infertility

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Opinion: A Call For Protecting The Health Of Women Who Donate Their Eggs

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

Human egg and sperm (Spike Walker. Wellcome Images/Flickr)

By Judy Norsigian and Dr. Timothy R.B. Johnson

The egg market is growing.

As couples and individuals continue to rely on assisted reproductive technology to overcome infertility, to make parenthood possible for gay couples and for other reasons, the demand for eggs is increasing swiftly. Between 2000 and 2010, the number of donor eggs used for in vitro fertilization increased about 70 percent per year, from 10,801 to 18,306, according to a report in the Journal of the American Medical Association.

And although there are no exact figures for how many young women engage in egg-retrieval-for-pay, the numbers are at least in the thousands. Many of these women are in their early 20s — often university students in need of cash to cover their tuition fees. But what most of these women, as well as the general public, don’t realize is that there are no good long-term safety data that would enable these young women to make truly informed choices.

Now, a number of women’s health and public interest advocacy organizations — including Our Bodies Ourselves, the Pro-Choice Alliance for Responsible Research and the Center for Genetics and Society — are studying women’s knowledge about egg retrieval and calling for more and better research about its risks.

Here’s an example:

One drug frequently used to suppress ovarian function (before the ovaries are “over-stimulated” to produce multiple eggs that can then be harvested and fertilized) is leuprolide acetate (Lupron). The U.S. Food and Drug Administration has not given approval for this particular use of the drug, and thus its use during egg retrieval protocols is “off label.”

In various surveys of younger women engaging in so-called egg “donation,” it appears that this fact about off-label use is rarely shared. Probably few, if any, of these young women know about the 300-page review of many Lupron studies that Dr. David Redwine submitted to the FDA in 2011. In this report, he documents a plethora of problems, some long term.

How can we encourage the collection of adequate long-term data about the extent and severity of egg retrieval risks? Given the strong anecdotal evidence of problems such as subsequent infertility, a possible link to certain cancers and more prevalent short-term problems with Ovarian Hyperstimulation Syndrome (OHSS) than previously reported in the literature, more well-done studies are needed.

Continue reading

From Crushing Infertility To Letting Go Of ‘How It Should Be’

Sue Levy and her family (courtesy)

Sue Levy and her family (courtesy)

By Dr. Annie Brewster
Guest contributor

In April, Sue Levy of Brookline shared her story of living with Lymphangioleiomyomatosis (LAM), a rare, progressive and potentially fatal lung disease. Now, in the audio file above, she shares her story of navigating infertility, a journey that started years before her LAM diagnosis but ultimately was informed by it.

Sue underwent six unsuccessful cycles of IVF before she and her husband decided to explore alternative ways to have children. They initially pursued domestic adoption but ultimately decided on egg donor and gestational carrier.

Eleven percent of American women of child-bearing age have a difficult time getting pregnant or carrying a pregnancy to term. While assisted reproductive technology is used much more commonly today than it once was, the term “infertile” is still fraught with negative connotations, especially for women. Dealing with infertility can bring up feelings of shame, failure and loss.

Today, Sue can honestly say that her inability to get pregnant was a blessing, in part because her lung condition is estrogen-responsive and can worsen in pregnancy, but mostly because she cannot imagine having any other children than the two young daughters she has now.

Interview highlights:

The first pass was just trying to conceive on our own, and it not working, and getting involved in some reproductive health. And we ended up doing six rounds of IVF. And IVF is not for the faint of heart — injections, pumping yourself full of medications. I was very responsive to hormones and the moods — and trying to keep a full-time job and keep going with everything…

I fundamentally believed in the science and I thought, ‘This time it’s going to work.’ And you also have to figure out, how do you keep yourself safe in case it doesn’t? How do you deal with that crushing blow of, ‘They’ve implanted, I’ve seen the embryo on the screen, I’ve watched them put it inside of me, it’s got a 10 rating, it’s awesome, we’re in’ — to then, two weeks later, checking every time you go to the bathroom: ‘Am I getting my period? Am I not? Am I getting my period?’ And then saying, ‘Oh my god, it didn’t work.’

