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infertility

infertility problems and solutions

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May 15th 2018

The most common cause of female infertility – polycystic ovary syndrome – may be caused by a hormonal imbalance before birth. The finding has led to a cure in mice, and a drug trial is set to begin in women later this year.

three-quarters of whom struggle to fall pregnant. The condition is typically characterised by high levels of testosterone, ovarian cysts, irregular menstrual cycles, and problems regulating sugar, but the causes have long been a mystery. “It’s by far the most common hormonal condition affecting women of reproductive age but it hasn’t received a lot of attention,” says Robert Norman at the University of Adelaide in Australia.

Read more: We took his-and-hers fertility tests – this is what it was like

Treatments are available for helping affected women get pregnant, but their success rates are typically less than 30 per cent across five menstrual cycles.

Womb changes

Now, anti-Müllerian hormone.

The researchers discovered that pregnant women with polycystic ovary syndrome have 30 per cent higher levels of anti-Müllerian hormone than normal. Since the syndrome is known to run in families, they wondered if this hormonal imbalance in pregnancy might induce the same condition in their daughters.

To test this idea, they injected excess anti-Müllerian hormone into pregnant mice. As their female offspring grew up, they displayed many of the hallmarks of polycystic ovary syndrome, including later puberty, infrequent ovulation, delays in falling pregnant, and fewer offspring.

The excess hormone seemed to trigger this effect by overstimulating a set of brain cells that raise the level of testosterone.

Cure in mice

The team were able to reverse this effect in the mice using cetrorelix, an IVF drug routinely used to control women’s hormones. After treatment with this drug, the mice stopped showing symptoms of polycystic ovary syndrome.

The team is now planning a clinical trial of cetrorelix in women with the condition, which they hope to start before the end of the year. “It could be an attractive strategy to restore ovulation and eventually increase the pregnancy rate in these women,” says Giacobini.

“It’s a radical new way of thinking about polycystic ovary syndrome and opens up a whole range of opportunities for further investigation,” says Norman.

Read more: We’re heading for a male fertility crisis and we’re not prepared

If the syndrome is indeed passed from mothers to daughters via hormones in the womb, that could explain why it’s been so hard to pinpoint any genetic cause of the disorder, says Norman. “It’s something we’ve been stuck on for a long time,” he says.

The findings may also explain why women with the syndrome seem to get pregnant more easily in their usually signalling reduced fertility. But in women who start out with high levels, age-related declines may bring them into the normal fertility range – although this still needs to be tested, says Norman.

May 5th 2018

Can a high fruit diet help women conceive?

Eating plenty of fruit could help women conceive, a new study  suggests.

Researchers who looked at more than 5,500 women from Britain, Ireland, Australia and New Zealand found those who consumed the least fruit were 50 per cent more likely to be infertile.

And compared to women who ate fruit three or more times a day in the month before conception, women who ate fruit less than one to three times a month took half a month longer to become pregnant.

Similarly, compared to women who never or rarely ate fast food, women who consumed fast food four or more times a week took nearly a month longer to become pregnant. Their risk of infertility also doubled from eight to 16 per cent.

However the amount of green leafy vegetables and fish made no difference to conception times.

 Professor Claire Roberts, of the University of Adelaide, Australia, who led the study, said: "These findings show that eating a good quality diet that includes fruit and minimising fast food consumption improves fertility and reduces the time it takes to get pregnant."

First author, Dr Jessica Grieger, post-doctoral research fellow at the University of Adelaide, added: "We recommend that women who want to become pregnant should align their dietary intakes towards national dietary recommendations for pregnancy.

“Our data show that frequent consumption of fast foods delays time to pregnancy."

Previous research has focussed on the role that diet plays in women diagnosed with or receiving treatment for infertility however the impact of diet before conception for the general population has not been widely studied.

For the study pregnant women were surveyed by midwives on how long it had taken them to become pregnant, as well as their intake of fruit, and fast foods such as burgers, pizza, fried chicken and chips.

Dr Grieger said: "Most of the women did not have a history of infertility.

“We adjusted the relationships with pre-pregnancy diet to take account of several factors known to increase the risk of infertility, including elevated body mass index [BMI] and maternal age, smoking and alcohol intake.

“As diet is a modifiable factor, our findings underscore the importance of considering preconception diet to support timely conception for women planning pregnancy."

The research was published in the journal Human Reproduction .

April 25th 2018

Biology tends to play tricks on women

Before the digital age, the workings of the female body were even more mysterious and challenging to follow than today. Although women always had to be aware of the milestone dates of their cycles every month, tracking it was a hassle. Ten or fifteen years ago, paper-based menstruation calendars were supposed to help, but they usually had a tiny, not very user-friendly format, could not set reminders or send notifications, so it was easy to forget about them altogether.

Not to mention that women’s bodies are nothing like a Swiss atomic clock, sensitivity towards the weather or other environmental factors, stress or health issues can easily influence cycles. So, for many women the first day of menstruation usually came out of the blue, causing stress and unpleasant moments. Talking to the gynecologist could be an embarrassment, too, if you tended to forget the exact dates since the first thing they usually ask is about the cycle.

The entire situation was somewhat similar to ancient methods of fertility tracking, which were as efficient as trying to guess the number of red candies in a pack of M&Ms. When a couple wanted to start a family relatively fast, and they did not mind helping the process with a little bit of planning, they had to rely on rough estimations of menstruation and ovulation cycle. Luck, coincidence, God or the “universe” played a huge role in family planning.

e Ava fertility tracker offers a viable alternative to menstruation and fertility tracking apps as it promises accurate data measurement and a user-friendly solution for women trying to get pregnant. We tested the tracker and had an overall positive experience. Here’s our verdict.

Biology tends to play tricks on women

Technology helps reduce the role of luck

When smartphones with cycle and ovulation tracking apps appeared, many women could feel a bit relieved. Via the majority of these apps, you can not only track your period – together with any symptoms, such as mood swings, severe cramps, headaches, bloating -, but they usually predict when your next cycle begins. In the last couple of years, some apps have even been amended with machine learning technologies to read data patterns and predict the workings of the female body even more precisely. Period Calendar, Flo Period Tracker, Clue, My Calendar, Glow, Eve, Period Tracker Lite, Period Plus, My Cycles, Cycles – the list is too long to recount; these were the best ones according to Medical News Today in 2018.

The situation is somewhat similar when looking at the landscape of fertility trackers as they are understandably linked to menstruation cycle tracking. Glow, Clue and many other period trackers help figure out when is the best time to conceive, too. Many apps, such as Fertility Friend or Ovia use only data to try to do the guesswork, but many others already realized that they need sensors for estimating ovulation more accurately. Kindara and Natural Cycles use specific thermometers, Daysy has a fertility monitor, OvaCue and Me.Mum use saliva. Maja Bujas, CEO, and Co-founder of Me.Mum told The Medical Futurist that she developed her saliva testing solution for women using smartphones when she wanted to get pregnant. She aimed to increase accuracy and offer a user-friendly procedure that anyone can do at home.

The Ava fertility tracker has a similar promise, but a different solution. They use a wristband to measure many health parameters, just as in case of a fitness tracker, while you follow your results and estimations on a smartphone app. It certainly looks promising, and the editor of The Medical Futurist had the chance to test and review it for you. Let’s see how it performed!

Source: www.medicalnewstoday.com

Ava: cycle, fertility and pregnancy tracker

The Zurich-based company developed Ava for women who want to know more about their bodies: observe their menstruation or ovulation cycles or follow their pregnancies. Via logging symptoms as well as data, users can identify changes that may indicate potential health issues, while they can also get a clearer picture and a more accurate prediction when they are likely to be most fertile – not matter whether they try to get pregnant or avoid that situation.

The tracker itself is a fitness wristband-like device. It has a neat and streamlined design with a lovely color. It is great to see that designers and developers are moving beyond the girly equals pink and boyish equals blue scenario. Moreover, the sensor itself is put into a grey shell inspired by the process of conception – the logo of Ava also resembles that. In the box, you can find the bracelet itself, the micro USB cable for charging, as well as some information about the product.

The charging and the measurement process

Before going into details about what and how Ava measures, some words about the measurement process and charging the device. The latter is apparently the weakest point of the tracker. You have to charge it every day by plugging it into your computer or any other machine with a USB connector. When you plug it in, the tracker first starts synching with the Ava app via Bluetooth to read the measurement data. It works nicely, although sometimes you cannot really see whether the bracelet is charged as if you don’t connect it to the app, a blue dot is flashing for a while. But then it becomes quite clear: if the dot lights up red, it needs charging, if it’s green, the Ava is ready for use.

It is convenient that you do not have to wear the Ava bracelet throughout the entire day, only at nights. You just put on the bracelet and go to sleep. The users only have to keep in mind that the tracker only works if they wear it for at least four hours with three hours of sleep. But let’s be honest here: that doesn’t sound like an unachievable goal. It is an excellent feature of the sensor that it lights up green when it touches the skin, so the user precisely knows it started to work.

