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Archive for the ‘Research’ Category

That’s the question, isn’t it…I can say yes it is, just in my brief clinical experience, but after reading more lately, I can say for sure it is. Also I am seeing more and more secondary infertility. This is when conceiving child #1 wasn’t a problem, but the 2nd child becomes a challenge to conceive.

Infertility rates are on the rise and here are some reasons why.

About 10 to 15 percent of couples are truly infertile. But that number is getting closer to 15 or even 20 percent simply because more people these days are delaying childbirth, leading to a lot more infertility.

The trouble with waiting longer to have children is that a woman’s eggs decrease in both quantity and quality starting at age 30. When I say starting, we don’t know how fast that decline is and for some women it maybe faster. Also miscarriage rates increase because the rate of having a child with abnormalities also increase.  Typically once you hit 40, the likelihood of chromosomal abnormalities and unhealthier eggs are much higher.

Many preliminary diagnostics can be performed by a patient’s OB/GYN you don’t need to go see a specialist right away, but also don’t wait too long. If you are 40 you probably should go straight to a specialist and if you are in your 30s after a year of trying to conceive you should see a specialist.

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Can you believe it?  More environmental factors linked to PCOS! I can. When I first start researching this topic I was finding that more women were being diagnosed with PCO or PCOS later in life unexplained. Typically this was a diagnosis that started in adolescents.  Now women come down with it and don’t even show many symptoms other than an irregular menstrual cycle. Unfortunately that isn’t enough for your OB to investigate further.  It comes more clear when these women try to get pregnant and can’t or have multiple miscarriages…then they actually look further and discover cysts on your ovaries. It is normal to have them, but how many is normal is the question.

We can choose to live in a bubble and not think our environment is effecting us, but there is more and more proof that it is even effecting our reproductive abilities…read further on the studies.

A while back we talked about how the environmental chemical Bisphenol A is associated with PCOS.

Another study, from Nanjing Medical University in China evaluated 108 women with PCOS and 108 women free of the disorder.

They found that risk factors for PCOS were: occupation, education, disposable plastic cups for drinking, cooking oil fumes and indoor decoration. The strongest risks factors were disposable plastic cups for drinking, cooking oil fumes and indoor decoration.

More recent studies from Nofer Institute of Occupational Medicine in Poland and Mount Sinai School of Medicine in New York are strongly suggesting that daily exposure to endocrine-disrupting environmental chemicals is associated with early breast development in girls and precocious puberty.

Three common classes of chemicals — phenols, phthalates and phytoestrogens — are known to interfere with your hormonal system.

These disrupters can be found in numerous consumer products such as nail polishes, cosmetics, perfumes, lotions and shampoos. Other sources include various plastics, coatings on time-released medications, building products and plastic tubing.

Early continual exposure can lead later on to breast cancer, thyroid disorders, diabetes, asthma, allergies, attention deficit disorder, pregnancy and fertility problems, and more.

It’s all a little depressing and overwhelming, isn’t it? No one wants to live a life with out nail polish, cosmetics, shampoos, plastic drinking cups, or pleasant objects in our home made out of petrochemicals.

Regardless of how you feel about it, you’ll have to decide how important it is to you to deal with PCOS. If you plan on becoming pregnant, how important it is to you to reduce your future daughter’s risk of developing PCOS? If you’re a mother, how important to you is the future health of your daughter?

The more important all this is to you, the more action you’ll want to take to minimize exposure to environmental chemicals of all kinds. As a start, think of using glass, ceramic, wood or other natural materials as part of your lifestyle and environment instead of plastics. Use natural or organic products wherever possible.

Source: PCOS Review

Huang WJ et al, [Analysis of environmental factors and polycystic ovary syndrome], Zhonghua Fu Chan Ke Za Zhi. 2007 May;42(5):302-4.
Wolff MS et al, Investigation of relationships between urinary biomarkers of phytoestrogens, phthalates, and phenols and pubertal stages in girls, Environ Health Perspect. 2010 Jul;118(7):1039-46.
Jurewicz J et al, Exposure to phthalates: Reproductive outcome and children health. A review of epidemiological studies, Int J Occup Med Environ Health. 2011 Jun;24(2):115-41.

