Fertility and pregnancy
IVF babies do fine, but their moms may be at risk
Babies born by in vitro fertilization (IVF) do not face an increased risk of birth defects, nor are they at greater risk of being smaller than normal, according to a study conducted in Japan.
But the researchers did find that women pregnant via IVF were more likely than those who conceived naturally to develop a pregnancy complication called placenta previa, in which the placenta blocks the opening to the birth canal.
Some studies comparing babies born through IVF and those conceived naturally have found worse outcomes for the IVF infants, including higher rates of birth defects and greater likelihood of low birth weight, Mai Fujii of the World Health Organization in Geneva and her colleagues note in their report.
Studies shed light on preserving fertility among cancer patients
Cancer treatment has come a long way, leading to a multitude of therapy options and improved survival rates. These successes, however, have created a challenge for young cancer patients since chemotherapy and radiation treatments that often save lives threaten fertility. Techniques available to safeguard fertility, such as freezing eggs for later embryo development, have poor odds of success, leaving patients with very limited options for the future. But that is beginning to change as researchers improve current techniques, mature human eggs in the laboratory, and discover cellular mechanisms that could help preserve and even restore fertility. Researchers will report on these and other findings at the 42nd annual meeting of the Society for the Study of Reproduction (SSR), July 18 to 22, at the David L. Lawrence Convention Center in Pittsburgh.
Summaries of the findings are as follows:
Growing Egg Cells in the Lab
Researchers at Northwestern University are developing a method they hope will help preserve a woman’s fertility after radiation and chemotherapy treatment. Led by Teresa K. Woodruff, Ph.D., the team has grown undeveloped human eggs to near maturity in laboratory cultures. During a 30-day experiment, they grew human follicles―tiny sacs that contain immature eggs―in the lab until the eggs they contained were nearly mature. According to Dr. Woodruff, this is the first step in developing a new fertility option for young cancer patients.
Who goes abroad for fertility treatment and why?
A substantial number of European patients travel to other countries for fertility treatment, both because they think that they will receive better quality care abroad and in order to undergo procedures that are banned in their home country says a study of the subject launched at the 25th annual conference of the European Society of Human Reproduction and Embryology today (Monday June 29). Study co-ordinator Dr. Françoise Shenfield, from University College Hospital, London, UK, said that this was the first hard evidence of considerable fertility patient migration within Europe. “Until now we have only had anecdotal evidence of this phenomenon”, she said. “We think that our results will be of considerable value to patients, doctors, and policymakers.”
During a one-month period, the ESHRE Task Force analysed data from participating clinics in six European countries: Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland. Clinics were asked to provide questionnaires to patients coming from abroad for treatment. The questionnaires asked about their age, country of residence, reasons for travelling to another country for treatment, which treatment they had received, whether they had received information in their own language, how they had chosen the centre they were attending, and whether they had received reimbursement from their home country’s health system. 1230 forms were completed and returned.
“This may not seem to be a very high number”, said Dr. Shenfield, “but it reflects only one month of events in a limited number of centres in six countries. The total number of treatment cycles per year can be estimated by extrapolating our monthly data to a year and by assuming that the centres represent no more than half of the centres in each of the countries studied. This leads to an estimate of at least 20 000 to 25 000 cross-border treatment cycles per year in these countries. It is, however, difficult to derive a number of patients from these numbers as patients receive more than one cycle to obtain a pregnancy, the mean number depending on the type of treatment.”
Ovarian tissue transplant may restore fertility
Even after highly concentrated cancer treatment of the ovaries, long-term ovarian function and fertility can be restored by repeated ovarian transplant with tissue taken from the patient before treatment, researchers in Korea and the US report in the current issue Fertility and Sterility.
In frozen ovarian tissue, a lack of oxygen after ovarian grafting causes a substantial loss of follicles, shortening the life span of the tissue, so repeated transplantation may be required, Dr. S. Samuel Kim at the University of Kansas, Kansas City, and his co-investigators note.
Until now, the authors note, no successful pregnancies after transplantation have been reported.
Ovarian changes may link obesity and infertility
Obese women have alterations in the environment around the ovary before they ovulate that appear to play a role in the well-documented association between obesity and reduced fertility, according to a report in the Journal of Clinical Endocrinology and Metabolism.
“Characteristics of eggs are influenced by the environment in which they develop within the ovary,” lead author Dr. Rebecca Robker, from Adelaide University, Australia, said in a statement. “Our study found that obese women have abnormally high levels of fats and inflammation in the fluid surrounding their eggs, which can impact an egg’s developmental potential.”
Mood disorders common in polycystic ovary syndrome
The prevalence of depression and anxiety among patients with polycystic ovary syndrome is high and warrants routine screening and aggressive treatment, investigators report in the journal Fertility and Sterility.
In a previous study, Dr. Anuja Dokras, at the University of Pennsylvania and colleagues identified high rates of depression (35 percent) among women with PCOS, substantially higher than the 10.7 percent rate among the comparison subjects. The current report is a follow-up to that study to determine the persistence of mood disorders and the incidence of new mood disorders.
Sixty of the original 103 women participated in the second survey, conducted an average of 22 months after the first survey.
No drop in US preterm births, 2006 stats show
The Centers for Disease Control and Prevention’s newest statistics on US births show that preterm births continue to rise, while C-sections accounted for 31.1 percent of births in 2006-an all-time high.