Source: Ava Women

What does Ava measure and how?

The company says on its website that Ava was clinically tested in a year-long study at the University Hospital of Zurich, and their first findings were published in the peer-reviewed journal Scientific Reports. It is an FDA-registered and a CE-certified device which measures skin temperature, resting pulse rate, breathing rate, heart rate variability ratio, perfusion, movement, bioimpedance, heat loss and sleep.

Ava measures skin temperature to identify fertility phases – as skin temperature rises by about 1.5 degrees after ovulation and it remains elevated until the next period. During pregnancy, skin temperature is also higher than usual. It is also useful to know that skin temperature is generally lower than the value you get with a thermometer. The tracker measures resting pulse rate, which is higher at the beginning of the fertile phase. The value varies between 40 and 80 bpm, but if someone is more physically active, the rate might even go lower than 40.

The range for breathing rate is between 10-25 bpm, and it’s usually higher in the phase before menstruation. The heart rate variability ratio or HRV ratio is the variation in the time interval from one heartbeat to the next. Researchers use it as an indicator of physiological stress. In the case of Ava, the lower the HRV ratio, the less stressed you are.

Ava measures your sleep as well: how much light, deep sleep you experience and how much time you spend at night in REM phase. Although there are many other trackers for sleep quality, this information is useful to see how menstruation affects sleeping patterns.

  

Personal experience with Ava

While it took a learning period – approximately one week – to get Ava into the daily routine before going to bed, the richness of data compensated for the tiny inconveniences. The tracker and the app work nicely. The app displays data in a very user-friendly way and shows little tips for women – when to try getting pregnant, what happens during the luteal phase, what happens with an unfertilized egg. It’s easy to use and very straightforward.

Although we do not have a way to show whether the data is indeed accurate, and we cannot expect the same accuracy as in the case of the major fitness trackers, it seems to work and be in line with expectations. You can even receive your data in an e-mail and show it to your gynecologist.

The Ava fertility tracker clearly represents a niche area as many women believe apps are not enough for fertility tracking anymore but want something more accurate and user-friendly, which they can use at home. The fact that it can also track stress levels or sleep is a bonus. Although we would not recommend it for daily use mainly because of the charging issue, if a woman wants to get pregnant, it is genuinely worth discovering what Ava has to offer. And along the way, you might find something about your body that you never knew.

April 24th 2018

First scrotum and penis transplant performed in John Hopkins University

A man who lost his genitals in a war injury has received the world's first full penis and scrotum transplant. 

Surgeons at Baltimore's John Hopkins University have rebuilt the veteran's entire pelvic region from the parts of a deceased donor.

It is hoped that the operation will give the injured man full urinary and sexual function within weeks.

In an ambitious March operation lasting 14 hours, surgeons connected tiny nerves, blood vessels, skin, muscles and tendons to rebuild both the man's penis and extensive surrounding tissue.

While a handful of successful penis transplants have been reported in recent years, this was the first to reconstruct the scrotum as well - making it far more complex and expensive than previous procedures.

The recipient, who wishes to remain anonymous, said he "felt finally more normal" on waking up from the operation.

"It's a real mind-boggling injury to suffer; it is not an easy one to accept," he said.

The extent of the patient's injuries - he had lost his penis, scrotum, and much of his abdominal wall - meant taking an exact replica of what was missing was the most sensible option for the surgeons treating him.

"We've really replaced like with like," surgeon Dr Richard Redett said. "We looked at the defect our patient had and procured the exact same graft from our donor."

The full transplant is radically different to current procedures - often used in transgender surgery or to treat congenital abnormalities - that use a patient's own skin to construct a penis.

Such operations require patients to use an implant to achieve an erection, bringing a higher risk of infection than the highly experimental full transplant.

But while they avoid such problems, transplants present new ethical problems in penis surgery.

The families of deceased donors need to give explicit permission for a penis - as parts of the face or hands - to be given for transplant, for example.

It was also decided in this operation that a scrotum transplant should not extend to the donor's testicles, which would bring the possibility of having children. "We just felt there were too many unanswered ethical questions," surgeon Damon Cooney said.

Surgeons at John Hopkins described lost penises as "an unspoken injury of war", suffered in silence by patients who face stigma as well as a loss of sexual intimacy and urinary function.

The US Department of Defense trauma registry has recorded 1,367 male service personnel with having suffered genitourinary injuries between 2001 and 2013, although it is not clear whether how many of those resulted in the loss of all or part of the penis.

Patients can also lose a penis through cancer or accidents. One previous penis transplant, in China, was reversed after psychological problems experienced by the recipient and his wife.

After the surgery in March, however, doctors say the first penis and scrotum recipient is doing well.

March 15th 2018

 Male infertility is the most common reason couples in the UK have IVF treatment, official UK data has revealed. 

The most common reasons for IVF treatment after male infertility (37%) were ovulatory disorder (13%), blocked fallopian tubes (12%) and endometriosis (6%), although in 32% of cases the cause of infertility was unexplained.

The Human Fertilisation and Embryology Authority’s (HFEA) report for 2014-2016 revealed that 40 years after the first child was born following in vitro fertilisation, IVF treatment is at the strongest it has ever been in the UK. The report showed that in 2016, more than 68,000 IVF treatments were performed (an increase of 4% from 2015), with over 20,000 babies born. Current treatments are now 85% more likely to succeed than when records began in 1991, as the average birth rate per embryo transferred for women of all ages is 21%.

“Assisted reproduction has come a long way in the 40 years since British doctors pioneered IVF with the birth of Louise Brown,” said Sally Cheshire, chair of the HFEA. “With well over a million treatments performed in the UK since records began, and more than 300,000 babies born, as a country we remain at the forefront of fertility treatment.” 

Age remains the single most important factor for successful outcomes from fertility treatment. The average birth rate for women of all ages is 21%, while women under 35 have a 29% chance of a successful birth. 

In 2016, 42% of patients undergoing IVF treatment cycles were aged under 35. 23% were aged between 35-37, 14% aged 38-39, 14% 40-42, 4% 43-44 and 3% over 44 (1,812).

The HFEA noted several other trends in its latest report: Treatments involving donor eggs and sperm are becoming more popular. In 2016, 4,306 treatment cycles involved a patient using their own eggs and donor sperm, up 15% from 3,749 in 2015. There were also 3,000 IVF treatment cycles using donor eggs and partner sperm – a year-on-year rise of 6%.

The report also found that since 2014, the number of IVF treatments for patients with a female partner has increased by 30% and the number of IVF treatments for patients with no partner increased by 35%. IVF treatments for patients with a male partner increased by 6% over the same period.

Overall, heterosexual couples still account for the vast majority of all treatments. In 2016, 64,903 IVF treatments were for women who registered with a male partner (95%); 1,683 for women who registered with a female partner (3%) and 1,272 for women who registered with no partner (2%). 

I am delighted to see that more people than ever before are able to have successful treatment."Sally Cheshire CBE, chair of the HFEA

Despite a general increase in birth numbers, the report revealed that the multiple birth rate continues to fall. This is a positive step, as multiple births carry significant risks for both mother and child. Multiple births have reduced from 28% of IVF births in 2008 to 11% in 2016 - its lowest rate to date.

Other significant findings included the number of cycles using eggs frozen for later treatment rose by 10% in the last recorded year, with 1,170 freezing cycles in 2016. The age profile for women having egg thaw cycles is very different from standard IVF treatment, with the largest group aged over 44 (27%). Only 17% of patients using thawed eggs in treatment were aged under 35.

And, for the first time ever, the HFEA detailed the number of surrogacytreatments taking place in UK clinics: 232 surrogate cycles, and 79 births in 2016. The birth rate for surrogates is also higher than IVF overall, at 26% when using fresh embryos.

Cheshire added: “I am delighted to see that more people than ever before are able to have successful treatment. But the same level of care must be shown to those patients whose treatments do not result in a birth. In that way, the UK will lead not just in clinical treatment, but in the provision of vital emotional support from the beginning to the end of each patient’s journey”.

In 2016, 41% of IVF treatments across the UK were funded by the NHS, a ratio that has remained broadly stable since around 2010.

March 10th 2018

Fish oil and probiotic supplements for pregnant mothers may decrease children's allergy risk

Fish oil supplements and probiotic yoghurts during pregnancy may decrease children’s risk of developing allergies, a major evidence review has found.

The study on how childhood allergies are influenced by mothers’ diet also found that avoiding key foods like peanuts, eggs and dairy had little impact on future allergies or eczema.

The findings are now being considered by the British Government and could influence new dietary guidance for expectant mothers and infants.

“Food allergies and eczema in children are a growing problem across the world,” said lead author Dr Robert Boyle from the Department of Medicine at Imperial College London.

“Although there has been a suggestion that what a woman eats during pregnancy may affect her baby’s risk of developing allergies or eczema, until now there has never been such a comprehensive analysis of the data.

“Our research suggests probiotic and fish oil supplements may reduce a child’s risk of developing an allergic condition, and these findings need to be considered when guidelines for pregnant women are updated.”

