Increased Infertility topic of Conference- Montreal Gazette

MONTREAL — Human infertility is bound to grow around the world as more and more contaminants make their way into the environment, warns the co-chairman of an international conference on reproductive science being held in Montreal this week.

“Infertility is a serious problem,” said Bruce Murphy, a professor of reproductive biology in the faculty of veterinary medicine at the Université de Montréal.

“If you look at sperm counts of young men from 1950 until the present, you can see a decline over that period, and we believe it’s attributable — at least, in part — to environmental contaminants.”

A Canadian study last year found that in 1984, about five per cent of couples age 18 to 29 were infertile. By 2010, the infertility rate for that age group jumped to 13.7 per cent.

The obesity epidemic and the tendency of many women to get pregnant later in life are often cited as reasons for the rise in infertility. But a researcher at the University of Wisconsin-Milwaukee, Reinhold Hutz, is to present findings at the Montreal conference this week showing that “environmental contaminants have effects on the ovary and contribute to human infertility.”

Murphy noted that research in the 1960s found that pesticides like DDT interfered with the reproductive systems of eagles and peregrine falcons. Today, research has revealed that a compound used in many plastics, Bisphenol A (BPA), can interfere with the reproductive systems of lab mice.

“The BPA story was developed largely by (researchers) who discovered that when they got new plastic cages their mice stopped reproducing,” Murphy said.

Although may baby bottles are now sold as “BPA-free,” the compound is still found in the lining of food cans and even the paper on store receipts. Murphy predicted that other compounds — like brominated flame retardants that are used in some furniture — will likely be shown to disrupt the human reproductive system.

“We are now beginning to see the subtle effects of certain kinds of environmental toxins, and they are everywhere,” he added.

It’s not just human infertility that people should be worried about. Researchers are also grappling with rising infertility rates in dairy cattle.

Paradoxically, despite increasing human infertility, the global population is projected to climb from more than 7 billion today to 9.6 billion by 2050, according to a United Nations report.

“If the projections are right — particularly the projections about food supply which includes animal projects — we might not be able to keep up with the demand for food,” Murphy explained. “We’re going to have to produce more food for more people on less land. That’s one of the reasons why reproductive science is more important than ever.”

More than 1,200 scientists from around the world — including at least 80 from Quebec — will be attending the 46th annual meeting of the Society for the Study of Reproduction.

Other eagerly-anticipated studies that will be presented at the conference include one by Adam Watkins of the University of Nottingham in England showing that “maternal and paternal nutrition at the time of conception have an effect on the postnatal health of the offspring,” as well as the latest findings on embryonic stem cells.

 

Female Survivors Of Childhood Cancer Often Go On To Have Successful Pregnancies In Adulthood

Although women who survived childhood cancer face an increased risk of infertility, nearly two-thirds of those who tried unsuccessfully to become pregnant for at least a year eventually conceived, according to clinical researchers at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and Brigham and Women’s Hospital. This is comparable to the rate of eventual pregnancy among all clinically infertile women.

“Most women think that if they had cancer as a child, then they’ll never have children. It turns out that many of them can get pregnant. It just might be a little harder,” said senior author Lisa Diller, MD, chief medical officer of Dana-Farber/Boston Children’s and medical director of the David B. Perini, Jr. Quality of Life Clinic at Dana-Farber Cancer Institute.

The paper, published in Lancet Oncology, is the first large-scale study of female childhood cancer survivors that examines outcomes for those who experienced infertility, as defined by the typical clinical definition of infertility (attempting to conceive for a year or more without success).

Overall, 15.9 percent of women who survived childhood cancer were affected by infertility, with 12.9 percent trying to conceive for at least one year without success. The remainder of survivors included in the infertile group had ovarian failure and may not have even attempted pregnancy. In a comparison group comprised of sisters of childhood cancer survivors, 10.8 percent experienced infertility. This translates to a roughly 50 percent higher risk of infertility among the survivors of childhood cancer.

The new study is based on data from the Childhood Cancer Survivor Study, a cohort study of five-year survivors from 26 institutions who were under 21 when diagnosed with cancer between 1970 and 1986. Researchers studied 3,531 sexually active female survivors, age 18-39, and a control group of 1,366 female siblings of participants in the large-scale survivor study.

“This is the first study to examine direct questions about infertility and the use of infertility services,” said lead author Sara Barton, MD, a clinical fellow of reproduction and infertility at Brigham and Women’s Hospital at the time of the research. “Previous studies used surrogate markers. Parenthood. Pregnancy. Births. These don’t take into account people’s intent. They don’t take into account how long it took to achieve pregnancy.”

Among survivors of childhood cancer who had been trying unsuccessfully to get pregnant for at least a year, 64 percent conceived after, on average, another six months, compared with an average of five months for clinically infertile women in the control group who eventually conceived.

Women whose cancer was treated with alkylating agent chemotherapy or high-dose radiation to the abdomen or pelvis were most at risk of infertility. Although pediatric oncologists have changed a number of treatment protocols over the last several decades to reduce late effects, alkylating agents and radiation continue to be used.

