Thursday, December 5th, 2013
A rise in the number of multiples–triplets or even more–born in the U.S. is being attributed in a new study to a number of fertility treatments. Though many believe multiple births to be a result of multiple embryos being transferred during in vitro fertilization (IVF) procedures, the study, published in the New England Journal of Medicine, attributes the phenomenon more to drugs given to women to encourage them to produce more eggs. The Associated Press has more:
Multiple births raise medical risks and hospital bills for moms and babies. Guidelines urging the use of fewer embryos were strengthened following the 2009 “Octomom” case, in which a California woman had octuplets after her doctor transferred 12 embryos made from an IVF treatment.
But most cases of infertility are treated not with IVF but simpler measures such as drugs to make the ovaries produce eggs. The first step often is a pill, Clomid, to spur hormones that aid conception. If that doesn’t work, more powerful drugs can be given in shots, but those bring a much higher risk of multiple eggs being released.
Doctors are supposed to use ultrasound and blood tests to monitor how many eggs are being produced and advise couples against trying to conceive that month if there are too many, to minimize the risk of multiple births. But that monitoring often isn’t done, or done well, and couples eager for a baby may disregard the advice.
“It’s very easy to demonize this dumb doctor who didn’t do the right thing. That may not always be the case,” said Dr. Nanette Santoro, obstetrics chief at the University of Colorado in Denver. “Frustrated people who don’t get pregnant after a couple cycles will think more is better. It’s the American way.”
The new study examined trends over several decades and finds that the rate of triplet and higher-order births peaked in 1998 and has been declining since then.
From 1998 to 2011, the estimated proportion of twin births due to IVF increased from 10 percent to 17 percent, while the proportion of triplets-and-more declined.
During the same period, the estimated proportion of triplet and bigger multiple births from non-IVF treatments such as fertility drugs increased from 36 percent to 45 percent.
Image: Infant sleepers on clothesline, via Shutterstock
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Friday, November 1st, 2013
A team of researchers from a number of top Boston medical institutions are working together on new research that could help the best sperm from a man’s sample travel better through fluid, increasing its chances of successfully finding and fertilizing a woman’s egg. The research, if successful, could increase the chances of success for couples who undergo in vitro fertilization (IVF). More from Boston.com:
Physicist Erkan Tuzel works in a field that seems just about as far removed as possible from delicate questions about human reproduction; his lab at Worcester Polytechnic Institute develops algorithms to describe the behavior of complex fluids. But after he heard a talk by Harvard Medical School bioengineer Utkan Demirci, who carves microscopically small channels and then allows fluids to flow through them, the two began to talk about collaborating. Their common ground? Designing technology that could cull the healthiest, fastest-moving sperm from the slowpokes.
Doctors trying to help couples reproduce through in vitro fertilization would like to have an easy way to identify and isolate the sperm most likely to result in a baby. Figuring out how to reliably do that, however, may have as much to do with physics as it does with biology.
In real-world experiments, sperm can swim through tiny channels created by Demirci at Brigham and Women’s Hospital. Computer modeling by Tuzel could be used to understand how to design those channels so that they select the right sperm.
“Sperm cells interact with each other when in confined geometries,” Tuzel said. “Just like birds when they fly in formation like a flock, similarly through the fluid, the sperm cells interact with each other and they synchronize their tails—they start beating in phase. … How can we use this information to learn from it and utilize it?”
Tuzel was recently awarded a $300,000 grant from the National Science Foundation to build computational tools that could help design systems that sort sperm in real life.
Image: Sperm collection container, via Shutterstock
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Monday, October 21st, 2013
The number of women who become pregnant using donor eggs has risen in the last decade, although the number of healthy babies born on time and at a healthy weight remains less than ideal for that group. More from The Associated Press:
That ideal result occurred in about 1 out of 4 donor egg pregnancies in 2010, up from 19 percent a decade earlier, the study found.
Almost 56 percent resulted in a live birth in 2010, and though most of these were generally healthy babies, 37 percent were twins and many were born prematurely, at low birth weights. Less than 1 percent were triplets. Low birth weights are less than about 5½ pounds and babies born that small are at risk for complications including breathing problems, jaundice, feeding difficulties and eye problems.
For women who use in vitro fertilization and their own eggs, the live-birth rate varies by age and is highest — about 40 percent — among women younger than 35.
Women who use IVF with donor eggs are usually older and don’t have viable eggs of their own. Because the donor eggs are from young, healthy women, they have a good chance of success, generally regardless of the recipient’s age.
The average age of women using donor eggs was 41 in 2010 and donors were aged 28 on average; those didn’t change over 10 years.
