Marijuana may undermine fertility treatment success

2019-08-22

By Anne Harding

(Reuters Health) – Women undergoing fertility treatment who smoke marijuana may have more success if they quit, recent research suggests.

Marijuana plants are displayed for sale at a medical marijuana dispensary in Seattle, Washington, November 27, 2012. REUTERS/Ant

Among more than 400 women undergoing treatment with assisted-reproduction technology (ART), the small fraction who reported using cannabis at the time were more than twice as likely to lose a pregnancy than those who had never smoked marijuana, or who had only used it in the past, Dr. Jorge E. Chavarro of Harvard T.H. Chan School of Public Health in Boston and his colleagues found.

Unexpectedly, the small fraction of couples in which the man was the only current marijuana user were significantly more likely to have a baby.

But this finding should be seen as showing lack of evidence for harm, rather than as evidence that pot has a positive effect on male fertility, Chavarro and his colleagues conclude in the journal Human Reproduction.

“The bottom line remains that we know way too little about the reproductive health effects of marijuana,” Chavarro said in an email. “The scarcity of information is particularly concerning given the concurrent trends of expanded legalization, increased perception that marijuana poses no health hazards and increased consumption among men and women of reproductive age, including among pregnant women.”

Just three studies have looked at how marijuana smoking by both partners affects fertility, the researchers note. Two of them, in couples trying to conceive naturally, found no effect. The third, in couples using ART, found no effect on pregnancy or live births but did find users had lower egg yields and fertilization rates.

The new study included 421 women who underwent 730 cycles of ART between 2004 and 2017 at a Boston fertility center. Male partners of 200 of the women also enrolled. Forty-four percent of the women and 61% of the men reported ever using marijuana, while 3% of women and 12% of men admitted to being current marijuana smokers.

During the study, 317 women had a positive pregnancy blood test in a total of 395 ART cycles, including nine women (16 cycles) who were marijuana users. Pregnancy loss occurred in 54% of the marijuana smokers and 26% of the non-users.

Among couples in which the male partner was the only current marijuana user (23 couples, 41 cycles), 48% had a baby, versus 29% of couples in which the man was a non-user.

Some animal studies have suggested that activating the endocannabinoid system – naturally occurring signaling molecules that chemically resemble cannabis – at low levels improves testicular function, while higher levels of activation depress it, Chavarro noted.

However, he said, “Most of the human literature to date has been among men on the higher end of use and most show a deleterious effect of marijuana on sperm and testosterone production.”

“The take-home message is still 100% do not use marijuana while pregnant or trying to get pregnant,” said Dr. Nathaniel DeNicola, an assistant professor at The George Washington University in Washington, D.C., who wasn’t involved in the study.

While research is scarce on marijuana use and fertility, he said in a phone interview, 30 studies have looked at marijuana and pregnancy, and the body of evidence shows a “signal” that women who use cannabis in pregnancy are at increased risk of having a low birthweight infant, of delivering pre-term and of stillbirth. “When marijuana is used at least weekly, or more than weekly, that’s when the risk starts to get more concerning,” he said.

In June, a practical guide for physicians published in the journal CMAJ summed up existing evidence on marijuana and fertility, echoing some of these warnings (https://bit.ly/2MvmZnw). Overall, men’s use of cannabis once a week or more was linked to a 29% reduction in total sperm count, and women’s use within the past three months was tied to delayed ovulation.

While the evidence does not show that using marijuana affects the ability to conceive for most couples, for those struggling with infertility, marijuana use “could compound their difficulties,” write Dr. Sara Ilnitsky and Dr. Stan Van Uum of the Schulich School of Medicine and Dentistry at Western University in London, Ontario, Canada.

SOURCE: https://bit.ly/31X0fjY Human Reproduction, online August 14, 2019.

Many marriages in Pakistan are troubled by sexual incompatibility but no one talks about it

2019-04-26

Lack of sex education and sexual intimacy has adverse effects on couples’ married lives

BY KAUKAB TAHIR APRIL 3, 2019

KARACHI: Rarely ever taken to experts, sexual incompatibility is dismissed as a non-issue. Sarah Aziz*, a 32-year-old divorcee – 28 at the time of marriage – says the root cause of the failure of her marriage was her partner’s sexual orientation. For the longest time, the couple struggled as her husband insisted that the lack of sexual intimacy between them was due to erectile dysfunction. But the truth was that he was gay.

“Even lying naked in his arms wasn’t enough to arouse him, and not once did he have an erection that lasted longer than five minutes … enough for him to be able to penetrate.”