Food allergies affect around one in 20 children in the UK.

These are caused by the immune system becoming sensitive to harmless chemicals in foods like peanuts or dairy and over-reacting. Then this triggers the body’s defence response that includes rashes swelling, and the closing off of the airways.

Eczema, a condition causing cracked, dry and itchy skin, affects 20 per cent of UK children. It is also linked to children having a higher risk of food allergies, although it’s not clear why.

The Imperial team reviewed over 400 studies, covering 1.5 million people, on the link between maternal diet, allergies and breast feeding, for the research – which is published in PLOS Medicine. It was funded by the Food Standards Agency.

Pooling multiple studies in this way means results are less likely to be statistical one offs.

The studies on probiotics and fish oil were all controlled trials where mothers were randomly assigned to a particular diet instead of just reporting what they ate, which also lends credibility to the results.

Looking at 19 studies where mothers took a daily fish oil capsule, they found there was evidence to suggest the daily omega-3 supplement from 20 weeks of pregnancy, and in the first three to four months of breast feeding, decreased the risk of allergies.

These studies tested infants for an egg sensitivity as a proxy for developing other allergies in future.

There was also some evidence to suggest omega-3 could reduce peanut allergies, by as much as 38 per cent. However this was only identified in two studies and therefore not as reliable.

The 30 per cent reduction amounts to around 31 fewer children with an egg allergy for every 1,000 mothers following this regime.

It also looked at 28 trials, covering 6,000 women, taking a variety of probiotic supplements 0 though most of them contained a bacterium called Lactobacillus rhamnosus.

While probiotic yogurt drinks are one source of these sort of gut boosting bacteria, most don’t contain a high enough concentration of helpful bacteria and these studies mostly looked at pill or powder supplements.

The analysis found taking probiotics in the last few weeks of pregnancy and in the first three to six months of breastfeeding, was related with a 22 per cent decrease in eczema cases in children – around 44 fewer cases in every 1,000.

Researchers found some limited evidence to support the suggestion that maternal breast feeding alone helped reduce eczema rates, and could also have benefits for lowering the risk of type one diabetes.

But there was not enough evidence to support other supplements, or leaving out certain foods.

“This is an important, well conducted piece of research, which adds to the growing evidence suggesting that nutrient supplementation during pregnancy and lactation may have the potential to prevent childhood allergy and allergic disease,” said Seif Shaheen, professor of respiratory epidemiology at Queen Mary University of London, who was not involved with the study.

Mar 1st 2018

Things you need to know about endometriosis and fertility

Endometriosis is a common and long-term condition which affects roughly one in 10 women in the UK.

It occurs when the lining of the uterus (endometrium) grows in other places, such as the fallopian tubes, ovaries or along the pelvis. The condition causes heavy and painful periods as well as pain in the lower abdomen, pelvis, or lower back.

Approximately 30% of women with endometriosis have fertility problems, which can occur as a result of scarring on the tubes and ovaries, issues with the quality of the egg or problems caused by the embryo travelling down the tube and implanting in the wall of the uterus.

For those of you who are worried about your fertility following an endometriosis diagnosis, we caught up with Mr Anthony Rutherford, Consultant Gynaecologist in reproductive medicine and surgery at Leeds Centre for Reproductive Medicine, who gave us his advice on how to deal and treat endometriosis in order to preserve fertility...

1.Act on your symptoms

"It is very important that women are aware of the symptoms of endometriosis as you may not discover you have the disease until you are actively trying for a baby. If you have a history of painful periods, including pain before you start your period as well as during, and have experienced pain during sex then I would advise speaking to your doctor.

"Early referrals for women with endometriosis are vital as surgical treatment in most circumstances would improve your outcome of natural conception in the future. In the biggest surgical study conducted in women with endometriosis, patients who had treatment for the disease compared to those that didn't were assessed across a nine-month period post treatment. The results showed a 17% chance of natural conception if women had no treatment and a 30% chance if they had treatment."

With diagnosis for endometriosis taking an average of 7.5 years in the UK, Endometriosis Awareness Week (3rd - 11th March) is aiming to raise awareness of the signs and symptoms of the condition for women who may not yet have a diagnosis.

2.Endometriosis doesn't stop conception

"Women with endometriosis can get pregnant naturally but have about half the chance of getting pregnant compared to their peers of a similar age. If you have been diagnosed I would recommend asking your doctor about your options as each case needs to be treated individually. This could involve trying to conceive naturally for six months or surgery to aid conception. If you have been trying for 2-3 years then you should explore alternative methods such as IVF as this would improve the chances of conceiving."

3.Don't rush into invasive surgery

"Having invasive surgery when you are already trying to conceive could delay conception, as medical management of the condition involves suppressing ovulation (which of course will stop you getting pregnant). There is no evidence that treating endometriosis before IVF would improve the outcome.

"I think that a lot of patients might benefit from not having to go through difficult and stressful surgery at a time when they are trying to conceive. Ultimately, having surgical treatment when you are already struggling with conception delays the fertility treatment itself and further delays the pregnancy. The other consideration about operating on an endometrioma is that while an ovarian cyst may be removed part of the normal functioning ovarian tissue may also be removed and that would mean a woman's ovarian reserve would be reduced on that side."

Mr Anthony Rutherford will be attending The Fertility Show, which takes place in Manchester from the 24th-25th March.

Feb 14th 2018

Five myths about emergency contraception you need to stop believing

Being clued up on emergency contraception (EC) is a must for anybody wanting to enjoy worry-free sex. However, it can often be difficult to separate certain facts from unhelpful fiction. Here, we bust some common EC myths for good. 

1. There is only one method of EC available

WRONG. There are actually two forms of emergency contraception that can be used to prevent pregnancy after unprotected sex. These are the emergency IUD (AKA the emergency coil) and the morning after pill. Pharmacist Deborah Evans explains: 

"You should speak to a healthcare professional about the various options available and the differences in effectiveness to ensure you are able to make an informed decision based on what is most suitable for you. We are there to help you at what can be a very anxious time."

2. EC can only be use the morning after unprotected sex

The term 'morning after pill' is actually very deceiving, as you're supposed to use emergency contraception as soon as possible after having unprotected sex.

However, the timescale does vary depending on what sort of EC you take. Levonorgestrel pills can be taken within three days (72 hours) of unprotected sex, while ulipristal acetate pills (such as ellaOne) can be used within five days (120 hours). The emergency IUD can also be inserted up to five days after unprotected sex. Deborah says: 

"Both pills work by preventing or delaying ovulation and must therefore be taken as soon as possible as they are not effective if ovulation has already taken place, so the sooner the better. The emergency IUD… Isn't always the most practical [choice], as it must be fitted by a trained health care professional."

3. The morning after pill affects your fertility</h3>

There is no evidence that taking the morning after pill, even multiple times, will affect your fertility or reduce your chances of falling pregnant in the future. It also does not work by causing an abortion or an 'emergency period'. Deborah explains: 

"The morning after pill works by delaying or inhibiting egg release. This means that the sperm waiting in the fallopian tubes will be unable to meet an egg and fertilise it. This is similar to regular contraceptive pills, which also work by preventing egg release."

She adds: 

"EC will not protect you from possible pregnancy if you have unprotected sex again several days after taking it. If you want to have sex after using the morning after pill, use a barrier method (like a condom) until your next period even if you use regular contraception. If you do not have a regular contraception method in place, then have a conversation about the options available with your healthcare professional."

4. EC comes with lots of side effects

All medicine comes with potential side effects, but that doesn't mean everyone will experience them in exactly the same way.

"The most common side effects are headaches, nausea, tummy pain and painful periods. Women sometimes experience delayed periods and if this happens, you should take a pregnancy test or speak to a healthcare professional. If you become ill (and vomit) within the first three hours after taking the morning after pill, you will need to go back to the pharmacy and take another one immediately."

5. The morning after pill is difficult to get</h3>

There are all sorts of channels through which you can access emergency contraception, including direct from the pharmacy (without a prescription), a sexual health clinic, your GP or a walk-in centre. It is also possible to order the morning after pill online, although research suggests that only 7% of women are aware of this. All you have to do is complete a selection of health-related questions on the pharmacy website to ensure the medication is appropriate for you. Deborah comments:

"[Ordering] the emergency contraceptive pill in advance allows you to have a provision to hand in your medicine cabinet. This means you can take it as soon as possible should you ever need to in the future, however if anything has changed in your general health or you are taking any new medicines, then do ask for some advice from your pharmacist before taking it."

If you require emergency contraception after unprotected sex or contraceptive failure, bear in mind that it is more effective the sooner it is taken. For this reason it is important that you choose a service that will ensure you can get emergency contraception as quickly as possible.

Feb 1st 2018

Permission given to create Britain's first 'three-person babies'

Doctors in Newcastle have been granted permission to create Britain’s first “three-person babies” for two women who are at risk of passing on devastating and incurable genetic diseases to their children.

The green light from the fertility regulator means that doctors at the Newcastle Fertility Centre will now attempt to make healthy embryos for the women by merging fertilised eggs created through standard IVF using DNA from female donors.

