Menopause test offers fertility warning

[vc_row][vc_column][vc_column_text]By Natalie Akoorie, NZ Herald News

A genetic test that can predict menopause – allowing women to better plan when to start a family – could be available within five years. The test will enable women to plan for natural conception or to consider fertility preservation measures, such as egg freezing for in vitro fertilisation (IVF), if they want to delay a family.

The research was presented at the Congress of the Asia Pacific Initiative on Reproduction in Brisbane last week by Bart Fauser, professor of reproductive medicine and gynaecology at University Medical Centre in the Netherlands. He said developing technology made it likely the test would be available soon.

Fertility Associates group operations manager Dr John Peek said most couples “crammed in everything before parenthood” – travelling, establishing careers and becoming financially secure before having children in their early 30s.

“It works for the majority but there’s still a lot of people whose fertility declines before they get to that stage so having some accurate information when you’re very young, you can think, ‘Well, I do really want children, but I’m going to have to go about it in a different order’ …of course you can’t escape age no matter how good your fertility.”

The average age of menopause is 51 but the ability to conceive falls dramatically 10 to 15 years before menopause.

If a test predicted menopause would start at age 43, for example, the woman’s fertility would start fading in her early 20s and be almost gone by her early 30s, markedly altering her family planning choices, Dr Peek said. Premature menopause, before 40, happened to about one in 100 women and could be genetic or due to environmental factors or conditions.

A person’s eggs and sperm are in place by the time a fetus is at 12 weeks’ gestation and the mother’s health or exposure to environmental factors could condition the baby’s reproductive fitness, Dr Peek said. Smoking can reduce the average age of menopause by two years.

In the research, scientists found complex genetic traits that can determine the age of menopause, which varies among women from 45 to 55.

Fertility Associates’ Hamilton medical director, Dr VP Singh, said the test could in future be routinely administered as early as age 18.

Mother says news was a huge shock

Anita Stokes was 29 and about to get married and start a family when she discovered she had already gone through menopause.

A fit and healthy young woman with no family history of premature menopause, Mrs Stokes said she was “absolutely shocked” when doctors told her she could never conceive.

“I was devastated when I found out. I’d been on the [contraceptive] pill for 10 years and I’d gone off the pill and my periods just didn’t arrive.”

Now 43, Mrs Stokes said doctors could not explain her ovarian failure but pinpointed a battle with meningitis at the age of 20 as a possible factor.

Mrs Stokes, a Waikato primary school teacher, and her husband, Paul, were faced with adoption or using an egg donor if they wanted to pursue having a baby.

They decided to use an egg donor and underwent IVF to conceive fraternal twin boys, who Mrs Stokes gave birth to in July 2002. She was pleased a genetic test to predict menopause was being developed.

“If only they had that about 12 years ago. Never mind, I got [children] in the end so that’s the main thing. It’s going to be great for giving people choices.”

What is menopause?

• The cessation of menstruation for more than 12 months.
• It happens as the ovaries stop producing eggs.
• The average age is 51.
• Symptoms include hot flushes and night sweats because of the withdrawal of oestrogen.
• Premature menopause can be caused by a family history, environmental factors, auto immune conditions, and chemotherapy.[/vc_column_text][/vc_column][/vc_row]

10 Things You May Not Know About Your Fertility

1. Your fertility is mostly determined by genetics, which influences how many eggs you are born with.

Doctors believe that the number of eggs you have at birth determines the length of time you will remain fertile. At birth, women have about two million eggs in their ovaries.For every egg ovulated during your reproductive life, about 1,000 eggs undergo programmed cell death. Other things, such as smoking cigarettes can accelerate egg cell death and promote an earlier menopause.

2. Regular menstrual cycles are a sign of regular ovulation.

Most women have regular cycles lasting between 24 and 35 days. This is usually a sign of regular, predictable ovulation. Women who do not ovulate regularly have irregular menstrual cycles. Those who do not ovulate at all may have a genetic condition called polycystic ovarian syndrome (PCOS).

