A study led by St. Jude Children’s Research Hospital investigators has found the chemotherapy dose threshold below which male childhood cancer survivors are likely to have normal sperm production. The study appears in September 17 edition of the journal Lancet Oncology.
The high frequency of the BRCA 1 and 2 genes reported in cancer-free Ashkenazi Jews, (“Study of Jewish Women Shows Link to Cancer…” Sept 4), calls for urgent action that should save many lives. The chance of an Ashkenazi Jew to carry a BRCA 1 or 2 genes exceeds 1 in 50. That frequency is already higher than many genes currently included in the “Ashkenazi Jewish Genetic Panel.”
Since the great majority of women with the BRCA gene will develop breast or ovarian cancer (and men – prostate cancer), finding the BRCA gene will allow them to take preventive measures and reverse their genetic misfortune.
BRCA 1 and 2 testing should be added to the routine Ashkenazi Jewish genetic panel. Since just 3 mutations are responsible for over 90% of affected cases, BRCA testing for Ashkenazi Jews is significantly cheaper than that of the general population. While the cost of the panel is expected to rise, the benefits of preventing potentially fatal cancer far outweigh the costs.
Read more about this health study, as reported in the New York Times, by Roni Caryn Rabin.
The increased risk of multiple births has been known for decades. In the past several years there has been a significant decline in the rate of higher order multiple births, partly, thanks to revised ASRM guidelines for the recommended number of embryos to be transferred in an IVF cycle.
Single embryo transfer is rapidly gaining grounds in most programs, especially for younger patients. However, a significant proportion of embryo transfers in the US in 2014 still involve the transfer of more than one embryo. This is more common with older patients, especially given the high rate of chromosomally abnormal embryos (which rises exponentially beyond age 40).
A second culprit is the fact that IVF is not covered by many insurance providers. The significant out-of-pocket expense of IVF drives patients to pressure their physicians to transfer two embryos (or more) to increase their chances of becoming pregnant.
The good news is that the solution is within reach and should focus on four aspects, which we have been practicing at Lenox Hill Human Reproduction and the Center for Human Reproduction at North Shore-LIJ Health System:
Having continuous dialogue with law makers and insurance providers to promote coverage for ART procedures, and especially for IVF with an emphasis on single embryo transfer.
Encouraging patients to freeze their eggs in their early 30′s when most eggs are “healthy,” which will allow for single embryo transfer later in life when they are ready to conceive (even if they are in their late 30′s or early 40′s).
Improving egg and embryo freezing techniques in the lab, which will allow all IVF centers to be able to offer single embryo transfers while saving the surplus embryos for potential future transfers.
Promoting genetic testing of embryos prior to their transfer back to the uterus – a technique called PGS (Preimplantation Genetic Screening) and transferring a single, chromosomally normal embryo (free of Down’s Syndrome and other abnormalities), thus reducing multiple birth rate with its exorbitant cost to healthcare, and increasing the chance of delivering healthy babies, one at a time.
“If you’re tired of legal thrillers written by lawyers, read this amazing medical thriller written by Dr. Avner Hershlag who not only knows his stuff, but also knows how to write. Combining a little science fiction with a lot of science fact, Hershlag takes us on a scary journey through the fields of genetics and into the near future. Misconception delves deeply into a subject no less important than the mystery of life itself.”
As part of undergoing in vitro fertilization (IVF), a woman must take hormone shots which encourage her body to ripen and release more than one egg at a time. These many eggs are then collected and used for fertilization in a laboratory setting. For women who don’t like needles, this can be a difficult, painful, and stressful experience. Luckily, this may soon change.
Currently, the IVF procedure requires 7 to 10 days of hormone injections. However, “pharmaceutical companies have produced longer acting gonadotropins that last for a week. A longer acting gonadotropin may help decrease the number of shots a patient takes during the IVF process. Studies are now under way to test for efficacy, side effects, and risks for ovarian hyperstimulation syndrome (OHSS) during IVF. The American Society of Reproductive Medicine Practice Committee states that this new preparation of gonadotropin holds promise for improving patient satisfaction while maintaining efficacy.”
This could mean that patients may need to only take one or two shots to stimulate their ovaries, rather than 7 to 10 shots. This is great news for those who don’t like needles!
Talk to your doctor about what medication is available for you; be open about what procedures you are comfortable with. Do not let a fear of needles or procedures stop you from becoming a parent.
Recent studies appear to show damaging effects of normal exposure to BPA to several reproductive areas in mice. Although there is still much we need to learn about the effects of plastics on fertility, especially in humans, I think most of us who have read about it agree that there is a reason to be concerned. As of a few years ago, I know that I and most colleagues stopped microwaving our food in plastic containers, and were sure to check our children’s bottles for the ‘no-BPA’ signs.
As the evidence accumulates and seems to be supporting the theory that BPA is toxic to ovarian function, it’s just common sense to take the simple precautions to eliminate this potential threat.
Celiac disease has been a hot topic for more than a decade. And it remains controversial. But one thing that seems to have been resolved is it’s association with infertility. A recent and large-population study has found that, in general, women with celiac disease have no more fertility issues than those without celiac disease. The interesting exclusion is woman diagnosed between the ages of 25-29.
A recent report in U.S News and World Report Healthday summarizes a study that supports the premise that antidepressive drugs used in pregnancy are not associated with any increase in the incidence of autism in the offspring, although there might be an increase in attention deficit/hyper-activity disorder in these children. While this is certainly reassuring for pregnant patients on these medications, it is an area that will require a great deal more research before all of the facts are known. Each woman must discuss the alternatives with her psychiatrist to weigh the risks vs. benefits, especially since there appear to be well-described risks to not treating the depression for both the mother and baby. Non-pharmacologic treatments need to be considered as part of the whole picture.
A New York reproductive endocrinologist says a recent Consumer Reports article cautioning pregnant women about eating tuna goes too far because women need certain nutrients found in fish.
“I think the recent Consumer Report maybe went a little bit overboard,” says Tomer Singer, MD, reproductive endocrinologist at the North Shore-LIJ Health System. “What we usually advise our patients is to have one portion of tuna a week rather than to avoid it altogether.”