It’s time to review the latest findings in Reproductive Medicine. This month there are new insights into why more boys are born in the US than girls as well as a new strategy for women undergoing fertility treatment to reduce the risk of having a child with autism. As always, I have included links to the studies for you check them out for yourself:
- More Boys are Born than Girls; here’s why—about 51% of all of the babies born are male. This observation has been consistent for several hundred years. A new study has provided the most comprehensive data to explain why we don’t see an equal number of boys and girls in the delivery room. It turns out that the explanation is based upon what happens during pregnancy; not prior to fertilization as previously assumed. The researchers found that although a higher number of male are lost during the first trimester; female fetuses are more likely to miscarry later in pregnancy. The end result is that a slightly higher number of males survive until birth than females.
- Supplementing Estrogen Does Not Improve Pregnancy Outcome—there has long been debate amongst fertility centers as to whether or not additional estrogen is beneficial to pregnancy rates. New data shows that levels higher than the normal physiologic ones are not helpful. Other studies have suggested the extra estrogen may even boost the risk of blood pressure problems later in pregnancy. Combined these findings support the ongoing trend to create a hormonally balanced environment rather than simply adding more.
- Genetic Testing improves Live Birth Rate in Women over 40—using pre-implantation genetic screening (PGS) to identify the healthiest embryos for transfer is an effective tool according to new information . They demonstrated a live birth rate that was three times higher using this technique then using standard IVF alone for women over 40. This means that identifying healthy embryos prior to transfer is a highly effective strategy to achieve a successful birth.
- Single Embryo Transfer associated with Lower Risk of Autism—previous data has suggested that there may be a higher risk of Autism Spectrum Disorder (ASD) associated with advanced reproductive techniques (ART). Other studies have shown that this is more likely age related or that it might be due to the population of patients seeking fertility treatment. This new study found that when only singleton pregnancies result following IVF; the observed risk disappears. This is another good reason to consider elective single embryo transfer (ESET).
- Vitamin D Deficiency associated with Lower Pregnancy Rate in IVF—a comprehensive review of 34 published trials has found that women with lower than normal vitamin D levels have less success when undergoing IVF treatment. There is not yet proof that supplementing with vitamin D reverses this trend. However, given the other health benefits and the low cost of this “sunshine hormone” it sure makes sense to consider vitamin D supplementation for women whose level is lower than normal.
- Smoking during Pregnancy can have Lasting Effects Upon your Child—it has long been recognized that women that were smokers had lower fertility rates, higher miscarriage rates and earlier onset of menopause than nonsmokers. New information now suggests that at least some of these negative reproductive effects can be passed on their children as well. Specifically, they found girls born to women that smoked had an earlier onset of puberty than those born to nonsmokers. Noted by the investigators was that early onset of puberty is also linked to a higher risk of certain types of cancer including breast cancer.
[r1]Link to http://www.pnas.org/content/early/2015/03/27/1416546112
[r2]Link to http://link.springer.com/article/10.1007/s10815-014-0402-1?wt_mc=alerts.TOCjournals
[r3]Link to http://link.springer.com/article/10.1007/s10815-014-0417-7?wt_mc=alerts.TOCjournals
[r4]Link to http://consumer.healthday.com/cognitive-health-information-26/autism-news-51/ivf-kids-have-higher-odds-of-autism-study-finds-697622.html
[r5]Link to http://link.springer.com/article/10.1007/s10815-014-0407-9?wt_mc=alerts.TOCjournals
[r6]Link to http://www.reuters.com/article/2015/03/19/us-womens-health-smoking-pregnancy-idUSKBN0MF29W20150319
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.
[r1]Link to http://www.fertstert.org/article/S0015-0282(14)02356-5/abstract
[r2]Link to http://www.endocrine.org/news-room/current-press-releases/most-men-with-borderline-testosterone-levels-may-have-depression
[r3]Link to http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_01.pdf
[r4]Link to http://consumer.healthday.com/cardiovascular-health-information-20/heart-attack-news-357/early-onset-hot-flashes-may-point-to-heart-disease-rosk-in-women-697085.html
[r6]Link to http://www.ovascience.com
[r7]Link to http://www.ajog.org/article/S0002-9378(14)00908-9/abstract
[r8]Link to http://press.endocrine.org/doi/abs/10.1210/jc.2014-3206
[r9]Link to http://press.endocrine.org/doi/abs/10.1210/jc.2014-3603