The Endocrine System, Thyroid Gland, and Fertility

How does the endocrine system impacts fertility, what can go wrong, and what can be done about it. We talk today with Dr. Mark Trolice, the Director of Fertility CARE: The IVF Center in Orlando and Professor of Obstetrics & Gynecology at the University of Central Florida College of Medicine. He is double Board-certified in Reproductive Endocrinology & Infertility and OB/GYN.

In this episode, we include:

·      What is the function of the endocrine system in human health?

·      How does the thyroid gland function within the endocrine system?

·      How is female fertility impacted by the endocrine system?

·      How is male fertility impacted by the endocrine system?

·      What is hypothyroidism?

·      What is hyperthyroidism?

·      How are dysfunctions in the endocrine system diagnosed?

·      How are dysfunctions in the endocrine system treated?

·      What dietary and lifestyle choices impact the health of the endocrine system and thyroid gland?

·      What are some common endocrine disrupting chemicals in our environment?

·      How are environmental endocrine disruptors impacting fertility?

This podcast is produced  by www.CreatingaFamily.org.  Creating a Family brings you the following expert-based content:
·         Weekly podcasts
·         Weekly articles/blog posts
·        Resource pages on all aspects of family building 

Transcript

0:00  
Welcome everyone to creating a family talk about infertility. Today we're going to be talking about the endocrine system, the thyroid gland and what those have to do with fertility. We will be talking with Dr. Mark Trellis. He is the director of Fertility Care, the IVF center in Orlando, and He is a professor of Obstetrics and Gynecology at the University of Central Florida College of Medicine. He is double board certified in reproductive endocrinology and infertility and OB GYN. He has multiple publications in medical literature, as well as he has received the physicians Recognition Award from the AMA. He has a podcast called fertility health and his latest book is the fertility doctors guide to overcoming infertility. Welcome Dr. trawlers to creating a family. We are so happy to have you all I'm happy to be here. JOHN, thank you so much for the invitation and for all of the incredible advocacy work that you do for on behalf of infertility patients. Great, thank you. So let's jump in and say what is let's start by just saying what is our understanding what the function of the inter consistent is in human health generally, before we dive into how it impacts infertility or fertility? Yeah, that's a that's a broad question. But that's definitely the place to start. So the endocrine system is really the system of hormones. And there are hormone producing organs all throughout the body, the thyroid, the parathyroid, the adrenal gland, the ovary or the testes, pancreas, liver, so many different organs have this and what it involves, and of course, the pituitary gland and the hypothalamus, those are a hormone is a is an organ that secretes a protein, we're from that organ, and it works someplace else. Okay, so that's just take the female reproductive system, right estrogen is produced from the ovary, but that works on the lining of the uterus among other things, it works in the lining of the uterus to build up and prepare for embryo implantation. So starting in one part of the body, and working in another the thyroid, another organ, right, produced from the thyroid hormone, and works for the metabolism of the of the body and other parts. So and you can system is essentially the hormone system of the body. So so it's it's the system, the endocrine system has many different organs as a part of it, including the thyroid, which we're going to talk about in a moment, but also the other systems that you mentioned, including the testes and the ovaries, the pituitary gland and others are all part of the intercom system. Am I understanding that correctly? Yes, exactly. You got it. Okay, perfect. All right. So now let's move and talk about the thyroid gland, which is one organ in the inter consistent. So what is the thyroid? What is the hormone that's produced through the thyroid gland? And how does that function in eyes are part of our general health? Again, before we start talking specific to fertility?

3:14  
Yeah, the the hormone so the thyroid, like many other organ systems, works in the feedback system, the pituitary gland, secretes thyroid stimulating hormone. And that was stimulated from the higher brain center called the hypothalamus that produces thyrotropin releasing hormone. Okay, so that's TRH. TRH, stimulates TSH from the pituitary, and that stimulates the production of thyroxin from the thyroid gland. And then there are two different types of thyroid hormone t four and T three that circulate the thyroid gland is vital. And it's involved in metabolism and growth and development of the human body regulates many, many functions by a steady state of thyroid hormone. Okay, so the the important thing is that when you're screening for this kind of thing, Dawn, you really, really don't need to check all the different hormones that are involved in thyroid function. TSH is the most, most important screen and that's the pituitary hormone that is released to stimulate the thyroid. So, a simple TSH screen is very, very valid in determining if thyroid function is normal or not. Okay, so, you know, when I talked about the T three and the T for the T three is really the active thyroid hormone t four is is what we call the precursor or the one before that, okay. So important to realize but I think the the bottom the take home message is that if you're going to screen for thyroid function, all you need to do is that