3. Basal temperature charting does not predict ovulation.

An older method of tracking ovulation involves taking your oral body temperature each morning before getting out of bed. This is called basal body temperature. This method is used to spot a rise in basal temperature, which is a sign that progesterone is being produced.

The main problem with using this method is that your temperature rises after ovulation has already occurred. This makes it more difficult to time intercourse at an optimal time for conception.

A better method is to use over-the-counter urine ovulation predictor test kits such as Clearblue Easy. These kits test for the hormone that prompts ovulation, which is called luteinizing hormone (LH).

4. Most women with blocked fallopian tubes are completely unaware they may have had a prior pelvic infection.

About 10% of infertility cases are due to tubal disease, either a complete blockage or pelvic scarring causing tubal malfunction. One major cause of tubal disease is a prior pelvic infection from a sexually transmitted disease such as chlamydia. These infections can cause so few symptoms that you may be completely unaware your tubes are affected. This is why fertility physicians will order a dye test of the tubes, called a hysterosalpingogram (HSG).

5. In most cases, stress does not cause infertility.

Except in rare cases of extreme physical or emotional distress, women will keep ovulating regularly. Conceiving while on vacation is likely less about relaxation than about coincidence and good timing of sex.

6. By age 44, most women are infertile, even if they are still ovulating regularly.

Even with significant fertility treatment, rates of conception are very low after age 43. Most women who conceive in their mid-40’s with fertility treatment are using donated eggs from younger women.

7. Having fathered a pregnancy in the past does not guarantee fertility.

Sperm counts can change quite a bit with time, so never assume that a prior pregnancy guarantees fertile sperm. Obtaining a semen analysis is the only way to be sure the sperm are still healthy.

8. For the most part, diet has little or nothing to do with fertility.

Despite popular press, there is little scientific data showing that a particular diet or food promotes fertility. One limited study did suggest a Mediterranean diet with olive oil, fish and legumes may help promote fertility.

9. Vitamin D may improve results of fertility treatments.

A recent study from the University of Southern California suggested that women who were undergoing fertility treatments, but had low vitamin D levels, might have lower rates of conception. This vitamin is also essential during pregnancy.

10. Being either underweight or overweight is clearly linked with lowered levels of fertility.

The evidence in recent years is that obesity is clearly linked with a longer time to conception. Having a body mass index less than 18 or over 32 is associated with problems ovulating and conceiving, as well as problems during pregnancy.

Understanding Male Fertility

At Waterstone Clinic, we see men every week who think they are the only one with this problem, but in fact, in at least one third of all cases, sub fertility can be attributed to the male. Men can also be reassured that male factor sub fertility can be overcome through various treatment options.

Male infertility is generally due to low sperm numbers, immobile sperm or the most severe form of male infertility is where there is no sperm in the ejaculate. This may be due to the fact that there is no sperm production or maybe because of a blockage that prevents delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.

Early fertility assessment in the form of Fertility Check is a self-referral service provided by Waterstone Clinic. It is ideal for those who are thinking of starting a family or have been trying to conceive for a short time and would like an assessment of their reproductive health. After an initial consultation, where an appropriate medical history is taken, a semen analysis will be performed. Semen analysis is the principle investigation used to evaluate male fertility – it measures the number of sperm, the motility of sperm and the morphology of the sperm. If semen quality is sub optimal some lifestyle changes may improve sperm quality before a number of fertility treatment options are considered.

Even when a man is faced with learning that there is no sperm in the ejaculate, the good news is that it is possible for him to still have his own biological child, it does not mean the end of the line. Waterstone Clinic offer Testicular Sperm Extraction (TESE). This involves a testicular biopsy to retrieve sperm from testicular tissue. Waterstone Clinic carry out approximately 40 of these procedures a year and a number of babies have been born by carrying out ICSI (Intracytoplasmic Sperm Injection) using sperm from these biopsies.

