Prognosis following in vitro fertilization-embryo transfer (IVF-ET) in patients with elevated day 2 or 3 serum follicle stimulating hormone (FSH) is better in younger vs older patients: Article

Here is a summary of a paper by Check et. al. puvblished in Clin Exp Obstet Gynecol 2002; 29:42-4.
Please note that the article is old (2000) and therefore pregnancy rates are expected to be higher in 2012. Overall the result is meaningful though. also note that the pregnancy rates in the study are per transfer and therefore do not include cancelled transfers. Also live birth  rates are expected to be lower.

IVF success/transfer	FSH <12	FSH >12
Age  <38	32%	28.6%
Age >38	30.3%	5.5%

Ivf Prognosis based on FSH and AMH levels

IVF Prognosis	FSH normal	FSH abnormal (high)
AMH normal	Good	Reduced
AMH abnormal (low)	Very Reduced	Poor

This table summarizes oocyte production based on (day 3) FSH and AMH (Anti Mullerian Hormone ) values. It appears , based on the study (referenced below) that AMH is the better predictor.  Please note that this table is relevant up to the age of 42yo. After 42 the disparity between FSH and AMH does not seem to matter and patients with "good" FSH levels do better , regardless of AMH values.

Reference:

Gleicher N, Weghofer A, Barad DH. Discordances between follicle stimulating
hormone (FSH) and anti-Müllerian hormone (AMH) in female infertility. Reprod Biol
Endocrinol. 2010 Jun 17;8:64. PubMed PMID: 20565808; PubMed Central PMCID:
PMC2894827.

What is the best protocol for poor responders in IVF? Long protocol, estrogen priming , microdose lupron , short protocol with antagonist, low dose , mini ivf  or clomid  plus gonadotropins?

The answer is none of the above , or more appropriately ,  any of the above! I have attended a myriad or conferences , conventions and debates on this topic and the conclusion has always been the same!

Often patients come to see me and tell me that they  have read online that a certain protocol is much better . this statement is unsubstantiated by facts.  In fact when one looks at the actual studies the evidence is that these are allover the place , which basically means that there is no better protocol.

Many of these protocols  end up being associated with certain centers. Typical example is the estrogen priming protocol frequently used at Cornell. Many patients read about it and ask for the protocol and I have nothing against trying something different.

Ultimately my perspective is that if all protocols are pretty much equivalent , the  reasonable way to go is minimal stimulation. Mostly for 2 reasons : less hormones in your body and less money out of your pocket to buy crazy expensive drugs like Gonal F , Follistim  , Bravelle or Menopure.


Link to a great  scientific article about this topic here (it's a pdf file)


.

What is a "good" FSH level? Age Specific FSH levels

 

Serum follicle stimulating hormone (FSH) level is  measured on day three ( or 2 or 4) of the menstrual cycle. (First day of period flow is counted as day one. Spotting is not considered start of period.) If a lower value occurs from later testing, the highest value is considered the most predictive. FSH assays can differ somewhat so reference ranges as to what is normal, premenopausal or menopausal should be based on ranges provided by the laboratory doing the testing. Estradiol (E2) should also be measured as women who ovulate early may have elevated E2 levels above 80 pg/mL (due to early follicle recruitment, possibly due to a low serum inhibin B level) which will mask an elevated FSH level and give a false negative result.

High FSH strongly predicts poor IVF response in older women, less so in younger women. One study showed an elevated basal day-three FSH is correlated with diminished ovarian reserve in women aged over 35 years and is associated with poor pregnancy rates after treatment of ovulation induction(6% versus 42%).

This study by Gleicher et al assessed what normal values for FSH should be according to age. As you can see below the normal values are way below what  we normally tell patients: less than 9  mIU/ml .

Since normal b-FSH levels rise with female age, these levels should represent a more accurate represent- tation of ovarian function than currently used universal cut-off levels for all ages. Women who exceed their age-specific cut off levels, should be suspected of demon- strating PREMATURE OVARIAN AGING and should, therefore, immediately, be directed towards further diagnostic evaluation.