Since 1990, there has been a 20 percent increase in the percentage of babies born preterm, or before 37 weeks gestation. Most of this rise has been driven by so-called “late-preterm” births, or infants born between 34 and 36 weeks’ gestation, Joyce A. Martin and colleagues from the CDC’s Division of Vital Statistics note in the January 7 issue of National Vital Statistics Reports.
There were nearly 4.3 million babies born in the US in 2006, the report shows, the largest number in more than four decades. While the Healthy People 2010 set a goal of 7.6 percent of babies born preterm, the actual 2006 number was far higher, with 12.8 percent of babies born before 37 weeks in the womb.
Post-cancer reproduction still low for women, men
Strategies introduced in the late 1980s for protecting fertility in patients undergoing cancer treatment may have indeed helped boost reproduction rates modestly among survivors of certain types of cancer, new research from Norway suggests.
However, overall, female cancer survivors remain about half as likely as women who had never been diagnosed with the disease to have a child within the 10 years following their diagnosis, the researchers found. For male cancer survivors, reproduction rates were about 30 percent lower than among their healthy peers.
“There is much left to be done to improve post-diagnosis reproduction, in particular in women,” Dr. Sophie Dorothea Fossa of The Norwegian Radium Hospital in Oslo and her colleagues conclude in a report in the Journal of Clinical Oncology.
Early cardiac activity predicts good IVF outcome
A beating fetal heart 4 weeks after in vitro fertilization (IVF) predicts successful completion of the first trimester of pregnancy.
“Early ultrasound, in the patient with no history of miscarriage, is a very good predictor of a viable pregnancy,” Dr. Peter G. McGovern from the University of Medicine and Dentistry of New Jersey in Newark told Reuters Health.
McGovern and his colleagues measured fetal cardiac activity 4 weeks after IVF in 139 women undergoing fresh IVF cycles.
Drug for ecoptic pregnancy won’t harm ovaries
Use of a single dose of the drug methotrexate to treat ectopic pregnancy does not appear to curb a woman’s fertility, according to Spanish researchers.
An ectopic pregnancy occurs when the fertilized egg is implanted outside the uterus, usually in the fallopian tubes. These pregnancies can result in bleeding and death if the embryo is not removed, either surgically or with drug therapy.
To see whether methotrexate therapy for ectopic pregnancy impairs future fertility, researchers measured blood levels of a protein called anti-Müllerian hormone or AMH, which is an indicator of “ovarian reserve.”
Consent form developed for infertility therapy
The Society for Assisted Reproductive Technology (SART) has developed a comprehensive document for doctors to use when obtaining informed consent from patients seeking infertility treatment.
“This is our compilation of the important elements of informed consent that should be reviewed with patients,” incoming SART president Dr. Elizabeth Ginsburg said in an interview with Reuters Health. “It’s designed to be used ‘as is,’ or it can be used by clinics to adjust their own consent forms.”
As presented at the American Society for Reproductive Medicine annual meeting in San Francisco, the form explains the different options available to patients, including, among others, in vitro fertilization and embryo frozen storage or “cryopreservation”.
Infections linked to premature births more common than thought, Stanford study finds
Previously unrecognized and unidentified infections of amniotic fluid may be a significant cause of premature birth, according to researchers at the Stanford University School of Medicine.
An analysis of amniotic fluid from women in preterm labor indicated that 15 percent of the fluid samples harbored bacteria or fungi - an increase of 50 percent over previous estimates. The heavier the burden of infection, the more likely the women were to deliver younger, sicker infants.
“If we could prevent these infections in the first place, or detect them sooner, we might one day be able to prevent some of these premature births,” said research associate Dan DiGiulio, MD, who conducted the study in the laboratory of senior author David Relman, MD. About 12 percent of all births in this country are premature and the frequency of premature birth is increasing.
Testosterone unproven as yet for women’s sex woes
Women should not take testosterone to treat loss of sexual desire until there is good evidence it is safe—and that it actually works—a behavioral scientist warns in a new report.
“I think that there is a lot of excitement about the use of androgens (’male’ hormones) to treat low sexual desire in women that is based on evidence that looks better than it really is,” Dr. Leslie R. Schover told Reuters Health. “I think that the evidence has some significant flaws.”
Shover, a professor at the University of Texas M.D. Anderson Cancer Center in Houston and the author of the article in the journal Fertility and Sterility, adds: “This area of research is being driven by the incredible profits that pharma companies are expecting, given that one in three women in the US will rate herself as having low sexual desire.”
Preeclampsia may up risk of kidney disease
Women who develop preeclampsia during pregnancy appear to be at increased risk for developing end-stage renal disease (ESRD) later in life—although the absolute risk is small—new research suggests.
Preeclampsia is a potentially serious condition that occurs in pregnancy, characterized by a dangerously high rise in blood pressure, protein in the urine, and an increased risk of having a premature infant.
“The biggest finding in our study is that preeclampsia is associated with a 4- to 5-times increased risk of ESRD. We were surprised that the association was that strong,” lead researcher Dr. Bjorn Egil Vikse told Reuters Health.
Newest fertility treatment may be a diet
The newest low-tech fertility treatment may be a diet, researchers said on Wednesday after learning that obese men have more abnormal sperm and make less semen.
Their findings, presented at a meeting of the European Society of Human Reproduction and Embryology in Barcelona, Spain, add to recent research showing that obese women are more likely to be infertile.
“We felt that it was possible that male overweight might contribute to fertility problems, particularly since it is a known risk factor for problems in conceiving among women,” said Dr. Ghiyath Shayeb of the University of Aberdeen in Scotland.
