Tag Archives: IVF treatments

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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Depression and Infertility

Research studies have documented the correlation between stress and infertility  since the 1980s. The usefulness of such information has lagged because the focus has been on vague definitions of anxiety, rather than symptoms of depression. Recently, however, a refined look at depressive symptoms and their impact on biology has been enlightening, offering new hope and a mind/body approach that has proved to be a heartening success for some men and women.

Consider these findings:

0.Women with a history of depressive symptoms reported twice the rate of subsequent infertility (Psychosomatic Medicine, 1995, vol. 57)

0.Women with depression, when treated showed a 60 percent viable pregnancy rate within six months, contrasting with 24 percent when depression went untreated. (Journal of American Medical Womens Association, 1999, vol.54)

0.Women who experienced depression following the failure of their first in vitro fertilization (IVF), had much lower pregnancy rates that their non depressed counterparts during their second IVF cycle (Journal of Psychosomatic Research, 1993, vol. 37)

0.A mind/body program can be a helpful adjunct to IVF. A study in Fertility Sterility (1998, vol. 69) suggests that because mind/body programs are effective for reducing negative emotions that may impair IVF success, IVF patients should be offered this type of program.

The Mind/Body Connection Between Depression and Fertility

Stress brought on by anxiety and/or depression can alter immune function. We have all heard about how the effects of depression can lower our immunity, making us more vulnerable to colds and other viruses during emotionally stressful periods. It is not such a stretch to discover that a suppressed immune system can adversely affect our ability to conceive.

Reproduction is one of our most delicately balanced biological systems. Psychological stress can affect our ability to get pregnant on multiple levels, including inhibition of the hypothalamus that helps regulate hormonal levels, or over activation of the hypothalamus which can change the pituitary and adrenal responses. Since the pituitary regulates both how much of a hormone is made and how much is released in the body, its alteration can have dramatic effects on the hormonal balance necessary for ovulation, fertilization, tubal functioning or even successful implantation of the egg once it reaches the womb.

Infertility causes depression, but what about prevention? The bad news is that even when women have not been depressed previously, depression often occurs by the second to third year of infertility and does not return to normal levels until six years later. The good news is that researchers have recently become proactive in studying the effects of treatment for non depressed women BEFORE they get depressed.

A study reported in Reproductive Endocrinology (April 2000, vol. 73, issue 4), treated women who were in their second year of infertility and not yet depressed. The women who received group psychological interventions to stem the tide of depression caused by infertility, had significantly increased viable pregnancies compared to those who did not receive preventative treatment for depression.

5 Ways to Increase Your Chances of Getting Pregnant

The following activities were part of the treatment program that the women in the prevention study received.

Consider these five guidelines for a mind/body approach to help you conceive — whether or not you suffer from depression:

1. Practice Relaxation Techniques Yoga, meditation, and visualization increase the body’s resources for achieving balance. Consider a daily activity that calms the mind, but do not stop there. I have had success in my own psychotherapy practice using a body-centered hypnosis, which utilizes imagery, not only for childbirth, but for infertility, too. The hypnotic effects of visualization, coupled with relaxation can be a powerful technique for communicating with the emotional center of the brain (limbic system) that regulates hormonal activity and balance.

Visualize your womb in a state of fertile health and readiness. Make a relaxation tape, or have a professional assist you in creating an audiotape in which imagery and sound helps you experience the sensation of conception and pregnancy.

2. Allow Yourself Emotional Expression
Releasing feelings is essential for deep relaxation. Do not use visualization as a form of “positive thinking” alone. Without releasing the “negative” feelings and fears you experience, you will be likely to repress your fears and disappointment, resulting in depression.

Acknowledge your anger, grief, disappointment and fear. Share your anxieties and feelings with others who may feel similarly. Cry when you are disappointed and verbalize anger when it arises, rather than hold it in. Releasing feelings will allow you to feel better later, allowing you to be hopeful instead of hopeless.

3. Take a Fresh Look
Practice cognitive restructuring. Write your feelings in a personal journal, but with an eye towards releasing your disappointment and continuing towards your desired goal. For example: When writing you may find yourself saying, “I will never have a child”. When you are tempted to express your feelings as a negative projection of your destiny, remind yourself that you are deeply disappointed, even angry. Stop short of crystal-ball interpretations that lead to depression. Acknowledge the feelings, rather than project them onto a future event. Instead, bring yourself back to reality and write the truth of your actions, “I am doing everything I can to conceive.”

4. Get the Support You Need
Your desire to become pregnant and your inability to “make it happen” may bring up emotions that surprise you. It is common for women to harbor feelings of inadequacy that effect their self esteem and performance at work as well as their marital relationships. Anticipate your needs. Do not let these feelings overwhelm you. Instead, use this opportunity to get the support you need from others, friends or professionals, to make this an opportunity for learning and growth.

