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Infertility Cubby

Infertility and the Use of Vaginal Lubricants: Confused Yet?
by Joanna Ellington, Ph.D., Reproductive Physiologist

Dr. Joanna EllingtonAt least six million couples in the US have medically defined infertility (about 15%), meaning they have had unprotected intercourse for over one year without a successful pregnancy. Even before the one year date for unsuccessful pregnancy, many couples become concerned if they are failing to conceive, with 9 million US women per year going to her doctor for fertility problems. In at least half of these cases, the male partner is partially or fully the reason for not conceiving.

A common complication for these trying-to-conceive couples ("TTC") is vaginal dryness in the female partner, with 75% of these couples reporting increased incidence of vaginal dryness due to: the stress of being infertile; having to have timed intercourse; and/ or fertility medications they are taking. Enjoying intercourse can become difficult during daily sexual activity when vaginal dryness and pain become an issue. In fact, over 25% of TTC couples "always" use lubricants while having intercourse (e.g. an estimated 2.25 million Americans).

Vaginal dryness is routinely treated with vaginal lubricant products, of which there are several hundred products marketed in the US. However, three decades of peer reviewed, published research has shown that all existing vaginal lubricants studied to date harm sperm, resulting in rapid losses in their viability (% live) and motility (% swimming). Specifically, there have been at least 11 studies on this topic conducted in Medical school settings, reviewing the effect of 16 different lubricants on sperm, including all of the top selling brands, such as KY, Astroglide and Replens. In each study, sperm motility and viability were dramatically reduced after exposure to even small concentrations (<10%) of these products.

Specific data from these studies show:

  • A spermicidal or sperm killing activity of the leading three brands of lubricants as being equivalent to contraceptive jellies such as Gynol. In these studies, sperm had ZERO motility after 30 minutes of contact with the top three selling lubricant products.
  • These effects are concentration dependent and were seen even with low concentrations (1-6%) depending on the lubricant product.
  • Critically, the negative effect of lubricants on sperm includes decreasing sperm penetration into the cervix in vivo, as determined by the post-coital test (PCT).

In order for conception to occur, motile sperm must be able to penetrate into cervical mucus and proceed to the Fallopian tubes in adequate numbers. Existing lubricant products rapidly decrease sperm motility, thus possibly decreasing the numbers of sperm penetrating the cervix and being able to participate in fertilization. The following quotes from these lubricant studies highlight the investigators' deep concerns with the use of vaginal lubricants by TTC couples (see a complete list of these references at www.helpconceive.com).

Dept of ObGyn; University of Texas Southwestern Medical Center. "For couples with infertility, the use of vaginal lubricants during intercourse is not recommended."
Dept of ObGyn; University of Connecticut. "We conclude that all traditional vaginal lubricants should be avoided in patients desiring conception."
Dept of ObGyn; University of Minnesota. "The spermicidal effect of the lubricants was statistically significant. The lubricants had a similar effect on both normal and abnormal semen specimens."
Dept of ObGyn; Uniformed Service University, Bethesda, MD. "In vivo (in people) data demonstrated severe impairment to sperm penetration of mid-cycle human cervical mucus by the lubricant."
Why do lubricants harm sperm? The best pH value for sperm migration and survival in cervical mucus has been established by the World Health Organization at between 7.0 and 8.5. This coincides with the normal rise in pH of cervical mucus found in women at the time of ovulation. In contrast, vaginal lubricants tend to have pH values below 7, and often as much as half of this value. These pH values can cause sperm death. Sperm are also sensitive to both high and low osmolality (concentration of osmotically active particles in solution) because these can cause the cells to either shrink or swell too much. A physiologic osmolality around 320 mOsm/kg (that of semen) is best for sperm function. Sperm motility decreases with exposure to increasing osmolality, with all motion stopping at 600 mOsm or greater. Lubricants have osmolality levels 3-10 times that of semen that causes irreversible damage to sperm motility at contact

In spite of the numerous publications cited above, there remains a great deal of confusion amongst physicians and lay people alike as to the safety of vaginal lubricant use while trying to become pregnant. In fact, many doctors are inadvertently recommending lubricants that harm sperm to their patients based on inaccurate information. In many cases there is a fundamental disconnect between the published data of the effects of lubricants on sperm function and the physician's knowledge. This confusion exists in part, because the leading brands state in their marketing material that they "will not kill sperm." or that they have "no effect on sperm motility" in spite of published literature to the contrary.

Additionally, a common misconception is that if a lubricant does not contain a spermicide or if it is water soluble, it will not impair sperm function. Unfortunately, this is completely inaccurate. Water based lubricants often have glycerin (which has been shown to be toxic to sperm) and propylene glycol both of which are highly hyperosmotic. This results in irreversible damage to sperm and a loss in motility after exposure to commercial lubricants. Damage to sperm and subsequent inability of the sperm to penetrate into the cervix following contact with lubricants may prevent conception in some couples, resulting in consequences such as undesired childlessness, or the advancement to more invasive advanced reproduction technologies (all of which carry added economic costs and medical risks). If there is any evidence that a vaginal lubricant can interfere or limit a couple's fertility, it should carry a warning label to avoid its use while trying to conceive, and testing needs to be established by the FDA for any products that claim to not harm sperm. You can read a full report on this topic written by the author to the FDA at http://ingfertility.com/newreports.html.

In contrast, Pre~Seed "sperm-friendly" Intimate Moisturizer was developed in response to the need for a product to replenish vaginal moisture without harming sperm while couples were trying to conceive. Each lot is tested to not harm sperm before it is sold. So if you are trying to conceive, know the facts about vaginal lubricants. They damage sperm and should be avoided. If you need help with dryness, as many couples do, Pre~Seed was developed by a Sperm Physiologist and has several studies presented at National Reproductive Meetings suggesting its "sperm-friendly" nature.

Dr. JE Ellington, recipient of the 2003 International Young Andrologist Award for her research in sperm-Fallopian Tube physiology invented Pre~Seed through her work with infertile couples.

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