AGE SPECIFIC b-FSH LEVELS


< 33 Years              33-37 Years                   38-40 Years           ≥ 41 Years
< 7.0 mIU/ml        < 7.9 mIU/ml                 < 8.4 mIU/ml      < 8.5 mIU/ml


abstract below  (source fertility and sterility)

We evaluated a study group of 434 consecutive patients under age 41 years with baseline (b-) FSH levels of <12 mIU/ml (considered to represent “normal” ovarian function), who underwent ovarian stimulation for IVF with an ovarian stimulation protocol consisting of long GnRH-agonist or antagonist suppression and modal gonadotropin stimulation of 300IU of FSH/HMG per day. We assessed IVF cycle outcomes, including oocyte yields, based on age-specific b-FSH levels, defined as levels ≤ the 95% confidence interval of the mean (95% C.I.) for each age group. In the literature production of fewer than 5 oocytes in response to ovulation induction is considered to be evidence of ovarian resistance. We consider women under the age of 41 who produce fewer than 5 oocytes to have POA. Women with b-FSH levels above the 95% CI for their respective age groups were considered to be at increased risk of premature ovarian aging (POA). A logistic regression model for the presence of fewer than 5 oocytes at retrieval was performed using SPSS for Windows15.0. Continuous variables are presented as mean ±1 SE.

Lower IVF Pregnancy Rates Widely Reported in Patients of African Origin May Be Consequence of Genetic Predisposition towards Autoimmunity

 It has long been known that ivf success rates differ amongst different races/ethnic groups. This new study suggests that predisposition to autoimmune disease may be the cause for these differences.

Despite general improvement in outcomes of fertility treatments, disparities between races/ethnicities have actually increased. Prevalence of infertility also differs in that African women experience infertility more frequently than Caucasians and Asians. Causes for these differences have remained largely unknown.
This new study, just published in the prestigious medical journal PLoS One (www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0018781), was conducted by the Center for Human Reproduction (CHR) in New York, NY, and involved 339 Caucasian, Asian and African women. As previously widely reported in the medical literature, African patients demonstrated significantly lower IVF pregnancy rates, compared to Asian and Caucasian patients, even after controlling for age and BMI. African patients also demonstrated the highest rates of the recently described FMR1 (fragile X mental retardation) gene sub-genotype het-norm/low, which the same group of researchers previously reported to be statistically highly associated with autoimmunity. Asian women, with lowest prevalence of het-norm/low experienced the highest pregnancy rates after IVF.

 

Myth: You Cannot Pursue Treatment and Consider Yourself a Believer/Religious

Interesting article on about.com.  here are few highlights:

 his myth plays out in two ways. One is that accepting help or treatment somehow implies a lack of faith in God. As if infertility is a sign from God that you are not worthy of carrying a pregnancy or becoming a parent, and therefore, finding and accepting help is wrong.

The other way this myth plays out is that fertility treatments are religiously unacceptable, specifically IVF. Some religious groups believe that conception should never occur outside of the body, or they fear that embryos will be destroyed or indefinitely frozen.
This is especially a problem for fertility challenged Catholics, and for Christians who oppose intentional destruction or freezing of embryos.

 

No one really knows what God thinks, and bad things happen to good people for reasons we do not understand. No one can say whether what happens is "meant to be" or not.
Accepting fertility treatment is no different than accepting help for any other medical problem. If you would accept herbs, drugs, or medical treatment for your non-fertility problems, there's no logical reason to turn it away for infertility. Remember that Rachel of the Bible took a fertility herb of her time.
There are options for fertility treatment that may help avoid whatever religious or ethical problems you have. Remember that 85 to 90% of infertile couples can be treated with drugs, surgery, or other low tech treatments, and IVF may not even be necessary.

Link here

Recent Pregnancy Rates at our center.


As many people ask I am reporting the recent pregnancy outcomes at AFS. Please remember that the rates reported here represent ongoing pregnancy rates . Delivery rates are, of course, not yet available , and will, as always, be reported to and through the national CDC and SART databases. Clinical pregnancy rates are reported with reference point embryo transfer (pregnancy rate/embryo transfer) and not cycle start, meaning that only patients who reach embryo transfer are counted.