MRT is an experimental treatment that was made legal in Britain in 2015. It aims to prevent serious disorders from being passed to children, caused by mutations in mitochondria, tiny structures that provide energy inside cells. Children inherit all their mitochondria from their mothers. MRT uses healthy donor mitochondria to replace the faulty ones.

The child therefore has the usual 46 chromosomes from its parents, plus additional DNA from the donor's mitochondria. To perform MRT doctors fertilise an egg from the affected woman with her partner's sperm using normal IVF techniques. But instead of letting the egg then develop into an embryo, the chromosomes are taken out and dropped into a healthy donor egg that has had its own chromosomes removed.

The resulting embryo now has DNA from both parents, as usual, plus mitochondrial DNA from the donor.

The Human Fertilisation and Embryology Authority (HFEA) confirmed on Thursday that it had approved the procedures which will now be overseen by Mary Herbert, professor of reproductive biology, and her team at the Newcastle clinic.

The women will be the first in Britain to have so-called mitochondrial donation therapy, a radical IVF procedure that was made legal by parliamentary vote in 2015. The Newcastle centre was granted a licence to perform the treatment, also known as mitochondrial replacement therapy, in March last year

While doctors at Newcastle Fertility Centre said they could not to talk about the cases, citing patient confidentiality, minutes from the HFEA’s approval committee reveal that the two women carry mutations in a gene that causes a rare condition known as myoclonic epilepsy with ragged red fibres, or Merrf syndrome. No more details are given on the women because both wish to remain anonymous.

Merrf syndrome can be a devastating neurodegenerative disorder that worsens over time and often results in an early death. The condition, which affects one in 100,000 people, is typically diagnosed in early childhood or adolescence when people develop sudden spasms which progress to a loss of muscle control, weakness, deafness and dementia.

Having reviewed the women’s medical and family histories, the HFEA committee agreed that any children they conceived may be affected by “serious multi-systemic and progressive disease” which would severely affect their quality of life. Neither woman was deemed suitable for an IVF procedure called pre-implantation genetic diagnosis (PGD), which can pick up harmful mutations in IVF embryos, but can only help if at least some of the embryos are healthy.

Salvatore DiMauro, an expert in mitochondrial disease at Columbia University in New York, said he was glad to hear that Newcastle was going ahead with the procedure to help the women. “It’s good to do this. Merrf is a crippling disease. It’s the only way to be sure it is not passed on,“ he said.

The vast majority of a person’s genes – about 99.8% – are found on the 23 pairs of chromosomes that sit inside the nucleus in each cell in the body. The women who will be treated in Newcastle carry mutations in the small amount of extra DNA that is bundled up in their mitochondria, the tiny battery-like structures that surround the cell nucleus in their thousands. While men and women both have mitochondria, they are passed solely from mother to child. Mutations in mitochondrial DNA cause thousands of genetic diseases that tend to hit the energy-hungry brain, heart and muscles, and worsen with age.

The two women in Newcastle will not be the first in the world to have the therapy. In 2016, John Zhang, a doctor at the New Hope Fertility Center in New York, announced the birth of an apparently healthy child created in a similar way at a clinic in Mexico. While news of the birth was welcomed by many scientists, some voiced concerns that the child might not have the regular follow-up checks that are needed to ensure it is developing properly.Mitochondrial donation therapy was pioneered at Newcastle by the neurologist Doug Turnbull to prevent women passing on harmful mitochondrial DNA mutations to their children.

To perform the procedure, doctors create a fertilised egg using IVF as normal. But rather than letting it develop into an embryo, the parents’ chromosomes are removed and placed inside a donor egg that has had its own genetic material removed. The embryo so created has all of the parents’ chromosomes, but the mother’s damaged mitochondria are replaced with the donor’s healthy ones. Doctors in Newcastle did not confirm whether they had already performed the procedure.

Professor Sian Harding, director of the British Heart Foundation Imperial Cardiac Regenerative Medicine Centre in London said Britain had reached the point of treating women with mitochondrial donation therapy “after a very thorough public consultation process”.

“It is absolutely fantastic that we have got to this point in such a well-regulated and controlled way,” she added. “It is going to be so important now to follow up and understand whether this is successful and how we can take it forward. If you don’t follow up the children, we just won’t know whether this is the right thing to do.”

An HFEA spokesperson said: “Our statutory approvals committee has considered applications from the Newcastle Fertility Centre at Life, part of Newcastle upon Tyne Hospitals NHS Foundation Trust, for the use of mitochondrial donation in treatment for two patients, both of which have been approved.”

Jan 31st 2018

Following this one diet may boost women's chances of pregnancy through IVF

Women who are hoping to get pregnant through in vitro fertilisation (IVF) may significantly improve their chances of success by following a Mediterranean diet. 

That's according to scientists at the University of Athens, who found that women following this style of eating in the six months before beginning fertility treatment had a much higher chance of becoming pregnant and giving birth successfully than those who did not.

In the study, which was published today in the journal Human Reproduction, scientists asked 244 women about their diets before they went through IVF.

And those who most closely followed the Mediterranean diet – which is characterised by lots of fresh vegetables, fruit, whole grains, legumes, fish and olive oil, as well as a reduced amount of red meat – had a 65-68% greater chance of having a successful pregnancy and birth than those participants with the lowest adherence to this style of eating.

'The important message from our study is that women attempting fertility should be encouraged to eat a healthy diet, such as the Mediterranean diet, because greater adherence to this healthy dietary pattern may help increase the chances of successful pregnancy and delivering a live baby,' said study leader Professor Nikos Yiannakouris in a release.

In fact, the team believe that both partners should consider following the Mediterranean diet while attempting to conceive through IVF.

'It should be noted that when it comes to conceiving a baby, diet and lifestyle are just as important for men as for women,' he continued.

'Previous work from our research group among the male partners of our study has suggested that adherence to the Mediterranean diet may also help improve semen quality.

'Taken together, these findings highlight the importance of dietary influences and diet quality on fertility, and support a favourable role for the Mediterranean diet on assisted reproduction performance.'

Dec 26th 2017

Eight lies we all still believe about fertility

There are too many myths surrounding fertility and falling pregnant. Here, with a little help from the experts, we attempt to bust some of the biggest... 

Myth 1: A woman's fertility drops drastically at 30

Women are led to believe that putting off having a baby until their 30s is risky business. But is it really that much harder to conceive when you're 28 than when you're 32? Dr Geetha Venkat, director of Harley Street Fertility Clinic, says:

'Ovarian reserve and egg quality keep declining as a woman gets older, but it's a gradual process – it doesn't just happen overnight. Your eggs don't go rotten at the stroke of midnight on your 30th birthday! However, we do always encourage people to start their families when they are young as younger eggs tend to be healthier.'

Dr Venkat says that while the drop in fertility between the ages of 30 and 35 is on a gentle curve, the decline is sharper when a woman hits 40 – and sharper still after your 42nd birthday.

Myth 2: All women ovulate on day 14

No two cycles are exactly the same: yours could be 28 days long, while your best friend's is 32. So why would you both ovulate on day 14? It's simple – you wouldn't. Dr Ernesto Bosch, from the world-renowned IVI fertility clinic in Spain, says that the highest probability of ovulation is between days 12 and 18: 

'Many couples that are trying to conceive pin their hopes on having sex on one day of the month, thinking that's the best chance of conception. It's much more effective to have sex every day between days 12 and 18.'

Myth 3: Men can have healthy babies at any age

A quick glance at any newspaper or magazine will reveal an article about modern women leaving motherhood too late, while we all assume men can wait their whole lives to become dads. Not true: a 2014 study showed that children born to fathers over the age of 45 are 13 times more likely to have ADHD, 3.5 times more likely to have autism, and 25 times more likely to have bipolar disorder. Just this year, Dr Kevin Smith from Abertay University in Dundee called for all men to freeze their sperm at 18 to avoid adverse health outcomes in their babies. Children of older fathers are also twice as likely to drop out of school early and have low IQs. Plus, a woman is more likely to miscarry if her partner has sperm with highly fragmented DNA – which occurs in older men. Dr Geetha Venkat, says,

'My message to all men is if you want to have a healthy baby, don't think you can start at the age of 70.'

Myth 4: Taking the Pill affects your future fertility

Mr Mostafa Metwally, a consultant gynaecologist at BMI Thornbury, says

'The Pill doesn't harm fertility in any way. While you're taking the Pill, you stop ovulating, but this effect is limited to the time you're taking the Pill and it doesn't harm your eggs. Occasionally, it can take a few months for you to start ovulating again after coming off the Pill, so it may take a few months for you to get pregnant.'

Indeed, recent studies show that 80% of woman who want to conceive after coming off the Pill do so within a year – the same proportion as that of the general population. But Mr Metwally does add, 'If you have a condition that affects your fertility, such as polycystic ovaries (PCOS), the Pill can mask the symptoms of irregular periods, and you won't know you have it.' Dr Venkat adds that if you have the symptoms of PCOS and want to go on the Pill to correct your hormone imbalance, you must be counselled on this fact and should be told that it may take longer to conceive when you do come off the Pill. 

