Polycystic ovarian syndrome (PCOS) is one of the most common things doctors see in both reproductive medicine and OBGYN practices. Patients often come to us complaining of infertility, miscarriages or irregular cycles, and sometime other issues such as facial hair, acne or weight issues. Because of these are the problems that bring PCOS patients in the office, most patients (and most doctors as well) think of it as a gynecologic disorder. However, most experts consider most PCOS to be a metabolic disorder, a problem with how the body handles sugar and produces insulin, and that the symptoms of PCOS are the consequences of these metabolic problems. A recent article from the Wall Street Journal, discusses PCOS and interviews some of the leading researchers in the field.
One of the most fascinating things about practicing Reproductive Medicine in an ethnically and religiously diverse area is learning to understand the value systems that our patients bring to the table when they come to seek out fertility treatment. Some faiths such as Roman Catholicism reject Assisted Reproduction as a separation between reproduction and intimacy and others such as Judaism encourage it emphasizing the importance of the biblical commandment “to be fruitful and multiply.” Sunni Islam permits assisted reproduction but forbids the use of donors or gestational carriers. The most fascinating and perhaps most paradoxical is that of Shia Islam, the predominant religion in Iran. Most of the world views the Islamic Republic of Iran as one of the most brutal and intolerant in the world, yet when it comes to Assisted Reproduction, it is actually one of the most open minded. As pointed out in an Op-Ed in the Pittsburgh Post Gazette, Iran’s Shiite theocracy allows relatively unrestricted access to ART and IVF, including the use of egg and sperm donation, a practice forbidden in most of the Middle East. Iran, in fact, now has over 70 clinics, luring patients from Sunni countries that forbid the use of donation.
One of the remaining challenges in Reproductive Medicine is helping women who were born without a uterus, or have had the uterus removed or have severe scar tissue in the uterus making it difficult or impossible to carry a pregnancy. One of the problems we see from time to time in our practice is women with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who are born without a uterus. The only options for these couples is to use a gestational carrier with IVF to carry the pregnancy for them, what most people think of as a “surrogate.” Picking up on research that began over a century ago, doctors in Sweden are using modern surgical techniques and medications to enable transplantation of the uterus. The big unknown is whether the blood supply in the transplanted uterus will enable adequate delivery of oxygen and nutrients to the unborn fetus and whether the drugs used to prevent rejection are safe for the pregnancy. Only time will tell.
It has been known for some time that couples suffering from infertility, including those who get pregnant using assisted reproductive techniques such as IVF, are more likely to have complicated pregnancies.: more high blood pressure, diabetes, miscarriages, preterm births and likely birth defects as well. This is true even with singleton pregnancies. What is not so clear is why this is so. Is it the patient population? Women who have infertility tend to be older and have more medical and metabolic problems. Is it the fertility medications such as clomid and injectables? Is it something in the process of IVF or IUI that causes problems? Researchers at Cedars Sinai Hospital in Los Angeles have received a large grant from the National Institute of Child Health and Development to help study the molecular events the underlie an early pregnancy after IVF. They will be looking at both genetics (the DNA in the chromosomes) and epigenetics (changes in gene expression that occur outside the chromosomes) to try to discover an explanation for these problems
In Reproductive Medicine we are comfortable in offering our IVF patients Preimplantatation Genetic Testing (PGD) and Screening (PGS) to prevent the transmission of genetic diseases and reduce miscarriages. Many of us in the field are concerned that there is also a slippery slope, and that advances in genomics may make it too easy to cross that line. Researchers in China are now trying to use these new tools to help couples select smarter babies. To many of us in the west this sounds like Brave New World, the novel by Aldous Huxley, but in China this idea is not so controversial. If their project is ultimately successful, it should raise enormous ethical concerns for all of us, and more importantly is the potential that our patients will insist on access to this technology regardless our ethical concerns.
In our countries’ race for energy independence, an new technique has been developed called fracking (hydraulic fracturing) in which high pressure fluid is injected into rock in order to extract fossil fuels such as natural gas. Besides water and sand, a number of other chemicals are injected into the rock, including some chemicals called endocrine disruptors. Endocrine disrupters can interfere with how the hormones in the body work and a number of these are found in the environment. A recent study the journal Endocrinology, suggests these endocrine disruptors may be found in higher doses in areas close to fracking sites, raising public concern about when this might be a public health hazard. While fracking may result in higher levels of these endocrine disruptors in the environment, it is not clear whether these levels are high enough to be concern to reproductive health issues such as affecting fertility or birth defect rates.
Researchers in Germany used very tiny tubes called nanotubes to control the motion of sperm. They used sperm mainly because the sperm are able to propel themselves. Today there is no real application for this even though this is fascinating. In the future, however this could represent a way to help fertilize eggs or even deliver drugs such as chemotherapy to their target. Here’s the video: