Endometriosis and loss of work productivity are, hold on, connected

In endometriosis, tissue that's supposed to grow inside the uterus instead begins to grow outside the uterus -- on the fallopian tubes, ovaries or elsewhere in the body, usually in the pelvic region but not always. And that tissue reacts as it ordinarily would to the body's hormonal changes -- thickening, then breaking down and bleeding, often worsening and causing scarring over time. You don't have to be familiar with the condition to see how this might cause pain.

Now researchers have found that, yes, such pain can lead to a loss of productivity at work.
 
"Duh," you might well, and justifiably, think if you're one of the estimated 5 million women in the U.S. who have the condition. (That number and other endometriosis facts can be found at womenshealth.gov.) But bear with us -- because the researchers also quantified that dent in productivity.

In what's touted as the first worldwide study of the condition's impact on society, researchers at the University of Oxford in the United Kingdom found that, among employed women, those with pelvic pain related to endometriosis reported 10 hours of lost work productivity per week, compared to seven hours for those with pelvic pain not traceable to endometriosis.

The endometriosis-and-productivity findings were announced Monday at the annual meeting of the European Society of Human Reproduction and Embryology. Here are other details on the endometriosis study, funded by the World Endometriosis Foundation.

Considering that the condition is still something of a mystery, that it's a leading cause of infertility and that women in the study, after reporting their first symptoms, went an average of seven years before being diagnosed ... well, beginning to quantify the effects -- obvious though they may seem at first glance -- can only be for the good.

Here's more basic endometriosis information, in the form of a pamphlet, from the American Congress of Obstetricians and Gynecologists.

And in other recent news from the meeting:

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

-- A blood test may be an accurate way to predict menopause

Plus, more fertility research reported there.

-- Tami Dennis

Photo: Aleve and other over-the-counter pain medications are on often recommended to relieve the pain of endometriosis.  For many women, they don't help.

Credit: Getty Images

Infertility group says better insurance coverage, not government oversight, is needed

The birth last year in Los Angeles of eight babies to Nadya Suleman after IVF treatment -- as well as cases in which embryos have been stolen or transferred into the wrong patients -- has spurred discussion about whether the field of assisted reproductive technologies should be subjected to government oversight.

The major professional group of infertility specialists hinted in statements last year that perhaps the field -- which is largely self-governed and relies on voluntary participation of doctors -- could use a greater degree of regulation. As we reported last September in Booster Shots, Robert W. Rebar, executive director of the American Society for Reproductive Medicine said:

"The time has come for policy makers to sit down with the leading experts in the field to explore ways we can codify our standards to give them additional regulatory teeth. . .We will lead an effort involving our members, representatives of patient groups, policy makers and other stakeholders to work together to come up with solutions."

The ASRM then held a workshop in December in Washington, D.C., to seek input on oversight from government agencies, patients, physicians, academic experts and others.

The group issued its decision on further oversight in a paper released Wednesday that -- stunningly -- finds that no further oversight is needed to prevent "Octomom" cases and other ethically and medically questionable incidents. The report concludes that better insurance coverage of assisted reproductive technologies would greatly reduce inappropriate uses of the technology.

If everyone had infertility treatment insurance coverage, ASRM leaders argue in the report, patients would be less tempted to transfer a high number of embryos or use dangerous fertility drugs. Insurance providers, moreover, could then enact rules that limit the number of embryos transferred and select which reputable doctors and centers would be allowed to perform specific treatments. "Unlike most medical procedures to treat most diseases, insurance coverage for ART treatments remains rare in the United States," the report states.

ART practitioners must abide by federal, state and Food and Drug Administration rules, as well as professional self-regulation and physician board certification, thus making the field already "one of the most highly regulated of all medical practices in the United States." Thus, ASRM leaders conclude, no further government oversight is necessary at this time. "A simple legal restriction on the number of embryos transferred would not be desirable," they wrote.

The report notes that the doctor involved in the "Octomom" cases is being appropriately punished under existing state medical regulations and that this one notorious case has led to unnecessary calls for additional legal enforcement and punishments of doctors who breach voluntary guidelines. But, the report says, "Standards set by members of the profession for the practice of reproductive medicine are widely followed and successful."