For a man, a diagnosis of infertility should not be underestimated. I have co-authored a paper, that has recently been accepted for publication, on the psychological impact of infertility and fertility treatment on the male. The paper explains that fertility investigations and the nature of fertility treatments mean that the male partner may have a relatively minor role compared to the female partner. But this may only add to his feelings of guilt and inadequacy. It is important to realise however, that if a few sperm are present, while it may not be possible to identify the reason for the man’s fertility problems, and while it may not be possible to correct the problem, with the use of ICSI, it may be possible to overcome the problem.

Dr. Tim Dineen, Head of Laboratory services, Waterstone Clinic

What Is Egg Freezing and Why Have You Been Hearing So Much About It?

IVF Pregnancy Rates Using Frozen Eggs Are Comparable to IVF Using Fresh Eggs

While celebrities like Maria Menounos and Sofia Vergara have talked about their decision to freeze their eggs there is still a lot of confusion. First, what exactly is egg freezing and why does it suddenly seem much more accessible? Fertility doctors such as myself have been trying for many years to crack the code about the best way to maintain excellent quality eggs, much like we’ve been able to do with freezing sperm.

Cyropreservation — using a slow-freezing method — delivered inconsistent results due to the potential for ice crystals to form in the egg, thus ruining its quality. In October 2012, the organization that sets standards for our profession, the American Society of Reproductive Medicine (ASRM), lifted its ban on egg freezing. This was due to the development of a new technology called vitrification, which is the process of flash freezing eggs. Vitrification was found to be more successful than slow-freezing. Specifically, the ASRM cited studies demonstrating egg freezing using vitrification resulted in pregnancy rates comparable to the same rates expected from an IVF treatment cycle using fresh eggs.

Freezing Eggs in the Early to Mid-30s Optimizes Pregnancy Later

Now that the ban has been lifted practices like Shady Grove Fertility have witnessed a significant increase in the number of women who want to freeze their eggs. For healthy, non-smoking women egg freezing can definitely provide some peace of mind if they are concerned pregnancy won’t be an option for them in the near future. Basically, through egg freezing a woman’s fertility potential is captured at the time the eggs are frozen. For example, now a 40-year-old woman using her own eggs, which were frozen when she was 35, can expect the comparable chances of delivering a baby as a 35-year-old women going through IVF using fresh eggs. At Shady Grove Fertility, we will freeze eggs for women between the ages of 30-40, depending on their ovarian testing, but to optimize future chances of conception, we recommend women freeze in their early to mid-30s, when fertility is still near its peak.

Women with Cancer Are Able Preserve Fertility before Undergoing Cancer Treatment

Egg freezing is also beneficial for women who have been diagnosed with cancer, and who would like to try to preserve their fertility before undergoing chemotherapy or radiation. Because these treatments can compromise fertility, egg freezing can be a positive option at a difficult time.

No Need to Freeze

Now, there is certainly a group of women who do not need to freeze their eggs. If you are in your 20s and want to wait to have children, you have plenty of time! The chances of becoming pregnant naturally are higher for a woman in her 20s and you may just not need those eggs you paid to freeze.

By Stephanie Beall, MD, PhD. Physician, Shady Grove Fertility

A Threat to Male Fertility

To study the impact of everyday chemicals on fertility, federal researchers recently spent four years tracking 501 couples as they tried to have children. One of the findings stood out: while both men and women were exposed to known toxic chemicals, men seemed much more likely to suffer fertility problems as a result.

The gender gap was particularly wide when it came to phthalates, those ubiquitous compounds used to make plastics more flexible and cosmetic lotions slide on more smoothly. Women who wore cosmetics often had higher levels of phthalates in their bodies, as measured by urinalysis. But only in their male partners were phthalate levels correlated with infertility.

