One of the chief concerns couples have is the about the safety of the procedures that fertility specialists use to help them achieve pregnancy, such as IVF (In vitro fertilization). Most of us in the field know that serious complications to the mother-to-be can occur but are quite rare. A recent study with the lead author from Emory University looked through nationwide database of IVF clinics across the country over the past 12 years, and confirmed that while IVF does entail risks for women, those risks are quire small.
Could a cure for real cure for infertility be on the horizon? Today many causes for infertility can currently be successfully treated such fertility issues caused by damage to fallopian tubes, ovulation disorders, endometriosis and low sperm counts or motility. These treatments currently available to us include fertility drugs, insemination, surgery and IVF. However, there are still issues in assisting women have very few or no eggs left or men who produce no sperm at all. This is a particular problem for women since women produce all they eggs they will in a lifetime while still in their mother’s womb, and by their mid 40s have hardly any normal eggs left.
These couples can be successfully treated only with the use of donor eggs or sperm. While these donor procedures are often quite effective, the children who result from these pregnancies do not carry the DNA of one or both of the parents. This is a problem since most couples who seek out the help of a Reproductive Medicine specialist want their own genetic children. With our current state of reproductive science this may not be possible.
One potential way around this would be using stem cells in the lab using cloning technologies. A group of scientists at the Weizmann Institute in Rehovot, Israel and Cambridge in the UK have brought us a little closer to this cure, figuring out how to more efficiently get these stem cells to grow into cells that will eventually develop into eggs and sperm. Their findings were recently published in the journal Nature.
The researchers have yet to take the next step; producing eggs and sperm from these stem cells. While it may become technically feasible, besides the technical issues, there are ethical concerns, perhaps even greater than when IVF when first introduced to overcome before this proceeds. IVF was enormous breakthrough when it was developed, but it is still merely a replication of natural conception, albeit in a laboratory dish. If this next step is even possible, it could bring reproduction to entirely new level. These technologies may make it possible to have genetic children without ovaries, without testes and without age limits, shattering our concepts about parenthood, even more so than it is today. It is not clear if society is ready for this yet.
As we reported in our blog earlier this year, fertility specialists in Sweden transplanted uteri into women who were unable to carry a pregnancy to help them. They were presumably motivated by one of the remaining challenges in Reproductive Medicine, helping women who were born without a uterus, or have had their uterus removed or have severe scar tissue in the uterus making it difficult or impossible to carry a pregnancy. The only options for these couples until now has been 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 used modern surgical techniques and medications to enable transplantation of the uterus. There is now some good news on this front. One of these transplants in Sweden resulted in a healthy live birth. The pregnancy and birth were not without complications. The baby was born 9 weeks early and the mom developed pre-eclampsia, a serious condition in pregnancy also known “toxemia” whose symptoms include high blood pressure and swelling. The doctors are also unsure if the uterus will be usable for a second pregnancy. Still, this an exciting first in Reproductive Medicine.
There are plenty of reasons to quit smoking. The health effects of smoking are well known and well documented, not just on your fertility, but a whole number of health issues including heart disease and cancer. Now, there’s yet another reason to quit smoking if you are pregnant or trying to get pregnant. Cigarettes may actually affect a woman’s male offspring’s sperm quality. As reported in Human Reproduction, the male offspring of pregnant mice exposed to high levels of cigarette smoke had sperm with lower counts, lower motility and more abnormally shaped sperm (low morphology), and these male mice took longer longer to impregnate female mice who in turn gave birth to fewer mouse pups. So, what does this all mean? While we don’t yet know if this is true in humans (or even 100 % sure it is true in animals), exposure to tobacco smoke could not only harm your fertility (among other things) but also could harm your unborn son’s chances of fathering children. This is another good reason to quit.
This 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.
This is one of the most common questions patients ask their fertility doctors and/ or their OBGYNs. Fortunately the short answer is no and this is backed up by large research studies. While their purpose may be to prevent pregnancy, the contraceptive effect of the pill wears off rather quickly. In some women the return to normal cycles and fertility can take a number of months, but usually there is not much of a delay. In other women, such as those with ovulation disorders such as PCOS, coming off the pill may actually increase the chances for conception. If your cycles have not regulated themselves 6 months after stopping the pill or they are becoming less regular over time after then and you’re trying to get pregnant, it’s probably not the pill, and it’s time to discuss this with your GYN or fertility specialist.
And why might this be important? Unless you are a Spanish farmer raising swine, or unless you live in Spain and are in the market for pork or ham, it should not matter. But is you work in the fertility field or are trying to get pregnant, it may be an issue. The concern over what is going on with Spanish pigs, is really about why the pigs were having trouble reproducing. It turns out that back in 2010, there was a marked drop in fertility in pig farms across difference regions of Spain. Investigators at first had trouble figuring our where there problem was. The one common thread in each of these farms was that all of the farms used plastic bags from the same manufacturer to collect semen for insemination. A researcher at the University of Zarazoga, Cristina Nerín, then analyzed the bags and found that an ingredient in the plastic bags was the cause of infertile Spanish pigs. The scary part is that this chemical (and similar compounds) are found in plastic products that are used to package foods and beverages we eat every day. The good news is that the pigs of Spain and happily producing lots of piglets again. However, there is likely more to come on this topic in reproductive medicine and potentially in other areas of medicine as well.
Several months back, we reported in our blog that the authorities that regulate IVF and other fertility procedures in the UK were considering allowing IVF with mitochondrial transfer to move forward. Mitochondrial transfer is more popularly known as “three parent IVF,” because it involves three genetic parents: the woman who provides her chromosomes, the husband who provides his chromosomes and the donor who provides the mitochondria which contain their own DNA. The HFEA in the UK has now given the green light for tightly regulated research to proceed on mitochondrial transfer. So, now it is likely that fertility researchers in Britain will move forward and learn whether this technique can help couples with mitochondrial diseases.
I welcome you to the Princeton Fertility Blog. I am a specialist in Reproductive Medicine and the Medical Director at Princeton IVF in Lawrenceville, NJ. I have been caring for couples with infertility and recurrent miscarriages, polycystic ovarian syndrome, endometriosis and other reproductive hormonal disorders for the past two decades.