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Make sure the men are getting tested as well!  You don’t know how many times I have heard couples come to me when only a basic semen analysis has been done. Years later they uncover the main reason for their infertility because of tests not done on the male.  There are other semen analysis and you need to ask about them, as well as genetic tests.  Apparently there is also a new male test out there as well to help determine the success of treatment…read on.

A new test for male infertility which will save time, money and heartache for couples, has been developed at Queen’s University Belfast.

The breakthrough is the result of 10 years research by Professor Sheena Lewis who leads the reproductive medicine research group.

It provides unique data by measuring damaged DNA in individual sperm.

This is used to predict the success of infertility treatments and highlight the treatment most likely to succeed.

Professor Lewis said the SpermComet test would also significantly reduce waiting times and improve chances of conception.

“One in six couples has difficulty in having a family. In 40% of cases, the problems are related to the man,” she said.

“Until now, there have been few accurate ways of measuring a man’s fertility.

“Good quality sperm DNA is closely associated with getting pregnant and having a healthy baby, and the SpermComet test is the most sensitive test available for sperm DNA testing.”

Professor Lewis, in partnership with Queen’s venture spin out company, QUBIS, has now set up a new company to market the test, which is already available through fertility clinics in Glasgow, Dublin and Galway.

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Infertility Myths

More than 7 million women in the United States struggle with infertility. Adding to the weight of the issue are the many myths and misunderstandings being spread about infertility — perhaps because it’s an emotional subject that people have a difficult time discussing openly.

Here are six common myths about infertility, and explanations from the specialists at Reproductive Laboratories of Augusta, a member of MCG Health System:

Myth No. 1: It’s easy to get pregnant. False. With each menstrual cycle, a couple has a window of opportunity in which to conceive. The egg survives for only 12 to 24 hours after ovulation. To get pregnant, a couple must have intercourse either in the period prior to or during ovulation. The bottom line: Couples who are trying to conceive have about a one-in-five chance of getting pregnant each cycle at their peak fertility.

Myth No. 2: Everyone should try to conceive for a year before seeking medical help. False. Infertility is defined as not achieving pregnancy after 12 months of attempting to conceive for most couples. Experts recommend that women over 35 years old see an infertility specialist after six months of unsuccessfully attempting pregnancy. Why? A woman’s fertility decreases significantly with age. It is important to seek help before treatment success is affected by age.

Myth No. 3. Infertility treatment is always complicated and expensive. False. There are many medications which are available to treat infertility which are not expensive and can be taken orally. These medications can be used in patients who ovulate and don’t ovulate regularly with success. Certain lifestyle changes can also help improve fertility, such as changing or adding certain prescription medications in men and women, or diet and exercise in women.

Myth No. 4. Stress can cause infertility. False. Stress is not felt to be a cause of infertility. Of course, stress or extensive work commitments can indirectly affect fertility if these things affect a couple’s personal relationship. Severe stress can interfere with ovulation or depress sperm production. But both situations are rare.

Myth No. 5. There’s nothing you can do to prevent infertility. False. You may not realize it, but sexually transmitted diseases can lead to infertility. Infections caused by Chlamydia and gonorrhea can cause scarring and damage to a woman’s reproductive organs that can interfere with fertility. You can reduce this risk by using condoms.

Myth No. 6. Infertility is primarily a woman’s problem. False. Infertility is a couple’s issue. In at least 40 percent of cases, a fertility problem is diagnosed in the male partner. It is important that both partners be evaluated at the initial appointment.

In 30 to 40 percent of cases, there is more than one problem when a couple can’t conceive, or infertility can be from an unknown factor. It is important to make sure there are no genetic conditions or other health problems that may be contributing to problems conceiving.

