This week’s picks from the Greene Guide include a first reported case of sextuplets from the drug Letrozole as well as a new twist on the “nature vs. nurture debate” as it relates to naturally elevated testosterone levels in elite female athletes:
- Oral Medication (Letrozole) and a case of Sextuplets—Ovulation induction is associated with a higher risk of multiple pregnancy than IVF treatment. That said, most patients and their providers often take for granted the relative safety of oral medications like Letrozole used to stimulate the ovaries. All that may change now that there is a documented case of sextuplets using Letrozole 7.5 mg—a higher than normal dosage. Take home lesson, this may have been preventable if the patient had been monitored using ultrasound and blood tests.
- Most Men with Borderline Testosterone Levels, More Likely to Experience Depression—New data on the hormone-brain connection suggests that a low testosterone level may trigger depressive symptoms. A recent presentation demonstrated that not only were these men more likely to experience emotional symptoms but also to have problems with obesity and an inactive lifestyle. Further evidence that men quality of life is also linked to a healthy hormone balance.
- US Fertility Rate Hits an All Time Low—The most recent government figures show that the number of births has dropped below 63 per 1000 reproductive aged women (15-44 y.o.a). Whether or not this reflects a growing number of women experiencing infertility or is simply a result of people delaying their family due to recent economic downturns remains an active debate. Most likely, it is a combination of both as well as other emerging factors.
- Early Onset of Menopausal Hot Flashes May be a Risk Factor for Heart Disease—It is indisputable that those uncomfortable hot flashes experienced by women going through menopause are the result of changes in blood flow patterns. However there has long been debate on whether these symptoms are simply a nuisance to endure or a warning warranting treatment. Two new studies suggest the latter. Given that there is now strong agreement that treatment of hot flashes is reasonable and safe this data offers new discussion points for patients and their healthcare providers.
- Fertility Center Courts Controversy: Offering non-FDA approved Treatment to Rejuvenate Eggs—The procedure involves removing a piece of a woman’s ovary in order to extract mitochondria—the power source—from immature eggs. These mitochondria are then added to mature eggs along with sperm during a subsequent IVF cycle. The company that developed this procedure has not yet reported any live as a result of the procedure. It does however add an additional $25,000 to the cost of IVF.
- Early Miscarriage; providing more options improves patient care AND lowers cost—About one out of every three pregnancies end in an early loss. In fact 25% of women will experience a miscarriage at some time in their life. A new study found that providing patients with more options—beyond D&C or taking a wait-and-see approach—improves patient satisfaction as well as results in a cost savings of about $241 per case. Since about 1 million US women per year experience an early pregnancy loss the emotional and financial impact of this can be huge.
- Testosterone Levels and Athletic Eligibility in Women—Since 2011/2012, the International Association of Athletics Federations (IAAF) and the International Olympic Committee (IOC) have implemented regulations that elite female athletes must have a blood testosterone level that is below the lower limit for men in order to compete. In reality, there is a vigorous debate on whether there is reliable biological evidence to support this restriction. The opposing opinion is that success in sport should be due exclusively due to talent and dedication rather than to any naturally occurring, potentially advantageous biology. Currently, the restriction stands and some women may be required to undergo hormone reducing treatment in order to compete.