Written by Nicola Davis
Painkiller taken by mother in first three months of pregnancy could potentially reduce child’s number of eggs, say researchers.
Ibuprofen taken by women in their first three months of pregnancy might reduce a daughter’s number of eggs, potentially affecting the child’s future fertility, according to research carried out on human cells in the lab.
It is generally thought that women are born with a fixed number of eggs, although controversial recent research has challenged the idea that adult ovaries are unable to produce more.
Previous work in rodents has suggested that painkillers including ibuprofen might affect the ovaries and hence fertility, while recent research in men has linked prolonged high doses of ibuprofen to disruption of male sex hormones. Up to 30% of women are thought to take ibuprofen during pregnancy.
“We know that fertility rates have declined over recent years, and essentially we are looking for a potential reason why that might be the case,” said Rod Mitchell, co-author of the research from the University of Edinburgh. “Because it is a relatively recent decline, it is felt that environmental factors [including painkillers] in addition to societal factors might have a role to play.”
Writing in the journal Human Reproduction, Mitchell and colleagues from France and Denmark report how they examined the impact of ibuprofen on developing ovaries using ovarian tissue taken from 185 terminated human foetuses aged between seven and 12 weeks.
In the first step of the study, the team analysed blood taken from the umbilical cords of 13 of the foetuses whose mothers had taken ibuprofen in the hours before termination, to reveal that ibuprofen did indeed cross the placental barrier.
For each of the 185 foetuses, tissue was then cultured under multiple conditions, with one sample exposed to no ibuprofen and others bathed in various concentrations of the drug in a dish, reflecting concentrations that would circulate in humans.
After seven days, compared to samples not exposed to ibuprofen, those bathed in the painkiller at a concentration on a par with the cord blood levels had an average of 50% fewer ovarian cells, and between 50 and 75% fewer “germ cells” – cells that develop into eggs. This was down to an increase in cell death and fewer cells multiplying.
Further experiments showed that the damage began as early as two days after exposure to the ibuprofen for foetuses aged 8–12 weeks. After a five day recovery period for a subset of the samples, only a partial recovery from the effects of the ibuprofen was observed, but only germ cells appeared to bounce back.
But Mitchell cautions that the situation in the body might differ from that in a dish, that it is not clear what level of germ cell loss would be tolerated before fertility is affected, or whether the ovaries could more fully recover over a longer period.
“If we see effects on germ cells, which we do in the dish, that could indicate that there are potential for effects in ‘real life’ and potential for effects on fertility – but we haven’t shown or proved that by what we have done [in this study],” he said.
For pregnant women, he added “The advice doesn’t change,” noting that they should take painkillers only when necessary, and at the lowest dose for the shortest time possible. Currently pregnant women are advised to choose paracetamol over ibuprofen, and not to take ibuprofen after 30 weeks.
William Colledge, professor of reproductive physiology at the University of Cambridge, who was not involved in the research, said the study was interesting since it looked at a period in which women might not realise they were pregnant. But he had reservations.
“It is a big step to go from something that happens in the petri dish to saying, well, that definitely may happen in a pregnant woman – although it shows that we could be cautious,” he said, adding that the number of germ cells in the ovaries naturally declines from a peak of about three million mid-pregnancy. “At best [women] are only releasing one [egg] each month. So you can cope with the loss of quite a lot of these eggs,” he said.
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By SARANG KOUSHIK MD
Menopause. It’s a condition that affects millions of women, and it involves some pretty significant changes — as well as symptoms.
Here are a few answers to some of the most common questions about menopause.
What is menopause, and when does this usually happen?
Menopause is defined as not having your period for 12 months — a change that signifies the end of all monthly menstrual cycles you will experience. It happens when sex hormones like estrogen and progesterone begin to decrease.
According to the Mayo Clinic, a non-profit organization that focuses on clinical practice, education and research, menopause may occur in your 40s and 50s, but the average age in the United States is 51.
What are the symptoms of menopause?
The following symptoms can occur during the years leading up to menopause, according to the Mayo Clinic:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Sleep problems
- Mood changes
- Weight gain and slowed metabolism
- Thinning hair and dry skin
- Loss of breast fullness
What is perimenopause?
Perimenopause, or the “transition to menopause,” refers to the years leading up to menopause when the reproductive function starts to slow down. Irregular periods are common, and many of the other symptoms may resemble those seen in menopause. According to the North American Menopause Society, a nonprofit organization based in Ohio, this transition may last an average of four to eight years. Importantly, pregnancy is still possible during perimenopause.
What is premature or early menopause?
Early menopause occurs before the age of 40. There could be a number of reasons, including genetic or autoimmune causes.
I keep hearing about hot flashes … What are those?
