Drink during pregnancy and your sons may suffer, researchers say

Women who drink during pregnancy may be reducing their chances of someday becoming grandparents.

Danish researchers examined the sperm counts of 347 young men whose mothers participated in the “Healthy Habits for Two” study while they were pregnant in the mid-1980s. At the time, the women completed a questionnaire about their lifestyle habits, including their consumption of beer, wine and spirits.

Linking the data on alcohol exposure in utero with sperm counts as adults, the researchers found that sons of mothers who consumed at least 4.5 alcoholic drinks per week during pregnancy had sperm concentration of 25 million per milliliter. That was 32% lower than the 40 million/mL measured among sons whose mothers had fewer than one drink per week while they were pregnant. (One “drink” was defined as 12 grams of alcohol – roughly equivalent to a 12-ounce beer or a small glass of wine.)

The World Health Organization said last year that it considers sperm concentration of about 15 million/ML to be normal, so everyone who participated in the Danish study would seem to be fine. But Cecilia Ramlau-Hansen, one of the researchers, pointed out that the lower one’s sperm count, the lower the odds of conception.

Ramlau-Hansen, a senior researcher at the Aarhus University Hospital’s department of occupational medicine, discussed her study Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology, which is underway in Rome. She said the link is merely an association, not proof that alcohol is to blame for the reduced sperm counts observed in the study, but the finding warrants further study.

-- Karen Kaplan

Photo: This is a dangerous habit for pregnant women who want to have grandchildren someday. Credit: Christina House / For The Times

If you could put your biological clock on hold, would you?

Now that scientists have found a way to reliably freeze – and later thaw – human eggs, a growing number of women see the procedure as a way to buy them more time before starting a family. The procedure isn’t without risks – women who go through with the egg-harvesting process could find themselves suffering from ovarian hyperstimulation, bleeding, infection or worse. Nor is it cheap – prices can top $12,000 per cycle.

What would make women want to freeze their eggs anyway? Researchers offered some answers Monday at the annual meeting of the European Society of Human Reproduction and Embryology, currently underway in Rome.

Julie Nekkebroeck, a senior psychologist at the Center for Reproductive Medicine at University Hospital Brussels in Belgium, interviewed 15 women who had begun the process of freezing their own eggs. Their average age was 38, and they were “highly educated” and “financially secure,” according to the conference's description of her research.

Eight of the women said they wanted more time to find Mr. Right; four others said that once they found Mr. Right, they didn’t want to have to put him on the spot right away by asking about his plans for future fatherhood. In addition, five women saw egg-freezing as an insurance policy against infertility later in life. On average, these women estimated that they would try to get pregnant at age 43.

Meanwhile, Srilatha Gorthi of the Leeds Centre for Reproductive Medicine in England put the question to younger women (average age 21) for whom the idea of egg freezing was more theoretical.

Among 98 hard-charging medical students, 80% said the idea appealed to them. They saw the technology as a way to focus on their careers during their prime child-bearing years. Among 97 students majoring in education and sports studies, only 40% were open to the idea of freezing their eggs. For these women, the primary motivation for delaying pregnancy was to achieve financial independence.

You can read the BBC's coverage of their presentations here.

-- Karen Kaplan

Photo: These eggs at the USC fertility lab were frozen with liquid nitrogen. Credit: Bryan Chan / Los Angeles Times

A blood test may be an accurate way to predict menopause

Predicting when women will reach menopause has never been an accurate science, but a new study suggests it could become considerably more precise. Researchers have found that concentrations of a specific hormone can be assessed in a blood test, providing a fairly precise forecast.

The hormone in question is the anti-Mullerian hormone, which is produced by cells in ovarian follicles and controls the development of those follicles. Blood samples were taken three times from 266 women ages 20 to 49, and concentrations of the hormone were tested.

Researchers derived a statistical model to predict approximate menopause age from a single measurement of AMH concentration in blood serum. Since 63 of the participants reached menopause during the study, they had something to which they could compare those predictions.

