reproductive health

RECENT POSTS

CDC Report Tracks The IUD Renaissance

You might call it the “Comeback Contraception.” In any case, it seems, IUD use is on the upswing.

This week’s CDC National Health Statistic Report highlights the surge: The number of women using long-acting reversible contraception (LARC) has almost doubled in recent years, and most of the increase is due to the growing popularity of IUDs.

From the report:

Among women currently using contraception, use of LARC increased from 6.0% for 2006–2010 to 11.6% for 2011–2013. Use of IUDs makes up the bulk of this category, with 10.3% of current contraceptors using an IUD during 2011–2013.

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

The number of women using long-acting reversible contraception has increased from 6 percent in 2006 to 11.6 percent in recent years. (Source: Centers for Disease Control and Prevention)

Intrauterine devices remain less popular than other forms of contraception, according to the report. The pill ranks as the most widely used method (it’s taken by 25.9 percent of women who use contraception, or 9.7 million women), followed by female sterilization (25.1 percent, or 9.4 million women) and the male condom (used by just over 15 percent, or 5.8 million women).

Still, LARC devices, including IUDs and contraceptive implants, were used by 11.6 percent or 4.4 million women, according to the report: “While the most commonly used methods — female sterilization, the pill, and the male condom — appear to remain consistent over time, an increase has been noted in the use of LARC methods, primarily the IUD.”

A confluence of events have contributed to the IUD’s renaissance, experts say, including an improved product, a drop in price and more promotion by doctors, including the American Academy of Pediatrics, and backing by the family of Warren Buffett.

 

Related:

Forbidden Fruit: Pesticide-Laden Produce Linked To Lower Semen Quality, Study Finds

(Robert S. Donovon/Flickr)

(Robert S. Donovon/Flickr)

That apple a day? Consider choosing it wisely: If it’s laden with pesticide residues, it could mess with your sperm.

That’s the analysis from researchers at the Harvard School of Public Health in a study published online this week in the journal Human Reproduction.

The study found that men who ate a range of fruits and vegetables, including strawberries, peppers, spinach and apples, with higher levels of pesticide residues had a lower sperm count and a lower percentage of normally-shaped sperm compared to men who ate produce with less pesticide residue. (This finding was true even after fruit was washed before eating.) Researchers said it’s the first study to examine exposure to pesticides and semen quality.

Senior study author Jorge Chavarro, assistant professor of nutrition and epidemiology at the Harvard School of Public Health, said the research doesn’t mean people should eliminate fruits and vegetables from their diet — on the contrary; rather consumers should simply choose more carefully. In an email, he wrote:

I think there are two main takeaways from this work. The first one is that, as interesting and potentially alarming these findings may be, this is the first time that pesticide residues in foods have been linked to an adverse reproductive health outcome in humans. It is therefore very important that these results are replicated in other studies, and ideally in randomized trials, before firm conclusions can be made one way or the other.

On the more practical end, the other important point is that our results point to a very specific role of high pesticide residue produce, rather than to intake of fruits and vegetables in general which means that strategies specifically aimed at avoiding high residue produces, such as consuming organic produce if budget allows or selecting fruits and vegetables known to have low levels of pesticide residues may be the preferred way to address this issue…

Chavarro said the easiest way to determine produce safety is to check the dirty dozen/clean fifteen list that the Environmental Working Group releases each year. 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

AP: Supreme Court Strikes Down Buffer Zone For Abortion Clinics

(Update from the AP: “Attorney General Martha Coakley, whose office argued before the justices to keep the 35-foot zone, did not immediately say whether officials would seek to create a different buffer zone or take some other steps. But she said the ruling appeared to leave open other alternatives and called on lawmakers to act quickly.

“Every day that we don’t change the rules and make it safer for people to get access, people are put at risk,” said Coakley, a Democratic candidate for governor.

Senate President Therese Murray, D-Plymouth, said she expected lawmakers to act before the July 31 end of the legislative session, but would not speculate on what changes might be sought.”)

The AP reports that the U.S. Supreme Court today struck down a 35-foot protest-free zone outside abortion clinics in Massachusetts (read the court’s “slip opinion” here). We’ll update the news and add reactions as they come in, but for now, here’s the Associated Press, with reactions below:

The justices were unanimous in ruling that extending a buffer zone 35 feet from clinic entrances violates the First Amendment rights of protesters.

Chief Justice John Roberts said authorities have less intrusive ways to deal with problems outside the clinics.

While the court was unanimous in the outcome, Roberts joined with the four liberal justices to strike down the buffer zone on narrow grounds. In a separate opinion, Justice Antonin Scalia criticized Roberts’ opinion for carrying forward “this court’s practice of giving abortion-rights advocates a pass when it comes to suppressing the free-speech rights of their opponents.”

