Tag Archives: Fertility

Ethical Issues Related to Birth of IVF Octuplets : Not a Cause for Celebration, Doctors Warn

 

Two newspapers recently published two opinion pieces examining the ethical issues surrounding the recent birth of octuplets to a California woman, Nadya Suleman, who reportedly underwent fertility treatments. Summaries appear below.

 


~ Arthur Caplan, Philadelphia Inquirer: “Something has gone terribly wrong when a 33-year-old single woman — who has no home of her own, no job and a mother who worries her daughter is ‘obsessed’ with having children — winds up with 14 of them,” Caplan, director of the University of Pennsylvania Center for Bioethics, writes in an opinion piece. “Examining what exactly went wrong may shed some light on what ought to be done,” Caplan says, adding, “If doctors cannot prevent such shambles from recurring, then society must.” Caplan reports that Suleman became pregnant with all of her 14 children through in vitro fertilization. He writes that the “most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?” Although “[s]ome fertility doctors would answer that it’s not their job to decide how many children a person can have,” Caplan writes that the “idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.” He continues, “Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.” Government “needs to get involved,” Caplan says, concluding, “Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here” (Caplan, Philadelphia Inquirer, 2/6).



~ Ellen Goodman, Miami Herald:  The medical team that delivered the octuplets “expected kudos and high fives,” but “instead of smiles, they saw jaws drop,” syndicated columnist Goodman writes. She continues, “Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.” Questions about whether anyone has “a right to tell anyone else how many kids to have” and whether only women with husbands or certain income levels should have children are “questions that make us feel queasy when we are talking about old-fashioned families,” Goodman writes. She adds, “But they take on a new flavor in the unregulated wild west of fertility technology.” According to Goodman, the “heart of this case” is that “it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.” She adds that it is “against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, those who endanger patients ought to lose their licenses.” Goodman also writes that the infants will need “at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies.” A “reproductive business that generates so much controversy has produced a remarkable consensus,” she says, concluding, “Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is ‘nuts'” (Goodman, Miami Herald, 2/6).

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Second hand smoke affects fertility

If you need another reason to quit smoking, consider that it may diminish your chances of being a parent or grandparent. Scientists at the University of Rochester Medical Center have found that women exposed to second hand smoke, either as adults or children, were significantly more likely to face fertility problems and suffer miscarriages.

 second-hand-smoke1An epidemiologic analysis of more than 4,800 non-smoking women showed those who were exposed to second hand smoke six or more hours per day as children and adults faced a 68 percent greater chance of having difficulty getting pregnant and suffering one or more miscarriages. The study is published online in Tobacco Control and is one of the first publications to demonstrate the lasting effects of second hand smoke exposure on women during childbearing years.

“These statistics are breathtaking and certainly points to yet another danger of second hand smoke exposure,” said Luke J. Peppone, Ph.D., research assistant professor at Rochester’s James P. Wilmot Cancer Center.

 In the study, four out of five women reported exposure to second hand smoke during their lifetime. Half of the women grew up in a home with smoking parents and nearly two-thirds of them were exposed to some second hand smoking at the time of the survey.

More than 40 percent of these women had difficulty getting pregnant (infertility lasting more than a year) or suffered miscarriages, some repeatedly.

 “We all know that cigarettes and second hand smoke are dangerous. Breathing the smoke has lasting effects, especially for women when they’re ready for children,” said Peppone, who analyzed information in the Patient Epidemiology Data System, a well-studied cohort that has yielded information on a variety of cancers.

 Peppone analyzed surveys collected from 4,804 women who visited Roswell Park Cancer Institute for health screenings or cancer care from 1982-1998. The 16-page survey focused on lifestyle, habits, family and personal health history, and occupational and environmental exposures. Each participant in this study reported that they had never smoked, and had been pregnant at least once or tried to become pregnant.

Participants reported whether one or both of their parents smoked and if they lived with or worked with smokers as adults. They also estimated the amount of time they were exposed to second hand smoke.

 Peppone acknowledges that the data is based upon self-reporting and that is not perfect. However, he said “Women, especially mothers, have extremely accurate recall. Mothers can easily recall details like how long they breastfed, what vitamins they took during prenatal care, and childhood activities.”

