January 12, 2012 by  

Surrogacy: the new trend in reproductive tourism

February 14, 2011 by  

Surrogacy, something which was quite taboo just a few years ago, has become quite acceptable, even mainstream. This may be partly due to the publicity that celebrities like Rick Martin to Elton John, Sarah Jessica Parker and Nicole Kidman generated.

But for each surrogacy case, there are 2 sides to the coin: the “gestational carrier” (a term out of Kidman’s mouth) and the would-be parents. Although these roles are rather easy to define, the terms “biological parents”, “genetic parents” and “adoptive parents” are sometimes needed to clarify the issues. However, confusion remains so that there is need for us to look at the terminologies.

According to surrogacy.org. uk:

Traditional (straight) surrogacy – “the surrogate uses her own egg fertilised with the intended father’s sperm. This is done by artificial insemination…”

Gestation (Host IVF) surrogacy – “the surrogate carries the intended parent’s genetic child conceived through IVF…”

In many countries, surrogacy is legal. In some, it is not. It is a well-known fact that surrogacy is a big business in India and some countries in eastern Europe and South America where surrogacy laws are very lax if at all existent.

During the recent economic crisis, there was a recent surge in the number of women in the US who were willing to sell their eggs or serve as surrogates in return for a fee. Although the money involved is not well-publicized, it can range from as little as $3000 in India to $20,000 in the US. In many cases, the women had a valid reason for going into surrogacy – money for a loved one’s treatment, children’s education, etc.

Recently, Guatemala hit the headlines as a strong completion to India when it comes to “reproductive tourism.” Unfortunately, the laws in Guatemala are not ready for this rapidly increasing market. According to Karen Smith Rotabi, Assistant Professor of Social Work at Virginia Commonwealth University:

“Those developing surrogacy services in this desperately poor nation should take caution as they pioneer in this area of global fertility practice. As a business model, they are stepping into a grey area of human rights which will challenge us all to consider what is right and wrong and how far to take the privilege of purchasing power. Developing an expanded or more precise definition of human trafficking and a new area of regulatory control will become important considerations in this next wave of the global baby business.”

This and the highly publicized surrogacy cases of celebrities triggered heated debates on the ethics and legalities of surrogacy.

Here are some issues to ponder on:

  • Is surrogacy about renting wombs or helping infertile couples?
  • If surrogacy, which is illegal in many western European countries, is done in a country where it is legal, tantamount to a crime when the parents bring the baby home?
  • Does the baby have the right for its parent’s nationality even though it has been conceived and delivered through surrogacy, which may have been legal in its country of birth but not in its home country?
  • How do countries define the difference between surrogacy and intercountry adoption?

BPA exposure and semen quality

November 17, 2010 by  

The controversial BPA aka bisphenol A makes the headlines again. And this time it is the men that should pay attention. A new study recently published in the journal Fertility and Sterility found strong correlations between BPA levels in the urine and sperm quality in male humans.

If you may remember, BPA is a compound used in the manufacture of certain types of plastics. Unfortunately, it leaches out from the plastic products into our food and drink.

The study looked at factory workers in China exposed to high levels of BPA in their job. This occupation exposure to BPA was measurable by urinalysis and was linked to poor semen quality, as indicated by low sperm count and decreased motility. These two properties of semen strongly determine the ability of the sperm to fertilize the egg. In other words, BPA exposure impacts a man’s fertility and reproductive potential.

According to study author Dr. De-Kun Li, MD, PhD, a reproductive and perinatal epidemiologist at Kaiser Permanente’s Division of Research in Oakland.

“The higher the BPA exposure, the worse the semen quality. The findings add more weight to the evidence about the effects of BPA on sperm quality.”

BPA remains a controversial chemical and health agencies worldwide are divided in their stand on this chemical. Only two years ago, US health regulators did not believe that BPA may be dangerous, citing lack of scientific evidence as its basis. This year, the FDA finally admitted that the BPA may have some “potential health concerns.” Several American states have banned the chemical from baby products. Canada, however, is in the front line when it comes to eradicating BPA. Canadian health authorities recently placed BPA on its list of toxic (thus banned) chemicals). In Europe, BPA use is still widespread and no legislation is in place to regulate it.

Researchers believe that BPA is an endocrine-disrupting substance that plays havoc with our hormones, including sex hormones. Endocrine disruptors are also called “gender-bender” chemicals.

According to Dr. Laura V. Vandenberg of Tufts University in Boston:

“This study clearly shows that BPA exposures adversely affect men in a serious way: by influencing their semen quality, which could have obvious impacts on their ability to have children… [It] also shows that adult men are sensitive to BPA, and even small amounts of the chemical can have pretty drastic effects. What remains to be seen is whether the effects of BPA on semen quality are permanent after the kinds of low, chronic exposures that most adults experience.”

There are easy ways of protecting yourself and your family from BPA exposure.

Check out:

When hugs and medications don’t mix

November 11, 2010 by  

A hug can mean a lot of things, almost always positive. Unless it comes with something else. Hormones, for example.

