Reproductive Endocrinologist, Dr. Hurwitz Discusses a Link Between Folic Acid and Autism
PathtoFertility is a blog dedicated to educating and supporting men and women experiencing infertility challenges. Board certified reproductive endocrinologist, Dr. Joshua Hurwitz at Reproductive Medicine Associates of Connecticut (RMACT), brought an article to my attention last week that he thought would be good to share here, on our blog.
The article, which was published in the Stamford Hospital's Newsletter, refers to an observational clinical study, discussing findings about folic acid and the diagnosis of autistic disorder. The authors of the study are quick to point out that this study does not link folic acid taken four weeks before conception and eight weeks after conception to Aspbergers or PDD-NOS (pervasive developmental disorder-not otherwise specified). To read more about the study itself, click here.
The authors and the comments from other clinical professionals highly recommend replicating this study with an eye towards a causal link between folic acid and the diagnosis of autism. The study authors go on to discuss other factors that they were able to eliminate as possible causes for the increased diagnosis of autism for those women who had not taken the folic acid for the four weeks prior and eight weeks post conception.
Prenatal Vitamins are Still a Must for Preconception
A good, healthy diet, as well as pre-natal care may factor into the results, but do not appear to negate the substantial results showing in this study about the importance of folic acid during preconception. Starting a good prenatal vitamin while in fertility treatment has long been standard of practice at RMACT. If you are trying to become pregnant, whether on your own, or with a fertility doctor, please do seriously consider prenatal vitamins. Preconception is being considered more and more seriously here at RMACT. We are looking at a minimum of 90 days before you concieve.
What can you do in those 90 days before conception?
First, take a prenatal vitamin with folic acid. Check with your health care provider about the dose that they would like to see in that vitamin supplement.
Second, take a look at your food. There are simple adjustments that you can make that will support your efforts to become healthier. We do know that healthier moms make healthier babies.
Thank you Dr. Joshua Hurwitz for bringing this important study to our attention.
We hear so much in the news about what's good and what's not. There's so much contradiction out there. One news report will say, "yes, eat all the .... that you can", while another news report will tell you never to eat that very same thing. It's reassuring to hear from a top fertility specialist what they are reading. It's reassuring to know that they are concerned and aware of the tests being done and the results. So I'm happy to pass this on to you today. Again, thanks to Dr. Joshua Hurwitz, I know a little more that I can share with you. Take the prenatal vitamin with folic acid. And have a happy Wednesday.
Fertility Doctor Joshua M. Hurwitz, MD Earns Partnership at Leading CT Fertility Practice
Fertility Specialist Dr. Joshua M. Hurwitz, who sees patients in Connecticut and New York, has been promoted to partner of Reproductive Medicine Associates of Connecticut (RMACT). As a partner with the fertility practice, Dr. Hurwitz will greatly expand his leadership role while continuing his close work with fertility patients to help in their family building and infertility treatment. Dr. Hurwitz will also spearhead the practice’s new team-based comprehensive program to treat adolescents with polycystic ovarian syndrome (PCOS).
Dr. Hurwitz, who is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility, has been an infertility specialist with RMACT since 2006. During this time, he has helped hundreds of couples build their families by diagnosing and treating their fertility challenges. He is passionate about patient care and teaching, which he incorporates into his bedside manner; Dr. Hurwitz believes that patients who have a better understanding of their diagnosis and options make better choices for themselves and are more engaged with their fertility treatment.
Dr. Joshua M. Hurwitz Shares His Knowledge of Reproductive Medicine
“Working with patients is incredibly rewarding, especially in a field like reproductive medicine where the advances are rapid and far-reaching,” says Dr. Hurwitz, who teaches endocrinological, surgical, genetic and in-vitro fertilization (IVF) techniques at RMACT and Danbury Hospital. “For six years I’ve been proud that my patients have benefited from RMACT’s cutting edge medicine – and I’m thrilled to expand my role and responsibilities as partner in this dynamic and forward-thinking practice.”
In addition to his partnership with RMACT, Dr. Hurwitz is Division Director of Reproductive Endocrinology and Infertility (REI) services in the Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, where he develops and implements the division’s academic program, teaching residents, giving lectures, as well as caring for infertility patients. He is also an assistant professor of Obstetrics, Gynecology and Women’s Health at the Albert Einstein College of Medicine in the Bronx, NY.
Dr. Hurwitz received his undergraduate degree in Biology and Society from Cornell University, and his medical degree from the Jefferson Medical College in Philadelphia. Dr. Hurwitz completed his residency in Obstetrics and Gynecology at Thomas Jefferson University Hospital, also in Philadelphia. During residency training, Dr. Hurwitz was named Best Laparoscopic Surgeon, and has received many teaching awards.