5:00  
TSH, the other things like screening for free t four, total t three, those are things that you would screen if that TSH is abnormal and based on the direction of being abnormal, too high too low. But let me just add, anticipating your question. So hypo thyroidism. Right, hypothyroidism, you say is low thyroid, but the pituitary gland doesn't know what's going on. It says it's not getting a lot of thyroid, what's going on. So it increases the stimulation. So whereas hypo thyroid which is low thyroid is is a result of the T three and T four being low from the thyroid gland, which is which is in the neck. The brain just thinks the thyroid is being stubborn and just puts its foot on the accelerator and increases that TSH. So, elevated TSH means low thyroid, low TSH means that the thyroid is producing too much. So that's hyper thyroid or excess thyroid, and that lowers the TSH level from the pituitary. The caveat or the exception is if the pituitary gland is the problem.

6:15  
Okay, so that's pretty intuitive, right? So let's say the pituitary gland is just not functioning from an insult. Okay, primary, what happens there is that the pituitary gland is not making enough TSH. So if there's no TSH, it's not going to be a lot of T 43. So there you have hypo thyroid, but because the pituitary is not producing, as opposed to the thyroid gland, not producing, okay, so how can you tell the difference? How would you tell the difference? If you've test for TSH and you see it as abnormal, either high or low? How do you know whether it is the thyroid gland that's malfunctioning or the pituitary gland? Right, most commonly, most commonly, is due to primary hypothyroidism, which is the thyroid gland itself. Okay? secondary thyroid diseases the pituitary. So if you get a TSH level that's low, below normal, what could you say point five to five, somewhere around there, right 4.5 based on the laboratory, so if the TSH level is low, and then you start checking the thyroid hormone level, which is a free t four, and if that's low, then you have a low signal from the pituitary, resulting in low signal production from the thyroid. And that would lead you down the path of secondary hypothyroidism. tertiary, which is the third level is the hypothalamus, which is that top top top brain center that's making that TRH, or that thyrotropin releasing hormone so I don't want to get I don't want to lose anybody. But that's that's really where it starts is that you got to top top brains and our hypothalamus making TRH tells the pituitary, hey, let's get going making TSH and then that tells the thyroid gland to make the free circulating thyroid hormone t four and T three. So when you have a abnormal TSH result that your first thought would be to go primary, and that would be a problem with the thyroid gland, which encompasses a majority of the problems. And if that is not the case, and you would go to secondary, which would be looking for the problem for the pituitary gland. And if that isn't the problem, then you would move literally up the ladder to the hypothalamus. Is that does that the gist of it? Yeah, yeah, some of you definitely want to try to find the cause. But ultimately, you're going to have to replace thyroid hormone, okay with levothyroxine. But we always want to prescribe the brand of thyroid hormone of thyroxin the brand as opposed to generic because the generic is not as stringently required to have the degree of thyroid hormone as the brand. Okay, so the American call the American Association of clinical endocrinologists advocate for brand, the thyroid hormone, and there's several medications that will give the brand we always prescribe brand not generic, you'll have more fluctuations with that. Gotcha. Alright, so let's go back up and get more general, we'll come back circling back to diagnosis and treatment. But let's go back up and talk about we've talked about the endocrine system in general, made up of many organs, including the thyroid, including the pituitary, including the hypothalamus, including the ovary, the testes, whatever. So we've got a lot of organs involved. So how is this is a very general question. But I want to start with general before we get more detailed, and that is how is female fertility? We're going to come back to male in a minute, but how is female fertility impacted by the intercom system?

9:57  
Oh, right, exactly. I mean, that's

10:01  
You know, reproduction for the female

10:05  
involves two things, mainly anatomy and endocrinology. Okay, so what's the anatomy? Well, the uterus has to be normal in the fallopian tubes need to be open and in good proximity to the ovary to pick up the egg. So anatomy needs to be intact. But it's equally important that we're releasing an ache and that's observation. So observation is an intricate, intricate end to end consistent. That is where the hypothalamus talks to the pituitary that talks to the ovary and we call that the hypothalamic pituitary ovarian axis. Okay, so the hypothalamus is making that that top brain center is releasing gnrh, which is called gonadotropin releasing hormone. Okay, and the the pulse of title release of that in spirits, then signals the amount of FSH and LH that's being released. But that's also a feedback that FSH and LH of the pituitary is being influenced by the ovaries production mainly of Astra dial which is the main estrogen in the body Astra dial, and progesterone. And the first half of the menstrual cycle where an egg is growing, and assist called the follicular cyst, the follicle so that first half of the cycle is where the pituitary gland is increasing FSH levels.