Please note delivery rates can be anticipated to be  lower than ongoing pregnancy rates, since additional pregnancy losses can be expected. 
It's important to note that  our approach to fertilty is to do less before more and that the majority of our patient conceive without undergoing IVF.  Only the patient that fail all other treatments undergo IVF.  This approach selects the most difficult cases.
Contrary to what most centers do , we do not  any type of patient selection. Patients with very abnormal FSH levels who have been rejected by other centers have been able to cycle with us. This approach means that in the end our overall pregnancy rates in the past have  been  lower than in centers who practice patient selection. I have never cared about this as i always prefer to do the right thing  for the patient rather  than withdrawing treatment  for my self interest . nevertheless i am proud of these results that will be updated fequently
.

A Sperm Bike for a sperm bank!

From the Sperm Bank of Copenhagen. A brilliant way of carrying  frozen sperm around town!  (Not the most discrete , to tell the truth)

Source: http://www.copenhagenize.com/2011/04/sperm-bike-in-copenhagen.html

Femara (Letrozole) or Clomid (clomiphene) for ovulation inducion: which one is better? Study shows they are equally effective.


Clomifene (INN) or clomiphene (USAN and former BAN) or Clomid or Clomifert is a selective estrogen receptor modulator (SERM) that increases production of gonadotropins by inhibiting negative feedback on the hypothalamus. It is used mainly for ovarian stimulation in female infertility due to anovulation

Letrozole (INN, trade name Femara) is an oral non-steroidal aromatase inhibitor.Estrogens are produced by the conversion of androgens through the activity of the aromatase enzyme. Estrogens then bind to an estrogen receptor, which causes cells to divide.

 Letrozole prevents the aromatase from producing estrogens by competitive, reversible binding to the heme of its cytochrome P450 unit. 

Letrozole has been used for ovarian stimulation by fertility doctors since 2001—having less side-effects than clomifene (Clomid) and less chance of multiple gestation. A Canadian study presented at the American Society of Reproductive Medicine 2005 Conference suggests that Letrozole may increase the risk of birth defect. A more detailed ovulation induction follow-up study found that letrozole, compared with a control group of clomiphene, had significantly lower congenital malformations and chromosomal abnormalities at an overall rate of 2.4% (1.2% major malformations) compared with clomiphene 4.8% (3.0% major malformations).

A recent meta analysis comparing the two treatments for ovulation induction, Clomid vs Femara  , published on RBM  online, suggests that the two treatments are equivalent outcome-wise. Side effects seem to be less for the Femara group.
In my experience the response seem to be very individualized : some patients respond better to Clomid , others to Femara.

Abstract Below

Abstract 

The aim of this study was to systematically compare the clinical efficacy and safety of letrozole with clomiphene citrate for ovulation induction in women with polycystic ovary syndrome (PCOS). The Cochrane Central Register of Controlled Trials, PubMed, EMbase, CBMdisc and CNKI were searched for eligible randomized controlled trials (RCT) comparing letrozole with clomiphene citrate in PCOS patients. Two reviewers independently extracted information and evaluated methodological quality according to the Cochrane Handbook 5.0. Meta-analysis was performed with the fixed-effects model or random-effects model according to the heterogeneity. Six eligible RCT involving 841 patients were included. Letrozole was associated with a number of lower mature follicles per cycle (standardized mean difference, SMD, –1.41; 95% CI –1.54 to –1.28; P < 0.00001) compared with clomiphene citrate. There were no significant differences in pregnancy rate (relative risk, RR, 0.97; 95% CI 0.79 to 1.18), abortion rate (RR 1.38; 95% CI 0.48 to –3.96) and multiple pregnancy rate (RR 0.34; 95% CI 0.07 to –1.72) between the two groups. The evidence from ovulation rates was not enough to support either letrozole or clomiphene citrate. In conclusion, letrozole is as effective as clomiphene citrate for ovulation induction in patients with PCOS

http://www.rbmojournal.com/article/S1472-6483%2811%2900180-5/abstract

Celiac disease is not a risk factor for infertility in men: study 

To follow up on research suggesting that men with celiac disease have impaired sperm quality, a team of researchers recently set out to examine fertility in men with biopsy-verified celiac disease.

Across the board, for every given time span, both before and after celiac disease diagnosis, men with celiac disease showed no higher rates of infertility. In fact, men with celiac disease fathered children at the same rate as these without, and showed similar rates for not fathering children.