It's important that women do not view breastfeeding as a contraceptive

Myth 5: You can't conceive while breastfeeding

You don't have a period, so you can't get pregnant – right? Nope. Mr Metwally says that when you're breastfeeding, levels of a hormone called prolactin, which is responsible for milk production, are raised and this stops the ovaries from producing an egg each month. However, when you've been breastfeeding for a while – a few months – your levels of prolactin go up and down in spikes, so an egg could escape. This can even happen without you having a period. Then the next thing you know, you're pregnant! 'It's important that women do not view breastfeeding as a contraceptive,' says Mr Metwally. 

Myth 6: We're all born with the same number of eggs

Although each woman is born with the total number of eggs she'll have throughout her lifetime, that number is not the same for all women. In 2012, researchers found that if your mother starts menopause early (before age 45), your ovarian reserve – or how many eggs you've got left stored up – is depleted quicker than if she had started menopause later. But before you go into panic mode about your diminishing egg stores, Mr Metwally points out that it is the quality of eggs that matter and not quantity. 

'Women shouldn't use an ovarian reserve test to determine when they should have babies, as it doesn't tell you anything about the quality of your eggs. Someone who's 40 when they come in for fertility treatment may have a lower success rate than someone of the same age with a lower ovarian reserve, but this is because their eggs may be of a lower quality.'

Myth 7: There are contraceptive pill hormones in our drinking water

Scaremongering in the press has led us to believe that our increased use of the contraceptive Pill has contaminated our drinking water with synthetic hormones. Some news reports have gone as far as comparing the potential effects to those of the thalidomide controversy or mad cow disease.

However, in 2011, Tracey Woodruff and her team at the University of California in San Francisco published a report in Environmental Science and Technology that debunked the synthetic hormone in water myth. They found that the amounts of synthetic hormone – namely oestrogenic compounds – leaked into waterways from the Pill are negligible. In fact, crop fertilisers, hormones form livestock, chemicals, medications, pregnant women and wait for it – men – are just as likely to contribute natural or synthetic oestrogen to our water than the Pill.

Myth 8: Sperm allergy = no pregnancy

Human seminal plasma hypersensitivity – or being allergic to semen – may cause genital itching, burning and swelling after sex (apart from when you use a condom) but it doesn't mean you have to ignore your dreams of having a family. Desensitisation therapy, which involves treatment with allergy injections containing small amounts of your partner's sperm and having sex two or three times a week to get your body used to the sperm, can help. Interesting fact: the first successful pregnancy by insemination in a woman with sperm allergy was in 1981 – she had twins.

Dec 14th 2017

An IVF baby was born with cystic fibrosis after its parents were mistakenly identified as not being carriers of the condition, according to a report.

The Human Fertilisation and Embryology Authority (HFEA) said the grade A incident, the most severe, took place after screening results from a pathology laboratory were not properly read by the treating clinician, and were not signed and transposed into the patients’ medical records.

The case was detailed in the HFEA’s first 'state of the sector' report, which contained largely positive news about IVF in the UK.

It said the number of women who have twins, triplets or more following IVF treatment has reduced from nearly one in four in 2009 to one in 10, described as a 'fantastic' achievement which has increased the safety of the procedure for mothers and babies.

The drop in multiple births has also reduced the burden on NHS antenatal and neonatal services, the Government’s independent regulator overseeing fertility treatment and research said.

But it added that 'some areas for concern' included that the number of reported adverse incidents increased last year, from 497 in 2015 to 540.

Of these, 325 were categorised as grade C and 176 were grade B, with just the one grade A incident in 2016.

Other findings from that incident were that there was no robust system providing evidence that reports are reviewed by the treating clinician or nurse before being filed.

The clinic, which was not named, did not have a standard operating procedure to ensure reports are allocated to the appropriate member of staff for review.

It added that changes have been implemented since.

The HFEA said that through working with licensed clinics in the UK, it has reduced the national multiple birth rate from 24% in 2009 to 11%. This has come without a reduction in birth or pregnancy rates, with the latter rising from 24% in 2008 to 32%.

Multiple births are the greatest risk associated with fertility treatment.

At least half of twins are born premature and underweight, which can lead to serious health problems and even death.

Mothers are far more likely to have an early or late miscarriage if they are carrying multiple babies and are more likely to suffer from health problems such as high blood pressure, gestational diabetes, anaemia and haemorrhage.

More than 76,000 cycles of IVF were carried out in 119 licensed fertility clinics across the UK in 2016/17.

Three in five treatments (60%) were paid for by patients themselves.

There are 132 treatment and research clinics working under licence in the UK, of which 34% are privately run, 29% are in public/private partnership, and 22% are NHS only, according to the report. The remaining 15% are research only.

NHS Choices estimates that around one in seven couples in the UK have trouble conceiving, around 3.5 million people.

IVF success rates depend on how old the woman is, ranging from 32.2% of treatments resulting in a live birth for women under the age of 35 in 2010, to just 5% for women aged 43 to 44.

The National Institute for Health and Care Excellence (Nice) recommends eligible patients should have access to three rounds of IVF funded through the NHS, but just 12% of local health bodies offer this many cycles. Others offer one or two cycles and some offer none at all.

Costs vary but they can be around £5,000 for one cycle.

HFEA chairwoman Sally Cheshire said the report 'outlines the importance of us working together to ensure patients, donors and the donor-conceived get the highest possible quality care'.

Nov 26th 2017

Females' Eggs May Actively Select Certain Sperm

New evidence challenges the oldest law of genetics.

In the winner-takes-all game of fertilization, millions of sperm race toward the egg that’s waiting at the finish line. Plenty of sperm don’t even make it off the starting line, thanks to missing or deformed tails and other defects. Still others lack the energy to finish the long journey through the female reproductive tract, or they get snared in sticky fluid meant to impede all but the strongest swimmers. For the subset of a subset of spermatozoa that reach their trophy, the final winner would be determined by one last sprint to the end. The exact identity of the sperm was random, and the egg waited passively until the Michael Phelps of gametes finally arrived. Or so scientists have thought.

Joe Nadeau, principal scientist at the Pacific Northwest Research Institute, is challenging this dogma. Random fertilization should lead to specific ratios of gene combinations in offspring, but Nadeau has found two examples just from his own lab that indicate fertilization can be far from random: Certain pairings of gamete genes are much more likely than others. After ruling out obvious alternative explanations, he could only conclude that fertilization wasn’t random at all.

“It’s the gamete equivalent of choosing a partner,” Nadeau said.

His hypothesis—that the egg could woo sperm with specific genes and vice versa—is part of a growing realization in biology that the egg is not the submissive, docile cell that scientists long thought it was. Instead, researchers now see the egg as an equal and active player in reproduction, adding layers of evolutionary control and selection to one of the most important processes in life.

“Female reproductive anatomy is more cryptic and difficult to study, but there’s a growing recognition of the female role in fertilization,” said Mollie Manier, an evolutionary biologist at George Washington University.

* * *

The idea of sexual selection is as old as Charles Darwin himself. In On the Origin of Species, he wrote of the peacock’s showy tail and the elk’s giant antlers as examples of traits that evolved to help males show off their appeal as mates to females. For the next century, biologists focused on all the aspects of sexual selection that operated in the events leading up to copulation. After mating, the female had made her choice, and the only competition was among the sperm swimming to the egg.

This male-oriented view of female reproductive biology as largely acquiescent was pervasive, argued Emily Martin, an anthropologist at New York University, in a 1991 paper. “The egg is seen as large and passive. It does not move or journeybut passively ‘is transported’ ... along the fallopian tube. In utter contrast, sperm are small, ‘streamlined,’ and invariably active,” she wrote.

“There are incredible things that eggs and seminal fluid can do.”

Beginning in the 1970s, however, the science began to undermine that stereotype. William Eberhard, now a behavioral ecologist at the Smithsonian Tropical Research Institute, documented all the ways that females can affect which males fertilize their eggs even after mating. It’s a long list, and scientists still can’t say for sure whether they’ve documented everything. The belatedness of these discoveries wasn’t all due to sexism. Two walruses dueling with their tusks is easy to observe; games of hide-and-seek with sperm inside the female reproductive tract are much less so.

“As soon as you have eggs and sperm, you have sexual selection. There are incredible things that eggs and seminal fluid can do,” explained Andrea Pilastro, an evolutionary biologist at the University of Padova in Italy.

In those species in which fertilization happens outside the body, the females often coat their eggs with a thick, protein-rich ovarian fluid. Experiments in 2013 by Matthew Gage of the University of East Anglia in England showed that this fluid contains chemical signals to help attract the correct species of sperm. When they exposed eggs from salmon and trout to mixtures of sperm from both species, the eggs’ own species successfully fertilized 70 percent of the time, significantly more than to be expected by chance.

“The sperm behaved differently in different ovarian fluids. They actually swam straighter in their own fluid,” Gage said.

