Monthly Archives: October 2008

Cell phone risk to sperm supported

An in vitro comparison study has strengthened concerns that electromagnetic radiation from cell phones impairs male fertility.

 Ashok Agarwal (Cleveland Clinic, Ohio, USA) and colleagues set out to validate the implications of recent epidemiologic studies, which reported reductions in sperm motility, morphology, and viability associated with cell phone exposure.

 They studied neat semen samples from 23 normal healthy donors and nine infertility patients. They divided the samples into two aliquots and exposed one of each sample to radiation from cell phones in talk mode, leaving the second aliquot unexposed to serve as controls.

 Analysis revealed significantly lower sperm motility and sperm viability in aliquots of exposed compared with unexposed sperm (49 vs 52 percent and 52 vs 59 percent, respectively).

 Levels of reactive oxygen species were also significantly higher in samples of exposed compared with unexposed sperm (0.11 vs 0.06 x106 cpm/20 million sperm), Agarwal et al report.

 Total antioxidant capacity and levels of DNA damage did not differ significantly between the two groups.

 “We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility,” the researchers conclude.

 Source: Fertility and Sterility 2008; Advance online publication  

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Freezing improves DNA integrity

Gamete cryopreservation could help improve the fertility of men whose spermatozoa show a high level of prefreeze DNA fragmentation, study findings indicate.

 Laura Thomson (Fertility First, Hurstville, Australia) and co-authors note potential cryoinjury of sperm from subfertile men is an issue of primary concern “considering that subfertile men form a very large proportion of the men requiring semen cryopreservation.”

The findings were observed during a study comparing different cryoprotectants used to store spermatozoa for fertility treatment. The study involved 320 men who presented for fertility investigations and provided semen samples.

Post-thaw sperm DNA integrity was unaffected by the type of cryoprotectant used during freezing, but showed a significant, negative correlation with the prefreeze level of DNA fragmentation. Among men with prefreeze sperm DNA fragmentation levels within the normal range, 89 percent showed an increase in fragmentation post-thaw. Conversely, 64 percent of those with very high levels of prefreeze fragmentation showed a decrease in fragmentation post-thaw.

The authors suggest that the result “gives rise to a possible novel method of reducing fragmentation in sperm used for assisted reproductive technology treatment cycles, in some cases without the need for invasive and expensive testicular sperm retrievals.”

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Depression during pregnancy may lead to preterm delivery

Pregnancy is supposed to be one of the happiest times of a woman’s life, but for many women this is a time of confusion, fear, sadness, stress, and even depression. About 10-20% of women will struggle with some symptoms of depression during pregnancy, and a quarter to half of these will suffer from major depression.

Depression is a mood disorder that affects 1 in 4 women at some point during their lifetime, so it should be no surprise that this illness would also touch women who are pregnant. But all too often, depression is not diagnosed properly during pregnancy because people think it is just another type of hormonal imbalance. This assumption can be dangerous for the mother and the unborn baby.

Women who are depressed early in their pregnancy run a higher risk of preterm delivery, the leading cause of infant mortality, a new study suggests.

For the study, researchers interviewed 791 San Francisco-area women near their 10th week of pregnancy. Forty-one percent reported “significant” symptoms of depression, and 22 percent reported “severe” symptoms.

Those women with severe symptoms had almost twice the risk of an early birth, defined as before 37 weeks’ gestation. Those with significant symptoms had a 60 percent risk of early birth, the study found.

Women who were likelier to report depressive symptoms tended to be younger than 25, unmarried, less educated, poorer, black, and have a history of preterm delivery.

Discovering a possible cause of preterm birth, about which little is known, makes the findings significant, said study lead author Dr. De-Kun Li, a perinatal epidemiologist and senior research scientist at Kaiser Permanente’s Division of Research in Oakland, Calif.

Scientists have been researching for the causes of high rates of infant mortality in the United States, Li said, but, “we don’t know what is going on. If we can find something as obvious as depression that can be treated during pregnancy, that is very, very significant.”

The findings were published online Oct. 23 in the journal Human Reproduction.

Dr. Shari I. Lusskin, director of reproductive psychiatry at New York University Medical Center, said she doesn’t think the study establishes a link between depression in early pregnancy and preterm delivery. She said the women in the study weren’t clinically diagnosed with depression but had scored high on a screening test.

“We don’t know if the depression at 10 weeks is a marker for something that happens later in pregnancy, which is the real culprit,” she said.

Li hopes the study’s findings will make “ante-natal depression” as widely recognized as postpartum depression has become. Until now, depression during pregnancy has been “under-estimated and under-treated,” he said, “not just by women, but also by their doctors.”