 It's important to remember that this study covers male fertility, and that several studies have shown that women with celiac disease do suffer reproductive and/or fertility issues at higher rates than women without celiac disease.

 abstract below

Fertility and Sterility
Volume 95, Issue 5 , Pages 1709-1713.e3, April 2011
doi:10.1016/j.fertnstert.2011.01.132

 

 

DHEA and fertility. Does it help in decreasing infertility in women with diminished ovarian reserve and low AMH (Anti Mullerian Hormone)? Study.

A recent review study published on RBMonline  put together all the published cycles of  DHEA use ad IVF outcome in poor responders. The result was disappointing as there was no diference in the two groups (DHEA users vs non-users). 
As usual when it comes to retrospective meta analyses we have to be extra careful in making final conclusions as  this type of study puts together  a very eterogeneous group of patient treated in different clinics.
At this point , as the data is not conclusive i still think it is a good ideat to try DHEA  , it is a supplement that  does not require a prescription , in the dosage of 50 mg/day .

Reproductive BioMedicine Online

Article in Press

Effect of androgen supplementation or modulation on ovarian stimulation outcome in poor responders: a meta-analysis

Abstract 

Many trials have evaluated the use of androgen supplements and androgen-modulating agents to improve outcome of poor responders undergoing IVF treatment. This study conducted a systematic review and meta-analysis of controlled trials of androgen adjuvants (testosterone, dehydroepiandrostereone) and the androgen-modulating agent (letrozole) in poor responders undergoing IVF treatment. Searches were conducted on MEDLINE, EMBASE, Cochrane Library, ISRCTN Register and ISI proceedings. All randomized and non-randomized controlled trials were included. Study selection, quality appraisal and data extraction were performed independently and in duplicate. The main outcome measure was clinical pregnancy rate. The secondary outcome measures were dose and duration of gonadotrophin use, cycles cancelled before oocyte retrieval, oocytes retrieved and ongoing pregnancy rates. A total of 2481 cycles in women considered as poor responders undergoing IVF/intracytoplasmic sperm injection (ICSI) treatment were included in nine controlled trials. Meta-analyses of these studies did not show any significant difference in the number of oocytes retrieved and ongoing pregnancy/live-birth rates with androgen supplementation or modulation compared with the control groups. There is currently insufficient evidence from the few randomized controlled trials to support the use of androgen supplementation or modulation to improve live birth outcome in poor responders undergoing IVF/ICSI treatment.

Link:  http://www.rbmojournal.com/article/S1472-6483%2811%2900115-5/abstract

Birth rates in the United States are way down for all ages with the exception of women over 40!

New report from the CDC today. Study finds total U.S. births dropped from 4.3 million in 2007 to 4.1 million in 2009.this is obviously due to the economy. Fertility physicians also have noticed that less women are going for a second child!  But the good news that  birth rates have risen  6% for women over 40. Probably a sign of improved reproductive health. and (maybe) better fertility treatments!

Key findings

• From 2007 through 2009, birth rates for women aged 15–44 (fertility rates) fell for most states and nearly all major population subgroups.
• Birth rates declined for all women under age 40 with some of the largest decreases for women in their peak childbearing years.
• Fertility rates dropped for all major racial and Hispanic groups with the largest declines among Hispanic women.
• Birth rates by live-birth order also fell with the largest declines for third-order births and progressively smaller declines for second- and first-order births.
• Fertility rates decreased or were unchanged in every state and the District of Columbia with the largest declines among western and southeastern states.

The number of births in the United States reached an all-time high of 4,316,233 in 2007, but that number has since fallen (1–3). From 2007 through 2009, births fell 4 percent to 4,131,019; and the provisional count of births through June 2010 indicated continued declines (3). Fertility rates—which relate the number of births to women aged 15–44 (i.e., the childbearing years)—also fell during this time frame.
This report takes a more detailed look at the decline in births from 2007 through 2009 by mother's age, race and ethnicity, birth order, and state. The analysis is based on a comparison of 2007 final and 2009 preliminary birth data from the National Vital Statistics System (NVSS), and are the most current detailed birth data available.