“It’s the males in the study that are driving the effect,” said Germaine Buck Louis, an epidemiologist at the National Institute of Child Health and Human Development and lead author of the report, published in February in Fertility and Sterility. “They’re the signal.”

Phthalates belong to a group of industrial compounds known as endocrine disruptors because they interfere with the endocrine system, which governs the production and distribution of hormones in the body. The chemicals have been implicated in a range of health problems, including birth defects, cancers and diabetes.

But it is their effect on the human reproductive system that has most worried researchers. A growing body of work over the last two decades suggests that phthalates can rewire the male reproductive system, interfering with the operation of androgenic hormones, such as testosterone, that play key roles in male development. That mechanism, some experts believe, explains findings that link phthalate exposure to changes in everything from testicular development to sperm quality.

“I wasn’t surprised at all by this finding,” Andrea Gore, a professor of pharmacology and toxicology at the University of Texas, and editor in chief of the journal Endocrinology, said of the new report. “We see the cell studies, the animal studies and now the human epidemiology work, and they are all showing us a similar picture.”

The focus on male fertility dates back to the early 1990s, when researchers in the United States and Europe published a paper suggesting chemical exposures could be linked to a steady decline in semen quality. One of the authors, Niels Skakkebaek, a reproduction researcher at the University of Copenhagen, has since suggested that an increase in malformations in male reproductive systems, which he calls “testicular dysgenesis syndrome,” may be linked to environmental exposure to compounds including endocrine disruptors like phthalates.

More recent studies in the United States have also suggested links between phthalate exposure and apparent sperm damage in men. The findings are supported by a host of animal studies, particularly in rats, which have shown that the compounds can interfere with masculinization of young animals and result in odd physical changes to male reproductive tracts.

“They interfere with how testosterone is made,” explained Heather Patisaul, a biology professor at North Carolina State University who is studying the effect of endocrine-disrupting compounds during puberty. “Anything you can think of that’s testosterone-dependent is likely to be affected.” 

Women also have androgenic hormones, but to a lesser degree, and according to some theories this accounts for the smaller but still observable effects of phthalates on female fertility. (Testosterone, for instance, is part of the cascade of hormones that leads to egg production.)

There are plenty of uncertainties in this picture. The Centers for Disease Control and Prevention notes that while studies suggest that phthalate exposure is “widespread in the U.S. population,” it’s difficult to know what those levels are. Health effects from very low levels are still not well understood.

While the “evidence for an effect on male fertility is compelling,” said Tracey Woodruff, director of the program on reproductive health and the environment at the University of California, San Francisco, it’s still difficult to gauge the impact. “We are still pulling the tricky aspects together.”

There are different kinds of phthalates complicating the picture; some seem to have a much larger effect than others. And these are far from the only factors, chemical and otherwise, that influence human fertility. Dr. Buck Louis’s group is looking at a broad range of industrial compounds, including heavy metals like lead and cadmium, that tend to accumulate in the body.

Phthalates, by contrast, tend to be metabolized within a few hours. Their impact would not be so profound if it were not that people are constantly exposed from multiple sources.

These include not only cosmetics and plastics, but also packaging, textiles, detergents and other household products. Phthalates are found in the tubing used in hospitals to deliver medications; enteric coatings on pills, including some aspirin; materials used to create time-release capsules; and countless other products. In 2008, the government banned them in children’s toys, and the European Union is also moving forward on restrictions.

“The W.H.O. called them ‘pseudopersistent’ in one report,” Dr. Woodruff said, because continued exposure keeps phthalates in the body. But here’s the silver lining: the transient nature of these compounds also means that consumers can take fairly simple measures to reduce their phthalate levels.

One is to read the labels on cosmetics and other personal care products and to choose those without phthalates. Another is to be cautious with plastic food containers, and to avoid using them to heat food and drink, as the phthalates in them may get transferred to what you consume.