Given the comments that L.A. Times readers submitted to our website after Octomom gave birth, however, it seems that many people do believe further regulation of the industry is needed -- even if it's to control the occasional rogue doctor. The ASRM's "We're just fine, thanks" position is sure to be challenged. According to a position paper by ethics think tank the Hastings Center, the ASRM clearly lacks the ability to enforce its voluntary guidelines.

"Without governmental oversight, clinicians may practice medicine in accordance with their own beliefs. Variability in the beliefs of different practitioners permits most patients turned down by one clinic to find another where practitioners will feel comfortable treating them," the Hastings Center's position paper states. "The lack of regulation and practitioner variability means that individual decisions about eligibility for ARTs may be arbitrary, biased and inconsistent, shielding practitioner prejudices, subjecting prospective parents to great uncertainty and avoiding public discussion of difficult policy issues in reproductive policy."

-- Shari Roan

Photo: One of the Suleman babies. Credit: AP Photo  /  NBC NEWS

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. 
 

Ads soliciting egg donors violate guidelines

The use of donor eggs for infertility treatment has soared in the United States, mostly among women older than 40 whose eggs are no longer viable for in vitro fertilization and among gay men wishing to have a child. But the ethics of how to compensate egg donors -- who are often college-age women -- have been a long-standing issue in the field of reproductive medicine. Donating one's eggs is not without some physical and psychological risk. Some ethicists have questioned whether young women are coerced into donation by the lure of big money.

A study published in the new issue of the Hastings Center Report suggests this issue is far from resolved and that voluntary guidelines set by the American Society for Reproductive Medicine are sometimes ignored. Researcher Aaron D. Levine evaluated 105 advertisements from 63 different student newspapers (that's where ads for egg donors are usually placed). About half the ads met the ASRM guidelines of compensating egg donors $5,000 or less -- the amount considered fair for the donor and yet not high enough to be exploitative or to commodify human eggs.

Another 27% provided compensation between $5,000 and $10,000, which is also within ASRM guidelines, although the guidelines call for justifying an amount that exceeds $5,000. Finally, 23% offered compensation exceeding $10,000, which violates guidelines. Levine found that the ads in violation of ethics rules were placed by donor agencies, rather than infertility clinics or individuals, and usually appeared in the papers of prestigious universities, such as Harvard and Brown. Some of these ads request applicants with specific attributes, such as a particular ethnicity, high SAT scores or brown hair.

Given that almost one-quarter of the ads studied are in violation, Levine suggests voluntary guidelines used for egg donor solicitation in this country don't work. Violating these ethical guidelines, Levine writes, "has few serious consequences."

In an editorial accompany the study, however, an ASRM member says the system works well. John A. Robertson, a law professor at the University of Texas who chaired the ASRM ethics committee, says that the amount of compensation is arbitrary; no one really knows what is appropriate compensation. Moreover, he says, there is little the reproductive medicine profession can do about this issue. Trying to enforce the ethical guidelines might force behind-the-scenes deals, he notes. Finally, of the ads that request specific donor characteristics, he writes, "We allow individuals to choose their mates and sperm donors on the basis of such characteristics. Why not choose egg donors similarly?"

One point overlooked in the debate is the soaring cost of higher education. College women comprise the largest market for donor eggs, and students struggling to pay college bills may be more tempted than ever to part with their genetic material. I can imagine some women, down the road, may regret that exchange.

-- Shari Roan

Photo: Human eggs in a laboratory dish. Credit: Rick Meyer  /  Los Angeles Times

Does adult health differ when you're conceived in a dish?

Considering that children have been born using in vitro fertilization for about three decades, it's reassuring to learn that they are healthy and well-adjusted people.

That is the conclusion of a study published Wednesday in the journal Fertility and Sterility. Researchers at the Jones Institute of Reproductive Medicine at Eastern Virginia Medical School questioned a group of young adults conceived by IVF at that clinic between 1981 and 1990. The first IVF birth in the United States was achieved there in 1981.

The IVF-born young adults in the study (173 of them) were found to be healthy and well-adjusted with no increased susceptibility to chronic diseases. Other studies, however, have raised questions about whether IVF conception raises the risk of certain birth defects or diseases.