Hot flashes are experienced by the majority of women going through menopause. Changes in hormone levels –- specifically estrogen — can cause the blood vessels in the skin to dilate, leading to sweating, rapid heart rate and flushing/redness of the face. Hot flashes can be associated with mood changes and other symptoms.
When a hot flash is occurring, there can be a feeling of intense heat in the face, neck, or other parts of the body. Although skin temperature may briefly change during this time, there is no change in core temperature.
What can I do to make menopause easier? Are there any treatments?
Menopause treatments focus mainly on helping to manage symptoms. Your doctor will be able to explain the risks and benefits of different therapies.
Hormone therapy: Estrogen, usually in combination with progesterone
Selective estrogen receptor modulators (SERMs)
Vaginal estrogen: used to relieve vaginal dryness
Antidepressants: to help with mood symptoms
Vitamin D: to maintain bone density (strength)
What is the treatment for a hot flash?
Daily exercise, limiting triggers, and sleeping in a comfortable environment can all help to prevent or reduce the duration of a hot flash. If none of these options work, women can speak to their physician about starting a variety of treatment options, ranging from over the counter products to antidepressants and hormone replacement therapy (HRT).
Will there be any long term health consequences?
The change in hormone levels that occur during menopause may lead to increases in risk for heart disease, stroke, or osteoporosis. There may be additional health issues that come up as well so routine follow-up and screening with a physician are recommended.
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Written by Fran Cusworth
A study has cast doubt on a popular fertility test that claims to predict the probability of falling pregnant.
Ovarian reserve testing involves a blood test to measure levels of the anti-Müllerian hormone, which is secreted by cells in developing egg sacs. Women who have less ovarian reserve are considered to be closer to menopause.
These so-called “egg-timer tests” have become more popular in recent years, as some women delay having children to pursue careers or until they’re in a stable relationship.
But a recent study in the peer-reviewed Journal of the American Medical Association found AMH testing is not an indicator of natural fertility. Researchers found a lower ovarian reserve was not associated with the ability to conceive among some women.
The study looked at women aged 30-44, with no history of infertility and who had been trying to conceive for three months or less.
Melbourne IVF medical director Dr Lyndon Hale, whose clinic offers AMH testing, says the method helps to determine whether IVF might be difficult for a particular woman. But it does not predict the likelihood of natural conception.
“I’ve seen a lady with very low AMH and after a month off the pill she was pregnant. It [AMH level] doesn’t tell me anything about the quality of the oocytes (eggs) remaining,” Dr Hale told The New Daily.
“However, I knew if she did IVF she would only ever get a small number of eggs.”
As women age, their remaining eggs start to decline in number and quality.
Dr Hale says AMH testing should be used alongside other clinical considerations, including menstrual cycles and age.
Professor Robert Norman, a reproductive and infertility expert from the University of Adelaide, says the best predictor of fertility is age.
“Age is everything – your optimal fertility is between 20 and 34,” he says.
According to Jean Hailes for Women’s Health, fertility starts to decline after age 28, significantly after 35 and dramatically after 40.
Professor Norman said the JAMA finding did not surprise him. But he believes AMH testing is here to stay.
The test started as part of IVF procedures, but is increasingly being marketed as a standalone fertility prediction tool, he says.
“It’s a test that’s going to be popular among women and their partners,” he says.
“It may make a difference between someone deciding, ‘I’m going to have a child when I’m 30, versus when I’m 37’. It’s a piece of information that could help people get pregnant naturally and avoid IVF, rather than driving them to it.”
How much does it cost?
In Australia, AMH testing generally ranges from $50-$100 per blood test.
The cost of follow-up procedures – such as freezing eggs or IVF – can run into six figures.
If you are having trouble conceiving, a fertility specialist might:
- Check for genetic or medical conditions (such as diabetes)
- Check medication or substance use
- Conduct an immunisation review
- Order a blood test to check for hormone changes
- Test your partner’s sperm count
Increasing natural fertility
- Manage stress and take the time to relax
- Don’t smoke
- Reduce alcohol and caffeine intake
Source: Jean Hailes for Women’s Health
For a complete and individual fertility assessment, speak to your GP or specialist.
View original article here.
Written by Cheryl Platzman Weinstock
(Reuters Health) – A self-help cognitive behavioral therapy program combined with relaxation techniques can ease working women’s menopausal symptoms, according to a British study.
The program helps users learn strategies to control their thoughts and feelings. Working women who used it were able to significantly reduce the frequency and interference of hot flushes and night sweats, and improve their overall quality of life, researchers found.
Menopause symptoms can be more difficult to deal with in the workplace than in other settings due to an inability to control the temperature, embarrassment, stress and other factors, coauthor Myra S. Hunter, emeritus professor of clinical health psychology, Kings College London, told Reuters Health by email.
She said that while hormone replacement therapy is an effective treatment for menopausal symptoms, not all women want to take it.
