INFERTILITY will be the third most serious health condition after cancer and cardiovascular diseases this century.
With as many as one in six Aussie couples infertile, a conference on assisted reproduction will be told this week the increasing childlessness rate is taking a heavy toll.
World Health Organisation estimates show that in 2010 48.5 million couples worldwide were unable to have a baby after trying for five years and when the inability to have a second child is taken into account this infertility rises to 168 million people worldwide. Australian fertility experts Dr Clare Boothroyd says infertility can be compared to cancer and cardiovascular disease because of the impact it has on a desperate family’s quality of life. “The World Health Organisation says having a family is a human right and it is fundamentally important to who we are,” she told News Corp Australia.
Professor Robert Norman from the Robinson Institute in Adelaide says in China alone, an estimated 40 million people each year experience infertility due to factors such as couples marrying later in life, growing urbanisation and associated stress levels, work pressures and environmental. “As a result, there is a growing reliance on assisted reproduction with around 15,000 babies born each year from IVF in Beijing alone,” he said.
One of the biggest causes of infertility is couples leaving reproduction until too late in life, says Dr Boothroyd. However, it is not just the age of the woman but also the age of the man that has an impact. “If a male is more than five years older than the woman he influences the infertility,” she says. A woman aged over 35 who has a partner five years older has her chance of achieving a pregnancy reduced by 30 per cent than if she was with someone the same age or younger, she said.
Written by Honor Whiteman
The research was recently published in Cancer Epidemiology, Biomarkers & Prevention - a journal of the American Association for Cancer Research.
For women who are not ovulating properly, the use of fertility medication is often recommended. These drugs work by triggering egg production in the same way a woman's hormones would naturally. Use of this medication alone can enable a woman to become pregnant, or it can be used alongside assisted reproductive technologies (ART), such as intrauterine insemination (IUI) and in vitro fertilization (IVF).
Whether such fertility medications increase breast cancer risk has been the subject of speculation for some time. Many studies have suggested a positive link between the two, but the researchers of this most recent study say they wanted to investigate further. "We wanted to evaluate the long-term relationship of fertility medications and breast cancer risk after controlling for other factors that have been shown to be correlated with both breast cancer risk and use of those drugs," explains Louise A. Brinton, chief of the Hormonal and Reproductive Epidemiology Branch at the National Cancer Institute (NCI).
To reach their findings, the research team analyzed data from a cohort of more than 12,000 women who were assessed for infertility at five different US medical institutions between 1965 and 1988. Of these women, 9,892 were included in the study and followed until 2010. Breast cancer developed in 749 of the women during follow-up. The researchers were able to obtain medical documentation for 696 of the women. Of these, 536 had invasive breast cancer.
Overall the study data of the team showed that women who took the fertility medication clomiphene citrate (brand name Clomid) or gonadotropins did not have an increased risk of breast cancer, compared with women who were not treated with these medications.
The team did find that women who had 12 or more cycles of clomiphene were 1.5 times more likely to develop breast cancer than women who did not use fertility medication. But Brinton notes that under current practices, women are usually limited to 3-6 cycles.
Furthermore, the researchers found that women who were still unable to become pregnant after being treated with clomiphene and gonadotropins had twice the risk of breast cancer, compared with women who were not prescribed these drugs. "The observed increase in risk for these small subsets of women may be related to persistent infertility rather than an effect of the medications," says Brinton.
She notes that the women in this study who developed breast cancer were an average age of 53, which she says is still young, considering that most breast cancer cases occur in women above this age.
Women who have used fertility medication and are approaching the typical breast cancer age range should receive ongoing monitoring, according to Brinton. In addition, she says further research is needed to determine the long-term effects of fertility medication prescribed under current practices.
Study: Stress may reduce fertility
Elizabeth Landau - CNN.com Health Writer/Producer
If you're trying to get pregnant, relax and try to keep your stress down. That sounds like good advice, which your doctor has probably given you, but there has been very little science to back it up - until now.
Researchers, publishing in the journal Human Reproduction, say they have put out the first prospective study showing an association between stress and infertility. They measured stress using biomarkers in the saliva of women who wanted to conceive, and found a strong correlation with alpha-amylase.
"The women who had the highest levels of this salivary stress biomarker had a 29% decreased probability of pregnancy over time, and that actually translated into a more than two-fold risk of infertility for them by the end of the study," said lead author Courtney Lynch, director of reproductive epidemiology at The Ohio State University Wexner Medical Center.
The National Institutes of Health already recommends reducing stress while trying to conceive, but this new research actually studied the relationship between stress and fertility, Lynch said. Four years ago, Lynch and colleagues showed in a previous study that women with higher levels of a stress biomarker in their saliva had a 15% lower chance of getting pregnant in the first cycle.
Keep in mind that these studies show associations, not causes. Researchers did not investigate why stress might lead to infertility, and there could be some other factor that links the two. And there are many other reasons that a couple may be having trouble conceiving.