11:35  
And that results in a lot of little baby cysts start growing. Those are all the antral follicles, the preantral follicles that are growing, but only one makes it. And once that want to get selected, FSH starts going back because there's enough estrogen being produced. And that's the feedback. Actually, it's inhibin B, which is another hormone produced from the ovary and that inhibin B as the name sounds, and hibben is a profound inhibitor of FSH more so than Ester dial. But that's what's coming out of that lead follicle and hidden B. Okay. And that stops FSH from continuing to grow, to continue to stimulate the ovary. Think about it. If FSH didn't go down, then every month a patient would be on their own IVF cycle, right? We'd have multiple births, because we'd have all these follicles that were becoming a mature eggs all could be fertilized by the sperm, and so we would have high level multiples. Exactly, exactly. So what we do with IVF, of course, is that we override the normal system and keep that steady, high dose of FSH, whereas the body nature lowers the FSH level to optimize a single follicle to release Now sometimes to get released. Okay, and that's how we get twins. Another way for twins is that the embryo divides right, so we see the two eggs getting released or an embryo divides anyway. So as to dial is the dominant hormone and the first half of the cycle, building up the lining of the uterus, releasing the egg. And then as the doll stays around, of course, in the second half of the cycle, but that second half is really dominated by progesterone. And progesterone is the hormone of pregnancy pro gestation. That's how that name came up. So after oscillation, or actually pot of oscillation, so when a woman is testing their urine for the L h surge in these over the counter ovulation predictor kits, the OB KS, what they're testing is Lh and that's the pituitary Lh. And it's high levels in the urine at the time of ovulation. So a woman says testing, if you're above 28 days, when she would be ovulating is typically two weeks prior from their normal menstrual interval. So 28 days they are they typically 1430 days after they typically 16. When they get the surge in the urine.

14:07  
They'll be releasing an A within 24 to 36 hours if they test once a day.

14:13  
And the optimal time for intercourse to try to conceive is the day before that color change upsurge the day of and the day after those three days of peak now, when I teach my medical students and residents at UCF, what's the purpose of the Lh surge? Well, there's three critical, vital reasons. One of them is we just said got to release the egg. Okay. The second we sort of talked about as well is that progesterone now is being produced. And interestingly dawn progesterone is being produced from the same cells that were making extra dial. Those are granulosa cells that are the supporting and nurturing cells.

15:00  
The egg. So those granulosa cells then become Lh influenced. Lh is luteinizing hormone. Guess the big name, we come up with those granules, the cells luminize granulosa cells, okay? And then making progesterone created creative and then making progesterone. And that progesterone is necessary to now convert that fluffy endometrium that was getting ready for the embryo to convert that endometrium to receive the embryo. And it is exquisitely programmed. In other words, if that embryo makes it to the lining of the uterus,

15:40  
for whatever reason, if we do an embryo transfer, past the time that the endometrium is ready when we're not going to get a pregnancy, if it's a little bit early, then the endometrium seems to be able to wait. But if it's past that time, then it's post mature and we're not able to get an implantation. So we transfer embryos, typically, on day three, of embryo development, and and on day five of embryo development. Even though sometimes we freeze on day six of embryo development, we consider day five, so it's timed. The day of progesterone exposure to the lining of the uterus, is the day we do the embryo transfer.

16:22  
So once we get fertilization of the embryo in the Fallopian tube, the embryo makes it into the uterus about five to six days later, getting ready for implantation. Okay, so we have our second reason for

16:36  
Lh surge. One was the isolation egg release. The second was progesterone production. And the third is the resumption of a biologic processing that aims to make it fertilizer herbal

16:53  
unless that AIG goes through a the completion of what we call meiosis. So without getting really, really technical, the eggs and the sperm are one cell, and they were created. And and they are frozen. in meiosis one, it completes that process and goes to meiosis two, from Lh surge. And it stays like that, until it's fertilized. And after it's fertilized, it completes its process to be then getting into a mature embryo rather. So the Lh surge, and that's why we are so obsessed about the timing, as well as the appropriate dose of the famous trigger. With IVF, right, we get the trigger shot to get the eggs to mature. Because if it's an inadequate trigger shot, we're gonna get all the immature eggs or even worse, no eggs.

