Former Endocrine Society president Teresa K. Woodruff, PhD, professor of obstetrics and gynecology at Northwestern University in Chicago, yesterday participated in an Ask Me Anything (AMA) session on the social media site Reddit. The platform allows the participant to field questions from “Redditors,” so we’d thought we’d share some of the highlights below. Of course, each question and answer generated much more discussion than we can put here. To see the full AMA, click here.
Redditor figgy_puddin asked:
Dr. Woodruff,
Thank you so much for doing this AMA. My question is in regards to human infertility.
The last I checked, human infertility rates (as defined loosely by the number of couples attempting to achieve conception and failing over a one year period), is increasing, and most recent reports list some 10% of the female population as being “subfertile,” or generally displaying reduced fertility. At the heart of a number of these instances is reduced or otherwise altered production of and/or sensitivity to gonadotropin signaling, which I’m personally interested in.
My big question, however, is- in your professional opinion- where do you think the cause of these trends in infertility lie? In a temporal sense, should we be looking towards development or prepubescent exposures (thinking endocrine disrupters, here) that might alter ovarian organogenesis and development, or are contemporary, adult exposures more promising as explanatory variables for sub-fertility? I understand that these don’t have to be (and likely aren’t) mutually exclusive, but I would expect their respective impacts to be different in magnitude.
Or is the whole concept of EDCs in this context totally off-base?
Woodruff‘s response:
Great question – we are all living in an environment that has more chemicals in our food, water and air than ever before. Modernity has an impact on our lives but in ways that we cannot fully quantitate. Endocrine distruptors are real and have impact at many levels of the reproductive system. The specific impact on ovarian or testicular function directly or on the gonadotropin hormones that that you mention are still under investigation in many laboratories. The changing landscape of fertility/infertility is no doubt being impacted at the developmental level and in adults. The magnitude of difference between these two has not been compared.
le_vicious had a question about PCOS:
Dr. Woodruff, thank you for doing this AMA. My question is in regards to PCOS – why isn’t there more known about it? Or, perhaps a better question – is there any new information that the general public may not know about in regards to treatment or causes?
I have been diagnosed with PCOS, but am not currently trying to conceive. How does this disorder affect me and what more can I do to regulate my hormones and help ovulation occur?
Woodruff:
PCOS impacts nearly 10% of women and is an endocrine disorder where the ovaries make more androgen than estrogen. Some folks will be surprised to know that the ovarian makes androgen, we typically think of this as the ‘male’ hormone But females make androgen which is ordinarily converted to estrogen. In PCOS, many small follicles grow and do not make this transition. Work from my lab points to an interesting new mechanism behind PCOS, the physical rigidity of the ovary. When we change the rigidity of the matrix that we use to grow follicles, the more rigid the ovary the more androgen is made. There are definitely genes that are part of the PCOS pathway and endocrine disruptors during development that can cause this phenotype as well. So PCOS is likely a series of diseases, each with its own origins. As we learn more about each factor we will be able to treat PCOS in a more personalized way! Stay Tuned for More Science on this!!
hillsfar wanted to know whether it was true that by age 30, women’s egg quality deteriorates:
Thank you for doing this AMA, Dr. Woodruff.
I have read articles that by age 30, a woman has lost some 90% of the million or so eggs that she was born with, and the overall quality of the remaining eggs has deteriorated, with attendant higher risks of miscarriage and birth defects. Is that true?
One such article: http://abcnews.go.com/GMA/OnCall/women-fertility-falls-lose-90-percent-eggs-30/story?id=9693015
Woodruff:
Yes! Here is the story – women are born with all the follicles we will have that contribute to fertility and endocrine health – on average 1 million follicles per woman. Follicles are selected from this ‘ovarian reserve’ from birth through menopause. Menopause is the time when no follicles are left in the ovary. Since the oocytes are present from birth through the fifth decade, it is AMAZING how good the quality is for so many years. But, they do start changing around age 37 when the oocytes are no longer able to maintain good chromosome quality – this leads to miscarriage and birth defects. My good friend and amazing reproductive scientist Francesca Duncan is working on this problem and has identified the tissue that surrounds the follicle as creating a negative environment for the egg. I look forward to her work because it is a new way to think about maintaining good egg quality, by targeting the physical environment of the follicle.
And KnightofBaldMt wondered about the effects of obesity on infertility:
Dr. Woodruff,
How large of a role does the obesity epidemic play in rising levels of infertility? How will this direct the future of medical care?
Many of our most impressive advances have been in IVF and IVM; how would you address more conservative groups about the benefits of these procedures?
Woodruff:
The world is facing a tsunami of diseases associated with the obesity and diabetes epidemic that is not just washing over our shores but is literally starting to take down the walls of our health. The food that we eat, the times that we eat it and the way chemicals in processed food changes the hunger centers in our brain is all contributing to these issues. These are the externals associated with obesity and the medical outcomes that are their consequences. Weight loss is hard in this setting but is associated with good outcomes in reproductive health and for overall health.
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