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07/06/2007

Fertility news niblets

Stop the presses!  Desperate women make risky choices.  A British research team has found a significant association between an IVF patient's mood and her willingness to take risks.  "Women estimated their chance of having a multiple pregnancy as lower when they were experiencing more negative moods," said the lead researcher.  In other words, women who were pessimistic about their chance of a multiple pregnancy (or indeed any pregnancy at all) tended to do what the study called "engage in greater risk-taking behavior," i.e., opting to transfer more embryos.  Yeah, uh, doctor?  Next time you have a question like that, don't spend millions in grant money.  Just ask a veteran of multiple failed cycles.  She'd have told you that for free.

PGD reduces older women's chances of pregnancy.  A multicenter, randomized, double-blind, controlled trial has found that PGD sucks.  Okay, the wording of the study itself is a bit more scholarly — "Preimplantation genetic screening did not increase but instead significantly reduced the rates of ongoing pregnancies and live births after IVF in women of advanced maternal age" — but it boils down to the same conclusion.  The subjects of the study, 408 women aged 35 to 41, had had no previous failed IVF cycles and agreed to a program of three cycles.  Patients in the PGD group had  "the two chromosomally normal embryos with the best morphologic features" transferred on day 4; known abnormals were not transferred.  An ongoing pregnancy rate of 37% was achieved in the control group; for the PGD patients, it was only 25%.  The cause of PGD's detrimental effect on the pregnancy rate in older women is unknown, and the jury is still out as to PGD's efficacy when used for reasons outside advanced maternal age, such as for recurrent pregnancy loss or repeated IVF failure.  "No other medical procedure with such profound medical and ethical consequences has been so poorly studied," said the director of the Genetics and Public Policy Center at Johns Hopkins.

Those presses?  Yeah, stop 'em again.  Women still desperate.  Women who used complementary or alternative therapies [CAT] such as reflexology, acupuncture, and nutritional supplements to improve their fertility had a 20% lower pregnancy success rate over a 12-month period.  The study, initially intended to examine patients' reasons for undergoing CATs, found that women who did seek out these treatments were more distressed and emotionally affected by infertility than women who did not.  It also found the aforementioned lower pregnancy rate — intriguing, but in no way conclusive, since the design of the study did not distinguish between therapies, especially between those that have some documented value behind them, such as acupuncture, and those that do not, such as regular infusions of vodka and Cheez-Its.  (Shut up.  I can call those nutritional supplements if I want.)  The lead researcher is aware of the study's limitations: "Our findings do not allow us to make a direct causal link between CAT use and pregnancy rate.  It may be that complementary therapies diminish the effectiveness of medical interventions.  Or it may simply be that persistent treatment failure encourages women to seek out CATs because they are more willing to try anything to get pregnant."

Immature egg retrieved, matured in vitro, frozen, thawed, fertilized, transferred, implanted.  Et voilà!  Practically instant baby!  The first baby has been born from a frozen, lab-matured egg.  The baby is doing well, with no apparent signs of freezer burn, and another three women are currently pregnant via the same method.  The most exciting application for this new technique, researchers say, is for women diagnosed with cancer, whose treatment might make them sterile; women's eggs can be retrieved without hormonal stimulation before their cancer therapy begins and frozen for later use.  Eggs have been retrieved and subsequently matured from girls as young as age five, a breakthrough that could allow survivors of childhood cancer to use their own eggs if they later wish to have children.

Infertile?  Hey, maybe your bully of a sister-in-law is to blame.  A British biologist has suggested that the patterns of the impressively ugly naked mole rat may shed light on stress-related infertility in humans.  Although mole rats live in colonies numbering between 100 and 300 animals, only one female, the "queen," reproduces.  "The queen exerts her dominance over the colony by literally pushing the other members of the colony around" — causing stress to the other animals by shoving them.  This bullying suppresses the other animals' fertility, causing the sperm count of the males to decline and halting ovulation in the colony's other females.  "By making careful comparisons with model species like mole-rats, we may be able to tease apart the relative contribution of genes, environment, upbringing and culture to complex social behavior in our own species," the researcher speculated.  Now if only we could get those naked mole rats to just relax.

Hey, those presses we were talking about?  You didn't by any chance start them again, did you?  Yes?  Oh.  Huh.  Well...Patient stress during ovarian stimulation is greater than appreciated by doctors, who are apparently blind, deaf, totally devoid of any powers of observation, human compassion.  Investigators have found that clinicians "underestimate the burden [the daily regimen of injections] places on patients and the high levels of stress associated."  Further, doctors "underestimated how many of the women believed they had made mistakes with dosages, taken the wrong medications and/or used incorrect self-injection techniques."  That the press release for this study comes from Organon, makers of the Follistim pen, which "provides women with a discreet, convenient method to self-administer FSH with ease and confidence," and Ganirelix (formerly Antagon), which eliminates the need for a long period of downregulation prior to ovarian stimulation, is, I am certain, no more than incredible coincidence.

Thanks to urszula for the PGD link.

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