One reason for this lack of attention is that there hasn’t been strong evidence of a connection between depression in pregnant women and harm to the fetus, Li said.

Women may not readily report depressed feelings when they are pregnant because of the societal expectation that having a baby should be a joyous occasion, said Dr. Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in New York City.

“I think many patients are very stressed about pregnancy and worried about the pregnancy and not sure about its impact on their lives,” Wu said.

Lusskin tries to spread the word about the dangers of depression during pregnancy.

“The more we know about postpartum depression, the more we realize that half the cases started in pregnancy,” Lusskin said. Ante-natal depression also carries the risk of noncompliance with prenatal care, poor nutrition, inadequate sleep, self-medication with drugs and alcohol, and suicide, she explained.

And, Lusskin added, “Ante-natal depression interferes with bonding with the baby both during pregnancy and post-partum.”

The take-home lesson from the Kaiser study, Lusskin said, “is that ante-natal depression and ante-natal depression symptoms have some effect on pregnancy, and they should be treated, even though we don’t know how that mood is translated into the biochemistry of that pregnancy.”

What is the treatment for depression during pregnancy?

If you feel you may be struggling with depression, the most important thing is to seek help. Talk with your health care provider about your symptoms and struggles. Your health care provider wants the healthiest choice for you and your baby and may discuss options with you for treatment. Treatment options for women who are pregnant can include:

1. Support groups

2.   Private psychotherapy

3.   Medication

4.   Light therapy

If your symptoms are severe, your health care provider may want to prescribe medication immediately. There are medications that have been used during pregnancy without adverse affects. Discuss with your health care provider what he/she feels is safest for your baby but still beneficial to you.

If you do not feel comfortable talking with your health care provider about your feelings of depression, find someone else to talk with. The most important thing is that someone knows what you are dealing with and can try to help you. Never try to face depression alone. Your baby needs you to seek help and get treatment.

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Understanding embryo implantation offers insight

Scientists at the University of Oxford, UK, believe they have identified the way in which embryos implant in the uterus, providing essential information which may be used in the future for infertility treatments and offering hope to thousands of infertile couples. Implantation of an embryo to the lining of the mother’s uterus is an essential process that takes place at an early stage of development. The embryo initially attaches and forms a contact with the uterus lining, which triggers a cascade of signals in both the embryo and the uterus. This allows cells from the embryo to start moving across into the uterus, finding blood vessels in the mother and eventually forming the placenta. Problems in the implantation process can lead to loss of potential pregnancies, even in couples trying to conceive without infertility problems. Current estimates suggest that infertility affects one in seven couples in the UK, with around 32,000 couples seeking infertility treatment each year. It is thought that a significant number of these patients could be infertile as a result of implantation problems.

The team of scientists, led by Professor Helen Mardon from the Nuffield Department of Obstetrics and Gynaecology at Oxford, along with Professor Anne J Ridley at King’s College, London, added embryos to a layer of cells from uterus lining in a culture dish to mimic events in the womb. They were then able to video embryos implanting themselves in the cell layer, allowing the scientists to dissect the molecular processes involved. Their findings were published in the journal Proceedings of the National Academy of Sciences.Their investigation led them identify two proteins that are essential players in the implantation process. They are from the Rho GTPase family of proteins, and ensure that cells in a particular part of the uterus lining move out of the way of the ‘invading’ embryonic cells. Professor Mardon said: ‘We have shown that two proteins, called Rac1 and RhoA, control the invasion. The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo. If the balance of RhoGTPases is altered, the cells of the womb lining don’t migrate and the embryo doesn’t implant’.

The findings bring new hope to people with infertility issues. The new information will help the understanding of how this process works, and therefore aid ‘the development of drugs to help embryos implant properly’, said Prof Mardon.

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Diabetes and male infertility

Researchers have found that diabetes may affect sperm quality, after a study comparing the DNA in sperm from diabetic and non-diabetic men found more DNA damage in the sperm cells of the diabetic men.

 

The study, conducted by the research group at Queen’s University Belfast, with findings published in the journal Human Reproduction, found that around 52 per cent of the DNA in the sperm cells of diabetic men was fragmented, compared with only 32 per cent for the non-diabetic men. Fragmentation of the DNA in sperm is one of the main causes of male infertility, because it prevents the sperm from delivering intact genetic information to the egg, which is required for the creation of a viable embryo.

 

The study compared the sperm from 27 diabetic men with that from 29 non-diabetic men in their early 30s. Dr Ishola Agbaje, who lead the research project, said, ‘Our study identifies important evidence of increased DNA fragmentation of nuclear DNA and mitochondrial DNA deletions in sperm from diabetic men’. He stated that these findings would have implications for male fertility, which has already been decreasing over the last 50 years. The increasing global incidence of diabetes could further propel the decline in male fertility.