17:56  
So those are the three important roles of the Lh surge, and all of that. So in essence, the inter consistent is the heart of female fertility it is it is the engine that drives the entire process. I mean, that wouldn't be an oversimplification.

18:14  
Because the anatomy plays a role too, but absolutely natural fertility, you need both with IVF we need a good uterus, and then the hormonal system that that can be manipulated as it were, with the medications that we give the ganache opens. Okay. Now if say, say an egg donor model, we obviously don't need the universe, all we need is all we need is one over okay to be able to get an egg be stimulated with kinetic droppings and then retrieve the eggs. Okay.

18:46  
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19:25  
So now that's female fertility. Let's talk about male fertility. How is the the intercom system involved in male fertility? Well, the the lighting, okay, so so the same hormones are from the pituitary gland that stimulate the testes to make testosterone and sperm production Now, unlike unlike the woman, okay. Females are born with all the eggs they're ever going to have. I mean when they were inside their mom, they had those

20:00  
70 million. Okay. At birth, one to 2 million are left. at puberty, you're down to 200 to 4000. I mean, incredibly wasteful, right? Yeah, then hundreds, hundreds get used every month on the one makes it the observation the rest die off.

20:19  
So a woman is estimated to have about 350 to 500 oscillations in theirs in their lifetime, okay. Men stopped making mature sperm. at puberty, to be able to procreate. I had to be involved in a conception. That is the difference as a woman ages the number of eggs that she has declines, but also the quality. Now, before I get too much into the endocrine system, I just want to share this point that men are not immune from the biologic clock. Men above age 40 to 45 have been shown to have lower fertility, high rates of miscarriage, preterm labor in their partner, but also autism, schizophrenia and birth defects. So it behooves the man and the woman to try to conceive in their younger years as opposed to waiting. Okay, so what's the endocrine system of the male? Well, the FSH of the pituitary gland stimulates the satelli cells to make sperm. Okay, that sperm production is absolutely necessary high levels. High levels of FSH are showing that we're not getting good sperm production typically. Okay, this the the test is is getting resistant, and we're not getting a good amount of sperm typically. Okay, but you would usually the best screen is the sperm analysis. I wouldn't do all the hormone testing First you want to just see the source. Okay. So FSH stimulates what's called the statale cells that are involved in sperm production. Lh stimulates the light excels to produce Lh Okay, and Lh is involved in producing testosterone. Okay, the light excels are the ones are both responsible for testosterone. So you got FSH stimulating this, the testes told the cells to expand, you got an Lh there stimulating the light excels to produce testosterone. Everything needs to be intact. Okay. And then there's feedback as well. Now, let me give you an interesting lesson, essentially, that we see men here that are complaining of erectile difficulty or fatigue and the primary care doctor or the urologist says, Let's get a disaster on levels on the lower side, and they give the patient to stash drone.

22:49  
Well, remember, we talked about the ovary having feedback? Well, the the the the testes has the same thing.

22:56  
The pituitary gland of the brain doesn't care where it sees testosterone. If it sees testosterone, it says, Hey, you got enough there? I don't need to keep on stimulating you're good to go. And it lowers the Lh right? That, obviously you can see lower sperm production lowers his testosterone and then sperm production. We have men who have been on testosterone will come in and their sperm count is zero.

23:27  
And that's because they're on testosterone. The injections are the most powerful suppressant to the pituitary. But wherever testosterone comes from, whether it's subcutaneous, whether it's injections, whether it's from the testes, whether it's a tumor, God forbid, the brain sees the same thing. And if it's high levels, it lowers and can dramatically reduce or eliminate sperm production.

23:52  
Fortunately, for most men, would that be reversible if they stopped the testosterone treatment? As long as it hasn't been years? Yeah, sometimes it actually is not. And if there is the removal of the cystoscope drone, it may come back to some degree, but it also could remain zero. Okay, so now let's talk about it, how there are so many things that can go wrong. It's really amazing to me when we think about human reproduction, human fertility, because there there are so many areas, it seems like in the inter consistent where you could have a problem that will impact male or female fertility. So how do we go about diagnosing the endocrine system problem? And let's say you've got the issue where you you, you do see reduced fertility. So how do you diagnose where the problem is where the dysfunction is in the endocrine system? terrific question, Donna. And I think this underscores the need for education. I mean, to say

25:00  
A lot of women come to me and say, you know, I'm interested in getting pregnant at some time. I just want to get my hormones checked. There is no hormone check. Yeah, the best measure of a woman's reproductive hormonal balance is if she's ovulating.

