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

The octuplets aside, there are fewer multiple births

The octuplet births last month in Bellflower brought much-needed attention to a little-known guideline that is supposed to apply to in vitro fertilization treatment. Studies now show that in healthy women, especially those under age 35, doctors should transfer only one or two embryos to the uterus. Research has shown that, in those women, the chances of giving birth to one child are substantial even if just one embryo is transferred. There are provisions allowing for transfer of a greater number of embryos, but that depends on the mother's age and other medical criteria.

Statistics released today show that efforts to reduce multiple births appear to be working -- at least outside of Los Angeles. According to the American Society for Reproductive Medicine, the percentage of live triplet births to mothers under 35 fell from 6.4% in 2003 to 1.8% in 2007.

Moreover, in 2003 in women under 35, only 0.7% of patients opted for a single embryo transfer and the average number of embryos transferred was 2.6. But in 2007, 4.5% had a single embryo transfer and the average number of embryos transferred was 2.2.

Multiple births from elective reproductive medical services should be avoided, experts say, because such babies are often premature or low birth weight and are at higher risk for other complications. Still, fewer than 5% of women under 35 elected for a single-embryo transfer in 2007, showing there is a long way to go to convince doctors and women that it's not always necessary to risk multiple births.

"Our latest numbers show our progress in decreasing the incidence of multiple pregnancies," said Dr. Elizabeth Ginsburg, Society for Assisted Reproductive Technology president, in a news release. "As our members continue their efforts in implementing ASRM-SART guidelines, we should see future improvements in patient care and outcomes."

Patients can go to the Society for Assisted Reproductive Technology website to search for SART member clinics and view each clinic's individual data.

-- Shari Roan

Photo: One of Nadya Suleman's octuplets. Credit: AP Photo / NBC News

Some egg donors have regrets

Egg donation is loosely regulated in the United States, making it difficult to know how many women donate eggs, why they do it and what their experiences are like. A study published in the current issue of the journal Fertility and Sterility shows that two-thirds of egg donors are satisfied with the process but the other third expressed some difficulties.

The study, from the University of Washington, examined 80 women from 20 states who had donated eggs from two to 15 years earlier. Participants, whose average age was 30, completed a detailed questionnaire. The researchers found that 16% of women complained of subsequent physical symptoms and 20% reported lasting psychological effects after donation. The physical complaints included bloating, pain, cramping, ovarian hyperstimulation, mood changes, weight gain or weight loss. Several women claimed the process damaged their ovaries, leading to a decrease or loss of fertility.

Psychological repercussions were feelings of attachment to the eggs or to the potential or resulting offspring, concern that a resulting child may want to have a relationship with them and stress resulting from the process. Some complained of being treated callously by clinic staff.

Egg donors are often college students, and they are paid an average of almost $4,000 for their services. The study showed that women who said they were motivated to donate for the money had less satisfying experiences compared with women who said they donated for altruistic reasons. About 19% said their motivations were purely financial and 32% said they just wanted to help others. The remainder of the women said both factors motivated them to donate.

"We were asking these women years later and a feeling of helping may last longer than money," said the study's lead author, psychologist Nancy Kenney, in a news release. "We know if clinics don't offer money, most women won't donate. Great Britain, where there is no paid egg donation program, for example, has a tremendous shortage of donors. But, as one of our donors said, 'If you do this just for money, you'll be sorry.' "

The study also found that a large number of women were not aware of the possible physical risks related to donation. Twenty percent said they did not recall being made aware of the physical risks at the time of their first donation. Young women, in particular, may not fully comprehend the risks, Kenney says. "Risks don't mean much to young women . . . If you are 25 and are told that something may cause cancer when you are 45 that may seem to be forever." More of the women reported being aware of the potential psychological risks.

The study seems particularly relevant during the current economic downturn, as more women might be considering egg donation as a way to make money. One Los Angeles infertility clinic employee I spoke with recently said the number of women enlisting as egg donors has quadrupled in recent months.

-- Shari Roan

Photo: Follicula fluid containing an egg. Credit: Francine Orr / Los Angeles Times

Choices are few for couples with leftover embryos

As many as 500,000 frozen embryos are in storage in the United States. While some will be used for in vitro fertilization, many others belong to couples who have completed their families or have abandoned infertility treatment. A study from the foremost researcher on frozen embryos published today reveals the anguish many of these couples have about disposition of their embryos.

Dr. Anne Drapkin Lyerly, an obstetrician/gynecologist and bioethicist at Duke University, has studied the problem of leftover frozen embryos for several years. The study published online today in the journal Fertility and Sterility is her largest survey of infertility patients -- more than 1,000. The survey found that these women feel responsible for the fate of their embryos but are dissatisfied with the choices they have. More than half are opposed to donating their embryos to other women for implantation. Twenty percent said they would likely leave their embryos frozen "forever."