Cognitive behavioral therapy (CBT) has been used since the 1960s to treat a variety of medical problems, including anxiety, depression and sleep problems.
“This study offers women who have problematic symptoms at work a brief, non-medical solution. The brief, self-help CBT helped women to manage symptoms, and also had broader impacts on sleep and wellbeing,” Hunter said.
The therapy also improved their work experience because they slept better, experienced less physical discomfort, social embarrassment, and memory and concentration problems.
As reported online January 8 in Menopause, the researchers produced a self-help CBT booklet designed to help working menopausal women learn CBT skills on their own. It included sections on work stress and how to discuss menopause at work.
Menopause has been and still is, in many contexts, a taboo issue in the workplace, Hunter said.
The new study involved 124 working postmenopausal women who were having at least 10 hot flashes or night sweats per week. Half the women were randomly assigned to receive the self-help CBT booklet plus a breathing/relaxation CD. The other half were placed on a waiting list (the control group).
On average, the women in the study were having 56 hot flashes and/or night sweats per week. They arrived to work late, left early or stayed home from work an average of two days per month due to menopausal symptoms.
The participants completed follow-up questionnaires at six weeks and again at 20 weeks.
In the self-help group, the frequency of hot flashes and night sweats decreased by 24% over six weeks and 35% by 20 weeks.
In the control group, however, the frequency of hot flashes and/or night sweats had fallen by only 0.5% at six weeks and 15% at 20 weeks.
The self-help group also reported significant improvements in sleep quality and functioning at work, home, leisure and social situations.
A subset of 27 women from the self-help group were interviewed after the trial. The majority, 82%, felt the intervention had helped them with hot flashes/night sweats. Fifty-two percent reported positive benefits to their work life, and roughly a third had talked about menopause to their line manager.
One limitation of the study was that is that it relied on subjective rather than objective measures. Also, the dropout rate was unexpectedly higher in the self-help group. Participants reported time pressures as the main problem for not following through with the intervention.
Dr. Mary Jane Minkin, clinical professor in the department of obstetrics, gynecology and reproductive sciences at Yale Medical School, New Haven, Connecticut, told Reuters Health by phone that she doesn’t see any harm in the self-help therapy.
“The question is, how much does it really help?” said Minkin, who was not involved in the study. “Women need to be apprised that there are more effective approaches to curb menopause symptoms if they’re feeling poorly. When you really get down to it, why not use estrogen?”
The authors’ self-help book for women with hot flushes and night sweats, “Managing hot flushes and night sweats: a cognitive behavioral approach to the menopause,” is available from booksellers.
View original article here.
Written by Jessica Migala
If you’ve been trying for a baby, seeing that positive pregnancy test is so exciting. But as you enjoy the first weeks of pregnancy (save for bouts of nausea and extreme exhaustion), you may also have one back-of-the-mind fear: What I have a miscarriage?
Needless to say, there’s a lot of anxiety surrounding miscarriages: In one 2015 study, which surveyed men and women, researchers reported that 41 percent of women who’d miscarried felt like they did something wrong, 47 percent felt guilty, 41 percent felt alone, and 28 percent felt ashamed. Many respondents also incorrectly believed that lifting heavy objects, taking birth control pills, or enduring stress may have caused their miscarriages.
But early pregnancy loss (before 13 weeks), or miscarriage, happens in about 10 percent of known pregnancies. And half the time, it’s due to chromosomal abnormalities, which cannot be prevented—though that doesn’t make it any less of an emotional experience.
Most times, miscarriage is an isolated event—couples will often go on to have successful pregnancies and the babies they planned for. Still, if you’ve been through this experience, any twinge, bleeding, or cramping can make you fear that you’re experiencing early miscarriage symptoms. If you’re worried at all, certainly reach out to your doctor who can tell you if you need to be examined. And, just because you notice some of these signs of early miscarriage doesn’t mean there’s anything wrong either.
That said, it doesn’t hurt to be informed about potential red flags. Here are five early miscarriage symptoms you need to know about:
Once you’re pregnant, you don’t expect to start bleeding again. But take a deep breath: It may be completely normal. For one, implantation bleeding may be an initial sign that you are pregnant. “As the fertilised egg burrows or implants into the uterus, you may see some spotting,” says Kecia Gaither, an ob-gyn and maternal foetal medicine specialist. You can also experience bleeding behind the developing placenta, she says. “Red flag” bleeding is bright red, “like a period accompanied by uterine cramping,” she explains. It may also contain tissue or clots. That said, half of women who miscarry experience no bleeding.
2. PAIN AND CRAMPING
When it comes to cramping, menstrual-like cramps can be totally normal as your uterus begins to expand. Other times, cramping can be a sign of an early miscarriage. “The cramping is from the uterus contracting trying to expel the pregnancy,” says Gaither. If you notice pain — particularly with bleeding — see your doctor, she advises.