 Many of the women in the study grew up in the 1940s and 1950s, long before the surgeon general issued the first warning about the dangers of cigarette smoking in 1964. Since then, millions of dollars were spent to study the dangers of cigarette smoking. Tobacco use contributes to more than nearly 90 percent of all deadly lung cancers and 30 percent of all cancer deaths in the U.S., and a host of other health problems.

 Since the mid-1960s, smoking bans and government-funded, anti-smoking campaigns have encouraged smokers to quit and discouraged others from starting using a number of passive and aggressive techniques. Smoking rates have declined, however people continue to use tobacco and suffer the health risks.

The study was funded by a National Cancer Institute grant and was previously presented at the Society for Behavioral Medicine and Society of Research of Nicotine and Tobacco conferences.

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Easing fertility through lifestyle changes

ls11Couples who have been trying to conceive can easily grow impatient when their plans don’t go exactly, or as easily, as planned. But before concluding that they may have certain fertility problems or that they need fertility drugs or treatments, it is good to first take a closer look into the way they are leading their lives.

 A study by the Harvard School of Public Health (HSPH) has found that women have a reduced risk of infertility due to ovulatory disorders if they adopt a combination of healthy lifestyle and dietary measures. The study, published in Obstetrics and Gynecology, was based on 17,544 women who were tracked for eight years as they attempted to get pregnant or became pregnant.   According to Dr Chavarro, the team leader,  ‘as women started following more of these recommendations, their risk of infertility dropped substantially for every one of the dietary and lifestyle strategies undertaken’. Senior author on the paper, and chair  of the HSPH Department of Nutrition, Walter Willett, said that ‘the key message of this paper is that making the right dietary choices and including the right amount of physical activity in your daily life may make a large difference in your probability of becoming fertile if you are experiencing problems with ovulation’. Infertility affects one in six couples, according to US studies, with ovulatory problems identified in 18 to 30 per cent of cases.

 There are some steps you can take to maximize your fertility and chances of conception, and have a healthier pregnancy. Simple lifestyle changes like eating healthier and quitting smoking can make a difference, as can regular exercise.

What you can do:

Following are some tips on how to maximize your chances of conception and your health before and during pregnancy.

Body Weight:

Being overweight or underweight can affect the chances of ovulating normally in a woman. It has been found that women who have 17% to 21% of their total body weight as fat provide the ideal condition for ovulation. Have less or more body fat may hinder your menstrual cycle, make conception difficult. Women that are underweight may want to consider putting on some weight if they find that menstruation tends to be sporadic. Additionally, being underweight may indicate that you will have a hard time producing the extra amount of energy required for pregnancy. Maintaining a healthy weight before conception is therefore advisable.

Overweight women with ovulation and menstrual cycle problems may want to lose some weight if they are having troubles conceiving. However, overweight women do not necessarily need to lose a significant amount of weight in order to help their conception rates. Even slightly reducing your weight can increase your chances of conceiving many folds. An Australian study found that, as soon as a group of obese women lost almost 20 pounds, their bodies began to spontaneously ovulate again. 

 

Eat Healthy

ls3A healthy diet is essential to your health — and your baby’s. Be sure to eat plenty of fruits and vegetables (at least five servings per day), eat low-fat dairy foods, and drink plenty of fluids for optimal health.

A recent study also suggests that woman’s diet around the time of conception can influence the gender of her baby. The study, completed by the Universities of Exeter and Oxford, appears in the Royal Society journal Biological Sciences and alleges that a woman who eats a high-calorie diet — and regular breakfasts — might have greater odds of having a boy. Participating in the study were 740 first-time pregnant women in the UK, who provided records of their eating habits before and just after becoming pregnant. Researchers found that 56% of women with the highest caloric intake around the time of becoming pregnant had boys, compared to just 45% among women with the lowest caloric intake.

 

Consider Going Organic

ls2Organic fruits, vegetables, meat and dairy products do not contain pesticides or synthetic growth hormones that many conventional foods may contain. What’s more, studies have shown that organically grown fruits and vegetables are actually more nutrient-rich than their conventional counterparts. Pregnant women, or women who are planning to become pregnant, may wish to switch to organic foods for better nutrition.