Many medications contain hormones, medications that can be in the form of creams, gels and sprays. An example is Evamist, a drug that is prescribed to menopausal women suffering from hot flashes. Evamist contains estradiol, a form of estrogen hormone. It is administered as a spray inside the forearm between the elbow and wrist.

The US FDA issued a warning in July this year regarding adverse events associated with accidental exposure to Evamist, especially children and pets. Exposure may be through direct contact when Evamist is not safely stored or when a child or pet is hugged by an Evamist user and come in contact with area of application. The reported adverse effects in children are:

  • premature puberty, nipple swelling, and breast development in girls
  • breast enlargement in boys

Other accidental exposure includes pets licking application area or pet owners petting their animals after drug application, without proper hand washing. The effects in pets include:

  • Enlargement of the nipples and swelling of the vulva in females in pets
  • Fur loss
  • Undersized sexual organs in male pets

To avoid inadvertent exposure to Evamist, the FDA gives the following recommendations:

Another drug called Dovonex, which is a hormone derivative of vitamin D, can also possibly cause similar effects. Dovonex is a cream used to treat the skin disorder psoriasis. Pet who inadvertently lick the cream present with “unusual thirst, appetite loss, and severe vomiting or diarrhea.”

What should you do if your child or pet comes in contact with these drugs. The US FDA recommends:

Viagra use in older men linked to increased STD infection risk

November 8, 2010 by  

The late 90s witnessed the widespread use of erectile dysfunction drugs among men, especially in the middle-aged and older. These drugs were welcomed as treatment for sexual dysfunction among men which translated to increased quality of life.

The most popular of these drugs is Viagra (sildenafil) and it is easily available over-the-counter in many countries and is extensively marketed over the Internet. Estimates showed that since the introduction of Viagra in the US market in 1998, the rate of erectile dysfunction drug use increased. By 2002, about 20% of American men older than 40 have tried taking an erectile dysfunction drug.

The increased use of erectile dysfunction drugs also coincided with an increase rate of HIV infection among men in the same age group. Thus researchers investigated whether there is a link between erectile dysfunction drug use and increased risk for sexually transmitted disease (STD). Insurance records of more than 1.4 American men over 40 were analyzed. The results suggest that

“…those who used ED drugs were more likely to have sexually transmitted diseases than were non-users.”

The study thus suggests that erectile dysfunction drug use is linked to increased risk for sexually transmitted diseases (STD), with HIV infection as the most frequently acquired STD, followed by chlamydia. However, STD rates in the general population did not increase. It is thus possible that the use of erectile dysfunction drugs led to increased risky sexual behaviour that could lead to high risk for STD infection.

According to lead author Dr. Anupam B. Jena of the Massachusetts General Hospital (MGH) Department of Medicine

“Anyone who does not practice safer sex, no matter their age, can contract an STD. Even though STDs are quite rare among older men — on the order of 1 per 1,000 individuals — we found that STD rates in men who used ED drugs were two to three times higher, both before and after they filled their first prescription.”

It is possible that older men probably belong to a generation who were not well-educated on the topic of safe sex. This is in contrast to younger people whose generation grew up with warnings against the likes of incurable STD infections such as hepatitis C and HIV.

Doctors who are asked to prescribe erectile dysfunction drugs are also urged to discuss the importance of safe sex practices with their patients even with older patients. Remember, nobody is too old to learn and nobody is too old to catch STD.

Bad food equals bad sperms

November 2, 2010 by  

Guys, what you put on your plate may determine the quality of your sperms.  Fries, burger, chips and all those tasty food that are swimming in saturated fat result in low sperm counts and sperms of low vigor. This is according a study by Harvard researchers.

The study looked at the semen quality and the diet of 91 male patients of the Massachusetts General Hospital Fertility Center in Boston. What they found out were as follows:

Men with the highest intake of saturated fat had 41% fewer sperm than men who ate the lowest amount of saturated fat.

Men with the highest intake of monounsaturated fat had 46% fewer sperm compared with men with the lowest intake of monounsaturated fat.

On the other hand, those who eat healthy – especially food rich in polyunsaturated fats such as omega-3 and omega-6 fatty acids – are more likely to have healthy, vigorous sperms in normal numbers.

“Men who had a higher intake of omega-6 polyunsaturated fats had greater sperm motility, and a higher intake of omega-3 polyunsaturated fats was related to better sperm “morphology” — the size and shape of sperm.”

The authors point out that these results provoke some serious thoughts. Not only does a healthy or unhealthy diet affect a person’s health, it may also affect his reproductive potential as well as the health of his offspring. “The dietary pattern of a father-to-be is affecting the composition of the sperm that will be delivering half of the genes to a future son or daughter. So, it’s one more reason to choose our foods wisely.

The mechanism behind the association between diet quality and semen quality is not clear but the authors speculate:

“Polyunsaturated fats are important components of sperm cell membranes and may influence the ability of sperm to fertilize an egg.”

Food which are rich in the “good” fats are fish, whole grains, some seeds and nuts, and olive and canola oil.

IVF gets Nobel Prize after 32 years

October 13, 2010 by  

Robert Edwards, pioneer of in vitro fertilization (IVF) and brought to the world the first “test tube” baby Louise Brown in 1978 was awarded the Nobel Prize in medicine this year.

What was controversial 30 years ago is now an established medical procedure. After Louise Brown, more than 4 million people worldwide were born via IVF. Imagine being instrumental in bringing to life this many people.

Current figures show that 1 in 10 couples have infertility problems.

According to Edwards:

“The most important thing in life is having a child. Nothing is more special than a child. Steptoe and I were deeply affected by the desperation felt by couples who so wanted to have children. We had a lot of critics but we fought like hell for our patients.”

Many colleagues and experts in the field believe that this honour for Edwards is long overdue. In fact, he founded the world’s first IVF centre, the Bourn Hall Clinic in Cambridge, together with English surgeon, Patrick Steptoe. Unfortunately, Steptoe cannot share the Nobel Prize with Edwards as he passed away in 1988. “The statutes of the Nobel Foundation stipulate that a prize cannot be awarded posthumously, unless the winner dies after the announcement of the prize itself.” Edwards himself is 85 years old and of failing health and may not enjoy his honor that long.

Indeed, IVF has changed human reproduction forever. It is currently estimated that worldwide, about 1 in every 10 couples have fertility problems. IVF enables them to procreate.

Nowadays, women as old as 70 could still bear children through IVF. The first “man to get pregnant” also did so via IVF.

However, despite being an established and widely practiced medical procedure, IVF remains controversial from an ethical and religious point of view, thus probably the reason of the delayed accolade.

Here are some quotes from family, friends and colleagues of Edwards about his Nobel Prize:

According to his wife Ruth:

“The success of this research has touched the lives of millions of people worldwide. His dedication and single-minded determination, despite opposition from many quarters, has led to the successful application of his pioneering research.”

Says Basil Tarlatzis of the International Federation of Fertility Societies

“This is a well deserved honour. IVF has opened new avenues of hope for millions of couples throughout the world. It has also had an immense impact on our understanding of medicine, leading directly to such developments as stem cell research, PGD, and many other fields. Edwards and Steptoe were real pioneers, and the award of the Nobel prize honours not just their work, but the whole field of reproductive science. After their breakthrough work, Robert went on to nurture the development of the assisted reproduction. No one deserves this award more, and we congratulate him on his award.”

Menopause: symptoms and treatment options

October 6, 2010 by  

I know it is waiting for me out there as I approach the 5th decade of my life. I dread it but I also look forward when it is finally over. I am referring to that stage of a woman’s life called “menopause.”

According to the October issue of NIH News:

Menopause is defined as the final menstrual period.  On average, women have their last period around age 51, but it can also occur in their 40s or late 50s. Symptoms usually begin to appear several years before menopause. This time of change—called the menopausal transition, or perimenopause—extends to 1 year after your final period.

The symptoms

The reason why I dread menopause is the symptoms that come with it. I remember my mom’s menopausal years and they were not that easy, neither for her nor for her family.

Menopause can be physically and mentally challenging. The good news is that not all women suffer from severe symptoms that require treatment. The bad news is that “those bothered by symptoms, choosing the best treatment can be confusing.” Some of the most common symptoms of menopause are:

  • Hot flashes
  • Sleeping problems
  • Mood changes

According to researcher Dr. Sherry Sherman:

“Hot flashes can be severe and highly disruptive. We used to think that they lasted for 2 or 3 years, but our studies have shown that for some women they can last a lot longer—up to 7 or 10 years.”

What causes these symptoms?

During perimenopause, levels of estrogen and progesterone—2 female hormones made in the ovaries—go up and down irregularly. This leads to changes in menstrual periods. The fluctuation in hormone levels that begins during perimenopause can affect many different parts of the body.

The heart, blood vessels, brain and brain are all affected by the hormone fluctuation, leading to a wide range of symptoms.

Treatment options

The convention treatment for menopause symptoms is hormone replacement therapy, especially estrogen. The hormone supplementation not only alleviates menopausal symptoms, it also has cardioprotective effects and benefits for bone health. Recent research evidence, however, indicates that this menopausal hormone therapy presents some risks including increased risk for breast cancer and stroke. Thus, “different therapies have benefits and risks that need to be weighed carefully.”

Alternatives to hormone therapy are being looked into, including

  • mind-body approaches
  • exercise
  • different medications
  • behavioral interventions
  • alternative medicine approaches

On the other hand, I am looking forward to life after menopause, a life without contraceptive pills, pre-menstrual syndrome and tampoons.

More bad news about BPA

September 22, 2010 by  

The story of BPA aka bisphenol A is not yet over. In fact, researchers believe that what we currently know about this compound is just the tip of the iceberg. As you may recall, BPA is a compound used in the manufacture of plastics. It is also an endocrine disrupting compound and micmics estrogen. BPA has been linked to a wide range of health problems from cardiovascular disease, to impaired fertility, neurological and developmental disorders and cancer.

According to University of Missouri researcher Dr. Julia Taylor:

“For years, BPA manufacturers have argued that BPA is safe and have denied the validity of more than 200 studies that showed adverse health effects in animals due to exposure to very low doses of BPA. We know that BPA leaches out of products that contain it, and that it acts like estrogen in the body.”

