Marijuana, Male Fertility & Female Fertility with Nurse Practitioner Amber Lambert
From an interview with Amber Lambert, nurse practitioner, on October 7, 2020.
Hello, everybody. So glad to be here with Amber.
I'm a family nurse practitioner, but people just call me Amber, Amber Lambert. My name rhymes, so it's easy to remember.
So glad again to have you here, and we're gonna jump right in with some questions. We want to get to know you a little bit. And then, of course, you're also going to talk about marijuana and fertility, which I know is a hot topic right now. So I'm so excited to learn more. Why don't you tell us a little bit about yourself?
So yes, I live in Louisiana. I have a family nurse practitioner degree. I got it from Louisiana State University right here in New Orleans. I'm currently pursuing my doctorate degree, set to graduate December of 2021. But I've been working with women for a little over 10 years now.
Why did you choose to work with Premom?
I really like this app. I feel like the app and Premom give women the opportunity to learn about their cycles and track their cycles over time and look at their peak and when they ovulate and the best time to have intercourse. The other thing, the component that it had in there, was tracking your cervical mucus. You can be familiar with when you are ovulating and the changes and the hormonal changes that take place with the mucus and to be able to identify those things. The only thing is it gives you the opportunity to try to figure things out without having to go to a fertility clinic, which sometimes can be scary for some people. And the other thing, it could be very costly. And then you have virtual consults that are available, where you can talk to somebody that's had the ability or experience with natural family planning -- or just family planning in general. The app also has a whole lot of education for these women to go on there and look at it and say, "Okay, what does this mean or what can I do with this?" I really like it. I feel like it has a whole lot of aspects in here that are good for women, especially women trying to get pregnant.
Can you talk a little bit more about what you specialize in and who you like working with in particular?
Predominantly women's health. Over the last 10 years, pretty much the time has always been with some type of women's health clinic. I don't work in the hospital. I'm not a midwife. So I don't deliver babies. My love -- or like a soft spot for me -- is teen pregnancy prevention, birth control and helping teens learn about their bodies and their cycles and what's normal and what's not normal. Because there are so many changes that take place as a teenager. So it's kind of one of my specialty areas there.
Oh, yes, I love that.
Because Louisiana -- at one point -- we had the highest unintended teen pregnancy rate, or unintended pregnancy rate, for a very long time. So it's one of those things that I really, really like to be involved in.
It can be scary, especially for young adults. There's so many things we talk about, something simple as cervical mucus: what's normal normal, what's not normal. I've got 13, 14-year-olds, and they've never seen something like that.
Let's jump into our topic for today. Here's your first question. Can I still get pregnant when on marijuana, and how does it affect women's fertility?
I'll tell you this topic -- I get asked all the time. That's why I thought it was a very important topic, especially now because we're having more legalization of marijuana. A short, easy answer to that is yes, you can. People get pregnant who smoke marijuana all the time. The question that comes to be is, though, does it affect your ovulation? There's some data, some studies that say yes; potentially, it can delay your ovulation.
But then when you look at databases on pregnancy and timing to get pregnant, there's nothing that really supports that as much. To dig in deep into the research and the information is when you see: these delays of pregnancy of people who smoke marijuana -- there's generally other additives, things that are going on, that can contribute to delay of ovulation, or delay of getting pregnant. Sometimes obesity, or diabetes, insulin resistance, all those things -- and add marijuana to that -- potentially can delay ovulation. So somebody might not have a period every 28 days; they might have a period every 35 or 45 days, and that can delay or prolong getting pregnant. But that doesn't mean necessarily that you cannot get pregnant just because you smoked marijuana.
So is it acceptable to have marijuana when you are pregnant?
I get that question a lot, too. I think the huge thing with this is the unknown. And mainly because there's not a whole lot of studies that we have -- or controlled studies -- on pregnancy. This is how I usually explain it: you have two groups, probably 20 people here that are pregnant and 20 people there that are pregnant. Everybody's the same kind of sample for this. But we can't do studies where we say this group is going to get marijuana, cocaine and ecstasy, and this group isn't going to get anything. And let's just see how everything turns out. It's not ethical; it's not moral. We can't do studies like this. That's why it's hard to have studies to see what these effects are, because you have to do observation over time, over long periods of time -- and not just of the pregnancy -- in the growth of the pregnancy, and also what happens in these babies later on. So that's why it takes a long time to get this information. But what we do know is it does cross the placenta. It enters in breast milk. So you see these things. And because there's so much unknown, we do not recommend marijuana in pregnancy.
