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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.
Posted by Julie at 12:47 PM in Jane, you ignorant slut | Permalink
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Comments (37)
As someone who has considered PGD, these results don't bother me as much, since I'd rather not get pregnant in a given month than conceieve a baby that wouldn't make it.
The mole rat theory is interesting. I've often wondered if infertility could be adaptive - since human babies are so expensive in every way, a small society might not be able to handle every young woman reproducing at the same time, especially with the high risk of death in childbirth. Not that that doesn't make it any less sucky for modern women, who no longer need villages for childrearing in this age of pacifiers and bouncy chairs.
Posted by: Molly-Claire at Jul 6, 2007 1:27:18 PM
That lab-maturation thing: super-exciting. Wonder if it'll be the next big cryo-tastic trend... twenty-something women putting a fresh dozen on ice for the future. I am imagining a teeeeeeeeeeny-weeny carton, nestled alongside the Eggos. So innovative... yet so CUTE!
Posted by: Jul at Jul 6, 2007 2:09:34 PM
Perhaps a naked mole rat cruise?
I saw these articles this morning (all of them, what a morning) and it had my head spinning. The lab-matured eggs story was of particular interest. Now if only I had a time machine... I bet my eggs were wicked awesome back in my fetal months.
Posted by: Ollie at Jul 6, 2007 2:38:51 PM
That egg-freezing news is fantastic. Until now, only male cancer patients have had a quick way to preserve their fertility (as my husband did when he was 17). My kid's been frozen twice - as sperm - for 15 years - and as an embryo. There's only a little freezer burn on his ears... oh wait, that's just dried cereal.
Posted by: kari at Jul 6, 2007 2:51:09 PM
The PGD study was actually not very good. I asked my RE and he tore it shreds over email all the way from the conference. He's pretty surprised the press is covering it.
The IVM is intriguing though, not because of frozen eggs or cancer. Julie, they do do this with ovarian stimming as well as drug free. Basically instead of cancelling a cycle when eggs aren't growing they do early retrieval, and mature them in a lab dish until they are big enough to add sperm and make embryos.
Have you ever looked into IVM at this place Julie? Do they do it at Cornell or just in Montreal? It just sounds like maybe it would fit your situation.
Posted by: Paula at Jul 6, 2007 2:54:42 PM
"'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.'"
Wow, I mean, that's kind of a long shot, but...golly, maybe, do you think?
Posted by: Jo at Jul 6, 2007 2:57:34 PM
It's important for people to do studies to confirm the obvious. It helps distinguish between things that everyone knows, and are true, from things that everyone knows and are false. Like, "just relax," for instance.
The study on complementary and alternative therapies seems really poorly designed, though. There is no way to tease out any kind of causation with that study. Yeah, people who seek out treatment for infertility have infertility problems! To figure out if these things work, you have to have randomized, controlled studies where similar groups of women would either get CAT or not, and then see who gets pregnant.
Posted by: Dr. Confused at Jul 6, 2007 2:58:47 PM
Stupid sister-in-law ruins everything.
As always, thanks for being my internet "Daily Show" for the latest infertility news. Your slant makes the hopeful (and even the depressing) news so much more fun to read about.
Posted by: Kori at Jul 6, 2007 2:58:48 PM
Paula, I'd be very interested to read some intelligent criticism of the PGD study. Any pointers? Thanks.
Posted by: Julie at Jul 6, 2007 2:58:48 PM
Like the naked mole rat, I often feel an urge to push fertile females around. And contrary to Julie's opinion, apparently the male mole rats find the female mole rat quite loverly.
Thanks, Julie, for sharing all this news. You are my primary source for information about new and exciting ways to waste thousands of dollars trying to have another child. :-)
Seriously, thanks, you always find the good IF news.
Posted by: kristylynne at Jul 6, 2007 3:04:20 PM
To be fair, Dr. Confused, it doesn't seem that the CAT group ever intended to establish any causal link. The decreased pregnancy rate is the splashier part of the story, but I don't think establishing that was the main thrust of the research effort.
Posted by: Julie at Jul 6, 2007 3:06:49 PM
Jo stole what I was going to say. Is that plagiarism?
If they had saved the money spent on the study by asking me, paying my accupuncturist would have been the perfect way to say "Thank you," although I would have accepted large quantities of Stacy's pita crisps and bourbon instead.
Posted by: Slim at Jul 6, 2007 3:18:14 PM
Fine, next time I'll actually read the links before criticizing. :)
The conclusion seems to be that women who are stressed-out by infertility seek out CAT, and while it doesn't help them get pregnant, it might help them de-stress a bit. But the researchers think they should find a shrink instead.
Meh, it just seems to be one of those "exploratory" studies, suggesting areas of intereesting research, rather than one that can actually conclude anything.