The report was prepared by researchers in the CDC's National Center for Health Statistics, Division of Vital Statistics, Reproductive Statistics Branch.

source : CDC

Can sperm be grown in a lab dish ? Breakthrough Research suggests it may be possible. this may represent a future  solution for men with maturation arrest: article on Nature.

Sperm are very complex cells : they have a head a tail , need to be able to swim and penetrate an egg. Because of this male fertility can be affected by any disease of sperm envelopment. Often we hear about  immature sperm or morphologically abnormal sperm.

Researchers have been trying to grow sperm  In Vitro for a long time but without success.This work  was pioneered by Takehiko Ogawa and colleagues at Yokohama City University. The procedure involves taking biopsies of mouse testes, breaking them up into small  pieces, placing them on agarose gel  that has been partially soaked with a special medium, and letting them be for two months. If all goes according to plan, the chemicals in the medium would induce the gonadal stem cells to differentiate into mature sperm.

The secret of the success of this research has been to tweak the culture medium over time with different nutrients : it would be too complicated  to cover them here.
this is the kind of experiment that  is going to be very hard to reproduce by other labs as these guys have been at it for years and  , in this type of experiments, the secret is to follow a series of minute details.

Therefore clinical application of this technology  (for people) is years away. Another caveat is that in this technology is only valid if you have immature sperm to start with.  This is not a technique to make sperms from "scratch". Therefore men who have no immature sperm in their testicles would  not be helped with this method.  Nevertheless it is a huge leap!

Abstract below:

Spermatogenesis is one of the most complex and longest processes of sequential cell proliferation and differentiation in the body, taking more than a month from spermatogonial stem cells, through meiosis, to sperm formation^{1, 2}. The whole process, therefore, has never been reproduced in vitro in mammals^{3, 4, 5}, nor in any other species with a very few exceptions in some particular types of fish^{6, 7}. Here we show that neonatal mouse testes which contain only gonocytes or primitive spermatogonia as germ cells can produce spermatids and sperm in vitro with serum-free culture media. Spermatogenesis was maintained over 2 months in tissue fragments positioned at the gas–liquid interphase. The obtained spermatids and sperm resulted in healthy and reproductively competent offspring through microinsemination. In addition, neonatal testis tissues were cryopreserved and, after thawing, showed complete spermatogenesis in vitro. Our organ culture method could be applicable through further refinements to a variety of mammalian species, which will serve as a platform for future clinical application as well as mechanistic understanding of spermatogenesis. (source : Nature.com)

Link :  http://www.nature.com/nature/journal/v471/n7339/full/nature09850.html

Wht is the best protocol for poor responders (diminished ovarian reserve)? A comparison of different protocols for poor responders in IVF: study.


"Poor responders" are women who have a sub optimal response to fertility drugs: they make less eggs than expected after taking fertility medication. This may be due to actual age or to premature ovarian aging.
What is the optimal stimulation protocol for poor responders? For many years people have tried different protocols such as estrogen priing , microdose Lupron , micro hcg , high fgonadotropin , low gonadotropin, clomid plus gonadotropin etc.

A doctor may try to tell you that one protocol is superior to the other but , in fact they are all very similar in outcome.

This recent study on fertility and sterility compares microdose lupron protocol to luteal phase ganarelix(Antagon or Cetrotide). the outcome of the study is no surprise: no difference between the two protocols.

abstract below.

We performed a randomized trial to compare IVF outcomes in 54 poor responder patients undergoing a microdose leuprolide acetate (LA) protocol or a GnRH antagonist protocol incorporating a luteal phase E₂ patch and GnRH antagonist in the preceding menstrual cycle. Cancellation rates, number of oocytes retrieved, clinical pregnancy rates (PR), and ongoing PRs were similar between the two groups.

source : fertility and sterility

Does the age of the father have an effect on IVF ?Minimal effect of paternal age on IVF reproduction outcome: study

Interesting review article published on Fertility and Sterility. It is a review of the 10 studies published on the topic, most of them retrospective. the result is a bit surprising as it shows no effect. It is possible that IVF corrects the observed anomalies in sperm production observed wit advancing age

Objective

To summarize the current knowledge about the association between paternal age and assisted reproductive technology (ART) outcomes. In contrast to the extensive investigation of the relationship between maternal age and the success of ART, there are few studies examining the effect of paternal age on ART outcomes.