A recent study published in NIH journal Environmental Health Perspectives shows that metabolism of BPA is similar in female humans, female monkeys, and female mice and BPA effects on the animals are grounds for major concern. According to study author Frederick vom Saal, professor of biological sciences at the University of Missouri:

“This study provides convincing evidence that BPA is dangerous to our health at current levels of human exposure. The new results clearly demonstrate that rodent data on the health effects of BPA are relevant to predictions regarding the health effects of human exposure to BPA. Further evidence of human harm should not be required for regulatory action to reduce human exposure to BPA.”

Furthermore, human exposure to BPA seems to higher than previously thought. It has always been assumed that BPA comes from the plastics that we use in our household. However, the current study results show that these sources alone cannot account for the amount of BPA we are exposed to, indicating that there are unidentified sources of contamination in our environment. The researchers, thus, are calling for “governmental agencies to require the chemical industry to identify all products that contain BPA.

Dr. Pat Hunt, co-author of the study, adds:

“We’ve assumed we’re getting BPA from the ingestion of contaminated food and beverages. This indicates there must be a lot of other ways in which we’re exposed to this chemical and we’re probably exposed to much higher levels than we have assumed.”

The stress-infertility-stress cycle

September 7, 2010 by  

Stress is linked to many health problems, including depression and cardiovascular diseases. Less known is the fact that stress can also cause infertility.

A joint study by the National Institutes of Health and the University of Oxford reports that stress can prevent a woman from becoming pregnant. The researchers identified the substance as alpha-amylase which is an enzyme secreted by the parotid gland via the saliva to help digest starchy food. However, starch is not the only thing that triggers alpha-amylase secretion. It is also secreted in response to the presence of catecholamines, “compounds that initiate a type of stress response.”

The researchers followed up 274 English women of reproductive age (18 to 40 years) who were trying to conceive and charted their ovulation cycles. The women were participants in the Oxford Conception Study that investigated whether daily information from a fertility-monitoring device would increase the chances of conception. The phases of their monthly cycles were tracked using home fertility test kits.

In the current study on alpha-amylase, the participants were asked to collect a saliva sample on the 6th day of their ovulation cycles. The saliva samples were tested for stress-related substances, including alpha-amylase and the stress hormone cortisol. The saliva analyses were performed till the participant conceives or until 6 menstrual cycles were completed.

The results showed that women with high levels of alpha-amylase in their saliva are less likely to conceive compared to those with normal or low levels during the fertile window –e.g. the 6 days of the cycle when conception is likely to occur.

According to study author Germaine Buck Louis, director of the NICHD’s Division of Epidemiology, Statistics, and Prevention Research:

“Overall, the 25 percent of women in the study who had the highest alpha-amylase levels had roughly an estimated 12 percent reduction in getting pregnant each cycle in comparison to women with the lowest concentrations.”

Cortisol levels on the other hand were not associated with the chances of conception. Dr. Cecilia Pyper who heads the Oxford Conception Study comments:

“This is the first study to show an association between a biomarker of stress and a reduction in women’s chances of conceiving throughout the fertile window — underscoring the importance of considering stress when attempting to identify the determinants of conception.”

In addition, it also highlights the need for finding ways to alleviate stress in women who are trying to get pregnant. This is especially difficult since each failed attempt brings even more stress that sets off a vicious cycle.

Atrazine – the nasty stuff in your herbicide

August 25, 2010 by  

I have been lately struggling with our backyard, which although just a little bigger than a postage stamp, nevertheless is too much work, what with the dandelions, clovers and other weeds sprouting up all over. Add to this the fact the neighbors’ backyards, simply separated by low bushes, are neat and trim – weedless. My neighbor to the left was kind enough to give me a tip on how to fight the weeds – mainly of out fear that the undesirables make their way from my green to patch to hers – use herbicide. My first reaction was of course “No way will I use herbicides and other chemicals in my backyard!”. But then I realized the necessity (if only to avoid suburbia war) and so I decided to do some research on how to tackle the problem the safest and the most environmentally feasible way. I learned that there are organic alternatives to conventional herbicides, mainly consisting of biodegradable, naturally occurring compounds. I also learned that several compounds used in conventional herbicides are really nasty. And one of them is atrazine.

A recent study funded by the National Institutes for Health (NIH) investigated the effect of atrazine in animals. When pregnant rats were exposed to atrazine, the following were observed:

  • Atrazine causes prostate inflammation in young male rats
  • Atrazine-exposed young animals experienced delayed puberty that non-exposed animals.

What is concerning is the fact that the effects were observable even at low levels and increased with increasing doses of exposure.

Atrazine is a herbicide predominantly used to control weeds and grasses in crop plants such as corn and sugar cane. Atrazine may be good for the crops and food production but it is definitely not good for the environment and the people around. Long after the crops have been harvested, the herbicide and its byproducts persist in the environment and eventually find their way into the water supplies – and the water we drink.

We may not be aware of the exposure and its effects but it seems that, as the study suggests, exposure starts even at the womb and the tissues most especially targeted are the prostate and mammary (breast) tissues. The long-terms effects are not fully known but we can speculate about cancer and infertility.