Don’t believe everything you hear. If you are having difficulty getting pregnant or are concerned about conception, talk to your doctor or seek advice from a reproductive specialist.

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This is a topic that has surfaced in the support group in Oakland recently and I thought I would share some information regarding stress and infertility.

There are women who get pregnant easily even if they smoke like a chimney, drink a six-pack after dinner, and think of exercise as a waste of good texting time. Then there are the women who do all the right things but months and years pass and the strip in the home pregnancy kit refuses to change color. Relax, say well-meaning friends. Chill out. Let it happen. Gee, thanks, thinks the beneficiary of their insight, gritting her teeth.

// Click here to find out more!

But as unwelcome as the advice may be, it may be right. New evidence suggests that stress does affect fertility. A recent study found that women with high levels of alpha-amylase, an enzyme that correlates with stress, have a harder time getting pregnant. Saliva samples taken from 274 women over six menstrual cycles (or until they got pregnant) revealed that those with the highest enzyme concentrations during the first cycle were 12 percent less likely to conceive than were women with the lowest levels.

What’s more, women involved in the study, published earlier this month in the journal Fertility and Sterility, had no prior record of infertility. Participants were either planning to get pregnant or had been trying for less than three months.

Researchers do not yet understand the role stress plays, since women can and often do get pregnant even under the intense stress, for example, that follows the death of a spouse. “I suspect that some women are more reproductively sensitive to stress than other women,” says Alice Domar, who directs the Domar Center for Mind/Body Health in Boston. And the effect can feed on itself. “If you are stressed and you don’t get pregnant quickly, then you get more stressed,” says Domar, citing evidence from a study in Taiwan in which 40 percent of participants seeking infertility treatment were diagnosed with depression or anxiety. The treatment itself can be stressful, she adds, adding even more uncertainty.

[Alternative Treatments May Boost IVF Success]

If stress can influence the chance of conception, managing it may improve the odds. Researchers like Sarah Berga, who heads the department of gynecology and obstetrics at Emory University School of Medicine, have been trying to prove just that. Berga and her colleagues studied women who had stopped ovulating for more than six months and found that they had high levels of cortisol, a stress hormone. In stressful situations, cortisol, like adrenaline, pushes metabolism into high gear; sustained high levels can raise blood pressure, cause weight gain, or lead to other health problems. In a small study by Berga published in 2003, seven out of eight participants who received stress management therapy began ovulating again versus two out of eight who got no intervention.

What are some practical ways women trying to get pregnant can reduce stress? Experts make these recommendations:

Enlist your partner. Research shows that women handle infertility-related stress differently from men. Women more often seek social support, for example; men lean towards problem-solving. That disconnect can strain the relationship. Constant attention on procreation, according to psychologist Julia Woodward of the Duke Fertility Center in Durham, N.C., also contributes, siphoning the fun and joy from sex. She advises couples to act as if they were dating again. Set aside time during the week to go to a movie. Take a dance class together. And put a time limit of 20 minutes or so on pregnancy discussions. Fertility talk that goes on and on can make matters worse, she says.

Rethink your attitude. Thinking “everybody else gets pregnant so easily” only causes distress. Woodward helps women counter their negativity with positive coping statements: “If getting pregnant was so easy, there wouldn’t be fertility clinics.” Recognize pessimistic thinking and practice forming a response that is more realistic.

Try journaling. Setting down on paper how you feel can take some of the pressure off, says Tracy Gaudet, executive director of Duke Integrative Medicine. It’s a way to off-load concerns you feel uncomfortable sharing, she says. And you can shred the pages or throw them out, a physical act that contributes to the effect.

Stay active. Continuing activities you enjoy is critical, says Woodward; otherwise the pregnancy project becomes the sole focus. Take pictures, plan special meals—whatever your passion, indulge it. Doing something enjoyable also boosts serotonin, a mood-enhancing brain chemical. That’s an added bonus.