After six rounds of it, you can imagine you would just cry. And I remember saying to my husband, ‘When are we going to know when to stop? Continue reading

Mother’s Day Memo: Don’t Forget Women Who Can’t Have Kids

(clappstar/flickr)

(clappstar/flickr)

By Karen Shiffman
Guest contributor

Last year, even days afterwards, I was still recovering. (And no, this isn’t a rant against Mother’s Day. I salute Moms. Hooray for flowers, manicures, homemade cards. I bought my mother earrings with blue lapis to match her eyes. I hope to borrow them, soon.)

But for me, Mother’s Day is the hardest date on the calendar: I can’t have children and will never be a biological mother. Bad genes, bad luck and a huge cancer scare a while back left me without a womb and a few other body parts.

But at least I have no cancer; I dodged the big one — twice. After my surgery, friends danced around the fertility issue, but I shut them down with this effective retort: “I’m lucky to be alive.” Looking back, I think they were just projecting their own anxieties about their biological clocks. I, on the other hand, was fine.

And I continued to feel fine for a while. I looked at condos. Got back in the pool. Went back to work. Everyone marveled at how quickly I’d bounced back. Then Mother’s Day came, and I fell apart. Bam. I couldn’t even buy my mother a card that first year. It was ugly.

The following year, as Mother’s Day approached, I didn’t do much better. My family went out for a celebratory brunch; I stayed home. I said it was too painful to be out with all those happy moms and families. I took my mother out to dinner later that week.

I confided to a friend about my struggle. He listened, comforted me and then did something extraordinary. The Sunday after Mother’s Day he lifted the chalice at his church, and spoke these words to the congregation:

“I light this second candle for all the special women for whom Mother’s Day last Sunday brought pain and anguish. For those women who are infertile or medically unable to conceive a biological child.”

He went on to talk about women who had suffered miscarriages or were estranged from their children by divorce or misunderstandings. He ended the blessing this way: “May our prayers and concerns be with all of you, this day.”

He got it. He heard me. I wasn’t alone. Continue reading

Widespread Chemical Bisphenol A Linked To Flawed Eggs In Women

Human egg

A human egg being injected with sperm (Eugene Ermolovich on Wikimedia Commons)

More bad news about Bisphenol A, the all-but-ubiquitous chemical used in plastic bottles and other products:

Researchers at Brigham and Women’s Hospital report today that Bisphenol A may contribute to  female infertility, based on their findings that in the lab, unfertilized human eggs exposed to high concentrations of BPA are significantly more likely to mature abnormally. From the press release:

“To our knowledge, this is the first study that has shown that BPA has a direct effect on egg maturation in humans,” said [lead researcher Dr. Catherine] Racowsky. “Because exposure to BPA is so ubiquitous, patients and medical professionals should be aware that BPA may cause a significant disruption to the fundamentals of the human reproductive process and may play a role in unexplained infertility.”

The randomized trial examined 352 eggs from 121 consenting patients at a fertility clinic. The eggs, which would have otherwise been discarded, were exposed to varying levels (20 ng/ml, 200 ng/ml and 20 µg/ml) of BPA in a laboratory setting. An egg from each patient was not exposed to BPA and served as the control. Researchers then examined the eggs and found that exposure to BPA caused:
· A decrease in the percentage of eggs that matured.
· An increase in the percentage of eggs that degenerated.
· An increase in the percentage of eggs that underwent spontaneous activation, the abnormal process when an egg acts as though it has been fertilized, even though it has not been.

Additionally, the eggs that were exposed to greater levels of BPA had a decreased likelihood of maturity, an increased likelihood of degeneration and an increased likelihood of spontaneous activation. Researchers note that these results are similar to the previous research examining the impact of BPA exposure on animal eggs.

Earlier research suggested that BPA may also be bad for male fertility: A 2010 paper in the journal Nature found that it could damage the DNA in sperm.

But not to panic. First, in an interview, Dr. Racowsky emphasized that this is very early research whose central message is that more research is needed — it is by no means ready for the clinic. Eventually, she said, it may help shed light on infertility in couples who have no other obvious reason for it. Continue reading

Mass. General Study: Eggs Of Underfed Mice Age Less

Generic lab mice

Please file this one under: fascinating, but definitely not actionable at this point. Massachusetts General Hospital researchers report that in female mice underfed on a “calorie-restricted diet,” their eggs showed fewer of the sorts of age-related problems that lead to declines in fertility.

