Tag: infertility

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The Possibility of Infertility Looms for Cancer Patient

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Staff writer Andrea Torres chronicles her breast cancer experiences in Tropical Life.

A woman in her early 30s should not have to think about infertility. But breast cancer changes everything.

Doctors have highly recommended that I have a hysterectomy, surgery to remove the uterus, and a prophylactic oophorectomy, removal of my ovaries. Both would be a preemptive move against uterine and ovarian cancer, which can develop after breast cancer.

Thinking about it has been difficult, especially faced with a gynecological appointment this week. On Saturday, I had a crying episode that lasted hours. I haven’t had one in months. Three of my best friends, all males, tried to comfort me.

I called Lawrence Pena, 34, who has a 2-year-old girl named Ella. After he heard my trembling voice, he asked, “What happened?”

“I sat in the shower holding my stomach crying this morning,” I said. “I haven’t been able to stop the tears.”

He listened and said, “It’s going to be OK.” I was calm again. He talked for a bit. And then his phone died.

Although the surgery is common, I am scared. Every 10 minutes, 12 hysterectomies are performed in the United States, or about 600,000 in a year. And about one-tenth of 1 percent of those, about 660 women, die from complications.

Also, when the procedures are done before age 45, there is an increased mortality risk associated with cardiovascular disease, osteoporosis, a decline in psychological well-being, and neurologic and mental disorders, such as cognitive impairment, dementia and Parkinsonism, which is similar to Parkinson’s disease. Of course, there are others who don’t experience these issues.

Estrogen treatment may prevent some of these, but for some breast cancer patients, estrogen feeds tumors. To block estrogen, I am taking a chemoprevention drug called Tamoxifen for the next five years. The drug protects me from osteoporosis, but increases the risk of cancer in the uterus.

Even more concerning is that I inherited a genetic mutation known as BRCA2. This increases my risk for breast and ovarian cancer. Hence, my doctors’ recommendation to undergo a hysterectomy and remove my ovaries. Compounding this are uterine fibroids and some “abnormal cells” found in the uterus.

Some women, who are not as high risk, may have the option of undergoing regular pelvic exams, combined with ultrasounds and blood tests to monitor any possible irregularities in their uterus and ovaries.

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What Are Fertility Drugs?

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There are a variety of drugs used for fertility treatment. Some are used to produce more ovarian egg follicles. Some are also used to suppress the pituitary gland and prevent ovulation. Others are used to support the uterine lining and early pregnancy.

Medications That Affect Follicles:

Eggs are housed in a protective sac called a follicle. To promote the growth of ovarian egg follicles, the pituitary gland naturally secretes the hormone Follicle Stimulating Hormone (FSH) into the blood stream. Typically only enough FSH is secreted each month to promote the growth of one egg follicle despite there being many follicles available in each ovary.  A tablet form of fertility medication called clomiphene citrate (Clomid) can be taken to increase the amount of FSH being secreted by the ovary. In this manner clomiphene citrate induces the growth of multiple egg follicles, typically 2-4 in number.

Alternatively, injections of FSH (called gonadotropins, Follistim, Gonal-F, Menopur, and Bravelle) can be used to induce the growth of even more follicles. These injections are given subcutaneously (under the skin) for 8-12 days. Once the follicles are ready, an injection of the hormone hCG (Ovidrel, Pregnyl) is used to ovulate the follicles. At this point eggs are either combined with artificial insemination or harvested and fertilized in the lab (in-vitro-fertilization) to create embryos which can then be transferred directly to the uterus.

Medications That Affect Ovulation:

During in-vitro fertilization treatment, drugs are used to turn off the natural pituitary hormones in order to synchronize egg follicles and prevent premature ovulation. The most common drug used for this purpose are oral contraceptive pills. During in-vitro treatment, injections of gonadotropin help eggs to develop better. However, during this stage eggs become vulnerable to premature ovulation. A second medication called leuprolide acetate (Lupron) can be used, in conjunction with oral contraceptive pills or alone, in order to prevent premature ovulation. Interestingly, leuprolide acetate actually belongs to a class of drugs called GnRH agonists- which, when injected, initially cause the pituitary gland to produce more FSH. However, with continued use, the drug eventually overwhelms the pituitary gland resulting in the opposite effect – pituitary suppression. For women who make a low number of eggs, leuprolide acetate in sometimes administered in micro-dose amounts to promote higher pituitary FSH production in order to yield more eggs. Instead of administering leuprolide acetate for a prolonged period of time to achieve pituitary suppression, a similar medication called a “GnRH antagonist” (Ganirelix, Cetrorelix), can be injected when egg follicles begin to grow. The use of this additional drug prevents the pituitary gland from causing premature ovulation. The “antagonist” provides instant pituitary suppression unlike that of leuprolide acetate which requires prolonged use to achieve suppression.

Medications That Support The Uterine Lining:

During a normal menstrual cycle, one egg follicle is recruited under the influence of pituitary FSH and subsequently ovulates as a result of the pituitary LH surge. The egg follicle makes a potent hormone called estradiol during the first two weeks of the egg’s development (pre-ovulation). After the egg is ovulated the remaining part of the egg follicle then begins to produce progesterone in addition to estradiol. These hormones together cause the uterine lining (the endometrium) to thicken and begin to secrete molecules which help the embryo develop into a pregnancy. In some forms of fertility treatment such as frozen embryo transfer, egg donation and surrogacy, tablets or patches of estradiol and suppositories or injections of progesterone are given to artificially prepare the endometrium to be able to support the early pregnancy.

By Dr. John Jain

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Fake Tans Can Cause Infertility Problems

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Does a woman risk fertility problems by using fake tan? ‘Cocktail’ of chemicals in products can affect development of babies

Women who use fake tan could put themselves at an increased risk of fertility problems and having babies with birth defects, according to experts.

Although seen as a safe alternative to sunbeds, the products can contain a ‘cocktail’ of chemicals which may pose a risk to health – and can even cause cancer.

Among the dangerous ingredients found in fake tan are hormone-disrupting compounds, which can affect the healthy development of babies.

The products often also contain carcinogens, including formaldehyde and nitrosamines, as well as skin irritants and chemicals linked to allergies, diabetes, obesity and fertility problems.

The potentially dangerous effects of fake tan are thought to be more worrying than for other cosmetics as it is applied over the whole body regularly.

Jacqueline McGlade, executive director of the European Environment Agency, said the chemicals it contains ‘may be a contributing factor behind the significant increases in cancers, diabetes, obesity and falling fertility’.

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Three Birthdays One Day of Conception

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For Joyce Mallon, the births of her three children are “a miracle.” Conceived on October, 26, 2007, in a lab by in vitro fertilization, the embryos were implanted into her uterus at two-year intervals, giving her and her husband three children conceived on the same day but born years apart.

“They are my Tripblings!! Triplets via conception, siblings by actual birth,” she wrote in an e-mail sent to CNN. “I believe our story to be an exciting and intriguing one, that NO ONE in the U.S. (to my knowledge), has any claim to.”

Fertility experts say while the Mallon births are exciting, they’re not a first. With better freezing techniques, many babies have been born by doing what the Mallons did: creating a group of embryos, using some to start one pregnancy, and then freezing the rest for future pregnancies. Three babies born this way aren’t triplets, but rather three genetically unique siblings conceived on the same day and born years apart.

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Schools failing to teach pupils about infertility

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Why doesn’t sex education cover infertility, when five children in every class are likely to experience it?

For a group of teenagers, Lauren, Fazana, Flora and Mackenzie are remarkably knowledgeable about fertility. Sitting in the library at St Marylebone school in central London, they’re explaining what they’ve learned. These year 10 girls know how common infertility is, how female fertility declines with age and they understand that IVF doesn’t always work. The discussion ranges from egg donation and surrogacy through to the dilemmas they know they may face later in life trying to balance careers with the desire for a family; “There’s never a time that’s exactly the right time to have a baby,” they explain.