3. BACK PAIN
Just like cramping, you may also feel a lower backache that can range from mild to severe discomfort. Though, again, this can be normal in a healthy pregnancy, too. The best advice is boring, but true: Always talk to your doctor if you’re concerned about your symptoms — they’re there to help you in every way they can.
4. NO SYMPTOMS
One of the scariest things for a newly pregnant mama is the worry that you’ll have a miscarriage and have no idea. It’s something called a “nonviable pregnancy,” says Gaither. (You may hear women also call it a missed miscarriage.) “It may persist for days until either the body expels it naturally or your healthcare provider intervenes medically or surgically to remove the pregnancy,” she says. You may notice that symptoms you felt before (nausea, for instance) have disappeared, though these may not go away until hormone levels have decreased.
5. A LATE PERIOD…
You’re always on time. Your period comes like clockwork. But if your period arrives a couple days late (and you’ve been having unprotected sex), you may have experienced a chemical pregnancy, which means the egg and sperm met, implanted, and your body produced the hormone HCG, but things failed to develop further. A chemical pregnancy may make up 50 to 75 percent of all miscarriages. You may have no idea that you even were pregnant in the first place.
This article originally appeared on Women’s Health US
Written by Tallulah Thompson
Twenty-two years ago Li Peng Monroe and her then husband, were having trouble getting pregnant. Like many couples with fertility problems, they turned to in vitro fertilisation (IVF).
“It’s not an easy process to go through … the probability of falling pregnant was quite low back then through IVF, for me certainly,” Ms Monroe, 51, said.
“There’s a perception that fresh is better so you start with the fresh ones, and then if the fresh ones don’t take, you’ve got embryos that are frozen that you can use,” she said.
It was her frozen embryos that gifted her two daughters, Melissa, now 20 years old, and Ashley, 17. Frozen embryo transfer has come a long way in the past few years.
A new study now gives couples trying IVF peace of mind whichever method they choose, showing both fresh and frozen embryo transfers offer an equal chance of having a child.
In women without polycystic ovaries, the pregnancy rates and live births were comparable when implanted with either fresh or frozen embryos, according to the study published in The New England Journal of Medicine on Thursday.
Rates of ongoing pregnancy occurred in 36 per cent of the frozen-embryo group and 34.5 per cent in the fresh-embryo group, according to the study.
Live births were recorded in 33.8 per cent of the frozen-embryo group and 31.5 per cent of women in the fresh-embryo group.
The study included almost 800 couples undertaking IVF in Vietnam, who received either fresh or frozen embryo transfers on a randomised basis and was completed in under a year.
Michael Chapman, Professor of Obstetrics and Gynaecology at UNSW and President of the Fertility Society of Australia – who was not involved in the study – said the slight percentage difference in groups is not significant.
“Even with 800 odd patients in the study … [frozen-embryo transfer] may turn out to give an extra one or two pregnancies,” Professor Chapman, who is also a consultant at IVF Australia, said.
“It’s good that [clinicians] will be able to advise patients that frozen-embryo transfer is as good as fresh, because historically frozen has not been as good.”
Co-author Ben Mol, Professor of Obstetrics and Gynaecology at the University of Adelaide’s Robinson Research Institute, said the study was done after the development of a ‘quick-freeze’ vitrification method in recent years resulted in an increased uptake of frozen-embryo transfers.
But the study suggests it may not increase the chances of a live birth compared to fresh embryos in the study population.
“There are many examples in medical history where people jump to innovation and new things, and then after a while it turns out that the new thing is not necessarily so much better,” Professor Mol said.
Previous research conducted on women undergoing IVF with infertility problems linked to polycystic ovary syndrome (PCOS), found frozen-embryo transfer led to more live births.
But until now, it was not known whether this was also the case for women confronted with fertility problems due to other reasons.
Professor Mol said going down the path of frozen-embryo transfer can come at a cost.
“It’s not a lot, but it’s a couple of hundred of dollars that you’re talking about, so obviously that could be part of the choice [for patients],” he said.
“The other thing is that people want to have their baby as soon as possible, and frozen transfer means a delay of at least one month, so there are arguments for fresh transfer.”
Professor Chapman said one limitation of the study was applying the results to Australia.
“They only looked at day-three embryos, whereas the general practice in Australia today is day-five transfers,” he said.
But the research was the first of its kind to study fresh versus frozen-embryo transfers in such a large number of non-PCOS patients.
“It’s fantastic that Australian researchers are collaborating with other countries to get high class research coming out of Asia,” Professor Chapman said.
“Health systems in other countries make it more possible to do proper randomised control trials, so it’s excellent that we are getting those relationships built up.”
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