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Fertility specialist Oluyemisi Famuyiwa discusses her KevinMD article, “Why is no one listening? The urgent impact of marijuana on fertility.” In this episode, Yemi explores the emerging concerns surrounding marijuana legalization and its effects on reproductive health, highlighting trends in usage, associated fertility risks, and potential solutions. Listeners will gain insights into the scientific evidence linking cannabis use to infertility, understand the long-term implications for couples trying to conceive, and discover actionable steps to mitigate these risks.
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Transcript
Kevin Pho: All right. Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Yemi Fambuyiwa. She’s a fertility specialist, and today’s KevinMD article is “The urgent impact of marijuana on fertility.” Yemi, welcome back to the show.
Oluyemisi Famuyiwa: Thank you. Thank you for having me.
Kevin Pho: All right. So tell us what this article is about.
Oluyemisi Famuyiwa: So this article came about when I noticed that in my patient population, ever since marijuana was legalized, especially in the state of Maryland, the consumption of marijuana has just exploded. And people almost seem to walk around thinking, “Oh, it’s so innocuous. I just feel nice.” I believe that there are certain impacts, and I’ve noticed some incentive in some of my patients, especially regarding their sperm and also the outcomes.
That made me think, you know what, I want to dig deeper into this, and I want to expose it and sort of bring to light some of the potential harmful effects of marijuana. Because I think everyone believes it’s innocuously normal and OK.
Kevin Pho: So tell us some of the data that links fertility with marijuana.
Oluyemisi Famuyiwa: So the data has been all over the place. If you were to look at data from the early 2000s or 1900s, it’ll tell you, “Oh, there was not a significant impact.” I know I read a retrospective review where they did a meta-analysis of all retrospective data from 2018 downwards that said, “Oh, there’s no significant impact.”
So there are no well-controlled prospective trials. And in addition, we’re now starting to get those being done, but also molecular trials, where they look in vitro in the lab and see what’s happening with the sperm and the egg. I know that the American College of Congress of OBGYN puts out a statement that you should try to avoid marijuana when you’re pregnant because there may be deleterious effects on the baby.
But now we’re getting molecular data straight from the lab, besides observational data, that says there could actually be some significant impact, and researchers are starting to work out the mechanisms of action for some of these deleterious effects.
Kevin Pho: Now you mentioned that there may be a connection between the THC component of marijuana and mitochondrial function in reproductive cells.
Oluyemisi Famuyiwa: Absolutely. So the cannabinoids and THC, when they were studied, there was actually a study I read where they looked at the mitochondrial membrane potential in cells that were exposed. They actually looked at sperm that were exposed to THC and found altered membrane potential at the mitochondrial level.
Further studies have shown THC can affect the membrane potential not only in sperm but also in tissue like the placenta of a pregnancy, and there are indications that other parts of the body, such as the brain, may be affected by this as well. But I chose to focus on the fertility-oriented part.
In addition to the membrane potential, we know that it can affect lipid peroxidation. Right now, let me know if you want me to explain what that is a little bit.
Kevin Pho: Sure.
Oluyemisi Famuyiwa: OK. So lipid peroxidation is when you get excess production of free radicals that are not neutralized. Free radicals are missing one electron—they don’t like to be that way—so they will try to steal an electron from their neighboring cells.
Now, if this happens in your membrane, they will steal an electron from the lipid bilayer. And where you steal that electron, that spot will also steal another electron from its neighbor, which then goes on to its neighbor, and so forth. It’s a domino effect. The way to visualize this is, let’s say you have a Jenga tower, and you’re pulling blocks out of it—when you pull electrons out, you’re not replacing them. Eventually the whole tower collapses; that’s oxidative stress. Another term for that is lipid peroxidation.
Kevin Pho: Now, you also made a potential connection between marijuana use and increased miscarriage rates as well.
Oluyemisi Famuyiwa: Huh. So one of the studies I looked at—now we’re trying to reconcile conflicting studies—used, I believe, an animal model for ethical reasons. They looked at the fertilized embryo.
We know that marijuana affects the membrane potential and mitochondria. And by the way, when you affect the mitochondria and affect the membrane potential, you do have decreased motility—that’s been documented. So they took it one step further. They looked at the embryos created from sperm that were co-cultured with THC.