Design

Systematic review of the literature. By means of a PubMed literature search using the phrases “paternal age”, “male age”, and “assisted reproductive technology”, we identified articles that investigated the role of male age in in vitro reproduction techniques.

Result(s)

The 10 studies included in this review did not show a clear correlation between advanced paternal age and rates of fertilization, implantation, pregnancy, miscarriage, and live birth. Paternal age was not found to affect embryo quality at the cleavage stage (days 2–3). However, a significant decrease in blastocyst embryo formation was associated with increased paternal age, probably reflecting male genomic activation within the embryo. Except for volume, characteristics of semen such as motility, concentration, and morphology did not decrease with age.

Conclusion(s)

There is insufficient evidence to demonstrate an unfavorable effect of paternal age on ART outcomes. Further study with well-defined entry criteria and uniform reporting of outcomes is needed to investigate the subject.

source Fertility and Sterility
Volume 95, Issue 1 , Pages 1-8, January 2011

Physicians Recommend Different Treatments for Patients Than They Would Choose for Themselves

 

Article from the annals of internal medicine. Very interestingly  the conclusion is that physicians opt for quality of life as opposed to overall survival. 
No contradiction here. Physicians are obliged to present all options to the patients but they have to emphasize survival. The are very aware that very few patients with potentially deadly disease would not  be happy if they were steered towards the option with the lesser chance of survival. 

Doctors by training have to recommend the "standard of care" but  their insights in  end of life issues is such that they may chose to opt out.



 Abstract below

Arch Intern Med. 2011;171(7):630-634. doi:10.1001/archinternmed.2011.91
Background  Patients facing difficult decisions often ask physicians for recommendations. However, little is known regarding the ways that physicians' decisions are influenced by the act of making a recommendation.
Methods  We surveyed 2 representative samples of US primary care physicians—general internists and family medicine specialists listed in the American Medical Association Physician Masterfile—and presented each with 1 of 2 clinical scenarios. Both involved 2 treatment alternatives, 1 of which yielded a better chance of surviving a fatal illness but at the cost of potentially experiencing unpleasant adverse effects. We randomized physicians to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient.
Results  Among those asked to consider our colon cancer scenario (n = 242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (²₁ = 4.67, P = .03). Among those receiving our avian influenza scenario (n = 698), 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients (²₁ = 14.56, P < .001).
Conclusions  The act of making a recommendation changes the ways that physicians think regarding medical choices. Better understanding of this thought process will help determine when or whether recommendations improve decision making.

 Comment Below From Huffpost

"I think the doctors, when they were imagining themselves as the patient, were saying, 'Yes, there is a higher survival, but I don't want to put up with these horrible side effects,'" Dr. Peter Ubel of Duke University told WebMD. "On the other hand, when they are making recommendations for the patients, it is easier to push those emotions aside.''
Here's how the study worked. In the first scenario, doctors were asked to imagine that their patients had been diagnosed with colon cancer and had two options: Surgery 1 would cure cancer in 80 percent of the patients with no complications; 16 percent would not be cured and would die within two years; and the remaining 4 percent would be cured, but would have serious side effects like wound infection or chronic diarrhea. Surgery 2 would cure 80 percent of patients with no complications, but 20 percent would not be cured and would die within two years.
The study's authors explained that the two scenarios were selected because they involve a "trade-off between the risk of death and the chance of four surgical complications."
The results?

Of the 242 physicians who returned the colon cancer questionnaire, only 24.5 percent of the physicians said they'd recommend surgery two -- aka the procedure with the higher mortality rate -- for their patients. But when asked what they'd do personally, 37.8 percent of the physicians said they would opt for surgery two.
A similar pattern held up in a second scenario.
This time, primary care physicians were asked to imagine that a patient had contracted a new strain of avian flu for which there was an immunoglobin treatment available. Patients who declined the treatment faced a 10 percent mortality rate and 30 percent hospitalization rate for an average of one week. If patients opted to take it, their hospitalization and mortality rates would be cut in half, but the treatment would kill 1 percent of patients and result in 4 percent being permanently paralyzed.
Of the 698 physicians who responded, 48.5 percent recommended that their patients avoid the immunoglobin treatment, but when asked what they would do themselves, that number jumped to 62.9 percent. They attribute this, in part, to the idea of "betrayal aversion," i.e., the fear that something meant to prevent harm actually causes potentially even more harm itself. They suggest that when physicians make recommendations for others, they tend to focus on the decision that's easiest to defend, which is typically the option with the lowest mortality rate, regardless of the potential side effects.
The study's authors go on to conclude that just because physicians often make different decisions for themselves, it does not mean their personal decisions are necessarily better, given that the best choice in each scenario is debatable