It is not only atrazine that we should we should be wary of. Herbicides may contain other similar compounds belonging to the chlorotriazine family, such as propazine and simazine. And many more.

So next time you reach for that bottle of herbicide in your garden shed, read the label and what is written there. Watch out for the nasties.

Do IVF children have increased risk for cancer?

August 17, 2010 by  

The long-term effects of in vitro fertilization (IVF) on the mother and on the child have always been a topic of speculation. Louise Joy Brown, the first person born who was conceived via IVF (used to be called the “first test tube baby”) turned 32 last July and she herself is a mother to a 3-year old who was conceived naturally. Researchers could only monitor and record what they observe and know about Louise and thousands, maybe millions of IVF babies like her as they grow, reproduce and eventually die. Only time can tell whether there are long-term health effects associated with this type of assisted reproduction.

One of the first results on the ongoing observation of IVF children are out – coming from Sweden.

Swedish researchers at the University of Lund followed-up 26,692 children born after conception via IVF between 1982 and 2005. Cancer data were extracted from Swedish Cancer Register and comparison was made between cancer patients who were born after IVF and those were not. The results indicate an increased risk for cancer among those conceived by IVF.

The expected number of cancer cases in the general population is 38. Among the IVF children of the same age, 53 were diagnosed with cancer, equivalent to a 1.42 total cancer risk estimate. The most common forms of cancer diagnosed among IVF children were:

In addition, 6 cases of Langerhans histiocytosis were reported where 1 case is expected.

The researchers ruled out maternal age, number of previous babies delivered, smoking, subfertility, previous miscarriages, body weight and multiple births as the cause of the increased cancer risk. Although, it can be speculated that the mode of conception might play a role, the researchers think this may not be the case.

Instead, factors that should be considered are genetic traits from the parents, many of whom may have had health problems that manifested in the infertility that made use IVF in the first place.

Another factor is the fact that IVF resulted in many multiple births that in return led to preterm delivery. Premature babies have higher risks for health problems than babies born at full term.

In addition, the study only looked at Swedish children, and the Swedish population has relatively lower biodiversity compared to say, the UK or the US where IVF is commonly used as assisted reproduction technique. Thus, findings in these children might not be true in IVF children elsewhere.

The authors are quick to reassure parents of IVF children that although they found “a moderately increased risk for cancer in children who were conceived by IVF”, absolute risks are still very low – less than 1%.

Female sexual dysfunction and diabetes

July 29, 2010 by  

Diabetes comes with a lot of complications, including sexual dysfunction. There has been a lot of research on the relation between type 2 diabetes and erectile dysfunction (ED) in male patients with reported prevalence of up to 50%, but little is known about female sexual dysfunction (FSD). FSD is characterized by lack of libido and sexual satisfaction, even discomfort and pain during intercourse.

Italian researchers decided to address this knowledge gap and investigated the factors that are correlated to FSD in diabetic patients.  Their results indicated that FSD was not linked to hemoglobin A1C or time since diagnosis, hypertension or smoking. However, FSD was shown to be most prevalent in women who are married or depressed. Whereas physical activity positive influences FSD, age, metabolic syndrome and poor lipid profile seem have a negative impact. Much more, FSD is more prevalent in menopausal women compared to non-menopausal women. The authors concluded that:

“Further studies are needed to elucidate in full the mechanisms underlying the evident differences between male and female sexual function. In the meantime, evaluation of female sexuality should become a routine evaluation in women with type 2 diabetes, such as other diabetic complications.”

The results indicate sexual dysfunction occurs in both men and women especially among those with diabetes. However, the determining factors seem to differ between sexes. Whereas ED is closely linked to cardiovascular risk factors, FSD seems to be more linked to neurological and social factors. In fact, several studies have linked FSD to depression and marital status

There is something that diabetic women can do to help prevent FSD – improvement in diet and more physical activity. Experts believe it is not just diabetic diet that would help but sticking to the so-called Mediterranean diet, according to the same team of researchers.

Mediterranean diet has been shown to be beneficial for the heart and blood sugar levels. However, this is the first study to demonstrate the positive effect of such a diet in reducing FSD.

Like many chronic diseases, diabetes and its many complications, including sexual dysfunction benefits from lifestyle change that involves diet and physical exercise.

The controversy surrounding prenatal dex and manipulation of sexual orientation

July 22, 2010 by  

The treatment seems straightforward enough at first glance. Using the steroid dexamethasone, clinicians are trying to treat a condition called congenital adrenal hyperplasia (CAH) right at from the womb. CAH is an in-born condition characterized by a malfunctioning adrenal glad that leads  toa serious hormonal disruption and the development of ambiguous genitalia. Children born with CAH have to be treated with steroids and hormones their whole life. Female babies born with CAH have a higher tendency towards tomboyism and lesbianism.

However, bioethicists at the Northwestern University Feinberg School of Medicine believe that the prenatal treatment goes beyond just CAH.  Researchers Alice Dreger and Ellen Feder believe that prenatal dexamethasone may be misused to prevent the occurrence of homosexuality.

Prof. Dreger states:

“This is the first we know in the history of medicine that clinicians are actively trying to prevent homosexuality.”