"The average difference between the predicted age at menopause using our model and the women's actual age was only a third of a year and the maximum margin of error for our model was only three to four years," said Dr. Fahimeh Ramezani Tehrani, co-author of the study, in a news release.

Tehrani, president of the reproductive endocrinology department of the Endocrine Research Centre and an associate professor at Shahid Beheshti University of Medical Sciences in Tehran, added, "The results from our study could enable us to make a more realistic assessment of women's reproductive status many years before they reach menopause... We believe that our estimates of ages at menopause based on AMH levels are of sufficient validity to guide medical practitioners in their day-to-day practice, so that they can help women with their family planning."

Tehrani presents the findings of the study Monday at the annual meeting of the European Society of Human Reproduction and Embryology in Rome.

-- Jeannine Stein

Photo credit: Los Angeles Times

Limit the number of embryos transferred in IVF, essay says

The United States should adopt a law similar to what is practiced in Sweden allowing, in most cases, only single-embryo transfers during in vitro fertilization treatment, according to an essay published Thursday in the Hastings Center Report.

Infertility doctors have been urged for several years to voluntarily limit the number of embryos transferred during IVF in order to avoid multiple births, such as the famous eight babies born last year to Los Angeles resident Nadya Suleman after IVF treatment.

Studies show that success rates are still good in healthy women when only one embryo is transferred instead of two or three. But the informal policy, while reducing the rate of high-order multiples, hasn't had as much success in lowering the rate of twin births. Any birth of multiples increases the risks of complications to both the babies and mothers and significantly increases healthcare costs. Many couples would rather have twins or triplets than pay out-of-pocket for multiple single-embryo transfers to build their families, notes the author of the opinion, David Orentlicher, of the Indiana University School of Law.

That's why he suggests that the United States enact legal limits to transfer only one embryo. Double-embryo transfer could be permitted for women at low risk of multiple births or because of a woman's age or medical history. Such a law reduced multiple births in Sweden from 35% to 5%, he said in his report.

"If the outcomes were similar to those in Sweden, and if transfer restrictions were coupled with insurance coverage of IVF, the restrictions would not limit reproductive rights," Orentlicher wrote.

— Shari Roan

Photo: One of the Suleman octuplets born in January 2009. Credit: Associated Press. 
 

Book Review: 'The Strong Women's Guide to Total Health' by Miriam E. Nelson and Jennifer Ackerman

Although men may have more heart attacks, more women die as a result of them. Women have stronger immune responses  --  with increased resistance to many infections -- but are much more likely than men to develop autoimmune diseases. Men are more likely to have schizophrenia and alcohol and drug addiction, whereas women have more depression, anxiety and eating disorders. 

Those are just some of the ways women's health differs from men's, according to Miriam E. Nelson and Jennifer Ackerman, authors of "The Strong Women's Guide to Total Health."

"Our gender affects everything from the makeup of our bones and the architecture of our joints, to our skin's response to sunlight and aging, to how we experience pain, react to drugs, and cope with stress," they write.

Until fairly recently, medical researchers considered men's bodies the prototype for both genders. But today women are more than half of participants in health studies, and researchers are looking closely at illnesses affecting mostly them, Nelson and Ackerman write. 

In fact, there is so much health information available to women -- much of it contradictory -- that it can get confusing.

That's where "Strong Women's Guide" comes in. The book aims to summarize the latest thinking on women's health and offer "basic, reliable guidelines for staying well in body, mind and spirit."

And it appears to do so remarkably well considering the range of topics it covers, including reproductive and sexual health; skin, teeth, hair and nails; body weight and metabolism; muscles, bones and joints; the heart and lungs; cancer and disease; vision and hearing; and mental health.

Nelson -- the director of the John Hancock Research Center on Physical Activity, Nutrition and Obesity Prevention and an associate professor of nutrition at Tufts University -- has gained a following with earlier "Strong Women" books on topics such as weight control and bone health. Ackerman is a science and health writer and the author of several other books, including "Sex Sleep Eat Drink Dream."

Their new book is not the place you would go for in-depth coverage of a specific health topic, but it offers solid overviews, useful advice and quite a bit of up-to-date detail. 