25:19  
Okay, if she's having monthly cycles, and she's ovulating, then the orchestration, the intricate orchestration of the hypothalamic, pituitary ovarian axis is fine.

25:30  
You don't have to be checking everything else, all the other sex or the other hormones that can have an impact on reproduction. Because our relation is the key. Now, severe thyroid disease can impair ovulation can cause abnormal bleeding. I mean, we can go into that. But typically symptoms will result in that the best measure of female hormonal health is ovulation. And the best measure of male reproductive hormonal health is a sperm count.

26:02  
But how would a woman know? Is there a way Is there a way to test declining fertility let's say I mean, many women continue to ovulate into their 40s. But their their fertility is is quite low there and their ovarian reserve at that point would be quite low. Is there any type of test to be able to determine the ovarian reserve for that that's not age dependent in a woman is oscillating and is still regular in her period? Another excellent question, john, the question is not is there an ovarian age test? The question is Why get one? That's the better question. And I say this because most important sole predictor

26:49  
of fertility and a woman, you know, age I would guess that's it. Her birthday. Women as they get older will decline. ovarian reserve, ovarian reserve is quality and quantity. Quality is their birthday. As the woman goes down, the quality of those eggs is diminishing. Doesn't matter what the ovarian is testing is, it's going to go down the quantity best measure is Hmh. I think that if a if your listeners are getting FSH levels, the doctor is not really up to date fertility specialist. That's been outdated for more than 10 years now. FSH levels are outdated. The only time we get them is if insurance requires it. Otherwise, they wouldn't cover IVF then we have to get an FSH level. But there was absolutely no reason to get an FSH level and a woman who's having menses.

27:43  
It could diagnose ovarian failure if you stopping having menses, okay, the best reliable valid marker of ovarian age testing for quantitative eggs is Hmh, anti mullerian hormone and that's in the cells, those granulosa cells again surrounding the egg. Okay. Women, unfortunately go online and are suffocating with the misinformation about Hmh. I'm going to say this and statically am age is not a predictor of natural fertility.

28:21  
There was an article in the Journal of the American Medical Association just a few years ago by Diane Steiner, that looked at women ages 30 to 44.

28:31  
A group of women had low Hmh, the other group of women had normally MH and they looked at those all of them who conceived

28:39  
year for year, same pregnancy rate, no difference in the pregnancy rate, irrespective of the Hmh.

28:49  
Where does Hmh come into play? really only IVF

28:54  
if a woman is not going to do IVF, and she's thinking about getting pregnant, no matter what age she is, and she hasn't even tried to try to get pregnant. ama's does not influence your natural fertility. If your Hmh level is low, and you're going to be doing IVF it will reduce the number of eggs that you get. It will compel us to increase the dosage of banana Trump wants you to produce eggs, and it does influence outcome to some degree, then the younger you are the better. But Hmh should not be used as to tell a woman Oh my god, you haven't tried to get pregnant. A match is so low let's get going. Or, oh my god, you got to freeze your eggs. Or Oh my god, you're gonna have to use an egg donor. It's just not that kind of a thing. And it needs a lot better counseling. Then websites like Charlie's ovarian reserve blog. You know, you need I don't know if there is a Charlie. Yeah, but I'm saying that you just need to have better education from a specialist as opposed to the reflex of reaction. Because it's not everything that people think it is. Yeah, it's

30:00  
is very important is our best measure of ovarian reserve, but it should not be done without reason. And the random screening of HGH levels in a otherwise considered fertile population can only risk unnecessary alarm.

30:16  
And from what you're saying is not a predictor of future pregnancy? No, it's not a predictor of natural exception rates, right. Okay.