source : huffington post

IVF officially a sin according to Catholic Church

One of the things that puzzles me the most about the Catholic church is it's insistence on using all sort of technology at the end of life (see it's insistence of keeping people on ventilators forever when they are brain dead) and at the same time be against all form of technology to help life at it's inception.
The article is in Italian from the Italian newspaper "La Stampa". In a nutshell, the Vatican experts on sin are currently meeting to analyze new "modern" forms of sin and undergoing IVF will probably be listed as one of them.

Link:  http://www3.lastampa.it/cronache/sezioni/articolo/lstp/394249/

 

IVF not a universal solution to infertility

This is an interesting new article about the realities of infertility treatments. Although modern fertility technology is able to help most couples. For many the road to success is paved with many hurdles and pains: physical , psychological and financial.

 quoting from the article

Though outcomes differ, the constant is that the couple is unable to conceive a child through intercourse, causing feelings of shame, embarrassment and isolation. Couples often are peppered with well-meaning advice and nosy questions from friends and family.
They begin a race against a clicking biological clock.
Some couples actually get divorced after successfully achieving a pregnancy, because they have ignored their relationship for so long.
Some have drained their savings, scraping together from $20,000 to $30,000 to travel to Washington or Colorado to fulfill a dream of giving birth. If they want to try again after a failed treatment, or want more than one child, they must pay again.

link: http://billingsgazette.com/news/local/article_ccd6b4a9-a925-5ae2-8000-3103313536a9.html

 Perfluorocarbons (PFCs) play a role in early menopause.....and most likely in reduced fertility


 This is an important article. Perfluorinated compounds (PFCs) are a family of fluorine-containing chemicals with unique properties to make materials stain and stick resistant. PFCs are incredibly resistant to breakdown and are turning up in unexpected places around the world. Although these chemicals have been used since the 1950s in countless familiar products, they’ve been subjected to little government testing.
There are many forms of PFCs, but the two getting attention recently are:

• PFOA or perfluorooctanoic acid, used to make Teflon products. they are used in many non stick pans.
• PFOS or perfluorooctane sulfonate, a breakdown product of chemicals formerly used to make Scotchgard products.

 source: contemporary obgyn

Perfluorocarbons (PFCs)—manmade surfactants widely found in the environment and in human tissues—are associated with early onset of menopause and endocrine disruption in women, a new study from the West Virginia University School of Medicine suggests.
Researchers conducted a cross-sectional analysis of data on 25,957 women 18 to 65 years of age, excluding those who had reported hysterectomy and adjusting for age within group, smoking, alcohol consumption, body mass index, and exercise levels. Serum levels of PFCs—including perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS)—and estradiol were evaluated, and the probability that menopause had occurred in women of perimenopausal age (older than 42 to 51 years) and menopausal age (52 to 65 years of age or older) was assessed. In the perimenopausal and menopausal age groups, women with PFOS and PFOA levels in the highest quintiles had higher odds of having experienced menopause than women in the lowest quintile. The researchers also found an inverse association between PFOS and serum estradiol but not PFOA and estradiol in these age groups.
Study authors speculate that PFCs might have a toxic effect on follicles, mimic estrogen properties, suppress pituitary release of luteinizing hormone or follicle-stimulating hormone, or influence the release of gonadotropin-releasing hormone from the hypothalamus. PFCs are present in food containers, clothing, furniture, carpets, paints, firefighting foam, and photographic emulsifiers.
Because the study was cross sectional, researchers couldn’t determine whether decreases in estradiol from PFC exposure during childbearing years explain the greater likelihood of menopause, and they could not independently confirm the survey data used in the study or ascertain the exact age of onset of menopause.
Data were drawn from the C8 Health Project, which collected data on 69,030 adults and children from 6 public water districts in which drinking water was contaminated by PFOA. The study was published online March 16 in the Journal of Clinical Endocrinology.