"Parents care very much about what happens to their embryos," said Lyerly in a news release. "But that doesn't mean they want them to become children. Our study shows that many feel they have to do what they can to prevent their embryo from becoming a child."

The study comes at a time when several states have introduced measures that would designate frozen embryos as "persons" with legal rights or allow abandoned embryos to be adopted by another couple. The issues were described in a package of stories published earlier this year in the Los Angeles Times. Lyerly notes in her study that many families would like to have more options for disposition of their embryos. Two such options that are rarely discussed or offered involve implanting the leftover embryos in the woman's uterus during a time when she is unlikely to become pregnant or allowing a couple to have a ritual disposal ceremony of the embryos. "These may be the answers to many patients' desires as they allow the embryos to pass in a way that seems more respectful to them," she said.

Infertility clinics should develop detailed guidelines for informing couples of the likelihood of having leftover, frozen embryos, the options for disposition and how patients' feelings about disposition may change over time.

-- Shari Roan

Photo: A petri dish containing embryos. Credit: Mark Boster / Los Angeles Times

Who's your daddy? Offspring seek information on sperm donor

Adopted children often want to learn the identities of their biological parents. The same is true in the infertility world, where egg or sperm donors are frequently used to help a couple conceive. In a study presented today at the annual meeting of the American Society for Reproductive Medicine in San Francisco, researchers found that about 30% of eligible offspring chose to get information on their sperm donor.

The study examined the open-identity Sperm Bank of Davis. Researchers from UC Davis found that women were more likely to ask for information about the man whose sperm was used to father them. Family structure also seemed to influence the desire to know one's biological parentage. About 44% of offspring raised by single women requested information compared with 34% raised by lesbian couples and 20% raised by heterosexual couples.

In other studies about sperm donation presented at the meeting:

• Researchers from Houston found that among a group of adult offspring of sperm donors, most feel "neutral" to "good" about their means of conception but thought that identifying information about the donor should be made available to the adult offspring.
• A UC San Francisco study explored the psychological effect of using donor sperm or eggs on couples suffering from infertility. Both men and women said using donor gametes would raise their stress levels. They often cited fears that using donor sperm could decrease the strength of the bond between the father and child and might lead to marital problems.
• University of Wisconsin researchers looked at the websites of infertility clinics and found that fewer than 60% mentioned male infertility and only 7% listed a urologist as part of the treatment team even though male reproductive problems are a common cause of infertility.

-- Shari Roan

Photo: Vials containing sperm stored in freezing tanks. Credit: Robert Gauthier / Los Angeles Times 

Help for problems with infertility and embryo disposition

Almost 500,000 embryos are in frozen storage in the United States, according to the stories in today's Los Angeles Times. Some of the embryos are still destined for use to help individuals or couples with infertility problems in their desire to have children. But many others are simply in limbo while their creators grapple with their options for disposition. In today's Health section, I described some of the barriers to disposition of leftover embryos via adoption or research.

Several good resources are available for people who are struggling with these issues.

• Resolve: The National Infertility Assn., Southwest Region, will hold its annual Fall Family Building Symposium on Oct. 18, 8:30 a.m. until 4 p.m., at California State University, Long Beach, The Point at the Pyramid. The symposium will include a session entitled "Embryo Donation Workshops for Donors and Recipients," from 10:30 a.m. to 5:30 p.m.
• A three-part series on choices regarding the disposition of leftover, frozen embryos can be accessed from the archives of the online radio program, "Creating A Family," hosted by infertility expert and author Dawn Davenport. The shows aired on May 21, May 28 and June 4.
• The national headquarters of Resolve will sponsor several events during National Infertility Awareness Week, Oct. 19-25, including a series of Web chats entitled "Take Charge!"

- Shari Roan

Photo: A magnification view of human embryos. Credit: Courtesy of Dr. David Diaz

Biologists describe how embryo attaches to womb

Advances in treating infertility over the last three decades have also yielded a wealth of fascinating scientific information about the basics of human biology. Today, another mystery was explained by Oxford University scientists who showed just how a fertilized egg attaches to the womb and implants itself, thus beginning the pregnancy.

When an embryo comes in contact with the lining of the womb, chemical signals are exchanged that allows the cells of the embryo to invade the womb and, eventually, connect with the mother's blood supply to form the placenta. In lab experiments, the Oxford scientists discovered that two specific proteins are involved in this process.

"We have shown that two proteins, called Rac1 and RhoA, control the invasion," said Helen J. Mardon of Oxford University. "The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo."

If the balance between these two proteins is altered, the cells of the womb lining won't move aside to allow for implantation, the researchers said. The failure of implantation is a major cause of infertility. Understanding the process could lead to the development of medications that help embryos implant properly. The study is published today in Proceedings of the National Academy of Sciences.

-- Shari Roan

Photo: An eight-cell embryo. Credit: AP Photo