Work on relaxation. One easy way, Gaudet suggests, is to spend time once or twice a day coaxing the body into a state of deep relaxation. Take five minutes or so to close your eyes and transport yourself to a far-off destination, a mini-mental vacation. Allow yourself to experience all the senses of your surroundings, says Gaudet, and your body will respond as if you are actually there. The benefits of the “relaxation response” include a slower heart rate and lower blood pressure. If a specific kind of technique is preferred, there’s no shortage of choices. Meditation, yoga, and progressive muscle relaxation are just a few.

[Relax! Stress, if Managed, Can Be Good For You]

Exercise. Walking, swimming, yoga, or other moderate exercise may take the edge off stress, and it has additional advantages. Overweight women who trim pounds through physical activity benefit, for example; extra body fat produces excess estrogen, which interferes with ovulation. Higher-energy workouts like running or jogging stimulate the release of feel-good endorphins. Berga warns that too much exercise for women who are already stressed, however, can make matters worse, since exertion triggers the release of cortisol. Relying exclusively on exercise to relieve stress, moreover, won’t do anything about what is causing it—a hostile boss, for example.

[5 Mind-Blowing Benefits of Exercise]

Get individual counseling or group support. A woman struggling to get pregnant needs someone who can empathize, says Woodward. Counseling can be an outlet for feelings of confusion, sadness, and frustration. Group support, says Woodward, is particularly helpful for women who feel isolated as a result of infertility. Resolve.org, a website of the National Infertility Association, has links to local support groups across the nation.

Source: By Megan Johnson U.S. News & World Report

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Women who fail to become pregnant after undergoing in vitro fertilization treatment often grapple with the decision of whether to try IVF again. It’s a difficult one to make: The procedure carries hefty financial, physical and emotional costs, and there are no guarantees it will work.

Now a team of Stanford University School of Medicine researchers has developed a model to predict the outcomes of a subsequent round of IVF for those women who have already gone through a cycle. The researchers found that their test, which relies on taking clinical data from prior, failed treatments to provide more personalized predictions, is 1,000 times more accurate than the age-based guidelines currently used to counsel patients.

“Our findings show that the first IVF cycle can provide quantitative, customized prediction of the live birth probability in a subsequent cycle,” the researchers wrote in their paper. “This concept is radically different from the current paradigm, in which age is a major predictor.”

The paper, published online July 19 in the Proceedings of the National Academy of Sciences, was led by Mylene Yao, MD, assistant professor of obstetrics and gynecology. It follows previous work from Yao about another method she and her colleagues had devised that provides more accurate predictions about whether a woman undergoing IVF treatment will become pregnant. The newer test not only integrates more data into its methodology, but also its success was measured with a different outcome: live birth instead of pregnancy.

Yao said she’d like to see the new test widely available for clinical use, and she and co-author Wing Wong, PhD, professor of statistics and of health research and policy, have founded a company, Univfy, to develop and market prognostic tests to support clinical decision-making in infertility. Stanford holds the patent on this test.

Each year, close to 100,000 IVF cycles are performed using a woman’s fresh eggs, and around 29 percent of the treatments result in live births. Physicians typically use age-based data, with adjustments based on other clinical factors, to counsel patients on the probability of success. But given all the factors at play — including the number and quality of eggs and the total number of embryos implanted — age may be misleading as a prognostic factor.

Consider this scenario: A 38-year-old patient is told that women in her age bracket have a 33 percent chance of becoming pregnant from IVF. But because she has a lower-than-usual number of eggs, her physician says her chances are actually less than 33 percent. “The problem is that the patient will ask, ‘How much less?’” said Yao. And currently, the answer is at best an educated guess from the doctor.

Co-author Lynn Westphal, MD, an associate professor of obstetrics and gynecology who treats patients in Stanford’s Reproductive Endocrinology and Infertility Center, said a woman’s decision to repeat IVF is influenced by several factors, including financial considerations and her chances of becoming pregnant. “Many patients, even if they have insurance coverage, will drop out — either because they don’t understand what their odds are or they find it’s a very emotionally challenging experience to go through,” she said.