“These compounds leach from plastics,” Dr. Buck Louis said. “You can switch to glass for drinking. You can cook your frozen dinners on paper plates.”

Studies have shown that these kinds of actions do make a difference; experiments have found measurably lower levels within several days in people who make these changes.

“Lifestyle has an important place here,” said Dr. Buck Louis.

By Deborah Blum, The New York Times

What to consider when choosing a fertility clinic

Choosing a fertility clinic is a particularly critical decision that should not be taken lightly. It can be very overwhelming when couples are faced with trying to make a decision that will have such an important impact on their life.

In order to find the right fertility clinic to meet your needs, be sure to take the time to thoroughly research any clinic you may consider. Although it is easy to do, pursuing fertility testing and treatment is a big step and can also involve a large amount money and certainly lots of time. You should choose only the very best.

Be Knowledgeable and Informed

Choosing a fertility clinic is a very personal, yet subjective decision. Often women or couples are referred to a particular clinic by their GP or gynaecologist or given a recommendation from friends and relatives.

Even if you are given a recommendation, it is important to do your own research in advance of visiting a clinic. It is to your benefit to be a well-informed and knowledgeable when visiting a clinic for the first time.

Evaluate Clinic Options

When researching possible fertility clinics, there are several ways to find information:

• Most fertility clinics have valuable information on their website

• Speak to a clinic representative over the phone or in person

• Speak with current or former patients (via local infertility support groups)

Success Rates

Review fertility clinic success rates.

Ask Questions

A fertility clinic is only as good as its doctors and staff. Questions to consider when choosing a fertility clinic include:

  • Do the doctors and staff take time to answer all of your questions?
  • When and where were the doctors trained?
  • It is important to determine if they are board certified reproductive specialists.
  • Does the fertility clinic have an andrologist? If you’re dealing with male infertility issues, having an andrologist available is important. If you’re dealing with endometriosis or any other structural issues, a reproductive surgeon available at the clinic is definitely a plus.
  • How many reproductive specialists work at the clinic?
  • Will your case be managed by one doctor or a team, and who will you see during your visits? If your case is complex, having a team can be beneficial.
  • How long have the director and staff been with the clinic? The longer employees stay with the fertility clinic, the more likely the working environment runs smoothly, creating a positive atmosphere for you and your partner.

If you decide to pursue testing and treatments, you may be working closely with the clinic staff for a long time, therefore, you will want to find a team that not only cares, but also knows how to best help you.

Free Fertility Information Seminars

FREE FERTILITY INFORMATION SEMINAR

The Waterstone Group will host a number of Fertility Information seminars in March to give practical advice to couples about fertility issues and how to maximise their chances of conception. As part of the seminar, there will be a series of short and informative talks from the clinic’s specialist team of gynaecologists, scientists and nurses who will also be available to answer general queries from couples who are trying to conceive.

The information seminar will begin with a talk called ‘Trying to conceive – understanding your fertility’, followed by a presentation by Dr Waterstone which will give an overview of the fertility treatments and options available  at Waterford Fertility and the Waterstone Group . Couples will also have an opportunity to meet leading embryologist Dr Tim Dineen who will discuss male fertility tests and treatments. There will be an opportunity for questyions and answers throughout the morning.

Details as follow:

Saturday March 1st 2014, No. 1 Pery Square Hotel, Limerick City

Sunday March 2nd 2014, the Tower Hotel, Waterford

Saturday March 22nd 2014, Cashel Palace Hotel, Tipperary

New Fertility Clinics Open in Waterford and Limerick

New Fertility Clinics now open in Waterford and Limerick City.

We are delighted to announce the opening of two new fertility clinics in Limerick and Waterford. The expansion of the Waterstone Group enables people to avail of our expertise in their own locality.

The new clinics, located in Waterford City and Limerick City, provide key fertility services including fertility consultations, fertility testing, diagnostic ultrasonography, ovulation induction (OII), follicle tracking and intrauterine insemination (IUI) from its new facility. These clinics are a welcome arrival for the people of the South East and Limerick who have previously had to travel for fertility treatment.