30:26  
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31:11  
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31:35  
Now we have been, it's hard to get pick up any publication or get any listened to anything or read anything without hearing about endocrine disrupting chemicals in our environment. So I wanted to talk some about dietary and lifestyle choices that impact the health of our endocrine system, since we know it the endocrine system is is the most vital that if for conception for fertility, it is it is the whole ball of wax. So what are some? First of all, let's just start let's start with dietary, then we're going to move to lifestyle and talk about some of the common endocrine disrupting chemicals. But let's start with dietary first, although the two are connected, because we certainly can be exposed to endocrine disruptors in our diet. But is there anything that's known about diet that will impact improve our hurt, the inter consistent and thus our fertility? You know, the endocrine system is not a dietary or nutritional susceptible organ system. I can think of nutritional I mean, just in general nutritional status. I mean, let's just say this is not endocrine disrupters. I mean, the thyroid is not made in the by I'm sorry, iodine is not made in the body. Okay, so iodine supplementation and food is necessary for thyroid hormone production. So that's, that's critical, okay. All the other elements that are necessary hormone production is made in the body and nutritional relationship that is pretty profound, is a woman that has an eating disorder, okay, or it has other reasons for calorie deficit, she's not bringing in as much calories as she's expanding. So say, an Olympic trainer, a marathon runner, swimmer high schools, intense exercise, particularly at the time of puberty. That's called the female athlete triad. And what happens is that there's a critical amount of calorie intake and versus end energy expenditure that can stop your periods. So the triad of the female athlete is decreased calorie intake, aimed at area which has no periods and bone loss, because Astra dial is necessary to preserve bones. Okay, so that's really very tied in to the nutritional aspect that to which you're referring, it's even life threatening anorexia, particularly as a cause five to 15% mortality rate 30% of women can have persistent our relation dysfunction as a result of that. So those are the ones that come to mind with direct nutrition relationship toward the endocrine system. What about overweight, which can also be an eating disorder as well. But how does obesity or just being overweight impact fertility or impact the the endocrine system? Yeah, well, I you know, in every way, obesity and morbid obesity is a challenge in the body. It's a significant stress. There is evidence that for fertility purposes for the woman

35:00  
Either this dysfunction are higher rates of miscarriage or birth defects. Lower fertility, okay, so higher pregnancy complications clearly, for the man, obesity and morbid obesity it can reduce sperm counts because the estrogen the estrogen in the testosterone gets converted to estrogen in the man in the fat cells, the adipose cells, so the more adipose cells from fat, the more estrogen production estrogen then inhibits FSH in the pituitary, and that lowers the sperm count are a common hormonal problem in women is polycystic ovary syndrome. p c. o s is the most common isolation disorder for infertility. It is the most common hormonal problem in women during their reproductive years and beyond and is worsened by weight. You could the degree of patients obesity and PCs is really matching the general population. The problem is that obesity with PCs worsens all aspects of the disease PCs has a reproductive consequences but also metabolic consequences. So reproductively higher miscarriage and infertility, abnormal bleeding, diabetes and pregnancy, metabolically pcls increases the risk of the metabolic syndrome. Those five things that we need is three. So you have elevated blood pressure, elevated blood sugars, elevated triglycerides, abnormal HDL, low HDL, and abdominal circumference. So obesity worsens all of those things. So it's it's a and liver dysfunction from severe obesity through a condition called fatty liver that results in elevated liver enzymes. Think about the challenge that insulin resistance some significant obesity has on the pancreas that results in diabetes. Yeah.

37:03  
Alright, so So from a dietary standpoint, the inter consistent is not directly connected to a specific nutritional need or not need, however, it is significantly impacted by weight, either underweight or overweight. Yes, I would say that. Alright. So now let's talk about lifestyle. And we'll talk generally about lifestyle choices that can impact the intercom system, and then moving into our exposure to endocrine disrupting chemicals. But before we move to indican, disrupting chemicals, are there specific things that we know that people can choose to do that will improve or hurt the endocrine system and thus, their fertility through the integrand system to being impacted? Things such as smoking or sleep or things like that?

37:55  
Well, we don't understand exactly, you know, the circadian rhythm with with sleep. I mean, there's been studies on that as to its impact of fertility. I can't tell you that there's a direct endocrine effect of lifestyle choices other than what we just talked about with obesity. Cigarette smoking, can cause genetic alterations of the sperm in the egg it can increase the risk of miscarriage, ectopic pregnancy, reduced sperm fertilization potential. Okay, and so, probably, you know, for those that are trying to conceive who are listening, probably the worst thing that you could be doing, if you're trying to conceive is smoking. That's probably the sabotage event. Okay. And so what I tell my patients who are smoking and trying to conceive is what would you rather be holding? Okay, you got a cigarette? Oh, baby. So the answer is pretty clear. And so that's somewhat of a motivating factor. I know it's difficult, addictive substance, but it is also dangerous during pregnancy itself for baby. So