Yoga and Fertility

Interesting article on Yoga and fertility.  I am not sure that  any activity that helps reduce your stress is better than any other.  If yoga works for you then I highly recommend it.
A couple of quotes Below:

“We will never promise that you will get pregnant by doing yoga,” Ms. Quinn said. “We can tell you many women who have done yoga have gotten pregnant. But there’s no clinical data supporting the fact that yoga increases conception rates. The last thing we would want to do is give false hope.”

Some infertility clinics advise patients not to do vigorous exercise like running for fear of twisting their drug-stimulated enlarged ovaries. (This excruciating condition, called torsion, is rare, but surgery is often required if it happens with the possibility of losing the ovary, said Dr. Brian Kaplan, a partner at the Fertility Centers of Illinois, who advises his patients to limit exercise while taking stimulating drugs.)
But Dr. Domar, the executive director of a namesake center for mind-body health in Waltham, Mass., has found that some women are loath to give up their daily anxiety-relieving run during infertility treatments, or are “freaked out about gaining weight on fertility drugs.” In some cases, yoga is her bargaining chip. She tells those patients, “you can do hatha yoga and stay fit and toned, and give up your run.”
Ms. Spencer explained in an e-mail that for many patients, “There is a feeling of walking on eggshells and also that one false move may throw off the chances of success.” A class like hers lets them move and blow off steam, students said. “It’s like a can of worms,” she said in an interview. “You can’t stop women from talking to one another.”

Link to article http://www.nytimes.com/2011/02/06/fashion/06yoga.html?pagewanted=print

Does Stress Reduce Fertility or cause infertility? New Article

Does stress cause infertility?  IU get asked this question at lieast 2 times per day.  My answer is that it is possible.

But a ew article  on British Medical Journal  suggest that there is no relationship between   stress (as defined buy the clinical trems of anxiety and depression) and outcome of fertility treatments. this article is a meta analisys  which means that the authors put together the data of multiple studies and analised them together.

I would probably argue that the findings are close to the truth. It is very likely that in cases of extreme stress fertility is certainly affected.

In another are  of medicine it is interesting to note that most studies show that attitude towards  a cancer diagnosis does not seem to have an effect on survival.

  
source : BMJ 2011; 342:d223 doi: 10.1136/bmj.d223 (Published 23 February 2011)


abstract below

Abstract



Objective To examine whether pretreatment emotional distress in women is associated with achievement of pregnancy after a cycle of assisted reproductive technology.

Design Meta-analysis of prospective psychosocial studies.

Data sources PubMed, Medline, Embase, PsycINFO, PsychNET, ISI Web of Knowledge, and ISI Web of Science were searched for articles published from 1985 to March 2010 (inclusive). We also undertook a hand search of reference lists and contacted 29 authors. Eligible studies were prospective studies reporting a test of the association between pretreatment emotional distress (anxiety or depression) and pregnancy in women undergoing a single cycle of assisted reproductive technology.

Review methods Two authors independently assessed the studies for eligibility and quality (using criteria adapted from the Newcastle-Ottawa quality scale) and extracted data. Authors contributed additional data not included in original publication.



Results Fourteen studies with 3583 infertile women undergoing a cycle of fertility treatment were included in the meta-analysis. The effect size used was the standardised mean difference (adjusted for small sample size) in pretreatment anxiety or depression (priority on anxiety where both measured) between women who achieved a pregnancy (defined as a positive pregnancy test, positive fetal heart scan, or live birth) and those who did not. Pretreatment emotional distress was not associated with treatment outcome after a cycle of assisted reproductive technology (standardised mean difference −0.04, 95% confidence interval −0.11 to 0.03 (fixed effects model); heterogeneity I²=14%, P=0.30). Subgroup analyses according to previous experience of assisted reproductive technology, composition of the not pregnant group, and timing of the emotional assessment were not significant. The effect size did not vary according to study quality, but a significant subgroup analysis on timing of the pregnancy test, a contour enhanced funnel plot, and Egger’s test indicated the presence of moderate publication bias.
Conclusions The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.