Just so his orientation remained closeted, he even took Viagra but nothing made the situation better. She says, “I had to live in agony for over two years until one day I caught him doing a Skype session with a man.”

As a set norm in Pakistan, married couples are expected to deal with sexual incompatibility behind closed doors and drawn curtains. In this silent struggle, many red flags go unnoticed until it is too late. Kinza Raza*, who is 23 years old (21 at the time of marriage), spoke to Cutacut about her traumatic, four-month-long relationship with her impotent partner. Crushed under society’s many taboos on the subject, Raza suffered from sexual discontentment silently. She kept quiet out of fear of judgement and blame, thinking that talking about problems in her sex life and sharing what she was going through would worsen things for her.

“Even lying naked in his arms wasn’t enough to arouse him”

“Since my husband was impotent, we could never have sex,” says Raza. But instead of working with her on the problem, her husband would beat her up, threatening her to never speak about it. Raza continued to suffer alone, in silence, until one day she fought back and beat up her husband with a wiper.

These stories are far too common in Pakistani society. A number of young people, especially women, have heartbreaking accounts surrounding sexual dissatisfaction in wedlock.

Misinformation about sex

But the issue doesn’t only extend to women; men, too, struggle to discern head from tail. Couples aren’t aware of the basic dos and don’ts of having sex. They are yet to inform themselves on what may result in a pregnancy.

“I had a love marriage and despite being extremely fond of my wife, I was scared to penetrate thinking she might get pregnant,” said Mubeen Ahmed*, a 30-year-old working professional. Ahmed said even until the end of their honeymoon, the couple hadn’t had intercourse. Only after coming back from the trip, when his partner sought medical help and was prescribed contraceptives, they felt comfortable enough to consummate the marriage.

Speaking of misconceptions, Dr Kishwar Lucas, a general practitioner and sonologist at Karachi’s Good Samaritan Hospital, shared a harrowing experience where she examined a patient who complained that she was unable to conceive.

After a thorough checkup, it turned out that her hymen was still intact and that she was having anal sex with her husband that whole time.

“Men misuse girls and misbehave with them,” said Dr Lucas. Plenty of similar cases are reported to hospitals on the daily.

Sexual health and emotional well-being

Sometimes, the cause of sexual discomfort between couples is also linked to a person’s previous sexual experience. If diagnosed in a timely manner, it can be treated through cognitive therapy.

Problems around not being able to perform sexually generally stem from psychological ups and downs. Many times, the psychological hangups manifest into adverse effects on a person’s physiological health. So it makes matters worse when treatments such as counseling therapy are shunned by our society when, in fact, they should be readily available.

Neither children nor adults are provided the adequate knowledge. The information should come through a reliable source within their reach instead of porn or gossip, said Dr Humair Yusuf, a psychotherapist and private practitioner based in Karachi.

Read: Does watching too much porn affect your sex life?

“It is about time that torrents are excluded from the list of sources that teenagers (and adults) learn about sex from.”

Learning about sex from unreliable sources

Curiosity around sex and asking questions about it is discouraged. When compared, this censorship is especially strong among teenage girls as sexual empowerment for women remains a taboo subject in our society.

People can only be prepared on what to expect if they are taught about sex from a young age, preferably their teens. Radio silence about these matters leads teenagers, especially girls, into believing that sex is an unspeakable crime or sexual activity makes them untouchable.

Read: We answer sex questions guys are too afraid to ask

“The problem in our society is that sex has been extremely romanticised, and not educating 17 or 18-year-olds — who are dating and are suffering from peer pressure — often lands them into trouble because they are not aware,” says Amna Imran, a lecturer and a mother of an 11-year-old. “I am open and honest with my daughter. She already knows that babies aren’t sent into this world through angels but in fact come out of the mother’s womb.”

How do we fix this endemic?

It is a norm in Pakistan for people to be exposed to sexual activity only after they are married. Prior to that, most are sexually inactive. They discover their sexuality and learn about their sexual health once they enter wedlock, which makes things a lot more complicated.

Ideally, the government should take up the responsibility to educate masses about healthy sexual habits, added Dr Yusuf.

In the age of the Internet, where people, including teenagers, regularly indulge in pornography, it is crucial that they learn about healthy sexual relations from a young age.

“People aren’t able to flag issues because they don’t have the slightest idea. It is important we conduct timely counseling so couples know when to escalate the problem,” stressed Dr Lucas.

Men are still able to identify the signs but it takes women a long time to figure out what’s going on. By the time they learn, their relationship and sexual chemistry has already worsened irreparably, she adds.

*Names have been changed to protect identity