“Women getting alkylating agents or radiation to the pelvis or abdomen should be triaged for fertility preservation. In addition to being at highest risk to report infertility, female cancer survivors who received those cancer therapies were the least likely to conceive once they had infertility,” said Barton, who is now a staff physician at the Heartland Center for Reproductive Medicine and clinical professor at the University of Nebraska Medical School. The new research, she added, will help clinicians offer guidance to current patients based on the treatment protocol for their cancer. “If you’re newly diagnosed with Hodgkin’s lymphoma, for instance, you may be slightly more likely to experience infertility, but I don’t necessarily think you need to delay your therapy to freeze your eggs.”

The researchers also found that only 42 percent of cancer survivors who sought treatment for infertility were prescribed medication, compared with 75 percent in the control group. Both groups – 69 percent of survivors and 73 percent in the control group – were similarly likely to seek medical help for their infertility.

Prior research has found that survivors of childhood cancer face a greater risk of infertility but, once pregnant, are not at greater risk for miscarriage or stillbirth.

“What we found delivers a really nice message to clinicians,” Diller said. “If you have a patient who is a childhood cancer survivor and is self-reporting clinical infertility, the chances are good that she will become pregnant. Women who have a history of childhood cancer treatment should consider themselves likely to be fertile. However, it might be important to see an expert sooner rather than later if a desired pregnancy doesn’t happen within the first six months.”

 

Endometriosis and Infertility- Womens College Hospital

Endometriosis: a common cause of pelvic pain

 

March 25, 2013

By Patricia Nicholson

Endometriosis is a condition in which tissue similar to the endometrium – the tissue that lines the uterus – also grows outside the uterus. It is a common condition that affects women in their reproductive years.

One of the main symptoms of endometriosis is pain, says Dr. Abheha Satkunaratnam, a gynecologist at Women’s College Hospital. Women with endometriosis may experience:

  • menstrual pain
  • premenstrual pain
  • pain on ovulation
  • pain during intercourse
  • chronic pelvic pain
  • bowel pain, or pain on bowel movements
  • pain on urination

Pain associated with endometriosis can be debilitating, and can affect work, school and other activities as well as quality of life

The condition also affects fertility – in terms of both infertility and miscarriage. In some cases, women don’t experience pain, and infertility is their only symptom.

“Endometriosis has certainly been demonstrated to impact fertility, not only getting pregnant but staying pregnant,” Dr. Satkunaratnam says. “Sometimes the primary presentation is an inability to get pregnant.”

In many cases of endometriosis, the endometrial tissue located outside the uterus is in the abdominal cavity, such as on the ovaries or on the outside of the uterus. In rare cases, however, it can be located in other areas, such as the lungs or even the brain. Despite being outside the uterus, this endometrial tissue still behaves like the lining of the uterus, thickening and shedding with the menstrual cycle. However, unlike the endometrium inside the uterus, this tissue has no way to exit the body. This trapped endometrial tissue is believed to cause inflammation, which may lead to the pain and fertility problems associated with endometriosis.

The exact causes of endometriosis are not clear, but it is believed that multiple factors are involved.

The original theory put forth in the 1920s was that endometriosis was caused by menstrual blood going backwards – or retrograde – through the fallopian tubes rather than through the cervix, and then implanting itself in the abdominal cavity.

“We know now that it’s more than that,” says Dr. Satkunaratnam. “But certainly that’s believed to be one of the mechanisms by which it happens.”

Many women with retrograde menstruation never develop endometriosis. It’s now thought that once the endometrial tissue has entered the abdominal cavity, cellular changes may occur that cause that tissue to behave differently.

“Some people with retrograde menstruation are more likely to then have endometriosis than others, so there may be a genetic predisposition,” says Dr. Satkunaratnam. “We often see endometriosis in families.”

Traditional figures estimate that endometriosis affects about 10 per cent of women in their reproductive years, but Dr. Satkunaratnam notes that recent population-based data suggest that it may be much more common.

“It is postulated that up to 30 per cent of women may be affected. The issue is that often it’s undiagnosed,” he says, so the number of women with endometriosis may be greatly underestimated.

“What we realize with pain in women is sometimes they don’t complain about it. Certainly the old archaic mentality that periods are supposed to be painful still prevails.”

Even for those who do seek help, the difficulties in diagnosing endometriosis were highlighted in a U.K. study that found that many women see multiple doctors before getting a diagnosis.

“The U.K. data showed it took an average of eight health-care professionals to finally come up with a diagnosis,” says Dr. Satkunaratnam.

Fortunately, endometriosis can be treated with hormonal medication, surgery or both. Surgery can remove misplaced endometrial tissue, but without medication it will likely return.

“If we remove it surgically, in women who are still going to be menstruating for another five, 10, 15 or 30 years, it always comes back,” says Dr. Satkunaratnam. “That’s where medical therapy is equally important.”

Ultimately, the permanent cure for almost all cases of endometriosis is menopause.

Coffee and Fats May Affect Fertility Treatments- Access Atlanta

By Kathleen Doheny, Reviewed by Louise Chang, M

 

What a woman drinks and eats — especially coffee and fat — may affect her chances of success withinfertility treatments, two new studies suggest.

