Breast cancer drugs to treat infertility ?

clomiphene-letrazoleThis sounds kind of odd. Why would fertility specialists use a drug intended to treat breast cancer patients to help couples conceive? To those in the field, the concept is nothing new. Clomiphene (Clomid) is a close relative of Tamoxifen, a drug used for years to prevent the recurrence of breast cancer.  These drugs which block the action of the female hormone estrogen, cause hormone fluctuations that stimulate eggs to grow.  Over the past decade, doctors have begun to use another breast cancer drug called Femara or Letrozole to treat couples in with infertility. Like tamoxifen, letrozole is used to prevent recurrence in breast cancer patients, and like clomiphene, it can also be used to stimulate ovulation (release of an egg). Until now, clomid has been the gold standard to help make women ovulate since it is relatively inexpensive and safe. Recently, however, a large study was published suggesting that letrazole may actually be more effective than clomiphene  and result in fewer multiple births. Over time, it is likely that letrazole may replace clomiphene as  a first line fertility drug.

How old is too old to try IVF ?

Pregnant womanWith stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment.  When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40’s. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual.  A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of  45 year olds’ embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.

Fertility drugs and breast cancer

fsh penOne of the most common questions patients ask us when they are about to start fertility drugs, is are they are safe? This question comes up whether they are going to start pills (Clomid, Femara) or injectable fertility drugs (Follistim, Gonal-F, Bravelle, Menopur). Unfortunately, the answers are not always so clear cut as we would like. One of the major concerns women have is about cancer, and the cancer which more women seem to fear than any other is breast cancer. In the past there have been questions about whether fertility drugs increase the risk of breast cancer. A recent study may help to reassure anxious couples. The researchers followed fertility patients from multiple institutions and showed that women treated with fertility drugs, both oral and injectables had the same rates of breast cancer as those who were not. The only exception was women with who took clomid for over year, who did have a slightly higher rate of breast cancer, another good reason to be proactive and see a fertility specialist early on.

Should we be teaching about fertility in schools?

cervixOne Australian Fertility Specialist says yes, the classroom is the perfect place to learn about this, as reported on Yahoo News 7. Surveys continually show that the public, both women and men understand very little about their own fertility, and this is perpetuated in the media by stories of miracle late life pregnancies. Many women understand very little about how their own reproductive systems work, and even less about the true effect of age and lifestyle choices on their ability to have a family. Most of us reproductive specialists see patients all the time whose infertility could have been prevented. This doctor in Adelaide sees education as a sort of preventative medicine for infertility and  is advocating making fertility education a part of the school curriculum in his country, along side with  contraception. Will it work? And could it happen here in the US?

Hope or hype for women with ovarian failure

ImageAs a fertility specialist, one of the most devastating diagnosis I can deliver to a patient is that she has ovarian insufficiency or ovarian failure, essentially meaning that she in premature menopause.  While these women are usually able to bear children with the use of donor eggs, the chances for pregnancy with their own eggs are extremely low. As highlighted in a recent issue of Time magazine, researchers at Stanford have attempted to reinvigorate their ovaries using a procedure called In Vitro Activation (IVA) . Of the 27 couples in trial, 2 actually became pregnant. While the odds for pregnancy were quite low, this represents a glimmer of hope for women with ovarian insufficiency.