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Preconception Consumption Of Caffeinated Beverages May Increase Risk Of Pregnancy Loss.

April 5, 2016

The scientific literature abounds with negative information regarding caffeine, yet the official nutritional recommendations continue to support its use?  Reproductive Medicine studies have demonstrated for years, the negative impact of caffeine on IVF pregnancy rates.  The basic physiology of caffeine includes a doubling of cortisol that clearly tells us that it sends a life threatening signal to the brain.  Nature does not want a stressed female to become pregnant.  There are multiple things that send this signal to the brain to create “physiologic stress” and caffeine is just one of them.

Lets look at the chemical structure of caffeine.  [see attachments maybe line them up in the text with the names?]  If we compare to nicotine, amphetamine and cocaine, there are distinct similarities.  Most would agree that these drugs are not healthy but caffeine slips in under the radar.  Who would knock coffee, right?  Just think about the names and how similar they sound.  Prescription Drugs such as Adderall, Vyvanse and Adipex also fall into this category.   Adipex, used as a weight loss drug works through an appetite suppression mechanism (starvation).  Amphetamine addicts are always very thin, but are they healthy?  Caffeine and nicotine are the “legal varieties” of these stimulants and the prescription drugs below are also legal if a doctor is convinced to prescribe.  See pictures of structures below.
Drug Name                       Generic name
Adderall                     Amphetamine and dextroamphetamine salts
Vyvanse                    Lisdexamfetamine dimesylate
Adipex                      Phentermine             
The physiologic stress, no matter how stimulated, results in a decrease in the brain signals to the ovary (FSH and LH).  These are the growth stimulants of the follicle and hence the egg.  Like plant fertilizer, if the egg is deficient in these hormones, it will not be completely developed.  These eggs are still ovulated but when fertilized the egg doesn’t function properly.  The genetic outcome of the combination of sperm nucleus and egg nucleus is not normal.  The resulting embryo is not genetically normal and therefore not capable of producing a normal full term pregnancy.  Two outcomes are possible: no pregnancy or miscarriage.  We see many patients presenting with multiple miscarriage who have physiologic stress as the diagnosis.
Major causes of physiologic stress include:
1.  Nutritional stress with hypoglycemia – Insulin resistance causing hypoglycemia due to carbohydrate ingestion and low calorie or starvation diets fit this category.
2.  Aerobic exercise stress – humans were not meant to engage in prolonged aerobic (increased heart rate) exercise.
3.  Significant sleep disruption – decreased sleep time, sleep apnea, or hormonal (low estrogen) induced sleep disturbance are potential causes.
4.  Caffeine, nicotine, adderall, phentermine, and vyvanse
We advocate the elimination of all of these stress factors in order to optimize the reproductive outcome, both in our patients and anyone who desires pregnancy.  We were very disappointed when the general pregnancy guidelines were recently amended to include coffee, which formerly was strictly forbidden.
Michael D. Fox, MD
Jacksonville Center
Reproductive Medicine

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