They noticed that these embryos did develop to blast, but the resulting blast had fewer cells on the outer layer—that’s the trophectoderm. A blastocyst is formed when an egg fertilized by a sperm becomes a zygote, which initially divides into two cells, then four cells, then eight, then sixteen, and so on, until you get what is called the morula (where you can’t distinguish individual cells). The morula then develops a cystic cavity within it, and the next stage is the blastocyst, a sphere with an outer layer, a fluid-filled center, and then a clump of cells (which could be at any orientation but let’s say six o’clock). That clump on the inside is the inner cell mass—that’s going to become the baby. The outer layer is the trophectoderm, which will become part of the placenta.
When these embryos were cultured in that THC environment, the inner cell mass had fewer cells, and the outer trophectoderm layer also had fewer cells. So the blastocysts you get from these exposed embryos and sperm had fewer cells overall, which makes you wonder about the ability to implant and overall developmental potential. That was one of the first things noted.
In addition, they noticed that THC affected the amount of microRNAs that were produced in the sperm. MicroRNAs are important in regulating how the DNA is read and transcribed; in other words, they’re part of what is called epigenetics, right, that we often hear about. If you change those microRNAs with THC, some of those changes can be passed on to the offspring. So now the offspring could potentially be affected because of what the parent did—and you have something being passed on down the genetic line.
Kevin Pho: Now, what about marijuana derivatives like CBD oil, which doesn’t have a THC component? Are those also risk factors for problems in fertility as well?
Oluyemisi Famuyiwa: I think the data is still out on that. I’ll confess I didn’t really read about the oils per se. I went straight for the THC and the cannabinoids themselves. What they’ve shown—and what I’ve read—is that it affects the cannabinoid receptors and also disrupts the endocannabinoid system, the endogenous cannabinoid system that’s there. They believe some of this disruption can happen in a competitive, agonistic fashion. How did they come about that? They gave an antagonist to the receptor and noticed they were able to reverse a lot of these changes. So I think that’s an excellent question, Kevin. I’d like to do more research on that. I didn’t look specifically into the oils.
Kevin Pho: Now, how do you counsel couples who come to your fertility clinic and they recreationally use marijuana? How do you counsel them?
Oluyemisi Famuyiwa: I usually discourage it, but most of the time, the most severe disruption I’ve seen in sperm is if someone comes to me and they have 1 percent morphology of sperm, or 0 percent—meaning no normal sperm shape. The sperm’s barely moving; you wonder if they’re alive, and the count is down. Then I’ll counsel that person, “You really want to consider stopping this habit.”
There’s data now that says marijuana is being used more than alcohol. Recently, its use has exploded. And most of the people using it aren’t using low concentrations—like 0.03 micromolar. Some of these people, if you check their system, they have 4.8 micromolar. Right? So they’re using a lot. I had a gentleman walk into the office—golly—we had to aerate the office, fumigate, turn on every fan, and I had to kindly ask him, “Could you please either not come in my office or stop smoking marijuana?” They walk in their own cloud of smoke, and they think it’s innocuous.
Look, there was another observational finding where they saw that even women who were pregnant and whose partners smoked marijuana had a slightly higher incidence of miscarriage. Hmm. I do tend to counsel them to think about all the new data coming out. And if we’re struggling to get normal sperm or eggs, then you want to meet us halfway.
Kevin Pho: Now, why do you think this isn’t as well known as it should be? Why is there not more of a public health campaign that publicizes the risk of medical marijuana?
Oluyemisi Famuyiwa: I think more and more scientists are starting to show this in their respective fields. ASRM last year—there was a big group from China that actually presented basic science research showing the effect. I think the reason we’re not talking about it is that it’s not politically correct, right? You know, the marijuana industry is not going to like what I have to say about this.
Now, my objective is for people trying to get pregnant. What they do after that—that’s their headache. But I’m saying that there is a problem, there is an issue that no one wants to pay attention to because it’s not politically correct.
Kevin Pho: We’re talking to Yemi Famuyiwa. She’s a fertility specialist. Today we’re talking about “The urgent impact of marijuana on fertility.” Yemi, as always, let’s end with some take-home messages that you want to leave with the KevinMD audience.
Oluyemisi Famuyiwa: So I think we need to be more aware of this, and people need to pay attention. All these scientists that are coming out and saying there is a problem—at what point are we going to say, “OK, let’s seriously look at this and see what’s going on,” especially if it could potentially lead to epigenetic disease changes that are lasting?
Kevin Pho: Yeah. Yemi, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Oluyemisi Famuyiwa: Thank you for having me.