 

Exercise Regularly

ls4A healthy lifestyle also includes exercise. The American Society of Reproductive Medicine reports that regular exercise (five times a week for at least 45 minutes), as well as a healthy diet, boost fertility by keeping body weight at a normal level and relieving stress and anxiety. In addition, women who are overweight or obese have been shown to have increased perinatal mortality risk when they become pregnant. Exercise regularly for your health and the health of your baby to be.

A new study by the Kaiser Permanente Medical Group reports that women can decrease their chances of contracting gestational diabetes by not gaining weight. Women in the study who gained about 5-22 pounds each year prior to the five years before getting pregnant were 2.5 times more likely to develop gestational diabetes. Gestational diabetes is marked by glucose intolerance that is first experienced during pregnancy, and can require daily insulin injections. It is also associated with fetal complications. The condition usually resolves after childbirth.

 

Smoking

It has been known for a long time that smoking has a negative effect on conception but many fail to realise just how drastically smoking effects both male and female fertility. In men who smoke, sperm counts average 17% lower than those who do not smoke and it can also affect the health of the sperms.

Women who smoke not only increase the time it takes them to conceive as well as raise their the risk of spontaneous miscarriage, they also jeopardize the health of their baby yet to be born. Female smokers are also at a greater risk for delivering premature or low birth weight babies and developing pelvic inflammatory disease.

Studies have shown that smokers are 30% less fertile and require a much higher dose of fertility drugs if they opt for fertility treatments than non-smokers. Passive smoking, too, is equally dangerous to women and their pregnancy

The effects of reducing or totally stopping smoking can produce noticeable results in days.


Alcohol, Caffeine and Drugs

Regularly drinking alcohol can reduce fertility levels by up to 50%. It can also decrease sperm count while increasing the production of abnormal sperm. Similarly, drugs like marijuana and cocaine have been found to cause disruptions in a woman’s menstrual cycle.

Another chemical to avoid in order to improve your chances of conception is caffeine, which can be found in tea, coffee, chocolate and soft drinks. Caffeine reduces the fertility level of both men and women. Some studies have also shown a link between consuming large amounts of caffeine and delayed conception. What’s more, studies have also shown women who consume more than 300 mg (three 5 oz cups of coffee) a day may also be at an increased risk for miscarriage.

 

Reducing Stress

Stress can have a big effect on fertility. In women under stress, the reproductive hormone prolactin is over-produced and this can interfere with ovulation. The hypothalamus stops secreting gonadotrophin hormone, which in turn will affect the release of both the luteinizing hormone and follicle-stimulating hormone. As these hormones stimulate ovulation – fertility is affected.

 

Know Your Cycle

It is essential to understand your monthly (or not so monthly, in some cases) cycle in order to maximize your chances of conception. Keep track of the days you menstruate and the length of your cycle for a few months, and use an ovulation calendar to track your ovulation to time your intercourse for conception.

 

So, there you have it – a range of natural ways to increase your fertility. Each of these lifestyle changes won’t guarantee that you will get pregnant, but following these changes may shift the odds and help you get the baby a little easier. Good Luck!!

 

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Study Shows It May Be Possible to Preserve Child-Bearing Ability in Young Girls with Cancer

Research appearing in the on-line edition of Fertility and Sterility revealed that it may be possible for girls suffering from cancer in childhood to preserve their ability to have children later in life.

While advances in cancer therapies have dramatically improved survival rates for patients who suffer from childhood cancers, the use of chemotherapy and radiation often results in impaired fertility or sterility as those patients reach adulthood. For males mature enough to be producing sperm, sperm freezing has long been an option. For young females however, the ovulation induction and egg freezing techniques that might help adult women are not an option.

Researchers at Hadassah Hebrew University Medical Center in Jerusalem examined the ability to remove and preserve ovarian tissue from young female cancer patients and then retrieve, mature and freeze eggs from that tissue. They worked with 19 patients between the ages of 5 and 20. On average they were able to retrieve an average of nine oocytes per patient and 34% of them were successfully matured. The next step in this research will be test the ability of these eggs to become fertilized.

“As our ability to treat childhood cancers improves, it becomes more important that those survivors are able to live rich, full lives, including the ability have children. This research helps moves us to the goal of allowing pediatric cancer survivors to become parents,” said David Adamson, MD, President of the American Society for Reproductive Medicine.