The section on birth control, for example, looks at the varied oral contraceptives available today, including a spearmint-flavored chewable pill, the three-month combination pill, the mini-pill, the "no more period" pill and other hormonal options such as a skin patch and injections. The chapter on menopause sorts through recent research findings on hormone therapy and summarizes the options for easing symptoms. A discussion of heart disease details the symptoms unique to women and tells what to look for in cholesterol, triglyceride and blood pressure screenings.

The writing is intelligent, accessible and sometimes personal; amid the matter-of-fact health discussions are anecdotes such as one in the sexuality chapter that describes a nervous first-time trip to a sex-toy boutique. A chapter on changing habits includes a story about how a colleague once chastised Nelson for not practicing what she preached about exercise -- a comment that prompted her to start running regularly to train for the Boston Marathon.

"Strong Women's Guide" is as much a how-to health book as it is a medical reference work. It starts with a health self-assessment section that looks at everything from body mass index to joy quotient. Sprinkled throughout the book are checklists of ways to protect or improve health. The book ends with chapters on managing stress and sleeping well, eating and exercising right and getting the proper screenings, tests and vaccines at every age.

-- Anne Colby

Photo: "The Strong Women's Guide to Total Health," Miriam E. Nelson and Jennifer Ackerman, Rodale Books, $27.99 

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Triplet births have increased, risks are high, Norwegian researchers say

The rate of natural triplet births--those not resulting from assisted reproductive technology (ART)--is 2.5 times as high as it was in the 1970s, probably because of the increased use of ovulation-inducing drugs and the older age of mothers, Norwegian researchers reported Wednesday. And despite improvements in prenatal care, the death rate for triplets is about 10 times as high as for a singleton, Dr. Anne Tandberg of the Haukeland University Hospital in Bergen and her colleagues reported in BJOG: An International Journal of Obstetrics and Gynaecology.

The researchers studied the records of more than 2 million pregnancies in the Medical Birth Registry of Norway between 1967 and 2006, examining all live births and stillbirths after the 16th week of gestation. The highest rate of triplet births was 3.5 per 10,000 pregnancies in the five-year period between 1987 and 1991, probably because of the increased used of ART and in vitro fertilization. Following the introduction of new guidelines that called for the implantation of only one embryo during IVF, the number fell to 2.7 per 10,000 and has remained constant at that level.

The mother's age at birth increased by 2.5 years during the period, while the Cesarian-section rate for triplet pregnancies increased from 46.7% to 92%. The gestational age of triplets at birth fell from 34.1 weeks to 32.1 weeks, accompanied by a fall in the infants' birth weights

The study found that it is very important to prolong the triplet pregnancy beyond the 28th week of gestation, Tandberg said. Before that milestone, the mortality rate is 50%, but beyond it the rate falls to 3.8%.

-- Thomas H. Maugh II

Photo: Allison Penn looks at her identical triplets, from left, Logan, Eli and Collin, at North Shore University Hospital in Manhasset, N.Y.  Photo credit: Associated Press / Ed Betz

U.S. birth rates back on the rise

Birth rates are climbing after years of significant declines, according to an annual report released Monday in the journal Pediatrics.

Researchers from the Centers for Disease Control and Prevention found that the number of U.S. births for 2007 had jumped 1% to 4,317,119, "the highest number ever registered for the United States," they said. Almost 1.9 million people joined the population due to "natural increase," which is basically the net birth rate. 

As the birth rate rose, the age-adjusted death rate also dropped 2.1%, another record low for the U.S. Life expectancy at birth reached a record high of 77.9 years.

One shocker: The United States' infant death rate is 6.83 per 1,000 births. Compare that with Malaysia (6.2) or Korea (3.8). And in the U.S. capital, the District of Columbia? It's nearly double the national rate, at 12.22.

Younger mothers, particular adolescents, pushed the birth rate higher. From 1991 through 2005, teen birth rates dropped 34%. Since 2005, though, they've popped back up 5%. "The recent increase was preceded by the slowing decline but, nonetheless, caught the public and the public health community somewhat by surprise," the study said.

