ballsballsballs: “A lot of people on the fertility forum I used to frequent were convinced that acupuncture would help the success of IVF. Is this true?”
SA: “In 2010 the British Fertility Society published a review of the existing data/publications and found no evidence that acupuncture has a positive effect on the outcome of IVF. Another review published in 2012 saw no clear benefit, but found that the type of clinical trial influenced the outcome. In any case it is difficult to say with any conviction that acupuncture has a direct influence on the outcome of IVF.”
9. joycep: “There are so many stories out there of people who tried for years and years and then they properly gave up and they then got pregnant. Stress is known to contribute to infertility. But what about worry and negativity? Is there any evidence to suggest that it can prevent a pregnancy? It just astounds me that there are so many of these stories out there. It is almost like some women become so het up by not getting pregnant, their bodies refuse to do until they relax about it.”
SA: “Most women are aware that stress can affect their menstrual cycles, just as it can affect so many aspects of our physiology. A relaxed state is a healthier state to be in, and worry/negativity are really aspects of the conditions we call stress/depression. It is certainly possible that these conditions may inhibit conception, and their removal may improve the chances of achieving a pregnancy. However, a positive attitude is not a cure for infertility where there is identified pathology. We would always encourage a positive attitude, and as relaxed a state of mind as possible for the sake of general health.”
Age and fertility
10. YouAreMyFavouriteWasteOfTime: “I would like to see more scientific information about fertility decline and aging. Information in the news appears to be low on statistics and high on scaremongering, and unhelpful to people wanting to understand the real changes that will/are taking place in their body.”
GL: “The science is clear. Ever since Malcolm J Faddy first dissected thousands of ovaries taken from foetuses, babies, girls and women of all ages, we have known that a baby girl is born with every egg she will ever have and that they are lost at a predetermined rate influenced principally by genetics but also by health and lifestyle. Smoking, surgery, endometriosis and infection can all damage the ovary’s ability to ovulate fertilisable eggs. The quantity and quality of eggs remains perfectly adequate until the late thirties and then there is, on average, a decline in both from the age of about 37-38. It is at this age that the risk of miscarriage starts to rise along with the risk of chromosomal problems like Down’s Syndrome. It is vital to remember that ‘biological’ age and ‘chronological’ age can vary by 3years in either direction, so if you are a life-time smoker and your mother had an early menopause (before 50), then it is likely that at age 35 you will have the ovarian reserve of a 40 year old. Don’t forget that ovarian reserve is only one factor in getting pregnant successfully, and that sperm quality, tubal status, general health and uterine factors such as the presence of fibroids and polyps all play a role.”