Supportive group therapy was a part of the treatment in the study correlated with increased pregnancy. Sharing feelings can help you feel less alone and allow you to work through discouragement. These groups focused on the impact of infertility on self esteem, marriage, family, friends and work. Find ways to share your feelings rather than hold them inside.

5. Do Not Delay!
Seeking treatment may not only help you conceive, but may prevent an even greater spiral of depression that can result from protracted infertility. Treating your depression now may help stem a vicious cycle.


Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

 

 

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Prognosis ‘encouraging’ after total fertilization failure in IVF and ICSI

More than 40 percent of patients who experience total fertilization failure after an IVF cycle have a baby at a later attempt, researchers report.

Total fertilization failure after IVF or ICSI can be very frustrating for patients and clinicians alike.

Little information has been available about patients’ chances of success in the future or how changes in treatment could improve the likelihood of fertilization in later cycles.

To investigate, Donna Kinzer (Boston IVF, Waltham, Massachusetts, USA) and colleagues conducted a retrospective analysis of data for 555 couples who experienced total fertilization failure during conventional IVF or ICSI.

They found that 44 percent of IVF patients who chose to continue treatment eventually gave birth. This equated to a delivery after 25 percent of embryo transfers and 22 percent of cycles.

After ICSI, 36 percent of couples had a child, after 23 percent of their embryo transfers, in 18 percent of their cycles.

Results also showed that fewer mature oocytes were used in the transfers that ended in complete fertilization failure, compared with earlier or later transfers, Kinzer et al report.

They say these results suggest that “total fertilization failure is not related to sperm parameters but rather is a result of suboptimal response to ovarian stimulation.

They add: “If subtle improvements in oocyte yield can be effected, this may increase the chance of fertilization in subsequent cycles for these patients.”

Source: Fertility and Sterility 2008; 90: 284-8

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Insulin resistance : a root cause of PCOS

Are you one of the millions of women with Polycystic Ovarian Syndrome who, no matter what they’ve tried, has failed to better manage or reverse the symptoms of this condition? It may not be due to lack of willpower. Instead, you could be Insulin Resistant, a root cause of PCOS. Scientists at the National Institutes of Health, Stanford University and other research centers have clearly identified the existence and effects of Insulin Resistance, a biochemical condition that can cause excessive weight gain and Polycystic Ovarian Syndrome.

 

PCOS AND INSULIN RESISTANCE

Polycystic Ovarian Syndrome is a hormonal imbalance linked to the way the body processes insulin after it has been produced by the pancreas to regulate blood sugar (glucose). Insulin Resistance, an underlying cause of PCOS, has many factors that contribute to its presence in the body. In essence, our environment and lifestyles have evolved too rapidly for our bodies to keep pace. We are still genetically “wired” to thrive on the entrenched habits of our ancestors, who consumed different, nutrient-rich foods and a diet low in carbohydrates and who sustained greater levels of movement and exercise. Some people may also have a genetic predisposition to Insulin Resistance, while others develop the condition through high stress and unhealthy lifestyles.

INSULIN RESISTANCE NEGATIVELY AFFECTS GLUCOSE AND INSULIN LEVELS

Over time, the above factors have damaged the complex ability of the body’s cells to properly utilize insulin to convert glucose to energy. This process creates Insulin Resistance.

Insulin Resistance vastly reduces the insulin sensitivity of cells, which impairs the processing of glucose through the cell wall for conversion to energy. As a result, glucose remains in the blood stream, causing elevated levels of blood sugar, which are sent to the liver. Once there, the sugar is converted into fat and stored via the blood stream throughout the body. This process can lead to weight gain and obesity, key factors in creating PCOS, which is also referred to as Polycystic Ovarian Disease or PCOD.

 

 

Insulin Resistance can also cause PCOS is by raising insulin levels in the blood stream. Unhealthy lifestyles and genetic conditions can lead to the pancreas overproducing insulin. This excess insulin stimulates the ovaries to produce large amounts of the male hormone testosterone, which may prevent the ovaries from releasing an egg each month, thus causing infertility. High levels of insulin also increase the conversion of androgens (male hormones) to estrogens (female hormones), upsetting a delicate balance between the two and having a direct effect on weight gain and the formation of cystic follicles or ovarian cysts.

 

 

SYMPTOMS OF PCOS

The symptoms of Polycystic Ovarian Syndrome vary widely from woman to woman. In addition to polycystic ovaries, they can also include: irregular or completely absent periods, Hirsutism (excessive facial or body hair), Alopecia (male pattern hair loss), obesity, acne, skin tags (raisin-like growths on the skin), Acanthosis Nigricans (brown skin patches), exhaustion or lack of mental alertness and decreased sex drive. Because the symptoms vary so widely and not all women display all the symptoms, doctors very often misdiagnose PCOS. This became an issue of critical concern after a study in 2000 found that women suffering from PCOS have a higher risk of coronary heart disease.