It’s something every girl at St Marylebone will cover in their religious studies lessons, where the curriculum covers religious attitudes to family, relationships and family planning, as well as the ethics of fertility treatments. But in some other schools this highly topical issue barely gets a mention. IVF may be covered as a technological advance in science, but infertility isn’t part of the sex education curriculum, where the focus is on preventing pregnancy and sexually transmitted infections. This may seem sensible when dealing with young people, but the reality is that pupils are far more likely to have a fertility problem in the future than they are to get pregnant while they’re still at school. The teenage pregnancy rates for England and Wales are the lowest they’ve been since the 1960s, but infertility rates are rising; one in six of the population will experience problems getting pregnant – that’s about five pupils in each class of 30.

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Women Who Fail to Bear Children Twice as Likely to be Hospitalized for Alcoholism

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ISTANBUL – Women who want to become mothers but fail to bear children are at more than twice the risk of being hospitalised for alcoholism as those who succeed, it appears.

Researchers also found the risk of ending up in hospital for other serious psychiatric disorders including schizophrenia was markedly higher in women unable to become pregnant due to infertility.

The academics behind the study, presented at the annual conference of the European Society for Human Reproduction and Embryology (ESHRE) in Istanbul, said their results were “only the tip off the iceberg” because many more would be affected, but not so badly as to need in-patient treatment.

British fertility specialists argued the results were “shocking” evidence that infertility should be classed as a disease, reported the Daily Telegraph.

They said it added weight to the argument that IVF should receive greater public funding, because infertility was a disease in its own right.

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Continued Infertility Treatments Drive Pregnancy Successes

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Women in their 30s and 40s who undergo multiple infertility treatments may be nearly as likely to deliver a baby as women who conceive naturally, according to new research that provides men and women with a more realistic view of their chances of becoming parents.

Until now, the success of in vitro fertilization and other assisted reproductive technology (ART) was based on live births following a single course of treatment, called a cycle. However, researchers for the first time have calculated cumulative success rates for women undergoing several treatment cycles. Among nearly 250,000 U.S. women treated with ART in 2004-2009, 57 percent achieved a live birth, they reported. In addition, 30 percent of all ART cycles were successful, they found.

“This study shows that if you keep at it …your chances of becoming pregnant continue to rise with continuing treatment,” said lead researcher Barbara Luke, a professor of obstetrics, gynecology and reproductive biology at Michigan State University’s College of Human Medicine in Lansing. “The takeaway message from this is you may need to look at infertility treatment over a course of cycles.”

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Secondary Infertility: An Unexpected Diagnosis

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For a woman who has already conceived and given birth to a child, or even several children, the diagnosis of secondary infertility can be a bewildering and disorienting experience. According to the Centers for Disease Control, infertility affects approximately 5.3 million Americans; one out of ten married couples are facing some form of infertility issue, whether it’s the quest for their first child or adding additional children to their family.

For Leigh Kenyon (not her real name), disbelief colored her inability to conceive following the birth of her first child. “When my daughter was two, I miscarried my second pregnancy in the first trimester. When we tried again, I simply couldn’t get pregnant.”

As Leigh and many others have discovered, because it’s called “secondary,” (which means you’ve conceived in the past regardless if the outcome was a live birth, still birth, abortion or loss of pregnancy to miscarriage), your anxiety may not be taken seriously. The “proof” of her previous fertility kept Leigh from following up on her concerns as she struggled to make sense of the disparity between what her body was telling her and the reassurance offered by others. “I worried that something was wrong, but friends, family and even my OB kept telling me to relax, not to be in such a rush since I was obviously able to get pregnant. Even I assumed I must be able to conceive since I had done so twice before.”

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Infertility In Your 20s: Getting Diagnosed When You Should Be In Your ‘Fertility Peak’

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Olivia Tullo was 28 when she and her husband decided to start a family. They’d bought a house; they had a puppy. They were ready.

“We started trying, and several months went by. I just had a feeling,” Tullo said. “I just knew something wasn’t right.”

Her OB-GYN recommended a fertility specialist, who eventually recommended surgery for what was determined to be endometriosis. After that, there was more trying, more tests and the discovery that she had premature ovarian failure.

“My ovaries were shutting down,” Tullo said. “And I was only 29.”

Age is one of the main factors that can drive up a woman’s risk of infertility, which affects approximately 10 percent of women between the ages of 15 to 44. By 40, a woman’s chances of becoming pregnant drop from 90 to 67 percent; at 45, a woman has just a 15 percent shot.

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