Westphal said improvements in the ability to predict a patient’s chances of IVF success would make counseling more meaningful. “The more information, the better,” she said.

It was the goal of Yao, Westphal and their colleagues to develop a way to provide patients with more personalized predictions. They took data from 1,676 IVF cycles performed at Stanford Hospital & Clinics between 2003 and 2006 and identified 52 factors — such as patient age, levels of certain hormones, number and quality of eggs and individual characteristics of each embryo — that influence a woman’s chance of having a baby. They then developed a computer model that sorted patients into subsets defined by similar clinical characteristics (so-called “deep phenotyping”) to predict live-birth probabilities in a subsequent round of IVF.

When testing their model with data from a separate set of more than 600 IVF treatments performed in 2007-08, the researchers determined that the model’s predictions were significantly different than the age-based predictions in 60 percent of patients. Interestingly, out of this group, more than half were assigned greater odds of having a baby than what age-related data indicated.

What’s more, in further verifying the accuracy of their new method, Yao and her colleagues determined that their model predicted outcomes with 1,000 times more accuracy than the age-based guidelines widely used in clinics.

Their findings, the researchers said in the paper, indicated that “the current age-based paradigm may provide misleading live birth outcome probabilities for a large portion of patients.”

Yao noted that because it’s critical to have data from previous treatment, this model wouldn’t be able to predict chances of success for those embarking upon their first IVF. But she said having personalized, accurate prognostic information would be invaluable in assisting women’s decisions to keep going or not. “For some of the patients, we may be able to reassure them and help them move forward and do another cycle if they have good odds,” agreed Westphal. “For other patients, if they’re in a poor category, we’ll help them move on to consider better options.”

Source: The first author of the paper is Prajna Banerjee, PhD, a postdoctoral scholar in obstetrics and gynecology. Other Stanford co-authors include Bokyung Choi; Lora Shahine, MD; Sunny Jun, MD; Kathleen O’Leary; and Ruth Lathi, MD. Funding came from the National Institutes of Health and the Coulter Foundation Translational Research Program at Stanford University.

More information about Stanford’s Department of Obstetrics and Gynecology, which also supported the work, is available at http://obgyn.stanford.edu/.

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A cause of miscarriage and other pregnancy complications has been identified by the University Magna Graecia in Italy.

The researchers compared 73 pregnant women with PCOS and 73 pregnant women who did not have PCOS. They measured the flow of the artery that supplies blood to the uterus during pregnancy. They discovered that the PCOS group had reduced or abnormal blood flow to the uterus, which substantially increased the risk of pregnancy problems.

What might be a reason for the abnormal blood flow?

Women with polycystic ovary syndrome are more likely to have a condition called “endothelial dysfunction”. Endothelial dysfunction means that the cells in your artery walls are not working properly. This condition is an “early warning” sign of future, more serious cardiovascular problems such as atherosclerosis (hardening of the arteries).

What might you do about it?

Eat a healthier diet. Avoid unhealthy fats and eliminate all refined sugars from your diet. (If you don’t know what an unhealthy fat is, read the “Fats and Oils” section of The Natural Diet Solution for PCOS and Infertility ebook.

Of course, regular exercise is highly advisable.

There are also certain nutritional supplements that may help. For example, a report from the University of Indiana School of Medicine indicates that L-carnitine can reduce endothelial dysfunction in some people, especially if they have a weight problem.

Source: PCOS Review

Sources: Melnik B et al, Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris, Exp Dermatol. 2009 Oct;18(10):833-41
Danby FW, Acne, dairy and cancer: The 5alpha-P link, Dermatoendocrinol. 2009 Jan;1(1):12-6
Melnik B, Milk consumption: aggravating factor of acne and promoter of chronic diseases of Western societies, J Dtsch Dermatol Ges. 2009 Apr;7(4):364-70
Melnik B, Milk–the promoter of chronic Western diseases, Med Hypotheses. 2009 Jun;72(6):631-9

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