Internal fertilizers have their own methods of what Eberhard dubbed “cryptic female choice.” Some female reproductive tracts are labyrinthine, complete with false starts and dead ends that can stymie all but the strongest sperm. Some females, including many species of reptiles, fish, birds, and amphibians, that copulate with more than one male (which biologists estimate are a vast majority of species) can store sperm for months, even years, altering the storage environment to stack the odds to favor one male over another. Many female birds, including domestic chickens, can eject sperm after mating, which lets them bias fertilization in favor of the best male.

All these strategies, however, provide females with opportunities only to select the sperm of different males. Within an ejaculate, which sperm fertilized the egg still seemed to be left to chance.

“We’ve been blinded by our preconceptions.”

In fact, the randomness of fertilization is implicit in the principle of segregation—the first law of genetics going back to Gregor Mendel. Parents carry two copies of each gene, which are divided randomly into gametes that carry only one copy. It’s what gives rise to many of the probabilities students learn in high-school biology. If both parents are heterozygotes—meaning they carry two alternate versions of the same gene—then half their offspring would also be heterozygotes. A quarter of the offspring would be homozygotes carrying two copies of one version, and the remaining quarter would be homozygotes with the other version.

“It’s one of the most broadly applicable rules in biology,” Nadeau said.

Yet these probabilities work out only if fertilization is random. If the egg or the sperm can somehow influence the identity of the other gamete involved in fertilization, then those ratios could be very different. This striking difference was what caught Nadeau’s attention back in 2005. When he started looking at the inheritance of two particular genes in mice, the probabilities were all off. In his Seattle lab, he began to wonder: Could Mendel have been wrong?

* * *

Nadeau hadn’t set out to question Mendel. Instead, he wanted to know how interactions between two genes (Apobec1 and Dnd1) affected risks for testicular cancer, one of the most heritable forms of cancer. When Nadeau and his doctoral student Jennifer Zechel bred female mice carrying one normal and one mutant copy of Dnd1 with heterozygote Apobec1 males, everything appeared to follow Mendel’s rules. So far, so good. But when they reversed the breeding (a female Apobec1 heterozygote mated with a male Dnd1 heterozygote), things got weird: They found that only 27 percent of the expected offspring carried copies of mutant Apobec1, mutant Dnd1, or both, compared with the 75 percent they expected to see.

As a researcher who had spent several decades studying heredity, Nadeau was aware of myriad factors that could affect Mendel’s ratios. If a fertilized egg ended up with two mutated copies of a recessive gene, the resulting embryo might die early in development. Such embryonic lethal mutations would alter the ratio of homozygotes to heterozygotes, but it would also reduce the average number of mouse pups in each litter. Yet all of Zechel and Nadeau’s mice had standard litter sizes, and they found no evidence that embryos were dying early after fertilization.

Perhaps, Nadeau reasoned, the problem lay in the sperm, not the egg. He therefore bred male mice with and without the mutation to healthy mutation-free females and found no differences in the males’ fertility—something that would have become obvious if the mutation were affecting sperm formation. Step by step, Nadeau and his team eliminated every possible cause of these wonky ratios of offspring genotypes ... except one: that during fertilization, the egg and sperm were genetically biased against the mutant genotype.

Surely, someone else must have already seen this, Nadeau reasoned, so he searched the scientific literature. Although he could find plenty of examples of unexplained offspring ratios, no one had seriously pursued genetically biased fertilization as an answer.

“I don’t think we still really appreciate how common this is and how often it happens.”

“Everyone just interpreted it as embryonic lethality because we see what we look for and we explain it using what we know,” Nadeau said.

One of those examples Nadeau found was from the lab of the cancer researcher Roseline Godbout at the University of Alberta. Godbout studied the role of a protein called DDX1 in the development of retinoblastoma, a highly heritable childhood cancer. Mice that were missing one functional copy of the DDX1 gene (but with another, fully functional gene as backup) seemed normal and healthy. When Godbout and Devon Germain, now a postdoctoral fellow at the Max F. Perutz Laboratories in Vienna, bred such heterozygote males and females, they found that none of the offspring lacked both copies of DDX1, even though simple Mendelian math would suggest 25 percent of them should. Given the gene’s importance to DNA replication, however, this wasn’t surprising: The homozygotes without DDX1 presumably died after conception. Godbout and Germain also found lower-than-expected numbers of homozygote offspring with two copies of DDX1. A complicated series of mating experiments led the scientists to propose that their results came from a rare mutation that had occurred in the DDX1 gene during their experiments.

Nadeau wasn’t convinced. He wrote to Godbout to ask how her lab had verified that the “knockout” homozygotes without DDX1 genes had died as embryos. They hadn’t. He also asked whether they had considered genetically biased fertilization, wherein the egg preferred to fuse with a sperm of the opposite DDX1 genotype.

“We really thought it was just a weird pattern of inheritance,” Germain recalled. “We hadn’t thought about nonrandom fertilization.”

Later, on a whim, Germain decided to review all the raw data from his experiments. As he looked over the results, he remembered Godbout’s questions that had been prompted by Nadeau’s email. The more he looked at the data, the more that genetically biased fertilization looked like “the most plausible explanation,” he said.

Frustrated at how few scientists had seriously considered genetically biased fertilization as an explanation for their results, Nadeau wrote up his hypothesis in “Can Gametes Woo?,” an article published in October in Genetics. His goal, he said, was to spur more research into this area and determine if and how egg-and-sperm interactions can alter fertilization.

“We’ve been blinded by our preconceptions. It’s a different way to think about fertilization with very different implications about the process of fertilization,” Nadeau says.

Other scientists, such as Manier at George Washington University, say that Nadeau’s hypothesis is intriguing and even plausible, but they point out that no one has any evidence about how it could happen. Nadeau agrees and points to two possibilities.

“Females are going to have a vested interest in the outcome of fertilization.”

The first involves the metabolism of B vitamins such as folic acid, which form important signaling molecules on sperm and eggs. Research in Nadeau’s lab has shown that these molecules play an outsize role in fertilization, and he believes abnormalities in certain signaling genes may alter how much sperm and egg attract each other.

A competing hypothesis builds on the fact that sperm are often present in the female reproductive tract before the final set of cell divisions that produce the egg. Signals from the sperm could influence these cell divisions and bias the identity of the cell that becomes the egg.

Whatever the mechanism might be, this work challenges the standard view of female physiology as passive during fertilization. “Females were seen as passive objects with no choice, but females are going to have a vested interest in the outcome of fertilization,” said Renee Firman, an evolutionary biologist at the University of Western Australia. “We still have a long way to go to understand this process, but I don’t think we still really appreciate how common this is and how often it happens.”

Finding data to support or refute this hypothesis could be challenging, Manier said. It will depend on showing that genes within the sperm affect their surface molecules, and that the egg can sense these differences. Such results will require detailed biochemical studies of individual sperm cells and sequencing information about their genome.

Nadeau is prepared for skeptics—he’s encountered many at conferences when he presents the results of his mouse studies and his hypothesis for what’s going on. Critics often approach him after the talk and begin asking him questions. Whether they walk away convinced is unclear, but Nadeau feels they are much less certain that biased fertilization doesn’t happen. To Harmit Malik, a geneticist and virologist at the Fred Hutchinson Cancer Research Center, the situation is the ultimate Sherlock Holmesian solution.

“If you’ve eliminated the impossible, then what remains, however unlikely, must be the truth,” he quipped.

 

Sept 15th 2017

Nearly half a million people in the UK are diagnosed with a sexually transmitted infection (STI) every year. But what many don't realise is that some STIs can affect your fertility. In fact, as many as a quarter of all infertility cases are thought to be linked to an STI.

Here are some common issues associated with STI's and fertility:

1.Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection in the upper genital tract and can be either asymptomatic or symptomatic. It is a serious condition because it can permanently damage the uterus and the fallopian tubes. However, if PID is mild and treated early, your chances of conceiving are high. Sadly, if you have severe PID or it goes untreated, the chances of your tubes becoming blocked are higher. It's estimated that one in five women with PID have fertility problems.

2.Chlamydia and gonorrhoea

Both infections present absolutely no obvious symptoms at all, so you might not even realise that you're infected. Therefore, it's extremely important to get tested regularly - the longer you're infected with chlamydia or gonorrhoea, the greater the likelihood that these infections will damage your fallopian tubes and future fertility. It also means that you may be inadvertently infecting a partner, impacting their future fertility as well.

3.Herpes

In most cases, the herpes virus does not affect either a woman or a man's ability to conceive. However, the biggest detriment that herpes will have on a couple's fertility is the need to abstain from intercourse during an outbreak in either partner. This can limit their chances of conceiving depending on how long the outbreak is and how often they experience 'flare ups'.

4.Male infertility

The negative impact of chlamydia on male infertility is often underestimated. Chlamydia in men can damage sperm and cause scarring in the reproductive tract (which can lead to permanent infertility). It is estimated around 25 - 50% of all male chlamydia cases go completely unnoticed.