This came to light when parents who were carriers of the CAH genes had their babies checked for the abnormality while still in the womb.  An endocrinologist researcher at Mount Sinai Medical Center in New York City prescribes dexamethasone to pregnant women carrying babies with CAH. The only problem is that this kind of therapy using dexamethasone is off-label, e.g. the drug is approved for use in other conditions but not for this specific one – CAH. And the patients who received the steroid were not informed about this. Off-label use is not illegal and often done at the discretion of the doctor. However, there are certain procedures necessary to do this, including explain to the patient the risk and benefit and obtained a signed informed consent from the parents.

There are supporters for the dexamethasone (“dex”) treatment. It spares the baby the embarrassment of having ambiguous genitalia that would need to be corrected later. According to Dr. Ingrid Holm, a pediatric endocrinologist at Children’s Hospital in Boston.

“I see potential for benefits and I don’t see evidence there’s any negatives to this. There are lots of risks associated with surgery, and if this can prevent surgery, then it’s a good thing.”

However, there are those who question the safety of the treatment as the drug has not been fully properly tested in humans. In addition, although the drug addresses the problem of ambiguous genitalia, it does not address the real cause of the problem, e.g. the endocrine disruption. Some doctors believe it is the parents’ anxiety about the condition that is being treated but not necessary for the benefit of the child.

The controversy about dexamethasone is not new. It has been around for decades. However, with the advent of genetic prenatal diagnostics, more and more parents are asking for treatment long before the child is delivered with the embarrassing problem. However, it is not only the genitalia that may be abnormal. Girls with CAH would not behave like typical Barbie-touting girls. One researcher wrote:

“CAH women as a group have a lower interest than controls in getting married and performing the traditional child-care/housewife role. As children, they show an unusually low interest in engaging in maternal play with baby dolls, and their interest in caring for infants, the frequency of daydreams or fantasies of pregnancy and motherhood, or the expressed wish of experiencing pregnancy and having children of their own appear to be relatively low in all age groups.”

The bioethicists at Northwestern University are concerned that this treatment is being used to manipulate the sexual orientation of female babies while still in the womb. They were especially concerned about a paper that proposes using prenatal dexamethasone to change the behavior of girls with CAH to be “closer to the expectation of heterosexual norms.”

At the moment, the medical community is divided about the pros and cons of the dexamethasone. However, a new consensus from seven major medical organizations (including the American Academy of Pediatrics) is expected to be published in the coming months regarding this issue.

Heart, Mind and Sex: how they are linked

July 19, 2010 by  

When we think of erectile dysfunction, we think of infertility and impotence. However, there this sexual disorder actually goes deeper than just plain sex. Depression, sexual dysfunction and heart disease have common pathological mechanisms. At least in men. This is according to a study by researchers at the University of Florence, Italy.

Sexual dysfunction in men, mainly manifesting as erectile dysfunction can cause depressive symptoms. However, as we all know, negative emotions put a strain on the heart and much more so in this patient population when depression can be severe. by a team led by Dr Elisa Bandini (University of Florence, Italy).

According to study leader Dr. Elisa Bandini (to heartwire):

“In a large sample of men with erectile dysfunction, after controlling for other risk factors, we found that those with severe depression had increased risk of cardiovascular events. We know that depression and erectile dysfunction are both risk factors for heart disease, but this study shows that these risk factors are independent of each other.”

But what about obesity, which is also a risk factor for cardiovascular events and erectile dysfunction? The author checked whether obesity is the common denominator. However, although obesity does play a role, factoring it out doesn’t take away the fact that depression can lead to heart disease.

The results indicate that a healthy sexual life may also be linked to a healthy heart and a happy life. But does depression cause erectile dysfunction or is it the sexual dysfunction that brings about depressive symptoms? This is still something to be addressed in further research.

Dr. Bandini explains:

“Our results show that when evaluating patients for sexual dysfunction, doctors should think about general health as well. Erectile dysfunction may be the first disease or depression may be first disease, but we should look beyond these initial conditions to look at secondary consequences such as increased cardiovascular risk. If we treat depression and sexual dysfunction, we may be able to improve cardiovascular outcomes, too.”

Previous studies have identified common mechanisms between cardiovascular disorders and erectile function. German researchers have reported that both disorders are linked to endothelial dysfunction, endothelium being the inner lining of the blood vessels. And now depression also joins in. For such a multidimensional problem, a multidisciplinary approach is needed and cardiologists, psychotherapists and urologists should work together to help patients to improve their health status and quality of life.

“The wellness of the body, of the couple, and of the mind independently affects the cardiovascular fate of men with erectile dysfunction… the need for a regular screening for cardiac morbidity in men with erectile dysfunction is even greater in those patients showing depressive symptoms.”

OTC vitamin supplement may enhance fertility in women

July 6, 2010 by  

Over-the-counter (OTC) fertility pills for women? It seems too good to be true but this is exactly what researchers from the Tel Aviv University are saying.

The researchers found a statistically significant link between DHEA, a popular OTC vitamin supplement and improved fertility in women.