Posted by: Dr. Confused at Jul 6, 2007 3:20:03 PM
Of COURSE vodka and cheezits are legitimate supplements to overcome infertility, how do you think I got pregnant with twins? I guess the only reason it worked is because there aren't any pushy sisters in law over here ;)
Very informative, and humorous, post (as always)
Posted by: Chickenpig at Jul 6, 2007 3:23:10 PM
Agreed. I mostly just included it so I could work in a reference to Cheez-Its.
They don't pay me, but they should.
Posted by: Julie at Jul 6, 2007 3:23:16 PM
Well, my RE says that they collected the cells for PGD on Day 3 from some embryos that were as small as 4 cells. Most places won't ever collect cells on an embryo below 8 cells because they are worried about damaging the embryo or detecting chromosomal mosaicism instead of an embryo that is completely damaged.
The rest of his email seemed to be about the method of PGD, ie. the embryo lab sucked. But that could be grumbling.
I know other studies show much higher success rates. Anyone want to read something and compare for us? I'll buy the vodka!
Posted by: Paula at Jul 6, 2007 3:56:04 PM
Molly-Claire, the live birth rate was down for the PGD group, too.
Posted by: at Jul 6, 2007 4:03:26 PM
You crack me up!
Posted by: Heather at Jul 6, 2007 4:18:03 PM
NYT has an article on the PGD stuff: http://www.nytimes.com/2007/07/05/health/05embryo.html.
It seems to be a translation issue that leads to it being referred to in this article as "pregenetic screening" -- or so I infer since the scientists quoted don't appear to be native English speakers. I'm not sure where the article's title comes from, though. Sifting embryos leaves me with images of treating the things like cake flour...
Posted by: Alex at Jul 6, 2007 5:30:15 PM
I can totally understand why CAT wouldn't help infertility patients, and possibly even do harm to a cycle. Acupuncture seems to help some women, but other therapies and supplements definitely do more harm than good. Many supplements contain plant estrogens which when taken with a medicated cycle of any kind can wreck havoc with the effectiveness of the meds. They are meant to help women get pregnant, or to regulate their cycles, when they are NOT undergoing hormone treatments. Also, rubbing and massaging of the feet is a no-no when trying to get pregnant. At least two of the books that I read while pregnant warned about giving foot massages later in pregnancy because stimulation of the feet can bring on premature labor. If done by the right person, stimulation or acupuncture on the feet maybe helpful, but I have a feeling most CAT is practiced by inexperienced people at best, and quacks at it's worst. I think most IVF cycles are undertaken by people who are "desperate", but that doesn't mean they are ineffective.
Posted by: Chickenpig at Jul 6, 2007 5:51:59 PM
It just seems like so many of these studies are designed to still make it women's fault. Although the lab-matured frozen eggs sounds kind of great.
Posted by: AmyinMotown at Jul 6, 2007 9:35:46 PM
I am so chuffed - my hero of the net and conqueror of endometriosis read my forward :) Glad to be of service :)
Posted by: Urszula at Jul 6, 2007 10:12:19 PM
Is it selfish that I'm excited about IVM because then I wouldn't have to get OHSS and blow up like a fucking Macy's float at the merest whiff of stims? Because that would be cool.
Posted by: akeeyu at Jul 6, 2007 11:07:29 PM
Yah. I think the naked mole rat is enough to scare *anyone* into infertility, don't you think?
Now what we need is a study into CAT and infertile naked mole rats, eh? Maybe even those of 'advanced age' and then do PGD on them...
Posted by: jen at Jul 7, 2007 2:03:52 AM
Undocumented forms of CAT? As I sit here drinking wine, eating Cheezels and reading A Little Pregnant so that I can "just relax", it seems quite clear that those scientists need to expand their field of research.
I'm from Australia where we don't have Cheez-its, but I am pretty sure that a Cheez-it must be a first cousin of the much-revered Cheezel.
Posted by: South at Jul 7, 2007 4:17:45 AM
I just read all 5 years of your blog over the last 3 days! Thank you, thank you...I see I am NOT alone. Now that I am caught up to the present day of your life story I need a breather and some time to contemplate what the hell I am doing shooting myself full of drugs (Lupron is this week's injectable) while I have my "period" for the 9th day and counting. The doc says it's fine, but it can't be good to bleed for so many days in a row. Julie, I found you by searching "IVF side effects blog" in Google and I got your refreshingly candid and honest point of view. Thank you for putting it ALL out here for us to see.
I need to look up acupuncture and IVF next as I have gone to one appointment so far and since my epic period started have had to cancel 2 others (they won't do acupuncture during your period). With your latest bulletin on CATs decreasing pregnancy rates I am hesitating to shell out the cash for another appt. since we don't have any more to spare. It did stop the all day nausea that the metformin and birth control pills brought on and surprise...quieted the mental chatter in my stressed out head.