In terms of teen-pregnancy prevention, the study's authors conclude, "it could be that new messages and strategies are needed to reach the teenagers of today."

-- Amina Khan

Photo credit: iStockphoto.com

Two embryos aren't twice as nice for IVF patients

When couples with fertility problems turn to IVF, they often assume that they can double their chances for a healthy baby by transferring two embryos to the womb instead of just one.

But new data published in Thursday’s edition of the New England Journal of Medicine shows that what they’re really doing is increasing their odds of having twins – an outcome that is riskier for the mother and babies alike.

In the early days of in vitro fertilization, doctors routinely transferred half a dozen – or more – embryos into a patient’s uterus to boost the odds that at least one would implant and grow into a healthy baby. As the treatment improved, doctors were able to get better results using fewer embryos.

Debate lingers about the pros and cons of transferring two embryos instead of just one. As my colleague Shari Roan reported in the Health section in 2007, pregnancies involving multiples come with a greater risk of gestational diabetes, bleeding and preeclampsia for the mother and cerebral palsy, birth defects, developmental delays and death for the babies. Twins usually survive, but incur much higher medical expenses over the first five years of life.

A team of Swedish researchers is trying to assess the optimum number of embryos to transfer during a cycle of in vitro fertilization. In their study of 661 IVF patients, 331 women got two embryos on their first try, and 142 of them (or 43%) had a live birth. The other 330 women got a single embryo, and if that didn’t work, they made a second attempt with another embryo that had been frozen and thawed. Of these women, 128 (or 39%) had a live birth.

The difference between 43% and 39% wasn’t statistically significant. But one-third of the patients in the double-embryo group had twins or triplets, compared with only 1% of patients in the single-embryo group. Those results were published in the New England Journal of Medicine in 2004.

The research team, from Gothenburg, Sweden, continued to follow those 661 patients through as many as four additional IVF cycles (with no restrictions on how many thawed embryos were transferred at a time). In the latest issue of the journal, they offered the final tally.

Their key statistic is the cumulative live birth rate, which measures the number of patients who wound up with at least one live birth divided by the total number of patients. In the group that started out with a double-embryo transfer, the cumulative live birth rate was 51%. In the group that started out with a single transfer, the rate was 44%. As before, the difference wasn’t statistically significant.

Also as before, the difference in multiples was huge. There were four sets of twins in the single-embryo group (for an overall rate of 2.3%) versus 51 sets of twins and one set of triplets in the double-embryo group (for an overall rate of 27.5%).

The researchers conclude that for IVF patients, there’s little downside and plenty of upside to transferring one embryo at a time instead of two.

-- Karen Kaplan

Photo: Doctors performing in vitro fertilization should transfer only one embryo at a time, according to a new analysis. Photo credit: Liz O. Baylen/Los Angeles Times

Did the vasectomy work?

Women have had access to home ovulation test kits for years, but more options are becoming available to men to measure their lack, or abundance, of sperm.

In March, the U.S. Food and Drug Administration approved the first at-home test kit for men to use aftera vasectomy to make sure they have achieved sterility. Called SpermCheck Vasectomy, the test measures a protein called SP-10 that is present in each sperm head. The test may be useful because sperm can remain in the male reproductive tract for weeks or months after a vasectomy. Men are advised to follow up with their doctors to determine if the operation was successful. But a study in the British Journal of Urology showed high numbers of patients fail to follow up with their doctors. The kit will be available in drug stores by the end of the year and is available now from doctors or from the manufacturer, ContraVac.

The company also expects to release a home test kit to assess sperm counts for men who are hoping to father a child. A couple of home sperm test kits are already on the market. ContraVac is also developing a test kit that will be used to help evaluate the effectiveness of male contraceptives.

The evolution in assessing male fertility has been aided by 25 years of research by John Herr, a professor of cell biology at the University of Virginia. Herr and his colleagues identified the SP-10 protein.

-- Shari Roan

Photo: John Herr, director of the University of Virginia's Center for Research in Contraceptive and Reproductive Health. Credit: University of Virginia