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Hair Coloring and Pregnancy

 

Most experts agree that when it comes to hair coloring, safe is better than sorry. So wait out the first trimester before heading back to the salon to retouch those roots. If your practitioner is extra cautious, he or she may advise against hair coloring during your entire pregnancy, but there’s no hard evidence that the chemicals are harmful to your baby. So if you can’t stand those roots, fix ’em. Your best bet: Stick to highlights instead of single-process color so that the chemicals don’t touch your scalp, or ask your colorist about less harsh processing (an ammonia-free base, for instance   It is extremely difficult to be sure whether anything is totally safe during pregnancy. No one wants to conduct an experiment about a potential toxin on a pregnant woman, so many times we have to rely on animal studies or incomplete information ).

 Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Foods That Make You Fertile

Successful marathon runners know that to make it to the end of a race, good nutrition is critical — from the “I’m in training” trail mix to that carb-loading dinner the night before the big run. Like the marathoner, you can use food to boost your chances of making it to the finish line, whether it’s the qualifier race (getting pregnant) or the big event (the 40-week run).

Want to give yourself a head start before you’re even out of the gate? Food can help you get there. Just remember The Good, the Bad, and the Unknown of preconception eating.

·     The Good: Be sure you’re getting enough of these three important baby-making minerals (all can be found in a good prenatal vitamin, as well as the following foods).

·     Calcium (three servings a day) may actually boost your ability to conceive. You can find this important bone-builder (and baby-builder) not just in dairy products, but also in fortified juices, tofu and soy products (including that super-tasty snack, edamame), broccoli, leafy green vegetables, sesame seeds, and canned salmon with bones.

·     Manganese (about 2 mg a day) is important for good reproductive function — in other words, a baby-making essential. Spinach, carrots, broccoli, whole grains, nuts, bananas, and raisins are all good sources of manganese.

·     Zinc is crucial for conception — in fact, severe deficiencies can impair fertility. Get your full share (about 15 mg a day) via a supplement or by eating turkey, beef, lamb, pork, chicken, almonds, beans, wheat germ, yogurt, oatmeal, corn, eggs, fortified breads and cereals, and cooked shellfish, especially oysters. (Could that be why oysters have always been on the hot list when it comes to aphrodisiacs?)

In addition to these big three, don’t forget to get your fill of folic acid.   While it won’t make you fertile, it is critical to your baby’s health — not just in the earliest days of pregnancy but before you even conceive. You’ll find folic in spinach and other green leafies;  citrus fruits; nuts, legumes; and enriched products, such as grains and orange juice — but for insurance, take a prenatal vitamin too.

The Bad: Avoid two big fertility-busters: excessive caffeine (more than three cups of coffee a day) and alcohol (heavy drinking can impair fertility in both men and women).

The Unknown: Lots of herbal supplements and teas are billed as fertility enhancing, but it’s still too early to tell how effective — or how safe — they are. In fact, some herbs touted as conception promoting can even be dangerous to your baby if you do conceive. So be cautious with supplements — check with your practitioner before you use any of them. 

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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Father’s age and Infertility

Among couples with fertility problems, those in which the man is over age 35 have lower pregnancy rates and increased chances of miscarriage, a new study shows.

To come to this conclusion, French researchers looked at more than 12,000 couples who went to a fertility clinic in France. In most of the cases, the couples were being treated due to the man’s infertility. The couples underwent a total of 21,239 intrauterine inseminations (IUIs). The researchers found that women over age 35 had a pregnancy rate of 8.9 percent, compared to 14.5 percent in younger women.

“But we also found that the age of the father was important in pregnancy rates — men over 35 had a negative effect. And, perhaps more surprisingly, miscarriage rates increased where the father was over 35,” study author Dr. Stephanie Belloc, of the Eylau Center for Assisted Reproduction in Paris, said in a prepared statement. This is the first study to document such a strong paternal effect on reproductive outcomes.

“How DNA damage in older men translates into clinical practice has not been shown up to now. Our research proves for the first time that there is a strong paternal age-related effect on IUI outcomes, and this information should be considered by both doctors and patients in assisted reproduction outcomes,” Belloc said. “We believe that the use of IVF or ICSI should be suggested to infertile patients where either party is over 35 years of age,” she added.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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