In this study, 401 couples completed the entire protocol. Researchers followed the couples for up to 12 months as the couples tried to conceive. Those who got pregnant were also followed during the course of pregnancy. Out of 401 women who went through the entire study, 87% (347) became pregnant and 54 (13%) did not.
All of the women who participated were between ages 18 and 40, were married or in a committed relationship, had recently stopped using contraception and had a male partner aged 18 or above.
Researchers controlled for the age, race, and income of participants, as well as use of alcohol, caffeine and cigarettes while the women were trying to conceive.
Women gave saliva samples the morning after they enrolled in the study and another the morning after their first period during the course of the study. Researchers tested their saliva for the stress biomarkers cortisol and alpha-amylase.
When beginning the study, women answered a variety of lifestyle questions including one that required them to rate their overall daily stress level.
On a daily basis, couples kept a journal, writing down their stress levels as well as whether they had intercourse or experienced menstruation.
Information was collected between 2005 and 2009 as part of the LIFE Study.
Researchers found that women with the most alpha-amylase had a two-fold increased risk of infertility. There was no association with the other stress biomarker tested, the hormone cortisol.
Based on self-reporting, the women in this study seemed to have lower levels of stress than the general population, so even those with the highest levels of alpha-amylase in the study are likely experiencing a relatively low-level of stress, Lynch said.
Although typically couples are seen as having infertility problems if conception doesn't happen after a year, researchers in the new study saw a steep drop-off after five to six months. After that time, women with higher stress biomarker levels seem to have a much lower likelihood of becoming pregnant.
"We're suggesting that the five to six-month window is a really an opportunity for women to step back at that point and say, 'Wow, you know, maybe I ought to consider stress as a potential issue for me.' "
The study does not suggest that stress is the most important factor in determining whether a couple will conceive, Lynch said. Medical problems and semen quality would be more likely to influence fertility.
But if stress does affect fertility, why? Study authors ruled out the idea that stressed-out women are having less intercourse, based on participants' journal reports and alpha-amylase levels. There are many theories about how stress could impact fertility more directly, but science has not backed up any yet.
Stress may have increased for some women as more time went by without conceiving, but that would not have been recorded in this study.
The study did not repeatedly collect saliva samples over time. And although participants reported their levels of stress over time in their journals, researchers did not take this information into account in the results. Lynch said self-reported stress levels will be analyzed in a subsequent study.
Interestingly, it is not clear that the self-reported levels of stress correlate with measurable stress biomarkers. In their previous study, Lynch and colleagues noted this discrepancy - "We could not find a paper-and-pencil questionnaire that predicted this well," she said.
Researchers would also like to know more about who the women are who are experiencing stress-related fertility problems. Are they more anxious and depressed in general, and less resilient to new stressors? That would be a subject for further study.
Lynch and colleagues are working on a randomized controlled trial of a stress intervention to see if that helps women get pregnant faster if they are having stress issues.
In the meantime, if you're a woman having trouble conceiving after at least five or six months, Lynch recommends trying a proven stress-reducing activity such as mindfulness techniques, meditation, and moderate daily exercise.
"Until we have more data, I think that is the reasonable recommendation to make to women," she said.
London, 9 July 2013: An analysis of almost 10,000 first cycles of egg donation treatment at one of Europe's largest IVF centres shows that female obesity reduces the receptivity of the uterus to embryo implantation and thereby compromises reproductive outcome. The investigators report that excess female weight "impairs human reproduction" and that "the reduction of uterine receptivity is one of the mechanisms involved". As a result they advise weight reduction before pregnancy in any type of conception, including ovum donation.
The study is presented today at the annual meeting of ESHRE by the Spanish gynaecologist Dr Jose Bellver from the Instituto Valenciano de Infertilidad (IVI) in Valencia, Spain.
The effect of excess body weight on female fertility has been widely studied, with most studies finding an adverse effect on outcome. The reasons, however, have been less clearly explained, with effects on cycle regularity and ovulation the most frequently cited.(1) The presence of polycystic ovary syndrome, for example, the most common hormonal reproductive disorder, is regulated in part by body weight.
The study reported today was a review of 9587 egg donation treatments performed at three IVI clinics in Spain between 2000 and 2011. All the egg donors were of normal weight, so their body weight could not confound the results. Egg recipients, however, were of varying body weights, and divided into four groups: lean with BMI below 20 kg/m2 (1458 patients, 15.2%), normal with BMI 20-24.9 kg/m2 (5706 patients, 59.5%), overweight with BMI 25-29.9 kg/m2 (1770 patients, 18.5%), and obese with BMI >=30 kg/m2 (653 patients, 6.8%).
When the outcome of the treatment was cross-checked against the BMI of the egg recipient, results showed that the rates of embryo implantation, pregnancy, twin pregnancy and live birth were all significantly reduced as BMI increased.