However, the IVF babies -- especially the females -- in the study did have higher rates of clinical depression, attention deficit/hyperactivity disorder and binge drinking behavior when compared with other young adults. Almost 16% of the women reported some history of depression compared with 12.7% in the general population of women in this age group. Also, the rate of ADHD in the population is 3% to 5%, but IVF babies in the study had a rate of 27.1%.

It's unclear what, if anything, about IVF conception may lead to higher rates of depression, drinking and ADHD. According to the researchers, possible explanations are stress among parents who undergo IVF and family secrecy about the IVF process.

-- Shari Roan

Photo credit: Ken Hively  /  Los Angeles Times

Yoga and infertility, take two

Last week we told you about a pitch we got for actress Brenda Strong's Yoga4Fertility program. The pitch began like this: "Brenda Strong, Mary Alice Young from Desperate Housewives, has created a new yoga method--and it is getting women pregnant." Strong, a longtime yoga practitioner and instructor, developed the program to help women dealing with infertility, and has other programs for pregnancy and menopause.

We're used to seeing hyperbole in press releases, and we're also no stranger to celebrities touting health-related products and services or getting behind public policy issues. We felt compelled to comment on this one, cautioning readers to take any claims with a grain of salt, despite the fact that yoga can be effective in coping with various health-related issues, including cancer and multiple sclerosis. Some people are influenced by their favorite actor/actress/singer/athlete's involvement in various programs and causes, and they can be blind to the occasional outrageous statement or forceful proposal.

Today we spoke with Strong, who said that she was unhappy with the way the pitch went out, and wanted to clarify a few things. First, she said, she believes that before entering any health program people should research it to make sure it's viable and right for them. Infertile women should also seek help from their health professional in addition to trying other solutions. "In no way, shape or form," she said, "am I saying that yoga is the only way to get pregnant."

However, she does believe that yoga (specifically her program) does have physical benefits, especially for the endocrine system, and can help women survive infertility, an issue known to elicit enormous amounts of stress. "If anything," she says, "yoga gives women tools to deal with the stress of infertility and helps empower them, so they can say, 'I can go through this.' For a lot of women who feel out of touch with their body, this can give them a positive feeling again, like their body can be trusted."

And yes, women who have taken part in her program have gotten pregnant. But she can't say for sure if it was yoga, acupuncture, medical treatments, or various combinations of those that did the trick.

"My intention," she added, "has always been to help women help themselves."

-- Jeannine Stein

Photo: Actress and yoga instructor Brenda Strong. Photo credit: Robyn Beck / AFP/Getty Images

Term 'embryo adoption' is misleading, medical group says

In recent years, some private adoption agencies have promoted "embryo adoption" services in which people can take possession of donated embryos and use them in concert with fertility treatments to become pregnant. But a major medical group today blasted the term "embryo adoption," calling it inaccurate and misleading.

The position paper from the ethics committee of the American Society for Reproductive Medicine says that the traditional model of adoption involves a legal process to establish parentage of infants or older children and should not be confused with the transactions involving donated embryos. The group said the preferred term is "embryo donation," because it is a medical intervention that only become possible through medical technology.

Some adoption agencies that deal with embryos require prospective parents to divulge information on their religious beliefs or sexual orientation. Use of the adoption model places an "inappropriate burden" on patients seeking an embryo donation, the statement said.

"Embryo donation is an important therapeutic option for infertile patients," said Dr. Robert Brzyski, chairman of the ASRM Ethics Committee. "Home visits, judicial review and other adoption procedures are not necessary and not appropriate for a patient whose case entails what is most accurately characterized medically as a tissue donation."

Embryo donation, however, is regulated similarly to any medical procedure that uses donated tissues or organs.

The statement is published in the December issue of the journal Fertility & Sterility.

-- Shari Roan

Photo: A petri dish containing embryos suspended in a growth media. Credit: Mark Boster / Los Angeles Times

Fertility procedures do not delay cancer treatment, study finds

Women under 40 who are diagnosed with breast cancer often face the additional burden of losing their fertility due to the cancer treatment. If treatment is likely to cause future infertility, women may wish to undergo a procedure to harvest eggs to preserve future childbearing options.