After residency, he completed a three-year fellowship in reproductive endocrinology at the Albert Einstein College of Medicine in New York. During his fellowship, Dr. Hurwitz successfully launched several research programs related to reproductive aging and diminished ovarian reserve and has presented his research findings at many leading national and international fertility conferences. His research interests also include premature ovarian failure, oocyte cryopreservation, reproductive surgeries, embryo donation, and bioethics. He has published numerous abstracts, articles and book chapters on reproductive aging, reproductive hormones, IVF, ultrasound, and bioethics. Dr. Hurwitz is a member of the Society of Reproductive Endocrinologists, Fellow of the American College of Obstetrics and Gynecology, and the American Society for Reproductive Medicine.
Read below what the medical director of Reproductive Medicine Associates of Connecticut (RMACT) and the team of board certified reproductive endocrinologists in the program have to say about frequently asked questions.
"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director. "The questions and answers below are intended to give some basic knowledge. Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."
What is infertility?
Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.
Is infertility a "women's problem"?
Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.
How long should we try before we see a doctor?
In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.
What is a Fertility Specialist?
A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology. This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations.
Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.
At what time of the month is a woman fertile?
The most fertile time of a woman's cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.
It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of having sexual relations to every other day from day 11 to 18 ( 11-13-15-17). In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18). Therefore you would have relations days 15-17&19 to cover all your bases.
Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.
How can a woman tell if she ovulates?
The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.
How often should we have intercourse?
It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on "Day 14." And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
What fertility testing should our fertility doctor perform?
Your doctor will likely do the following:
- Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
- Complete semen analysis on the male partner
- Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
- Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman
What about smoking and drinking alcohol and caffeine?
There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.
Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.
Are hot tubs really bad for a man?
Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.
What else can we do?
Learn as much as you can about infertility.
- Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
- RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
- Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.
I'm reading a book called "Here's the Bright Side- of Failure, Fear, Cancer, Divorce and Other Bum Raps". This is most decidly not a best seller. It was written in 2007 by Betty Rollin, who is a writer and a TV journalist. The book was a give away by my library due to overcrowding and under interest in the book.
Sometimes one person's giveaway is another person's treasure.
I have found many treasures in this book. For the record, for the most part, I believe that in the midst of infertility and fertility treatment, you will not enjoy this book. I believe the bright side and silver lining, in the middle of treatment, is too challenging to find. But I think, maybe, you can hear bits and pieces here.
What the author has to say about "the prize" that goes way beyond learning to cope, is what I am savoring. Her discussion about the Harvard psychologist, Daniel Gilbert, who talks about the "psychological immune system that defends the mind against unhappiness." What a concept, that much like the body, the mind also has an immune system that kicks in when needed to protect itself.
She also talks about gratitude. Which of course makes me think of Kristin Magnacca, another of my favorite authors, who recommends a gratitude journal. I love it. When life feels both overwhelming and overbearing, I often will turn to the gratitude journal that I keep.
Betty Rollins talks about how we often feel grateful after a loss or crisis and not as often when life is going along pretty smoothly. That it's those heart wrenching situations that make us sit up and realize what we are made of.
Which brought me to thinking about a conversation that I had with Dr. Joshua Hurwitz the other day. When he announced that he regularly makes patients cry, as matter of fact as could be, I was flabbergasted. He is constantly getting accolades from our patients, as well as patient and peer awards for not only his medical expertise, but his gentle handling of the emotional end of things.
But I got what he meant, he tells patients lots of things that are upsetting, and even as well as he does it, we get upset. There were a few paragraphs in the book that spoke to this point eloquently.
Betty Rollins talks about her surgeon and how much she loves him. She writes about how she loves him, because in retrospect, she realizes that he lied to her. That he became her protector, realizing that she could not hear the truth in that minute. Knowing that she had to assimilate maybe before she could hear, "yes, cancer".
That made him the best doctor for her. Just as Dr. Hurwitz's unfailing gentleness makes it possible for his patients to cry when they need to. After all, what's the alternative? We all know the answer. We cry when we leave. We cry in the elevator, on the stairs, in the car, on the phone with our partner. Instead, Dr. Hurwitz makes it safe to have the human response of crying right then and there.
The bright side of infertility? Gratitude about infertility? Are either of those things possible to see without a positive pregnancy test or baby in arms?
There are many more bits in this book that make me grateful that I rescued it from a possibly early demise. And none of it keep me from understanding that seeing a bright side is not always possible nor does it make it anyone's fault or problem if they can't.
Just being able to put Dr. Hurwitz's comments into perspective made picking up the book worthwhile.