Researchers discovered a link between Polycystic Ovarian Syndrome and other metabolic conditions such as obesity, high blood pressure and high levels of LDL “bad” cholesterol, all of which are risk factors for coronary heart disease.

Studies have also shown an increased link between PCOS and atherosclerosis, which occurs when fatty deposits called plaque cling to the interior walls of the arteries, leading to blockages that can cause heart attacks or stroke. Not only do PCOS sufferers have higher rates of plaque buildup but those over 45 have thicker deposits of plaque.

Another report indicated that up to 40% of women with Polycystic Ovarian Syndrome have either impaired glucose tolerance or Type 2 Diabetes by the age of 40.

All these findings substantially raise the bar on the seriousness of PCOS, making it even more important that doctors correctly diagnose the condition and instruct their patients about Insulin Resistance.

Posted by : Goral Gandhi, MSc,

                   Laboratory Director,

                   Rotunda – Center for Human Reproduction (Pvt) Ltd

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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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Alcohol abuse in women linked to fertility problems

Researchers studying Australian groups of twins have established a link between heavy alcohol use and delayed pregnancy, in findings to be published in the journal ‘Alcoholism: Clinical and Experimental Research’.

Mary Waldron, assistant professor of psychiatry at Washington University School of Medicine and corresponding author of the research, wrote that this was the first study to look at the affect of alcohol on fertility. Both men and women were studied, but alcohol was found to have more effect on women’s fertility, with incidents expected to increase due to the higher rates of alcohol abuse currently seen in the young female population.

Some experts voiced caution, as the correlation between alcohol abuse and later onset of pregnancy could relate to the fact that alcoholic women have more relationship issues which cause them to have children later, rather than the effect of alcohol on fertility. However, other experts still stressed the fact that even small amounts of alcohol could affect fertility, because reproductive hormones rely on cholesterol made by the liver. Steve Hillier, Professor of Reproductive Endocrinology, University of Edinburgh, urged that the study results be treated cautiously, but that, ‘if nothing else they are valuable in alerting us to the potentially deleterious impact of alcohol abuse on the female reproductive system’.

The study authors have warned women to consider the impact alcohol might have on their efforts to conceive, and that women attempting to become pregnant should consider not drinking at all. Mary Waldron cautioned, ‘young women who drink alcohol may want to consider the long-term consequences for later childbearing. If drinking continues to increase to levels of problem use, their opportunity to have children may be impaired’.

Sharon Wilsnack, co-author of the study and professor of clinical neuroscience at the University of North Dakota School of Medicine & Health Sciences, warned that women already experiencing fertility problems should not use alcohol as a way to cope with the stress they might feel as a result of those problems. She said that, ‘alcohol would likely make the reproductive problems worse as well as carrying risks of possible alcohol abuse or dependence’.

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The Guinness Moms

It would appear that the quest for motherhood is for some, a desire that fails to subside with age. Empowered by new technologies such as IVF treatments, women are increasingly seeking the assistance of fertility clinics to fulfil their aim of bearing a child when their biological clock has ground to a halt. For single women in Japan, however, this type of assistance is not so easy to come by. Strict laws in the field of surrogacy and artificial insemination are imposed due to the country’s traditional approach to human reproduction. As a result, fertility treatment is provided almost exclusively to married couples.
Undeterred, a single 60-year old Japanese woman has taken such restrictions into her own hands. The Times newspaper has reported this week that the woman, who wished to remain anonymous, is now in her fifteenth week of pregnancy after travelling to the United States for fertility treatment. She is believed to be the first and oldest single woman to conceive from a donated egg. The use of donated eggs is strictly limited to married couples under a Japanese medical guideline.
After a series of unsuccessful attempts to find a doctor in Japan willing to handle the pregnancy, Yahiro Netsu, a gynaecologist at The Suwa Maternity Clinic in Nagano, central Japan, has stepped in to help. Speaking to the Associated Press, Mr Netsu confessed that the decision had been a tough one, especially as her age and single status meant that the pregnancy was a high risk and an uncertain future for the child. The gynaecologist, however, was won over by the woman’s desire to bear a child in spite of her age. He said:’But she wanted a child, and I decided to do all I can to help her through expected difficulties’.
Although the pregnancy has yet to reach a happy conclusion, Mr Netsu and his patient should take heart from the birth of a healthy baby boy born last summer to a British woman, aged 62. Dr Patricia Rashbrook, a psychiatrist from Lewes, East Sussex, conceived using a donor egg after her fifth attempt at IVF. Her son, nicknamed JJ, weighed a healthy 6 pounds and 10 ounces. But with the trend for older mothers continuing, it would appear that even Dr Rashbrook has been usurped in the trophy for ‘The world’s oldest mum’. This accolade is believed to go to a 67-year old Spanish woman who gave birth to twin boys following IVF treatment last year. She is closely followed by Adriana Iliescu, from Romania, who had a daughter called Eliza Maria in January in 2005 at the age of 66.

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