reproductive medicine


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.

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ABC: Orthodox Women Told To Be Fruitful, Freeze Eggs

Ultra-Orthodox Jewish men in Brooklyn

Ultra-Orthodox Jewish men in Brooklyn (Wikimedia Commons)

Remember that somewhat baffling moment in Genesis when Abraham’s wife, Sarah, finds she’s pregnant after decades of fruitless waiting, in her “old age”? Well, if Sarah lived these days, according to a report just out from ABC, her rabbis might well have advised her to backstop her fertility with a freezer.

In a post headlined “Rabbis urge single Orthodox women to freeze eggs at 38,” ABC reports:

Doctors in the United States who are familiar with “halacha” — or Jewish religious law — say they are seeing more Orthodox patients who have been sent by their rabbis to freeze their eggs before their fertility wanes.


“Most rabbis are strongly recommending this, and most should,” said Dr. Sherman Silber, director of the Infertility Center of St. Louis, whose practice caters to Orthodox Jews. “‘Be fruitful and multiply’ is considered the first commandment.”

The procedure helps make these single women more marriageable in the eyes of their communities, according to Silber.

“In truth, however, most orthodox women marry much earlier than this, often at age 20,” he said. “So it is an uncommon event, but an important one for them.”

It is also an expensive event. The procedure can cost $10,000 or so — and is still considered somewhat experimental.

Sperm Bank: No Red-Headed Men Need Apply

There’s been interesting coverage lately of sperm “super-donors” who father dozens of children, from this story in The New York Times to this one in the Boston Globe.

As co-author of a book that featured donated sperm, I can tell you that the prospect of dozens of half-siblings who could conceivably meet, fall in love with each other and unknowingly commit incest strikes a deep, atavistic chord in many people. At readings and events, it was one of the most common questions: “You mean there are no controls on how many children a donor fathers?”

Personally, it doesn’t worry me much. It’s a problem that could be solved by a national registry of donor-conceived children, and is already partly solved by the heroic efforts of a Colorado force of nature named Wendy Kramer, whose Donor Sibling Registry helps such half-siblings identify each other.

But here’s a true sperm-related outrage: Discrimination against red-headed men! Sisters, where is your discernment? Hat-tip to Beth Jones, who pointed out this article in the New York Daily News. Headline: “World’s biggest sperm bank, Cryos, tells redheads: We don’t want your semen.”

“There are too many redheads in relation to demand,” Ole Schou, the director of Cryos, told the Danish newspaper, Ekstrabladetaccording to London’s Telegraph.

Men with scarlett manes sell “like hot cakes” in Ireland, Schou said, but that’s about it. Continue reading

Study: Hormone Restores Menstrual Cycle In Women With Little Body Fat

You hear about it happening to gymnasts and runners, dancers and anorexics. A woman’s — or girl’s — body fat gets so low that she stops having periods; her reproductive cycle shuts down.

You can imagine how evolution may have worked it this way. In ancient times, if conditions were so bad that you were down to skin and bones, that was not the time to try to feed a baby. But in modern times, women with extremely low body fat may face unwanted infertility, and they have been found to be at higher risk for osteoporosis.

Today, researchers report that leptin — a hormone famed for its role in appetite and obesity — is a key to that loss of menstruation, known as “hypothalamic amenorrhea,” and that giving women synthetic leptin can restore their reproductive function and possibly protect their bones.

The paper’s lead author, Dr. Sharon H. Chou of Beth Israel Deaconess Medical Center, summed up the findings:

Women with hypothalamic amenorrhea, or loss of menstrual periods from excessive exercise, excessive stress, or decreased food intake, have additional neuroendocrine abnormalities and experience bone loss. These women also are found to have low leptin levels, which can be seen as a marker of energy stores. This study shows that replecement of leptin in these women restores menstrual periods, corrects some of the neuroendocrine abnormalities, and may improve bone loss.

And this from a Beth Israel press release:

The findings are reported on-line in the Proceedings of the National Academy of Sciences (PNAS), the week of April 4.
“This condition accounts for over 30 percent of all cases of amenorrhea in women of reproductive age, and is an important problem for which we didn’t have a good solution,” explains senior author Christos Mantzoros, MD, Dsc, Director of the Human Nutrition Unit at BIDMC and Professor of Medicine at Harvard Medical School.
“Our findings now prove beyond any doubt that leptin is the missing link in women with significantly diminished body fat, and that this, in turn, results in numerous hormonal abnormalities.” Without leptin, he explains, menstrual periods cease, the body becomes chronically energy-deprived and women experience bone loss and an increased risk of bone fractures. Continue reading