“If you drink more than five cups of coffee a day, you reduce your chances of achieving pregnancy during IVF treatment by 50%,” says researcher Ulrik Kesmodel, MD, PHD, a consultant gynecologist at the Fertility Clinic of Aarhus University Hospital in Denmark.

Eating high amounts of saturated fats and polyunsaturated fats also made IVF success less likely, says researcher Jorge E. Chavarro, MD, an assistant professor of nutrition and epidemiology at Harvard School of Public Health.

But eating higher amounts of monounsaturated fats increased the chances of having a live birth, he tells WebMD.

Both studies were presented in Istanbul at the 28th annual meeting of the European Society for Human Reproduction and Embryology (ESHRE).

However, other experts consulted by WebMD warn that both studies are small and it’s too soon to recommend drastic dietary changes based on the findings.

“In a small study, all sorts of spurious results can come out,” says Richard Paulson, MD, professor of reproductive medicine and head of the fertility program at the University of Southern California in Los Angeles.

About 1 in 6 couples worldwide have some type of infertility problem during their reproductive years, according to ESHRE. Since 1978, about 5 million babies worldwide have been born with the help of fertility treatments.

Diet & IVF Success: Coffee Study

For the coffee study, Kesmodel evaluated nearly 4,000 cycles in women undergoing infertility treatments at a Denmark clinic.

At the start of the treatment and before each treatment cycle, the women reported how much coffee they drank per day. Kesmodel also took into account age, smoking, alcohol habits, weight, and other factors that may affect the success of fertility treatments.

Those who drank more than five cups of coffee a day cut their chances of achieving pregnancy.

“They have only half the chance of achieving pregnancy compared to women who do not drink coffee at all,” Kesmodel tells WebMD.

The finding needs to be repeated in other studies, Kesmodel warns. But if the current study turns out to be valid, the effect of heavy coffee drinking on IVF success would be about the same as the known risk of smoking during IVF.

“I am not saying people [undergoing IVF] should not drink coffee at all,” Kesmodel tells WebMD. “One or two cups a day would likely be okay.”

He can’t explain the link, and points out that he found evidence only of an association between heavy coffee drinking and odds of IVF success, not proof that coffee causes IVF failure.

Diet & IVF Success: Fats

In previous research, Chavarro and his team found links between trans fats and saturated fats and fertility problems.

In the new study, he evaluated 147 women having IVF at the Massachusetts General Hospital Fertility Center.

He grouped the women into categories depending on how much of three different kinds of fat they ate.

He also took into account their body mass index, smoking habits, and infertility diagnosis, all of which could affect their treatment.

He found:

  • Women who ate the most saturated fats (found mostly in animal food sources) had fewer mature oocytes — cells that form eggs.
  • Women who ate the most polyunsaturated fats (found in plant-based foods and oils) had more poor-quality embryos than those who ate the least.
  • Women who ate the most polyunsaturated fats also had a 12% higher proportion of cells in the embryo that were dividing more slowly than expected.
  • Higher levels of monounsaturated fats (found in oils and many foods and found to improvecholesterol) increased the chances of a live birth after embryo transfer. Those who ate the most were about 3.5 times more likely to have a live birth than those who ate the least.

The amount of fats eaten varied. For instance, those in the lowest monounsaturated group ate about 9% of calories from this fat. Those in the highest group, about 25%.

Chavarro can’t explain the links. “At this point it is not entirely clear what the underlying mechanisms explaining these associations might be,” he tells WebMD.

Diet & IVF Success: Perspectives

No dietary advice changes should be based on the new research, experts who reviewed the findings agree.

“The coffee finding is not a shock,” says Harry Lieman, MD, interim division director of reproductive endocrinology and infertility at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, N.Y.

In studies of women trying to conceive without IVF, he says, increased caffeine intake has been linked with an increased length of time to get pregnant.

He already tells his IVF patients not to drink more than two cups of coffee daily. “Now I have IVF evidence,” he says.

The finding that women drinking five or more cups of coffee a day fared worse in IVF treatment may simply reflect other extreme habits, Paulson says.

“Anyone who drinks five cups of coffee a day probably has other habits that are not ideal,” he suggests. “We cannot conclude from this study that coffee in and of itself interferes with having a good pregnancy outcome following IVF.”

Paulson tells his IVF patients they can indulge in one cup of coffee a day, even if it is coffee-house coffee — typically double the serving size at home.

“Drinking coffee in excess, based on this study, does seem to have a detrimental effect,” says Peter Klatsky, MD, assistant professor of reproductive medicine at Montefiore Medical Center/Albert Einstein College of Medicine.

However, the findings may apply to a small percentage of patients, he says. “Most patients are not drinking five or more cups,” he says.

The research on fat is too new to trigger diet advice changes, the experts agree.

Until more research is in, the experts who reviewed the findings suggest women undergoing IVF stick with the same guidelines as others. The Dietary Guidelines suggest keeping saturated fat intake low and total fat intake moderate.

This research was presented at a medical conference. The findings should be considered preliminary as they have not yet undergone the “peer review” process, in which outside experts scrutinize the data prior to publication in a medical journal.