For example, live birth rate in the four groups was 38.6% in the lean underweight, 37.9% in the normal weight, 34.9% in the overweight, and 27.7% in the obese. Similarly, the rate of embryo implantation in the uterus was 40.4% in the lean underweight, 39.9% in the normal weight, 38.5% in the overweight, and 30.9% in the obese. These trends translated to a statistically significant 27% lower risk of live birth for an obese patient than for one of normal weight (relative risk 0.73).
The investigators acknowledge that there are possible confounding factors in the study (notably that maternal health information was incomplete in the second and third trimesters of pregnancy), but the design of this large study in a series of egg donation treatments ruled out any possibility that the weight of the egg donor (all defined as of normal weight) could affect results in the recipient. The lower level of implantation with increasing BMI suggests an unequivocal effect of recipient BMI.
"Based on our results, the chance of having a baby by egg donation is reduced by around one third for obese women," said Dr Bellver. "More specifically, we found that obese recipients of eggs from normal weight donors had a 23% lower implantation rate than normal weight recipients, 19% lower clinical pregnancy rate, and 27% lower live birth rate."
He explained that, as a systemic disease, obesity "probably affects the different components of the reproductive system independently". For example, some common pathophysiological pathways, such as hyperandrogenism or insulin resistance, may be involved. In the ovary, menstrual irregularity and infertility have been described in women with weight excess. "However," said Dr Bellver, "even in obese ovulatory women conception rates are reduced, showing that ovulation is not the only mechanism underlying this poor outcome. Oocyte and embryo quality also seem to be affected, although it is not known exactly how yet." Results of this study now suggest impaired endometrial receptivity may also contribute to the decline in fertility in obese women.
"The clinical evidence is now strong enough for implementing preconceptional health policies for obese patients considering assisted reproduction," said Dr Bellver. The control of excess weight, especially through lifestyle interventions, should be mandatory not only for improving reproductive and obstetric outcomes, but also for reducing costs derived from the greater consumption of drugs in IVF, failed treatments, maternal and neonatal complications, and metabolic and non-metabolic diseases in the offspring."
Reuters February 16, 2014
NEW YORK Reuters - More test-tube babies were born in the United States in 2012 than ever before, and they constituted a higher percentage of total births than at any time since the technology was introduced in the 1980s, according to a report released by the Society for Assisted Reproductive Technology (SART), an organization of medical professionals in the United States of America.
SART's 379 member clinics, which represent more than 90 percent of the infertility clinics in the country, reported that in 2012 they performed 165,172 procedures involving in vitro fertilization (IVF), resulting in the birth of 61,740 babies. That was about 2,000 more IVF babies than in 2011. With about 3.9 million babies born in the United States in 2012, the IVF newborns accounted for just over 1.5 percent of the total, more than ever before.
The growing percentage reflects, in part, the increasing average age at which women give birth for the first time. The average age of first-time mothers is now about 26 years; it was 21.4 years in 1970.
Although the rising number of test-tube babies suggests that the technology has become mainstream, critics of IVF point out that the numbers, particularly the success rates, mask wide disparities. "It's important for people to understand that women over 35 have the highest percentage of failures," said Miriam Zoll, author of the 2013 book "Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies." Earlier data from SART showed that the percentage of attempts that result in live births is 10 times higher in women under 35 than in women over 42 and that in the older women fewer than half the IVF pregnancies result in a live birth.
After years in which IVF clinicians were criticized for transferring multiple embryos to increase the odds of pregnancy - because that sometimes resulted in multiple pregnancies that had higher maternal and fetal morbidity and mortality risks - infertility clinicians transferred fewer embryos per cycle in 2012 than 2011. As a result, the number of twin and triplet births were both down.
By James Gallagher Health and science reporter, BBC News
A wide range of disorders and problems in school-age children have been linked to delayed fatherhood in a major study involving millions of people.
Increased rates of autism, attention deficit hyperactivity disorder (ADHD), bipolar disorder, schizophrenia, suicide attempts and substance abuse problems were all reported.
The study, in JAMA Psychiatry, suggests mutated sperm were to blame. Sperm are produced constantly throughout a man's lifetime. As the sperm-making mechanism ages, so too do the number of errors - older sperm have more mutations which may be damaging.
The investigation by Indiana University, in the US, and Sweden's Karolinska Institute has been described as the largest and one of the best designed studies on the issue. The researchers looked at 2.6 million people and at the difference between siblings born to the same father as it accounts for differences in upbringing between families.
Comparing children of a 45-year-old dad to those of a 24-year-old father it indicated:
There seems to be no starting point after which the risk started to increase, rather any increase in age had an associated increase in risk. However, the overall risk is likely to remain low. Even if a the risk of a rare disorder is doubled, it would still affect only a small proportion of people.
The study adds to a growing body of research, that suggests families, doctors, and society as a whole must consider both the pros and cons of delaying childbearing. While cons may exist, older dads bring many advantages such as more stable relationships and higher income, which "probably outweigh" the risks.
One at a time is a professionally-led site aimed at reducing the risks of multiple pregnancies from fertility treatment.