We have done 2 IUI's with injectables and are now in the suppression phase of our first IVF. I am 38, we tried on our own for 5 years. I guess because of my age the doc suggested PGD (for an extra $4,000) to find us the best embryo possible in our first transfer. We said no. Unfortunately, we felt that would push us into a very uncomfortable financial place to add that to our current debt load. We are blessed with insurance that is covering the IVF, but not the PGD. Need to read up on weather we are missing the boat on that, but feel pretty good that the extra 10% success rate won't make or break our chances, but then we are new at this and very clueless. I have control issues, I know.
Of course reading your blog, according to another study you cited, could lower my success rate too. Who really knows what is the right way to get through this!
Posted by: Carolyne at Jul 7, 2007 5:51:12 PM
You are hilarious! Thank you for being you!!
Daisy
Posted by: Daisy at Jul 7, 2007 6:19:29 PM
Re: IVM -- Yay Israel!!!
Posted by: at Jul 8, 2007 1:10:12 AM
The fairy flitting around tapping creatures with the bonny wand didn't get anywhere NEAR those naked mole rats, did she? My sperm count has plummetted just looking at the picture, and I don't even have testicles.
Posted by: alchemilla at Jul 8, 2007 8:59:12 AM
I'm waiting for an infertility study sponsored by Grey Goose.
"Women Who Drink Vodka During Fertility Treatments Don't Get Pregnant More Often, but They're More Fun to be Around."
Posted by: lisa at Jul 8, 2007 10:22:17 AM
Thanks for putting great links up. Your link to the PGD study is the first that I have seen that notes that the study is in regard to "age only." Other studies show that it is effective for "recurrent miscarriage" which is a common problem for us older women. I have had too many chemical pregnancies to count (with and without ART) and PGD was finally suggested. After eight treatments that resulting in negative or "chemical" results, our ninth (the only one with PGD) has resulted in us expecting a baby girl in December. We went this route because two other friends with multiple IVF and other ART "failures" both had successful results after using PGD. I wouldn't necessarily recommend the expense on your first IVF attempt, but don't rule it out because of this study. (And the PGD lab your doctor uses is crucial.)
With the CAT study, they don't differentiate between the various therapies. Studies focused on accupuncture alone have shown a significant improvement of success rates.
So there's my half a cent contribution to the discussion. Thanks for compiling all the informaiton and making us smile!
Posted by: jkmcgoo at Jul 8, 2007 11:03:43 AM
Heh, my MIL looks and acts like that naked mole rat -- now I know why I need to stay away from her!
Posted by: a fellow traveler at Jul 8, 2007 7:32:36 PM
Alex, PGS is where they do PGD for no real reason, just looking for any aneuploidy they can see. As opposed to looking for a specific translocation or mutation.
Posted by: at Jul 8, 2007 10:36:06 PM
I think the "alternate therapies" article (I could click on the link and read it, but I'm being a real lazy bitch today. Also, you mentioned Cheez-Its, and now that's all I can think about.) must pertain solely to increased fertility, as opposed to fertility treatments. As you mentioned, acupuncture has shown higher success rates when combined with IVF. My clinic even advocates acupuncture with IVF, and they're so conservative and traditional they don't even have cute Band-Aids.
Posted by: Vanessa at Jul 9, 2007 7:38:18 AM
In the aftermath of my failed IVF cycle and miscarriage (which, according to my dr's may or may not be related), I turned to acupuncture before my FET to try to get my body back in balance. I started a couple of weeks before I began the meds and continued with one treatment/week until just before my transfer. I also had an acupuncturist who does a lot of work with fertility patients at my clinic come and do one treatment immediately prior to my transfer and one immediately following. And now I'm 14 weeks pregnant.
I don't know that I was any more desperate than I was before, but mostly I did it because in the event that it failed again, I wanted to say that I'd tried everything I could. Is trying to avoid regret the same as desperation?
Also, where can I find a job that pays me to tell people the obvious? It looks like there are plenty out there.
Posted by: Erin at Jul 9, 2007 11:11:42 AM
I'm afraid my specialist (for recurrent miscarriage) agrees with that study - for unexplained recurrent miscarriage, PGD doesn't increase the rate of live birth. I know there are several studies on this but some do show an advantage, but they are mainly with small sample sizes. The problem does seem to be the mosaicism - even with larger embryos.
I'm another one who is not going to be doing any treatment that has only vague scientific backing, unless I'm part of a proper trial, and I'm definitely not going to be doing anything that has more than one study showing it doesn't work.
Posted by: katie at Jul 9, 2007 4:17:36 PM
I'll try almost anything if I know it's safe - which means I won't use herbal drugs that interfere with hormones, or procedures that carry a risk. But it's more of the "well, at least it won't hurt" mindset - maybe just something of a placebo effect helping me to "relax" because I feel like I'm helping things along. And well, I'd love to be able to write of the cost of frequent massages and high quality ice cream.
Posted by: Molly-Claire at Jul 25, 2007 1:10:28 PM