The study, by researchers at Emory University and the federal Centers for Disease Control and Prevention, was published online Thursday in the Journal of the American Medical Association and presented at the American Society for Reproductive Medicine’s annual meeting in Boston.
Image: Pregnant woman, via Shutterstock
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Tuesday, October 15th, 2013
An estimated 5 million babies have been born using the fertility treatment known as in vitro fertilization (IVF) since Louise Brown became the first baby born using the technique, 35 years ago. Most of those births took place in the last 6 years, a period when researchers say the stigma surrounding infertility lessened and technology improved. More from NBC News on the first-ever research presented Monday in Boston at the meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine:
“IVF has become sort of mainstream,” says Dr. David Adamson, a reproductive endocrinologist in San Jose and Palo Alto, Calif., who led the efforts to analyze 10 reports from two international organizations that monitor births resulting from fertility treatment.
Until now, it’s been hard to get a handle on the number of IVF births worldwide, said Adamson, who is part of a nongovernmental organization called ICMART, or the International Committee for Monitoring Assisted Reproductive Technology.
The reports spanned the years from 1989 to 2007, with a few years missing in between. They relied on available data, which is far from complete, meaning that 5 million births is really a “best guess,” says Adamson.
Researchers are relying on data that assumes they have information on two-thirds of reported IVF cycles worldwide. The figures in the 10 reports come in part from the International Working Group for Registers on Assisted Reproduction, a volunteer group of physicians that banded together in the late 1980s to begin collecting IVF data. About 10 years ago, that organization evolved into ICMART, which has continued to collect information about IVF births.
“There is so much missing data, which is the reason this hasn’t been done until now,” says Adamson. “The reality is no one will ever know exactly how many babies have been born because no one ever counted.”
There are nearly 200 countries in the world, and Adamson estimates that about half have at least one IVF clinic. But just 74 countries have ever tracked and shared their data, and they don’t all do so consistently. China, which is thought to account for close to 20% of IVF births, doesn’t report its data, although Adamson said the Ministry of Health has indicated it’s working toward that goal.
Births have increased exponentially over the years, according to the research. In 1990, a little more than a decade after the first IVF birth, about 95,000 babies were born. By 2000, that figure had grown to nearly 1 million, and by 2007, it had climbed to more than 2 million.
“A lot of this has to do with increased success rates,” says Dr. Robert Stillman, medical director emeritus at Shady Grove Fertility Center in Rockville, Md., which says it performs more IVF cycles than any other U.S. clinic. “There has been a steady improvement in the ability to culture embryos and improve pregnancy rates. A 38-year-old coming to us in 1997 versus 2007 versus 2013 has a very different prognosis.”
Image: Fertility lab, via Shutterstock
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Tuesday, October 15th, 2013
The chemical compound called bisphenol-A (BPA), which is found in many plastics and food can linings, has been linked to a heightened miscarriage risk in women who struggled to conceive or have experienced repeated miscarriages. The finding comes from a new study presented this week to the American Society for Reproductive Medicine. More from The Associated Press:
The work is not nearly enough to prove a link, but it adds to ‘‘the biological plausibility’’ that BPA might affect fertility and other aspects of health, said Dr. Linda Giudice, a California biochemist who is president of the American Society for Reproductive Medicine. The study was to be presented Monday at the group’s annual conference in Boston. Last month, ASRM and an obstetricians group urged more attention to environmental chemicals and their potential hazards for pregnant women.
BPA, short for bisphenol-A, and certain other environmental chemicals can have very weak, hormone-like effects. Tests show BPA in nearly everyone’s urine, though the chemical has been removed from baby bottles and many reusable drink containers in recent years. The federal Food and Drug Administration says BPA is safe as used now in other food containers.
Most miscarriages are due to egg or chromosome problems, and a study in mice suggested BPA might influence that risk, said Dr. Ruth Lathi, a Stanford University reproductive endocrinologist.
With a federal grant, she and other researchers studied 115 newly pregnant women with a history of infertility or miscarriage; 68 wound up having miscarriages and 47 had live births.
Researchers say it is virtually impossible to avoid exposure to BPA completely. The AP offers some tips on how to minimize exposure:
To minimize BPA exposure, avoid cooking or warming food in plastic because heat helps the chemical leak out, she said. Don’t leave water bottles in the sun, limit use of canned foods and avoid handling cash register receipts, which often are coated with resins that contain BPA.
Image: Food can, via Shutterstock
Get our Everything Pregnancy blogger’s take on the link between BPA and your miscarriage risk here.
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