Given that previous research has shown that too low a level of body fat can hinder fertility, I would definitely not start radically restricting my calories in hopes of getting pregnant. But the lead researcher, Jonathan Tilly, holds out hope that it may eventually be possible to develop drugs that let us get the effects of calorie restriction without actually having to semi-starve.

From the Mass. General release:

BOSTON – A strategy that has been shown to reduce age-related health problems in several animal studies may also combat a major cause of age-associated infertility and birth defects. Investigators from Massachusetts General Hospital (MGH) have shown that restricting the caloric intake of adult female mice prevents a spectrum of abnormalities, such as extra or missing copies of chromosomes, that arise more frequently in egg cells of aging female mammals. Their report appears in this week’s online Early Edition of the Proceedings of the National Academy of Sciences USA.

“We found that we could completely prevent, in a mouse model, essentially every aspect of the declining egg quality typical of older females,” says Jonathan Tilly, PhD, director of the Vincent Center for Reproductive Biology in the MGH Vincent Department of Obstetrics and Gynecology, who led the study. “We also identified a gene that can be manipulated to reproduce the effects of dietary caloric restriction and improve egg quality in aging animals fed a normal diet, which gives us clues that we may be able to alter this highly regulated process with compounds now being developed to mimic the effects of caloric restriction.” Continue reading

A (Nobel) Moment To Celebrate IVF

You probably know several wonderful young people who wouldn’t be here if not for the medical wonder of IVF, or in vitro fertilization. I do. At last count, about four million children worldwide had been conceived as “test-tube babies.” So I felt my heart lift in the pre-dawn morning when I saw that the Nobel prize in medicine had gone to a developer of IVF, Robert G. Edwards. And the story of his work makes for some good reading in the Nobel press release here. Funny to think that the practice used to be ethically controversial…

IVF began in Britain with the famed baby Louise Brown. but in the United States, the first family to have an IVF baby was here in Massachusetts, and we recently celebrated our own landmark: the country’s first test-tube baby, Elizabeth Carr — now Comeau — who grew up to be a journalist, gave birth to a child of her own — the low-tech way — and wrote about it in the Globe here.

Daily Rounds: Nobel For IVF; Slow Insurance Uptake; Obstacles to Electronic Records; How Tired Are You?

Test-Tube Baby Pioneer Wins 2010 Nobel In Medicine : NPR “Approximately 4 million individuals have been born thanks to IVF,” the citation said. “Today, Robert Edwards’ vision is a reality and brings joy to infertile people all over the world.”(npr.org)

The Associated Press: Growing pains for a centerpiece of health overhaul “The Pre-Existing Condition Insurance Plan started this summer isn’t living up to expectations. Enrollment lags in many parts of the country. People who could benefit may not be able to afford the premiums. Some state officials who run their own “high-risk pools” have pointed out potential problems.” (google.com)

Doctors, patients use smartphones, but can’t make mobile connection – American Medical News “PwC says the inability of many practice and hospitals electronic medical records systems to integrate data from smartphones isn’t stopping doctors from using them, but it is limiting their use.”(ama-assn.org)

2 Brothers Await Broad Use of e-Medical Records – NYTimes.com “To date, the push for a digital revolution in doctors’ offices has brought mostly frustration for the many companies big and small that are trying to conquer the field. Just ask the Doerr brothers — John Doerr, the well-known venture capitalist who was an early backer of Google and Amazon, and Dr. Tom Doerr, a physician and software designer.”(The New York Times)

How tired is too tired? – The Boston Globe “One in five motor vehicle accidents is related to “drowsy’’ driving. The problem is that, like drunk drivers, most of us don’t recognize when we’re too drowsy to drive well.”(Boston Globe)

And just in case you missed these over the weekend:

Antipsychotic Drugs – Side Effects May Include Lawsuits – NYTimes.com (The New York Times)

Syphilis Experiment Is Revealed, Prompting U.S. Apology to Guatemala – NYTimes.com A Wellesley professor brings to light an experiment that many consider worse than the infamous Tuskeegee. (The New York Times)