The case began when Boston-area grandmother Eleanor McCullen and other abortion opponents sued over the limits on their activities at Planned Parenthood health centers in Boston, Springfield and Worcester. At the latter two sites, the protesters say they have little chance of reaching patients arriving by car because they must stay 35 feet from the entrance to those buildings’ parking lots.

Planned Parenthood provides health exams for women, cancer screenings, tests for sexually transmitted diseases, birth control and abortions at its clinics.

The organization said that the buffer zone has significantly reduced the harassment of patients and clinic employees. Before the 35-foot zone went into effect in 2007, protesters could stand next to the entrances and force patients to squeeze by, Planned Parenthood said. Continue reading

How Being Obese May Hinder Pregnancy: Eggs Gone Awry

Human egg

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

The more obese you are, the harder it is to get pregnant, and a study just out in the journal Human Reproduction offers some new insight into why. For the 1/3 of American women of childbearing age who are obese, its concrete images of eggs gone awry may also offer a bit of added incentive to lose weight before trying to get pregnant.

The study, led by Dr. Catherine Racowsky of Brigham and Women’s Hospital, found that in severely obese women who underwent fertility treatments, the eggs that failed to fertilize were more likely to have abnormal structures and disorganized chromsomes than the eggs in normal-weight women.

In particular, the eggs in the obese women were roughly twice as likely to have double “spindles.” The spindle is something like the axis around which the gene-bearing chromosomes organize themselves; for an egg to fertilize normally, it must have a single spindle. (See the image below.)

spindles

Normal and abnormal spindles in human eggs (Courtesy of BWH)

How, I asked Dr. Racowsky, might all this work? How might obesity lead to double spindles and other egg malformations?

‘The egg, of course, develops in the ovary,” she replied, ” and the immediate environment in which the egg develops is called the follicle. And we know from other studies that there are various abnormalities in the follicles of women who are obese. A lot more work needs to be done to understand how these abnormalities in the follicles relate to abnormalities in the eggs, but we do know that the relationship between the health of the follicle and the health of the egg is of paramount importance.”

In the paper, I said, I caught hints of a couple of familiar elements that may go wrong in the follicles of obese women. There were mentions of leptin, an obesity-related hormone involved in appetite and metabolism, and of inflammation, which has also been found to increase in obesity. Continue reading

Why The IUD Is On The Rise (And You Might Want One)

(Above: A 7-minute IUD show-and-tell by a leading expert, Dr. Eve Espey)

Full disclosure: I had an intra-uterine device implanted soon after my second child was born, and in my own experience, using an IUD for birth control is something like what Churchill said about democracy: It’s the worst system around — except for all the other ones.

My first few months with a Mirena — an IUD that emits tiny levels of the hormone levonorgestrel — were rife with unpredictable spotting. That certainly got very old very fast. But then the spotting ended, and my periods blessedly all but disappeared, a common Mirena effect. It’s been nearly seven years now, and I’ve been both problem- and pregnancy-free. I even re-upped for a second device when the first one hit its five-year limit.

So that’s my bias when I report that in recent weeks, I’ve noted a striking convergence of signs pointing to a new era of far greater popularity for IUDs. There’s even talk of an IUD “renaissance” — once all but unthinkable after the debacle of a 1970s device called the Dalkon Shield.

The "Mirena" hormone-releasing IUD

In the not-too-distant future, getting an IUD, which costs several hundred dollars, will be universally covered and co-pay-free under new federal insurance rules. The latest numbers suggest IUD use among American women has risen dramatically in the last decade. And the IUD’s safety record is looking so good that recent research finds that the devices can even be implanted right after an abortion or a birth.

“The message is finally getting out there that IUDs are a great option — that they’re highly effective, that they’re long-acting, and they provide reversible, highly effective contraception with just one act,” said Dr. Alisa Goldberg, director of clinical research and training at the Planned Parenthood League of Massachusetts. (That “one act” is having the IUD implanted, a quick office procedure.)

Among the first 2500 women who enrolled in the study, 56% — that’s right, more than half — chose to get IUDs.

“And the message is finally getting out there that the old days — the days of the Dalkon Shield — are long behind us,” Alisa, who’s also director of the division of family planning at Brigham and Women’s Hospital, said. “There are increasing amounts of data showing the safety, the efficacy and the increasing popularity of these methods.”

In a country where nearly half of pregnancies are accidental, “This could have a huge impact on public health,” she said.

No, she’s not in the pay of the IUD makers. She sounds just like many other evidence-based experts on contraception who have been pushing for greater IUD use for years. In fact, it was because I’d read some of their research that I opted for an IUD seven years ago, despite a lingering sense of past disaster.

Now the factors in the IUD’s favor are visibly multiplying. Most recently, new federal rules announced earlier this week, requiring insurers to cover women’s contraception without co-pays, will remove the upfront costs that put many women off IUDs. Continue reading