38:57  
we talked about the man with the sperm, sperm production, caffeine, miscarriage risks, probably more than two cups equivalent of caffeine, but, and marijuana, the vaping. We know that that has impacts on fertility. But I can't give you the absolute Dawn of this is the lifestyle exposure, and this is the impact on hormones. Okay. All right. Now let's talk about endocrine disrupting chemicals. We certainly are reading and hearing about them. What are they to start with? And can you list a couple of common ones are where we find them commonly? Yeah, so when we talked about at the outset of the show that hormones are struct of chemicals that are produced in one part of the body and work in another and they do their action by binding to the shape of the receptor. Okay, well, endocrine disruptors have that same shape, okay, and they interfere with the binding and then cause havoc with that binding.

40:00  
Okay, so these are literally hormone disruptors. Okay. And the Queen disruptors. I and they are unfortunately, unfortunately, ubiquitous. Yeah, the global production of chemicals that have increased, and endocrine associated disorders, infertility, impaired brain development, diabetes and certain cancers. So So where would these things come from? Well, you're gonna get them a BPA. Is this a bison or a that are leached from landfills, okay, you get lead. Alright, validates validates all the other ones that you know you're going to see in, in cosmetics and plastics, food packaging, body care products and toys. I mean, it's all over the place. I'm, I'm drinking a bottle of water right now, this plastic, and that is a potential endocrine disruptor. So what happens is that these things, Leach from those items into the environment into the into the products that we use and consume. And the most common way that that happens is is orally. Okay, you're swallowing from food packaging, and cosmetic products, unfortunately.

41:19  
And like I say, they're ubiquitous, they are everywhere. Right? Right. Yeah. And it's a shame. And there is, I encourage that we all support a bill that's been out there trying to get the FDA to have more authority, it's called the personal care, Product Safety Act. Okay, we want the FDA to get the authority to recall personal care items that threaten consumer safety. Okay, all the things that I share with you, we want to get the FDA to get the authority to label to require them to label those products, ingredients that are not appropriate for children and those that should really be professionally administered only. And is there has there been research that indicates that excess of any of them BPA, phthalates, whatever, in a person, male or female, reduces fertility in that person. Do we know that? Yeah. Is there a direct causal link? Yeah, just salads have been shown to reduce testosterone and estrogen levels, blocking thyroid hormone action. They've been identified as as what we call a reproductive toxin. Okay, when also unfortunately as exposures decreased pregnancy increased miscarriage. preeclampsia does evidence of early menopause, abnormal steroid hormones. So it's now eight. So the bad news I encourage everybody to go on. And ducklin end o ci n.org. And and look up phthalates, or rather endocrine disruptors, etc. Okay, and you're gonna see a tremendous amount. So endocrine.org, forward slash topics.

43:04  
And then forward slash, he is an Edward D, as in David C is in cat and a plethora of information and great resource. We will include that link in the notes to this interview. Yeah, it's, and there are things that and although we keep saying or I keep saying that there is they are ubiquitous, that would imply that there is nothing that we can do individually. But there are things that we can do individually to reduce our exposure to phthalates, so learning more about where they are and how they are. And that ties in to dietary choices, because the more processed the food, the more fat lights as a general rule, and you also really want to, you know, going back to the thyroid, which which I know this was one of the focus, we need dietary sources of iodine.

43:55  
Okay, so, where's that going to come from cheese, cow milk, eggs, yogurt, those kind of things that soy milk will even have it. So those kind of things are important for thyroid health. We can't be thyroid deficient, because of the risk of goiter and thyroid abnormalities and we started talking about this at the outset again is I would have the mount is excess thyroids been shown to reduce semen volume density shapes, and then then low thyroid as well as reducing sperm shapes. So they both the extremes in men with thyroid hyper and hypo affects sperm production. Okay, so iodine being a dietary substance, something that we that we have to bring into our body that can influence the health of the thyroid gland, which is part of the endocrine system. Exactly. Okay, excellent. Well, thank you so much, Dr. Mark trollers for talking with us today about the inter consistent and thyroid gland and how this all impacts fertility. We truly appreciate your input.

44:59  
Always

45:00  
It's my pleasure, Don anytime I love being involved in educational events, and your organization should be so applauded for all that you have done to empower our patients and and healthcare professionals. So keep up the terrific work. Kudos to you all. Thank you so much.

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