With that being said, we have found that there are potential for what we call "neurodevelopment problems," and there is evidence that shows that. We have seen later on -- as studies have progressed and looked at these children over time -- some of these children have lower cognition or a decrease in academic achievements or lower IQs, increased risk in hyperactivity or attention or attention deficit (ADD kind of thing). It has shown those things. The other thing is it talks about potential fetal growth restriction during the pregnancy --but also usually those things are also affected with other comorbidities or risk factors that are going on during that pregnancy, too, like smoking tobacco, or blood pressure problems during the pregnancy. Those are all things combined. Because there's so much lack of data there, and there is a need for more research, because we don't know all the specifics of the rest - but we do know that there is some cognition and problems later on in life with the children -- we don't recommend any at all.
Yeah, that makes sense. I'm wondering if that ties into another question or if this is more for men: does high or low amount have a difference?
It kind of goes a little bit with the sperm situation. For years and years and years we used to say that marijuana affected sperm count. We went by that all this time and then last year, they had this big study that came out that says: "Hey, we looked at all these men, we looked at all these semen analyses, and it actually potentially could increase sperm count." But it talks about that at a low dose. It doesn't go into details of what happens with a high dose or increased demand, daily chronic use of marijuana. That goes more along the lines of it potentially decreasing the sperm count.
When you think about sperm and marijuana, it also affects it in other ways. And that's something that study did not really talk too much about. Men make about 1500 sperm a second, so billions and billions of sperm over time. The other thing is a sperm is real, real small, 0.05 millimeters, if you can think about that. It's super, super tiny. That sperm needs to travel about six inches to get from the cervix all the way up to the fallopian tube. That little sperm, it takes him about 30 minutes, maybe to an hour to get there. But what we know with male patients that smoke marijuana: the sperm motility is actually affected. Even if you just take out the article, the new study that came out about count, we still know that it affects the motility and how it can move and move fast up to fertilize that egg. What happens is sometimes they swim in circles, or they kind of go here and they go there instead of going where we want them to go. Or it might move really slow. So instead of taking 30 minutes to an hour to get there, it might take four hours to get there. Marijuana also affects the ability of the sperm to penetrate through that egg, which is huge -- fertilization. Those are things to think about. Going back to how long the sperm is affected -- I get that question a lot too -- so, 1,500 sperm a second, all these sperm, they are stored for up to like 70-75 days and are affected by marijuana. You really want to be off marijuana for at least 70-75 days to have potentially no stored sperm in there that have affected motility or the ability to become active over time.
Yeah, that's such an interesting point. It's not just about the count, it's about the effectiveness of the sperm that you have. Reminds me of those articles on coffee and wine that come up every so often. Like: "It's good for you!" Did you have any thoughts on CBD as well. Same thing?
I have mixed feelings about it because I think there just needs to be a whole lot more research on that. All of them are made a little bit differently: the production, the amount, and how it's absorbed. Cream versus inhaler. All these different things. Without knowing too much about it or having more data on it -- because there's so many various forms that you can get -- I still would recommend no at this time,
I know some might have some THC in them, even though they try not to, so there's that issue sometimes.
I think that covers our questions. Is there anything else you'd like to leave our community with? Any thoughts? Suggestions?
I think when we talk about the fertility, the sperm stuff or the ovulation, just keep those things in mind. Marijuana -- in pregnancy, potentially can have long term effects on the children later. Sperm -- we would like to be free of marijuana for 70-75 days to give you the best potential to get pregnant. And technically, there's nothing huge that says it's going to prevent a pregnancy, because we can get pregnant all the time even with marijuana, from what we see. Depending on your history and your background, you might have a little bit of a delay there. But other things are probably affecting that versus the actual ovulation. And I'm available for virtual consults if you need to. I've been doing this, absolutely love them. Kind of analyzing your period and your graphs and everything and figuring out when's the best time or some suggestions and things like that.
Yeah. Thank you so much for joining us today, Amber.
Yes, I'm glad we were able to do it. Thank you.