DHEA stands for 5-Dehydroepiandrosterone, “a naturally-occurring steroid found in the brain, which plays an important biological role in humans and other mammals. Produced in the adrenal glands, it is also synthesized in the brain. The pharmaceutical version of this molecule is known as Prastera, Prasterone, Fidelin and Fluasterone, and identical generics are widely available over the counter in the United States without a prescription.”

The researchers conducted a controlled trial that compared the effects of DHEA supplementation vs. no supplementation in women with fertility problems. The women who had ovulation problems underwent fertility treatments but half of the group received 75 mg dose of DHEA everyday for 40 days prior to the treatments, and continued for 5 months thereafter.

Their results indicate that those who took DHEA supplements were three times more likely to become pregnant than those who did not. In addition, the DHEA group also had higher likelihood of having a healthy pregnancy and delivery than the control group.

According to study leader Prof. Adrian Shulman of Tel Aviv University’s Sackler Faculty of Medicine:

“In the DHEA group, there was a 23% live birth rate as opposed to a 4% rate in the control group. More than that, of the pregnancies in the DHEA group, all but one ended in healthy deliveries.”

It is not clear how DHEA enhances fertility. The study authors, however, hypothesize that it could have a positive effect on the quality of the eggs or the follicles. They recommend that women with fertility problems should take DHEA supplements and continue doing so even during pregnancy. However, before undertaking such supplementation, women should first consult their doctor.

In the meantime, the researchers will continue to do research and try to understand the fertility-enhancing mechanism of DHEA. If DHEA really does work, then it will save infertile women a lot of pain, not to mention money that comes with fertility treatments, including IVF.

IVF children and congenital defects

June 15, 2010 by  

More than 30 years ago, the first in vitro fertilized (IVF) baby was born in the UK. Since then, thousands, maybe even millions of babies have followed Louise Brown’s footsteps. In vitro fertilization (IVF) has become the most popular assisted reproduction technology (ART) for couples with fertility problems. Scientists often wondered about the health outcomes of IVF babies. Recent studies have shown that babies born through ART have higher chances of having congenital defects compared to those conceived naturally. A recent study by French researchers looked at 15,162 children born using ART from 2003 to 2007. The survey showed an abnormally high rate of congenital malformations in this population.

According to Dr. Géraldine Viot, a clinical geneticist at the Maternité Port Royal hospital, Paris, France:

“We found a major congenital malformation in 4.24% of the children compared with the 2-3% that we had expected from previous published studies. This higher rate was due in part to an excess of heart diseases and malformations of the uro-genital system. This was much more common in boys. Among the minor malformations, we found a five times higher rate of angioma, benign tumours made up of small blood vessels on or near the surface of the skin. These occurred more than twice as frequently in girls than boys.”

In addition, other relatively rare conditions such as the imprinting disorder Beckwith Wiedemann syndrome and retinoblastoma were 6 and 4.5 times higher, respectively in this group of children than in the general population.

The next step is to find out the mechanisms that bring about these abnormalities. The researchers have identified some possible culprits:

  • infertility
  • ovarian stimulation for multiple oocyte production
  • the in vitro maturation of oocytes
  • the use of ICSI (direct injection of sperm)
  • the culture media used for the embryo
  • cryopreservation of gametes and embryos

Dr. Viot continues:

“By following all these children we hope to understand more about not only what can go wrong after ART, but why it goes wrong. At a time when infertility is increasing and more and more couples need to use ART to conceive, it is vitally important that we find out as much as we can about what is causing malformations in these children, not only so that we can try to counteract the problem but also in order for health services to be able to plan for their future needs.”

They authors also emphasized that fertility specialists shoudl inform their patients of the increased risks for their children. Their results were presented at the 2010 Annual Meeting of the European Society of Human Genetics last week.

BPA linked to male sexual dysfunction and infertility

June 1, 2010 by  

BPA aka bisphenol A is in the headlines again but this time it has nothing to do with baby bottles and formulas. It is more about where babies come from – male fertility.

The research institute Kaiser Permanente reports that increased BPA levels in the urine of men can mean decreased sexual function that would desire, erectile dysfunction, and lower semen strength.

Why aren’t we surprised? Because BPA is quite known to be a human endocrine disrupter that creates havoc with hormones – a gender bender chemical, you might say.

The Kaiser Permanente researchers conducted a 5-year study of 427 factory workers in China. One group of workers employed as packagers, technical supervisors, laboratory technicians and maintenance workers in manufacturing facilities where BPA is used as an ingredient, the other group did not. The results showed significantly higher levels of BPA in BPA manufacturing facilities and these levels are correlated to sexual dysfunction.

According to study lead author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente’s Division of Research in Oakland, Calif.

“Because the BPA levels in this study were very high, more research needs to be done to see how low a level of BPA exposure may have effects on our reproductive system. This study raises the question: Is there a safe level for BPA exposure, and what is that level? More studies like this, which examine the effect of BPA on humans, are critically needed to help establish prevention strategies and regulatory policies.”

Although this has been previously observed in animal studies, this is supposedly the first study in humans to link BPA levels in the urine with sexual dysfunction

The levels measured were 50 times higher than what were measured in men in the general US population, indicating very high exposure. However, there is evidence that the endocrine disruption even occurs at low levels of long-term exposure.

