One of the ways that I hope to serve people better is to explain breaking research in a timely fashion. The following are just a handful of the hormone related studies that can impact you or someone that you care about. Stay informed and click on the link of any study that is of personal interest to you. Then discuss the findings with your healthcare provider.

  • PCOS linked to a growing risk of other health disorders—Polycystic Ovarian Syndrome (PCOS) is the most common hormone imbalance of reproductive age women affecting an estimated 5 million in the USA alone. A new study  found that in addition to the increased risk of heart disease, obesity and diabetes; women with this disorder also have an elevated risk of asthma, musculoskeletal disorders, mental health problems (i.e., depression and anxiety) as well as an increased risk of certain type of cancer. There was also a noted increase in the risk of miscarriage, ectopic pregnancy and endometriosis. Bottom line is that taking steps to correct this hormone imbalance may not only help you get pregnant but actually have a healthy pregnancy and healthier life afterwards!
  • Radioactive Iodine used to treat thyroid cancer associated with lower subsequent birthrate—A new study  found that women in their 30’s that were given radioactive iodine (RAI) to treat well differentiated thyroid cancer had about a 30% lower subsequent birthrate than their peers. It is uncertain whether or not this was a result of the treatment or the recommendation for a prolonged waiting period to conception after treatment.  Regardless of the reason, given the improved success rates associated with egg freezing; women diagnosed with thyroid cancer should be considered candidates for this fertility preserving procedure prior to RAI treatment.
  • Higher exposure to certain common chemicals associated with early onset of menopause—A new investigation  found that women that were exposed to certain cleaning products, personal care items and specific pesticides tended to begin menopause two to four years earlier than their unexposed peers. They were looking specifically at specific chemicals like PCB’s and phthalates that have been linked to ovarian toxicity in previous research studies. This should further enhance your awareness of the potential negative impact of these unnecessary hormone disruptors and promote more careful selection of what products you use on a regular basis.
  • Bisphenol-A (BPA) exposure during pregnancy may predispose to subsequent health risks after birth—There is a growing awareness that metabolic challenges during fetal development may increase health risks during adulthood. A new study  has demonstrated that BPA can cause oxidative damage during pregnancy which is considered a precursor to conditions like subsequent heart disease or diabetes during adulthood. BPA is in a large number of products including plastic water bottles, canned food liners and cash register receipts. As more manufacturers continue to phase out products that contain BPA; pregnant women may want to take steps to avoid these chemicals to reduce their child’s future health risk.
  • Drinking soda may be linked to early onset of puberty—A new study  found that over consumption of sugary beverages may be triggering earlier onset of menstrual cycles in young girls. This was a well defined observational study performed on over 5500 girls during a 5 year follow up. The risk associated with two daily sugary beverages was independent of their weight, activity level or the remainder of their diet. More reason to avoid these unnecessary hormonal calories is their impact upon developing hormone levels.
  • Corn syrup may be more toxic than table sugar—A study  performed on mice recently demonstrated that when a portion of daily calories were supplied from corn syrup rather than table sugar; the mice had a shorter life expectance and a higher rate of reproductive problems. This negative health impact seemed to greatest on the female mice for reasons that are not fully understood. Although we are uncertain if this will be true in people, its best to avoid foods that contain corn syrup until further studies are available.

[r1]Link to http://consumer.healthday.com/diseases-and-conditions-information-37/misc-diseases-and-conditions-news-203/female-hormone-disorder-linked-to-numerous-other-conditions-695830.html

[r2]Link to http://www.medscape.com/viewarticle/838775

[r3]Link to http://consumer.healthday.com/women-s-health-information-34/menopause-and-postmenopause-news-472/pesticides-plastics-chemicals-tied-to-earlier-menopause-in-women-695892.html

[r4]Link to http://www.medscape.com/viewarticle/838387?src=emailthis

[r5]Link to http://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/sodas-may-prompt-early-puberty-in-girls-study-suggests-695871.html

[r6]Link to http://www.reuters.com/article/2015/01/06/us-usa-health-cornsyrup-idUSKBN0KF03820150106

It feels great to be blogging again. I figured the best was to re-start this blog was to provide an update and summary on how these remarkable techniques have grown and developed as well as summarizing their current success and limitations. The technique of In Vitro Fertilization (IVF) has become the gold-standard of fertility treatment both for its diagnostic value as well as its high success rates compared to other treatment options. It is currently estimated that over 5,000,000 people have been born using IVF since the first reported success in 1978. In 2012 about 1% of all births in the USA —a total of 65,160 babies—were conceived and born through IVF. So let’s first consider the safety of this technology.

