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FSH, three letters that can wreak havoc on those trying to have a child. Once referred to as the “cruelest number,” it has long been used as a predictor of someone’s chance to conceive – a/k/a a measurement of ovarian reserve. In this way, measuring FSH has been one of the earliest tools for helping to understand fertility decline with age.
The Right Stuff
In vitro fertilization has allowed many couples to have children. And while this has bestowed blessings on many, the technology is complex and constantly evolving. From the beginning of the use of IVF there has been a concern about the possibility that IVF could cause harm to the children created through this technology. For that reason, many studies have been done in an attempt to determine if IVF harms children.
The news has been good as all studies, and there have been many, have been reassuring that IVF does not harm the children conceived through the use of IVF. But, in science, in medicine and in life, there is seldom an iron clad guarantee. Therefore, the best we can do is to continue to monitor the outcome for IVF and try to determine if there is an emerging cause of concern for the IVF children.
A report published recently in Lancet Oncology is a welcome new information for women who are being denied hormone replacement therapy based on poorly designed and/or misinterpreted prior studies. These studies seemed to suggest a link between estrogen replacement and breast cancer, a link that was questionable but nevertheless became greatly sensationalized by the media. The article in Lancet clearly demonstrates no such link. Other recent data suggests that it is not estrogen, but a synthetic progestogen given together with the estrogen that may slightly increase the risk of breast cancer in postmenopausal women.
The Institute for the Study and Treatment of Endometriosis (Endometriosis Institute) has been in the forefront of endometriosis research, education, and patient care for almost thirty years. We have contributed to the knowledge on endometriosis through basic and clinical research and more than 300 publications on the subject. Over the years, we have participated in the development of new endometriosis treatment methods, such as Danazol, GNRH agonists, and GNRH antagonists, and continue to conduct clinical research trials supported by the pharmaceutical industry using new drugs that are in the process of development and FDA approval. These trials are at no cost to the patients.
A recent article from the journal Fertility and Sterility has created some controversy on the Internet and likely in the minds of those individuals and couples trying to conceive. The article, citing an Australian study, seemed to be lauding the importance of waiting to seek fertility treatment, claiming that many will become pregnant on their own within a year.
Some people have interpreted this article to mean that an individual or a couple, worried about being infertile, should wait and others have argued that you should wait only if you know the diagnosis. The reality is that if a person could predict the future, all of this would become instantly clear. Since that is not possible, waiting may actually deprive some people of an opportunity to resolve their infertility issues.
So, how long is too long?
Are men using over-the counter therapies to treat their infertility?
Most definitely!
Two reports show widespread use of alternative therapies for male factor infertility. The most commonly used self-administered supplements were antioxidants, with 92/147 (63%) using vitamin C or E, selenium, or zinc. Further, many men (11%) surveyed reported admitted using herbal preparations. Schoer (2002) reported a similar percentage of men taking herbs. The two most common herbal preparations being used were compounds containing ginseng or DHEA (dehydroepiandosterone). The Schoer study emphasized that, while the men took these preparations, over 80% had known medical causes of their infertility, such as varicocele, ejaculatory duct obstruction, or excessive marijuana use and, therefore, the herbal preparations would be unlikely to increase the pregnancy rate for these men.
Assisted reproductive technologies have given couples realistic options, and often solutions, when they face infertility. But, with these options sometimes come tough choices from unwanted or unanticipated outcomes. One such example is the issue of multiple gestations such as twins, triplets, quadruplets, or more.
Calling Dr. Google! Who hasn’t summoned the ‘good doctor’ to their home (computer) over a sickness, symptom or suggestion? The internet and the information highway have changed the practice of medicine forever. And both patients and physicians are trying to adjust to this new technology. The internet has given patients an amazing amount of information but unfortunately in an unorganized, unobjective way without the built in ‘controls’ that evaluate the information dispensed. Instead, patients gather information from the internet and then ask their physician to interpret the results. Problem is that the results that they have collected may be inaccurate at worst, and at best, have absolutely nothing to do with their individual circumstances.
Just like the Birds and the Bees, most people will have no problems conceiving once they decide to do so. However, about 15% of the couples trying to conceive will not get pregnant, at least not within their time frame. The temptation is to seek medical help will increase their chances of achieving a pregnancy. However, before embarking on this sometimes arduous journey, it might be a good idea to make sure that all non-medically necessary efforts have been made to enhance the chance of conception.
For some time, Reproductive endocrinologists have believed that Polycystic Ovarian Syndrome (PCOS) has psychological consequences on its sufferers. This general opinion was affirmed in the most recent edition of Human Reproduction (2011: 26: 1399). Deeks et al reported on a study involving 177 women with the diagnosis of PCOS. The authors tested the participants with a number of psychological tests designed to diagnose anxiety and/or depression. Women with PCOS were more likely to have problems with self-worth and body image. Women with PCOS also had higher levels of anxiety and depression. The problems with depression and anxiety occurred independent from weight and seemed to be related to the PCOS itself.
So much can be, and is, said about the best means to conceive a child in the shortest duration possible.
There is little doubt that when looking at ‘The Women most likely to…”, age plays a significant factor.
While earlier studies seem to point to women maintaining optimal fertility through the age of 35, 40 and beyond; recent evidence has demonstrated that a woman’s fertility peaks at @ 28 years of age and then begins a steady decline, with significant acceleration after the age of 35.
The story on RMI patient Sara Connell that ran in The Chicago Tribune and on The Oprah Winfrey Show highlights an interesting case of Gestational Surrogacy as a treatment for Recurrent Pregnancy Loss, as suffered by the patient described. And while the family and age related details of this case drew the attention of the media, it is the diagnosis and means of addressing this in order to ‘deliver’ a healthy pregnancy and baby, that is foremost to us at Reproductive Medicine Institute.
Hormones and hormonal therapy for women are frequently discussed by the media yet there is a great deal of confusion and misunderstanding on the subject among the general public. Based on my knowledge of female physiology, steroid hormone biochemisty, and more than 40 years experience in the management of hormone deficient states, I am hoping to shed additional light on this important issue for patients and physicians.
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