Dr. Li continues to explain:

“This is the first human study to show that high urine BPA is associated with lower male sexual function. Also, even among men exposed to BPA from only environmental sources (no occupational exposure and with average BPA level lower than the average observed in the American population), there were indications of an increased risk of sexual dysfunction.”

Although BPA is slowly being phased out in the manufacturing of plastics for food packaging, it is still being used in the manufacture of non-food related plastics. Workers in these factories are exposed to high amounts of this chemical each day.

Factors that can affect semen quality (thus fertility)

May 19, 2010 by  

Male fertility is highly dependent on semen and sperm quality. And quality of a man’s semen has been shown to be dependent on several factors. Let us look at these factors.


The quality of semen deteriorates with age as sperms accumulate genetic errors over time. Dr. Cral Herbert explains how these errors occur:

“Since sperm production is so high, a man has to keep copying his DNA over and over again to make sperm. All this DNA copying leads to small mistakes, called mutations. If you remember that at its most basic level, DNA is a series of letters that make up recipes called genes. If the recipe is copied millions of times a day, mistakes inevitably happen.”

Excess weight is found to be associated with abnormal semen quality and male factor infertility by South African researchers. Obesity affects directly or indirectly male infertility by “inducing sleep apnea, alterations in hormonal profiles (reduced inhibin B and androgen levels accompanied by elevated estrogen levels) and increased scrotal temperatures, ultimately manifesting as impaired semen parameters (decreased total sperm count, concentration and motility; increased DNA fragmentation index).” Whether this negative effect on fertility is reversible by weight loss is not known.


Diabetes is another condition linked to infertility. British researchers found that men with diabetes have more DNA damage in their sperms than non-diabetics.

Their results showed that:


Lifestyle factors, too, may play a role in semen quality, and lifestyle changes may help improve semen quality and thus fertility, according to a study by Italian researchers. The study looked at 52 male patients suffering a condition called high-grade varicocele without hypertrophy. Varicocele is characterized by swelling or lump that surrounds the testicle, usually the left. It is also associated with abnormal semen characteristics and decreased fertility. Semen quality as measured by spermiograms showed that smokers and alcohol drinkers have lower sperm counts and lower sperm motility and vitality compared to non-smokers and non-drinkers.

However, changes in lifestyle significantly improved sperm qualityby as much as 76%.

The lifestyle changes implemented included:

  • Quitting smoking or at least reduction of the number of cigarettes smoked per day
  • Reduction in alcohol consumption
  • Reduction in alcohol intake
  • Improved nutrition by increases daily consumption of fruits and vegetables

Primary ovarian insufficiency is not equal to infertility

May 5, 2010 by  

Primary ovarian insufficiency (POI) is a condition wherein young women present with menopausal-like symptoms. The symptoms range from irregular menstrual cycles, cessation of female hormone production, hot flashes, and yes – disruption of fertility. These young women – sometimes still in their teens or twenties – face loss of their reproductive potential rather early and become infertile. POI is actually quite common and is estimated to occur in 1 out of every 100 women under 40.

A recent study by researchers at the National Institutes of Health (NIH) reports some good for those women suffering from POI: most of them still have immature eggs in the ovaries! Thus, some of these women sometimes conceive unexpectedly. In fact, about 5 to 10% of women with POI can actually become fertile and get pregnant.

According to researcher Dr. Alan E. Guttmacher of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):

“The discovery that most women with primary ovarian insufficiency have immature eggs remaining in their ovaries raises the possibility of developing treatments for the infertility that accompanies the condition.”

How does POI happen? Senior author Dr. Lawrence Nelson explains:

“…during a normal menstrual cycle, the pituitary gland releases follicle-stimulating hormone (FSH), which causes follicles to grow. While they are growing, follicles release the hormone estradiol, a form of estrogen. The pituitary also produces another hormone, called luteinizing hormone (LH), which remains at low levels during most of the cycle and then surges when it is time to ovulate. This LH surge gives the follicle a signal to break open and release the egg… in women with primary ovarian insufficiency, both FSH and LH levels are higher than in women without the condition. “The high LH levels indicate that the pituitary is continually sending the ovaries the message to ovulate. The follicles get the message to mature before they are ready, and so they don’t grow normally, and in most cases, fail to release the egg.”

POI is treated by hormone replacement therapy to alleviate menopause-like symptoms such as the use of a patch which releases the hormone estradiol that lowers the LH levels to normal. Dr. Nelson and colleagues observed that although this therapy addresses the menopause symptoms, many of those who had the therapy became pregnant. It seems that the estradiol patch normalizes LH levels thus allowing the maturation of follicles.

The researchers are planning to pursue further studies to determine the real effects of the estradiol hormone therapy on ovulation.

Dr. Nelson continues

“The body needs estradiol both to prepare the lining of the uterus to support pregnancy and also to regulate FSH and LH levels in a feedback loop. We hope to test whether giving estradiol via a skin patch to women with primary ovarian insufficiency will tamp down their LH level, allow the follicles to mature at an appropriate time, and help women with this condition to ovulate.”

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NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.