A recent report  summarized the safety of Assisted Reproductive Technology in the US by reviewing all of the available data from 2000 to 2011. This analysis included 1.14 million IVF cycles in order to determine the incidence of medical complications within 12 weeks of the procedure. They were looking for complications like infection, bleeding, adverse reaction to medications, anesthetic complications and Ovarian Hyperstimulation Syndrome (OHSS). OHSS was the most common complication and occurred in about 1.54% (154 times in 10,000 cycles). Even this It was rare for any complications to require hospitalization which occurred in 0.35% (35 times in 10,000 cycles). Best of all, the incidence of complications—including adverse medical reactions—declined throughout the time period analyzed.

Importantly, as the pregnancy rates have increased; ART treatment is also resulting in the birth of healthier babies. For instance a 20 year review  of cycles performed in the Scandinavian countries of Norway, Sweden, Finland and Denmark demonstrated a remarkable decline in the incidence of preterm birth or with low birth rate. They also found a similar reduction in still birth and infant mortality. The most important contributing factor to this remarkable success is that these countries have a national policy of transferring only one embryo at a time. The practice of elective single embryo transfer (ESET) is rapidly becoming the norm in the US as well. Another reassuring finding  was that the risk of Autism Spectrum Disorder (ASD) was not increased in children born through IVF; a fear that many had theorized before the data was available to review.

Finally, a recent report  on the increased use of Intracytoplasmic Sperm Injection (ICSI) as a technique to fertilize eggs was recently misinterpreted—in my opinion—rather cynically by the popular critics. ICSI was a treatment first used in 1992 to overcome severe male factor infertility. This report revealed that the use of ICSI has doubled during the last two decades even though the incidence of male factor infertility has remained steady.  Their reports suggested it was being used unnecessarily. As a clinician however I know that many couples have multiple factors contributing to their infertility challenge. Even with a normal sperm count, the sperm may not be able to penetrate the egg; either because the sperm is too weak or because the egg shell (zona) is too tough. Either way, this technique overcomes either challenge. In fact, this recent study found that the rate of “failed fertilization” was markedly reduced by the wider use of ICSI. Another important benefit of using ICSI routinely is that it makes it possible to minimize the risk of a good egg being fertilized by an abnormal sperm. The end result is that ART becomes increasingly safer and more effective and ICSI is one aspect that has contributed to that success.

If you’d like to estimate your own unique chance of a achieving a successful pregnancy through IVF, check out the following link to the Society for Assisted Reproductive Technology: https://www.sartcorsonline.com/Predictor/Patient . There you can answer a few short questions about your current situation and you’ll be given your own personalized IVF cycle prognosis using the statistics from the SART National Database (2006-2012). The results from your center may vary but this should give you an excellent reference point to have further discussions with your reproductive healthcare provider.

[r1]Link to http://jama.jamanetwork.com/article.aspx?articleid=2088842

[r2]Link to http://humrep.oxfordjournals.org/content/early/2015/01/16/humrep.deu345.abstract?sid=ab6c68c3-4f95-40cb-9b74-c9367305e75a

[r3]Link to http://jama.jamanetwork.com/article.aspx?articleid=1707721&resultClick=3

[r4]Link to http://jama.jamanetwork.com/article.aspx?articleid=2091303&resultClick=3

Here is a link to this free blog post:

http://cnyfertility.com/2013/01/17/intra-uterine-hcg-at-embryo-transfer-jump-starting-the-implantation-process

I so enjoy writing and having this venue to share emerging evidence-based research in the field of reproductive medicine. In order to more efficiently balance my responsibilities to my patients as well as my readers, I will continue to reach out in this fashion. Starting this month however, I will be posting a title and excerpt in this blog with a link to the full post. That link will take you to the remainder of the post (free service that we offer to our patients– http://cnyfertility.com/blogs ). I truly hope you don’t find this to be inconvenient and I look forward to sharing more useful and practical information with you.
Best thoughts,
~Robert

Robert Greene, MD, FACOG
CNY Fertility Center

One of the greatest challenges in reproductive medicine is trying to figure out ways to improve pregnancy rates for women that produce a limited number of eggs. Other posts on this blog[u1]  address various steps to try to optimize/improve egg quality[u2] . But new data suggests that the use of intracytoplasmic sperm injection (ICSI) can improve embryo formation and more importantly increase a woman’s chance of becoming pregnant. Traditionally, ICSI has been used to overcome male factor infertility. Over the last several years, some centers have included it in all of their treatment cycles as a means of maximizing fertilization. Some experts criticized this practice since it was based upon a theory rather than clinical proof of an improved outcome. In fact, the American Society for Reproductive Medicine has a Patient Fact Sheet [u3] that describes the guidelines for the use of ICSI (last revised in 2008). Recently a large study attempted to settle this debate on whether or not ICSI should be used in women considered to be “poor responders” to fertility therapy.