5. Fallopian tube damage

Scarring or damage to the fallopian tubes can cause what is referred to as "tubal infertility

": Many cases of tubal disease are caused by infection such as pelvic inflammatory disease (PID). Scarred and damaged fallopian tubes can prevent sperm from reaching and fertilising the egg. If an egg does get fertilised, blocked tubes can also keep that fertilised egg from reaching the uterus. This can increase your odds of having an ectopic pregnancy - when the embryo implants in the fallopian tube wall, rather than in the uterus wall.

Dr Venket is the director at Harley Street Fertility Clinic

Sept 14th 2017

When online pharmacy Chemist 4 U revealed that they would be selling the morning after pill to women for just £4.99 per pack, the news polarised opinions.

Initially, the UK website was praised for its progressive move – being the first to make the pill available to buy online at such an affordable price tag.

However, campaigners on reproductive ethics have been quick to condemn the initiative, explaining that the accessibility presents the morning-after pill as custom contraception, when doctors advise only taking it in emergencies.

The online retailer is offering customers the opportunity to bulk buy a generic version of Levonelle, a well-known form of the morning-after pill.

Women will be able to buy as many as three packs of the pill in six months – whereas it has previously only ever been sold individually, after in-store consultations at high street pharmacies.

In some cases, the pill can be obtained for free on the NHS and at some sexual health clinics.

Now all it takes is an online form which is reviewed by a Chemist 4 U medic before distributing the drug at what Josephine Quintavelle, from Comment on Reproductive Ethics, calls “pocket money prices,” reports The Telegraph.

She explained that the low price tag raises moral concerns as it misleadingly normalises the act of taking the morning after pill so that it becomes all-too-casual a process when in fact, taking the pill, particularly more than a few times, comes with a slew of risks.

Experts have always strongly advised that women shouldn’t take it on a regular basis, though some have argued that Chemist 4 U’s “advanced supply” initiative inadvertently advocates doing so.

"They sell the product as an 'advance' purchase, ensuring a customer has a product on their shelf in case of emergencies," a spokesperson for Chemist 4 U told The Independent.

“We always advise women in an emergency situation, to go to their nearest pharmacy that day, rather than waiting a day to receive it from an online pharmacy," explained Chemist 4 U's managing director, Shamir Patel.

"However our belief is, an advanced supply from us avoids the panic in the unlikely event of barrier method failure. We advise all patients that EHC should not be used as a regular contraceptive method,” he said.

The initiative comes after Boots and Superdrug drastically reduced prices of the pill sold in store – with Superdrug’s dropping from £27 to £13.49. Tesco also sell it for £13.50.

However, the price reductions were not without controversy either. Initially, after the British Pregnancy Advisory Service urged high street retailers to drop prices of the morning after pill, Boots refused, claiming that it would encourage women to “abuse” it and that it might promote “inappropriate use.”

Alas, Boots ultimately retracted their claims and reduced the price of the pill from £26 to £15.99.

Aug 26th 2017

Flame-retardant chemicals used on furniture and other products could be making women infertile, a new study suggests.

Researchers in the US found more than 80 per cent of women having fertility treatment at the Massachusetts General Hospital had traces of three types of chemicals known as PFRs in their urine.

And those with high levels of the chemicals were 38 per cent less likely to have a child after a cycle of IVF treatment than those with low levels.

While the study does not prove the chemicals are causing infertility, it highlights a possible link.

One of the researchers, Dr Courtney Carignan, said: “These findings suggest that exposure to PFRs may be one of many risk factors for lower reproductive success.”

“They also add to the body of evidence indicating a need to reduce the use of these flame retardants and identify safer alternatives.”

And her colleague at Harvard Unviversity’s school of public health, Professor Russ Hauser, said the evidence was strong enough to make prospective parents think about trying to avoid exposure to the chemicals.

“Couples undergoing IVF and trying to improve their chances of success by reducing their exposure to environmental chemicals may want to opt for products that are flame-retardant free,” he said.

PFRs were introduced as flame retardants as a supposedly safer alternative to PentaBDE after evidence of its adverse health effects.

However concern has been growing about PFRs – organophosphate flame retardants – which are used in polyurethane foam in upholstered furniture, baby products and gym mats, for example. They can spread from furniture into the air and dust of rooms.

This adds to something of a cocktail of hormone-disrupting chemicals in modern houses, a problem that can be exacerbated by a lack of effective ventilation. Pesticides and phthalates, which are used to make plastic more flexible in a whole host of products, have also been linked with reproductive problems.

Commenting on the new study, Professor Richard Anderson, an expert in clinical reproductive science at Edinburgh University, said: “There is growing concern that the chemicals we are all exposed to may have an impact on fertility, but direct evidence of impact in men and women has often been limited.

“This carefully conducted study analysed chemicals from flame retardants in urine from women having IVF, and found that the chemicals were detected in most women.

“Worryingly, higher concentrations of these chemicals were associated with substantial reductions in the success of IVF, with a lower chance of having a baby.”

He said this method of studying the effects of chemicals on fertility was a good one.

“Studying couples having IVF is a powerful way of carrying out analyses such as this, as it allows each of the steps in conception and pregnancy to be examined, which isn’t possible in natural conception,” he said.

“While this study doesn’t prove that these chemicals are the cause of the lower success rate, it provides a firm basis for further experiments to investigate them.

“It also provides strong support for the need to regulate our exposure to chemicals and test their potential impact on fertility.”

Professor Allan Pacey, of Sheffield University, said the data obtained by the Harvard researchers “seems fairly convincing” and supported the idea of “a link between a woman’s exposure to these flame-retardant chemicals and her chances of getting pregnant”.

However, he also stressed that it did not prove this.

“We should be sensitive to the fact that the urinary metabolite concentration of these chemicals in this study could be a surrogate marker for another aspect of the woman’s lifestyle that is actually causing the effect observed,” he added.

“Ultimately, we need to keep our lives safe from fire and so before men and women undergoing IVF throw away their yoga mats, I think we need a bit more data in larger populations and in various parts of the world.

“We also need some more details about the likely mechanism by which these chemicals could be causing such an effect.”

A paper about the study was published in the journal Environmental Health Perspectives.

April 19th 2017

The contraceptive pill can reduce the general well-being of healthy women, a study has claimed.

Researchers at the Karolinka Institutet in Sweden and the Stockholm School of Economics studied 340 healthy women aged between 18 and 35. The women were either given prescriptions for a combined contraceptive pill containing ethniylestradoil and levonorgestrel (the most common type of contraceptive pill in the country and many others) or a placebo pill.

Neither group knew which pill they were taking but the women who were given contraceptive pills estimated their quality of life to be “significantly lower” than those taking the placebos. The women said their general well-being, along with their moods, self-control and energy levels, were all negatively affected by the pill.

However, despite these side effects the study suggested there was no significant increase in depressive symptoms.

The researchers emphasised that as the changes were relatively small, the results must be interpreted with caution but said the negative effects on the quality of life in individual women may be of clinical importance.

“This might in some cases be a contributing cause of low compliance and irregular use of contraceptive pills,” the study’s co-author Niklas Zethraeus said. “This possible degradation of quality of life should be paid attention to and taken into account in conjunctions with prescribing of contraceptive pills and when choosing a method of contraception.”

The authors said the findings could not be generalised to other kinds of combined contraceptive pills as they may have a different risk profile and side-effects.

Last year, a particularly large study suggested a link between women who take the pill and an increased risk of developing depression. The study analysed one million Danish women and found the combined oral contraceptive increased the risk of a woman aged between 20 and 34 being prescribed antidepressants by 23 per cent. For teenage women aged between 15 and 19, the risk of depression was 80 per cent and 120 per cent for those taking the progestogen-only pill (mini pill).

April 11th 2017

A man who froze his sperm more than two decades ago before having twins with his partner has claimed a world record.

The Scottish musician, who did not want to be named, had his sperm frozen when he was 21 before starting chemotherapy treatment for cancer, as doctors warned him he would become infertile.

After his sperm was kept in cold storage for 26 years and 243 days, his partner underwent in-vitro fertilisation in 2010.

“It’s quite a big deal for a woman to take that on,” he told The Times.

The couple gave birth to a girl and a boy the following year. He was 47, and his partner was 37.

Now 54, he knew he held a world record, but did not want to go public.

The previous world record holder, Alex Powell, had his sperm frozen for 23 years and the story was reported around the globe. He was also about to undergo chemotherapy.

But the musician learnt he could be listed anonymously in the Guinness Book of Records, and he agreed to speak to one newspaper to highlight how long sperm can be frozen and used to produce healthy children.

“For people going through chemotherapy, they should keep hope," he said.

Marco Gaudoin, director of the GCRM medical clinic where the treatment took place, said that frozen sperm could theoretically be stored “indefinitely”.

The Human Fertilisation and Embryology Authority claims sperm can be frozen for more than 40 years, but not all sperm survive the process.

It has to be frozen for at least six months before it can be used for treatment, to screen the donor for infections.