 

Professor Sheena Lewis, director of the Reproductive Medicine Research Group, and co-author of the paper, said that the study was very small, and so served to highlight a possible concern. She stated that ‘our study shows increased levels of sperm DNA damage in diabetic men. From a clinical perspective this is important, particularly given the overwhelming evidence that sperm DNA damage impairs male fertility and reproductive health’.

 

Transcription is the synthesis of RNA under the direction of DNA, and is the first step towards gene expression, where the information from the gene becomes a product such as a protein translating the genetic information into a cellular function. If there are errors in transcription, there will also be errors in the function of the gene.

 Sperm DNA quality is known to be associated with decreased embryo quality, low embryo implantation rates, higher miscarriage rates, and some serious childhood diseases, in particular some childhood cancers. Over the years possible causes for sperm DNA fragmentation have been suggested but to date the exact mechanism for the damage remains unknown, say the scientists.

 Professor Lewis said that further research would be needed to quantify the exact nature of the DNA damage caused by diabetes, and whether there were additional health effects for the children of diabetic fathers. Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield, stressed the importance of the quality of sperm DNA, and further said that ‘it would be important to understand the mechanism by which this damage occurs so that if it can be avoided we can work out how to do this’.

 

Matt Hunt, science information office at Diabetes UK, called for further research, after labelling the findings alarming. He said ‘this is the first research to suggest DNA damage may be occurring at a cellular level and that it is a cause for great concern’.

 

 

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Breast cancer recurrence not increased with controlled ovarian stimulation

Ovarian stimulation using gonadotropins and letrozole to preserve fertility in patients with breast cancer undergoing chemotherapy is unlikely to increase their risk for recurrence, say US researchers.

Kutluk Oktay, from the Center for Human Reproduction in New York, and colleagues evaluated 215 women with breast cancer for fertility preservation before adjuvant chemotherapy. Overall, 79 of the women underwent controlled ovarian stimulation (COS) for embryo or oocyte preservation, while the remainder served as controls.

An average of 10.3 oocytes were retrieved from COS patients, with 5.97 embryos or oocytes cryopreserved per patient.

The time between surgery and chemotherapy was significantly longer for patients who underwent IVF than control patients, at 45.08 versus 33.46 days. In patients who had COS, peak estradiol levels ranged from 58.4 to 1,166 pg/ml.

In the COS group, median follow-up after chemotherapy was 23.4 months, compared with 33.05 months in the control group. Recurrence occurred in 3.8 and 8.1 percent of COS and control patients, respectively, at a nonsignificant hazard ratio of 0.56.

The team concludes: “COS before embryo or oocyte cryopreservation is unlikely to result in a significant increase in recurrence of breast cancer compared with those who did not undergo ovarian stimulation, at least in the short term.”

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France: Woman, 59, is oldest mother of triplets

A 59-year-old Frenchwoman has given birth by Caesarian section to two boys and a girl, who are in good health, the Paris hospital treating her said on Monday last.

“Everything went smoothly,” said a spokesman at Cochin hospital where the triplets were born overnight Saturday.

The woman, of Vietnamese origin, is thought to have resorted to a private Vietnamese clinic willing to overlook the age limit for egg donation and in vitro fertilisation (IVF), set at 45 in Vietnam, according to press reports.

Egg donations are authorised in France but most fertility clinics here set a maximum age limit of 42 for would-be mothers.

But nothing prevents couples from seeking fertility treatment abroad and in 2001 a 62-year-old Frenchwoman gave birth to a child conceived through IVF, in the Riviera town of Frejus.

Earlier this year, an Indian woman said to be 70 years old gave birth to twins after receiving IVF treatment.

The baby girl weighed in at 2.42 kilograms (5.34 pounds) as did one brother, while the second boy weighed 2.32 kilograms.

The birth of triplets by a mother in her late 50s was unprecedented in France and possibly a world first.

But the news raised eyebrows among French health professionals concerned that science was pushing the limits of motherhood too far.

“Having children at that age is dangerous in terms of child development,” said child psychiatrist Nicole Garret-Gloanec.

Women of child-bearing age are able to “draw the link between their own childhood and their baby,” she said.

This case raises questions as to “how you can help a child grow, in educational terms and development,” said Dominique Ratia-Armangol, president of the national association of early childhood psychologists.

She said a child born to an older woman can become confused about the role of grandmother and mother.

Garret-Gloanec suggested that the mother’s late-in-life desire to have children was “a denial of ageing and of death.”

“It’s unhealthy, to project onto children your own anxieties about death,” she said.

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