Leading the new clinics is Dr John Waterstone, consultant at Cork University Maternity Hospital and Bon Secours Hospital and Medical Director of the Waterstone Group. Waterstone Clinic has been providing world-class fertility treatment since 2002 and its multidisciplinary team led by Dr Waterstone offer a wealth of experience and scientific knowledge that, when combined with the latest technology, allows the team to deliver success rates that match the best in the UK and USA. The clinic is at the forefront of new developments in the field of assisted reproduction and boasts some of the best success rates in Ireland.

Dr Waterstone said fertility difficulties affect as many as one in five couples in Ireland: ”Sometimes difficulties can relate to something as simple as lifestyle, which can be addressed and resolved easily. Other couples may need fertility treatment in order to conceive. We are delighted to offer our services to the people of Waterford. Our team is always available to give expert information and reassurance to couples and to explain the types of treatments available in Ireland. Assisted reproductive services are evolving and when the best medical and nursing care is combined with the latest scientific innovation and developments, notable success rates can be achieved for couples.”

Fertility experts urge one embryo at a time

New federal statistics show an epidemic of twins among IVF patients, and two babies come with added risk during pregnancy. Reproduction experts are now urging more women in fertility treatment to try it one embryo at a time. View what the experst say:

http://www.usatoday.com/videos/news/nation/2013/12/02/3800989/

At Waterstone Clinic our goal is to create healthy families and we have experienced great success with single embryo transfers, thus significantly reducing the risk of multiple embryo implantation and multiple births.

Despite advances, delaying childbirth may still come at a cost

THE reasons women postpone having babies are complex – and include the availability of safe and effective contraception, preferring to be in a stable relationship with a supportive partner, wanting to build a career and achieve financial independence, or enjoying the freedom that family life may potentially compromise.

It is a universal challenge that the best years for having babies coincides with the best years for establishing a career and the trend towards later maternity appears to be strongest among women with better educational qualifications. While delaying pregnancy and parenting until a couple achieve financial security seems wise, there is no doubt that it also comes with difficulties.

Women need to be aware of how fertility and pregnancy outcomes change with age, and that their decision to postpone pregnancy may in turn have financial implications.

Although women are healthier than ever, biology can still determine destiny. The decline in fertility and increased risk of pregnancy complications with age remain.

Biologically, the optimum period for childbearing is between 20 and 35 years of age. At the age of 30, 75pc of women will conceive naturally within a year. This falls to 66pc by 35 years and 40pc by age 40.

The risk of chromosomal abnormalities, such as Down Syndrome, increases with age, from one in 950 at age 30 to one in 100 at 40 years.

Many couples turn to IVF and other assisted reproduction techniques but these techniques cannot compensate for the effect of age on a woman’s eggs. The live birth rate for women under the age of 35 undergoing IVF is approximately 30pc. This rate falls to between 5pc and 10pc for women over 42 years of age.

In addition to the huge emotional and social stress that infertility and embarking on assisted reproduction carries, these treatments also come at a considerable financial cost.

Currently in Ireland a single cycle of IVF costs approximately €5,000. Couples are usually advised to budget for more than one cycle.

Women should be supported in their decisions of whether or not to have children and when to plan childbearing.

There are many advantages to postponing pregnancy, from greater financial stability to increased satisfaction with parenting.

However, while the unflattering term ‘elderly primagravida’ (a woman who becomes pregnant for the first time after 34) is now defunct, delaying having a family may still come at a cost.

Dr Aoife Mullally, Clinical Fellow in Obstetrics & Gynaecology, Coombe Hospital

 Irish Independent

http://www.independent.ie/opinion/analysis/aoife-mullally-despite-advances-delaying-childbirth-may-still-come-at-a-cost-29743325.html