Sept 26th 2016

Women in UK can now use an app dubbed 'order a daddy' to pick a sperm donor

A mobile app has been launched that allows women to select a sperm donor based on characteristics including race, nationality and eye colour.

London Sperm Bank Donors, dubbed the "order a daddy" app, allows users to narrow down their search and browse through potential fathers and create a "wish list" alert that informs them when a donor with their desired characteristics becomes available.

The search function on the app provides a list of potential fathers - titled by number such as "Donor 1000" and Donor 1004" - with their physical characteristics listed below.

The user can then choose to "Find out more", which brings up more detailed information about the donor, including medical information, personality and a written description of their characteristics.

The description gives an insight into what the donor is like. One states: "Pleasant, charming and easy to get on with, this donor was a cheerful intellectual teeming with positivity," while another reads: "He is a well mannered, well spoken and very likeable individual".

Applicants listed are from a wide range of professions including law, medicine, finance, engineering, hospitality, the performing arts and creative work.

Users can buy a donor's sperm sample by making payment of £950 via the app, and the sample is then delivered to the fertility clinic where the woman is being treated.

The app, which promotes itself as a way to "Plan your family on the go", is legal and meets the requirements of the Human Fertilisation and Embryology Authority (HFEA), the IVF regulator. About half of Britain's IVF clinics are said to have registered to use the service.

Critics have claimed the app trivialisesparenthood. JosephineQuintavalle, of the campaign group Comment on Reproductive Ethics, told The Times: “How much further can we go in the trivialisation of parenthood?

“This is reproduction via the mobile phone. It's digital dads. Choose Daddy. This is the ultimate denigration of fatherhood.”

But Dr Kamal Ahuja, scientific director of the London Sperm Bank, said the app was in keeping with the rise in online transactions, saying: “You make all the transactions online, like you do anything else these days.

"This allows a woman who wants to get a sperm donor to gain control in the privacy of her own home and to choose and decide in her own time. We think this is the first of its kind in the world.”

Sept 14th 2016

Smallest baby

A little girl born with feet the size of a fingernail is being hailed as the world's smallest surviving premature baby.

Emilia Grabarczyk was only 8.6 inches (22cm) long and weighed 8 ounces (229 grams) when she was born at a hospital in the western German city of Witten nine months ago.

Her tiny foot was only 1.2 inches (3cm) long.

In comparison, a large banana weighs about 7 ounces while an orange is 6 ounces.

Doctors have described her as the "little fighter" and her survival as a "medical sensation" while German media said she was the lightest premature baby ever born in the world.

The early birth was followed by a period of uncertainty. Emilia was born so early that it led to subsequent complications.

There was an increased risk of hyperactivity and learning difficulties. Emilia even survived abdominal surgery at a weight of just 12 ounces.

Yet luckily for the girl, there are no signs of serious disability.

She was initially fed with a tiny tube. The doctors used a cotton bud soaked in sugar water to soothe her and relieve pains.

Her birth at the Maria Hospital came after doctors decided with her parents Lukas, 34, and Sabine, 30, to deliver the baby by Caesarean section at the 26th week of pregnancy.

The record for the smallest baby was said to be held by Rumaisa Rahman, who was born in the Loyola University Medical Centre in the US city of Chicago in 2004 when her mum was only 25 weeks pregnant.

At birth, Rumaisa was 8 inches tall and weighed 8.6 ounces.

Professor Dr Sven Schiermeier, chief physician of obstetrics, said that Emilia would have died in the womb if they hadn't delivered her early as the placenta was not sufficient for her nutrition.

For comparison, the doctor said that usually a foetus in the 26th week of pregnancy would have weighed around 21 ounces.

For Lukas and Sabine, there was no question as to whether they would give the child a chance even if the odds for survival were low.

"There were many difficult days and many tears, but she clearly wanted to survive," the mother said.

Right now, Emilia weighs 106 ounces and seems to be in much better physical condition.

Dr. Bahman Gharavi, Head of Children and Youth Clinic at the hospital, said the Emilia's birth was truly unique.

The doctor said that the survival of the baby was only possible thanks to the joint effort of paediatricians, gynaecologists and paediatric surgeons.

"Even children with a birth weight of 14 ounces rarely survive. We have to thank Emilia as well for her own survival," he said.

"She is a little fighter.

"For more than six months, it was unclear whether she would survive. Only in recent weeks she is getting more robust."

Infertility is a very worrying problem for couples who are trying to increase their family but are being unsuccessful for no apparent reason, and it’s not very reassuring when your friends and family say that as soon as you stop worrying about it then it will happen, but there’s a lot truth in that, the wondrous thing that happens when a baby is conceived will only happen when your body decides that you are relaxed enough for motherhood.

Have you ever wondered why female has two ovaries, and are they the same? do they both produce an egg every month? this is unlikely or there would be more twins in the world, they do take turns at releasing an egg? yes they do and what happens if one of the ovaries is not functioning for some reason, does that mean you only get one chance every two months? yes it does. As you can see it’s a very complicated subject that produces more questions than answers.

The first step is a very thorough examination by your medical expert to see if there’s any obvious reason why you are not clicking, if there is nothing obviously wrong with you then will have to consider the health of your partner, if the sperm sample he produces has no obvious defects then will have to turn our attention to the technique and mechanics of your mating.

It is not a good idea to refrain from sex until the particular day that you have calculated to be your best time, there are several reasons for this firstly making this day special increases your stress level and that’s not a good thing if you are trying to be relaxed, it should be a stress free, every day event, well perhaps not every day, there are a few people with that much drive and stamina.

Then we have to consider the health of the little swimmers, there are constantly being produced and if they are not used the body reabsorbs them if they have nowhere to go, it’s obviously much better to use a supply of the freshly produced sperm and frequent ejaculation ensurers that what you’re getting is top quality, or at least as good as it gets.

Apparently female orgasm does not come into this calculation according to Masters and Johnson who have stated there is no indication that this helps the actual conception, or as a state in their book there is no indication of upsuck.

Also interesting

Australian scientists are designing a condom that actually feels goodReplacing latex with prosthetic skin.

FIONA MACDONALD 8 APR 2015 18.2k 

It's no secret that a lot of people don't enjoy using condoms. Sure, we appreciate their disease- and pregnancy-preventing benefits, but let's be upfront about the fact that no one really likes to wear them.But there's hope, because scientists at the University of Wollongong in Australia are working with an ultra-tough material called hydrogel that could be used to create condoms that can feel even better than nothing at all.Hydrogels are strong and flexible solids that have been used for decades, but have more recently been engineered to have a range of different properties. One of the most promising is the fact they can be made to feel and act like human tissue, and are already being widely used in prosthetics to create things such as blood vessels and even eye implants.But the Australian team, led by materials scientist Robert Gorkin, decided to take things one step further, and investigate whether hydrogel could replace latex to create condoms that people actually want to use (no offence, latex).University of WollongongThey entered the idea in a recent Bill and Melinda Gates Foundation call-out for a Next Generation Condom, and won one of 52 grants on offer, giving them access to US$100,000 to research the viability of their hydrogel condoms. Nine months on, and things are looking extremely promising, with the material not only able to physically act like a condom, but also able to block biological material.“Our original idea was just to try to prove that an original material could replace latex," Gorkin told ScienceAlert. "We were starting from scratch, we had an idea that these new materials would have the same properties as rubber with a nicer feel, but we weren't sure if they had the right properties for a condom."“The early indications are that the materials are strong enough and actually do prevent against the transfer of small biological molecules," he said. You can see some of their durability tests in action below:Even more impressive is the fact that hydrogels can be engineered to perform all kinds of different functionalities, such as self-lubrication, topical drug delivery, biodegradability and even electric conductivity. For example, imagine a condom that delivers its own dose of Viagra, or responds to stimulation just like human skin. Depending on how you fabricate the material, you can potentially open up a whole new world of pleasure.The team is not just relying on their own opinions on what feels good, however, they're now partnering with Swinburne University of Technology in Melbourne, Australia, to conduct biometric testing that will be able to measure the body's response to the material."We'll be able to look at brain activity to see whether it really feels better than latex," explained Gorkin. "If you make them so pleasurable that people can't wait to put them on, then more people will use them, and we can hopefully stop the spread of disease. It's as simple as that."University of WollongongThe next step is to prove that hydrogel is a potential material for the Gates Foundation Next Generation of condoms, and receive the next round of funding to start making and testing them more broadly. Of course, the aim is to one day be able to create something that does what no condom has been able to do yet - improve uptake and regular use.Although a lot of the focus is on regions such as sub-Saharan African and southeast Asia, the outcome would be just as important in countries such as the US, which, despite having plenty of access to birth control, has the highest rates of accidental pregnancies and HIV transmission in the developed world.Gorkin also wants to look beyond the science and make sure that cultural and social needs for birth control influence how they design their condom. "It's a branding exercise as much as a scientific one," said Gorkin. "A material alone can't change the way we look at sex, but we believe it can definitely help."We're already sold - bring on the future of birth control.

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