One of the limitations of previous studies on “diminished ovarian reserve (DOR)” was the lack of an agreed upon definition of how to diagnose this condition. In 2011 an international meeting was held to form a consensus [u4] on the identification of “poor response to ovarian stimulation.” Their goal was to improve the design of future studies and provide practical guidelines as well as assist doctors in the diagnosis of this condition. To meet diagnostic criteria it was agreed that a woman must have at least two of the following:

  • 40+ years of age or any other risk factor for poor ovarian response
  • A previous cycle producing  3 (or fewer) eggs with a conventional protocol (excludes Mini IVF)
  • An abnormal ovarian reserve test (i.e., AMH [u5] below the age- related norms)

The recent study [u6] referred to in this blog post followed over 1000 IVF patients that had failed on a previous cycle and met the new criteria for “poor responders.” These patient/couples completed nearly 3000 total cycles of IVF with ICSI. They found that including ICSI—despite a normal sperm count—improved the ongoing pregnancy rate by 40%. Another noteworthy fact is that this study was performed in Israel where IVF is a fully covered health benefit for all citizens. This made it possible for patients to continue treatment without concern of cost thereby removing a “selection bias.” The potential benefit of ICSI—in the absence of a male factor—does make sense. Some studies show that women with DOR have a thicker coating on the egg making it more difficult for a healthy sperm to enter. Selecting a sperm for use in ICSI may also reduce the possibility of an abnormal sperm fertilizing an otherwise limited number of healthy eggs. Whatever the reason, most women with a poor response to fertilization are immediately directed to use donor eggs. However, this study found that ~35% of these “poor responders” achieved a successful pregnancy within 5 to 7 IVF attempts. The bottom line is that couples that would otherwise have been discouraged from completing a second attempt went on to have a baby at least 1/3 of the time.

So discuss with your doctor whether or not you may benefit from including ICSI in your next IVF cycle. In doing so, be careful to ask if there is an additional charge for this service. At CNY Fertility[r7]  Center, we are pleased to offer this augmented fertilization technique to all of our patients as part of the standard IVF cycle (included in the standard fee). Now we have more data supporting this recommendation.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

Our society puts a priority on reproduction. That makes sense since it is hardwired into our brain. Unfortunately, that value often results in the assumption that women that choose to wait and begin their family later in life are somehow selfish or narcissistic for “wanting to have it all.” I am pleased to share that a recent report made great strides in dispelling this myth.

A British psychologist recently performed a thorough review [r1] of women’s motivations and situations resulting in “delayed motherhood.” In fact, she even took exception with the term “delayed” because it so strongly suggests that it is a choice that women are consciously making to wait until their late thirties or early forties to become pregnant. Instead, she found that it more often women are responding to their situation. Her research revealed that many women today are having babies later as a result of strategic decision making, extensive negotiations or response to their life’s circumstances. Better still women today have more options to preserve their fertility.

Techniques [r2] are available today to more efficiently freeze and store unfertilized eggs or viable embryos. Embryo freezing has been available for several decades but the efficiency of the process is much greater today. Egg freezing now makes it possible for women to preserve their unfertilized eggs when they are more plentiful and at their healthiest but actually delay fertilization and pregnancy until the time is right. Recently, the technique for freezing unfertilized eggs has been refined so much and the availability of the procedure [r3] has become so readily available that it is no longer considered experimental. So as more women speak out [r4] about their own choices and empower others to do so, it is rewarding to be able to meet their needs with more treatment options.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

In medicine, well intended advice often proves wrong. Sometimes, such recommendations are repeated for years until we lose sight of the where/how the ideas originated. It then takes well documented research to retract the outdated ideas—even then correction is often resisted. An example is the frequently repeated advice that women allergic to seafood should not undergo a hysterosalpingogram (HSG). This rationalization is due to the fear that the iodine-containing contrast that is used to perform the test may provoke a reaction in sensitized patients[r1] .

Food allergies occur in about 4% of the population[r2] . Seafood is among the most common of the foods that people are allergic to. Shellfish and seaweed are the most common foods that contain high levels of iodine. That fact aside, it is difficult to establish how the concern between seafood allergy and iodine first originated. True allergies result when your immune cells react to a protein—not a mineral like iodine—by producing antibodies. These antibodies can then create a reaction upon repeat exposures to the allergen (protein that the person is allergic to). A true seafood allergy is typically a response to a protein called tropomyosin. There is no tropomyosin in the HSG contrast.  Therefore, a classical allergic effect isn’t possible.

A recent review [r3] of the medical literature confirmed that the actual risk of a reaction to the contrast is rare. In fact, the odds of a severe reaction were far less than 1% (0.02-0.5%). So given the importance of the information obtained by performing an HSG, most patients benefit from this part of the infertility evaluation.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

 


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