A study published this week reassures women and their doctors that fertility procedures can be done in an orderly way that should not delay breast cancer treatment. The findings show the key to timely fertility procedures depends on all the parties involved -- the patient, cancer surgeon, medical oncologist and reproductive specialists -- working together and communicating effectively.

"The burden of facing premature menopause adds to the stress experienced by young cancer survivors," the lead author of the study, Dr. Lynn Westphal of Stanford University, said in a news release. "Our study shows that these procedures, when expedited and appropriately timed, do not delay cancer treatment."

The researchers identified 82 women younger than 40 who were diagnosed with breast cancer. Nineteen of the women underwent egg retrieval, while 63 did not. For the women who underwent egg retrieval, an average of 71 days elapsed between initial diagnosis to chemotherapy compared with 67 days in the women who did not have egg retrieval. The time elapsed between surgery and chemotherapy was also similar in the two groups.

The average age of the women who had underwent egg retrieval was 37, and most of them had not previously given birth. The study is published in the November issue of the Journal of the American College of Surgeons.

-- Shari Roan

Photo: Dr. David Diaz, medical director of the West Coast Fertility Centers in Fountain Valley lifts a canister containing frozen human eggs stored in liquid nitrogen. Credit: Mark Boster / Los Angeles Times.

Couples prefer preimplantation genetic diagnosis to later testing

People who know they are at high risk for passing on a serious genetic illness to their offspring prefer learning of their risk through preimplantation genetic testing rather than waiting to be tested after a woman becomes pregnant, according to a study published this week in the journal Fertility and Sterility.

Preimplantation genetic diagnosis is a technique that follows in vitro fertilization in which a single cell is removed from an embryo growing in the lab and is tested for evidence of gene mutations that cause serious illnesses or birth defects. If the test turns up no evidence of a defect, the embryo can be implanted in a woman's uterus with the intention that she will become pregnant.

A couple can also undergo genetic testing after the pregnancy is established. If the child is afflicted with a genetic disease, the couple has the option of carrying the pregnancy to term and preparing for the special needs of their baby or to terminate the pregnancy.

The study, of 210 Dutch couples carrying genetic disorders, found 60% wanted some kind of diagnostic testing. Of those, 74% preferred PGD. The major reason couples choose PGD was because they objected to terminating a pregnancy. The major reason some couples choose prenatal testing (such as chorionic villus sampling or amniocentesis) was because they did not want to go through in vitro fertilization.

In vitro fertilization and preimplantation genetic diagnosis are expensive procedures, said Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology, in a news release.

Many U.S. patients, she said, "would prefer PGD to [prenatal diagnosis] but lack insurance coverage for assisted reproductive technologies."

-- Shari Roan
 
Photo: Preimplantation genetic diagnosis. Credit: Dr. Bradford Kolb  /  Huntington Reproductive Center

Infertility treatments wane during recession

The turn of the century saw a huge burst of babies, worldwide, conceived with assisted reproductive technologies, such as in vitro fertilization, according to a new study. But, in the United States, infertility treatments are down due to the recession, according to some reports.

A study published today in the journal Human Reproduction found that assisted reproductive technologies, or ART, increased 25% worldwide between 2000 and 2002. An estimated 219,000 to 246,000 babies are born each year worldwide from ART procedures. The study also found a large increase in the use of intracytoplasmic sperm injection, a procedure where a sperm is injected into an egg in the lab to create an embryo, in all countries, ranging from 61% of IVF procedures in the United States to 92% in the Middle East.

The authors of the report, from the International Committee for Monitoring Assisted Reproductive Technology, noted that access to IVF varies widely among nations and that low-cost procedures should be more available to couples in poor countries.

Cost issues, however, are not limited to poor nations. A recent story in the New York Post found that a number of infertility clinics in the United States are experiencing a decline in patients and some may be struggling to stay afloat. ART procedures were expected to decline this decade as the last of the baby boomers exit their reproductive years, according to a blog post from the Center for Human Reproduction, a New York City clinic. The loss of jobs, and health insurance, has further reduced patients seeking IVF. And, the blog notes, in a recession, fewer families consider having a baby.

-- Shari Roan

Photo credit: Ken Hively  /  Los Angeles Times