Category Archives: Human Reproduction

STUDY QUESTION

What is the health-related quality of life (HRQoL) in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction with clomifene citrate (CC) combined with metformin compared with those using CC combined with placebo?

SUMMARY ANSWER

Overall quality of life in women with PCOS treated with CC plus metformin was significantly lower than in women treated with CC plus placebo.

WHAT IS KNOWN ALREADY

There are no data on HRQoL in adult women who receive ovulation induction with the purpose of conceiving. Women with PCOS have higher scores on depression and anxiety scales and lower QoL scores than women without PCOS.

STUDY DESIGN, SIZE AND DURATION

This study was a secondary analysis of a multi-centre RCT completed between June 2001 and May 2004. The randomization was stratified per centre, and the centres received blinded, numbered containers with medication. There were172 women available for the HRQoL assessment: 85 were allocated to metformin and 87 were allocated to placebo.

PARTICIPANTS, SETTING AND METHODS

The Rotterdam Symptom Checklist (RSCL), a standard self-administered questionnaire, was used to assess physical symptoms, psychological distress, activity levels and overall HRQoL.

MAIN RESULTS AND THE ROLE OF CHANCE

In the intention to treat analysis, we found differences between the treatment groups with respect to physical symptoms and overall HRQoL. Physical well-being was significantly impaired in women allocated to metformin but not in women allocated to placebo. The increase in physical symptoms in the metformin group was caused by side-effects typical of metformin, and was most pronounced at Week 1 (mean difference 12 [95% confidence interval (CI): 8–16] and still apparent at Week 16 [mean difference 7 (95% CI 2–12]. Overall well-being was significantly impaired in the metformin group compared with the placebo group [mean difference 13 (95% CI 6–20)].

LIMITATIONS AND REASONS FOR CAUTION

RSCL measurements were available only for three quarters of the participants. Although the number of missing questionnaires and the baseline measurements, were comparable between the treatment groups, some form of selection bias cannot be ruled out.

WIDER IMPLICATIONS OF THE FINDINGS

Our finding that metformin was more burdensome than placebo, strengthens the recommendation that CC only and not CC plus metformin should be the drug of choice in this patient population.

STUDY FUNDING/COMPETING INTEREST(S)

None of the authors declared a conflict of interest. There was no study funding.

Trial Registration Number

ISRCTN55906981.

Source:
http://humrep.oxfordjournals.org/cgi/content/short/27/11/3273?rss=1

Public release date: 17-Oct-2012 [ | E-mail | Share ]

Contact: Emma Mason wordmason@mac.com European Society of Human Reproduction and Embryology

Women whose first pregnancy is ectopic are likely to have fewer children in the following 20-30 years than women whose first pregnancy ends in a delivery, miscarriage or abortion, according to results from a study of nearly 3,000 women in Denmark. In addition, these women have a five-fold increased risk of a subsequent ectopic pregnancy.

The first study to look at long-term reproductive outcomes in women whose first pregnancy was ectopic is published online today (Thursday) in Europe's leading reproductive medicine journal Human Reproduction [1].

Ectopic pregnancies are pregnancies where a fertilised egg implants somewhere other than the lining of the womb; often it's in one of the Fallopian tubes. Approximately one per cent of pregnancies are ectopic, and they are never viable; often the eggs die, sometimes a drug called methotrexate is given so that the pregnancy tissue is absorbed into the woman's body, and sometimes surgery is needed.

Although it is already known that a previous ectopic pregnancy can increase the risk of a subsequent one, most studies have been small and with short follow-up. "We found no controlled study assessing long-term reproductive prognosis in women whose first pregnancy is ectopic," write the authors of the current study.

The researchers collected data from four Danish registries covering the period 1977-2009. They found 2,917 women whose first pregnancy was ectopic between 1977-1982 and who, except for those who died or emigrated, were followed to the end of 2009 or for an average of 23 years.

These women were matched with other women of the same age whose first pregnancy resulted in a delivery, miscarriage or abortion. They were also compared with a fourth group of women who had no recorded pregnancy in the year of matching.

Dr Line Lund Krhus (MD), a research student in the Gynaecological Clinic at the Rigshospitalet in Copenhagen, Denmark, said: "We found that the group of women who had a first ectopic pregnancy had the lowest delivery rate and total number of pregnancies over the following 20-30 years when compared with the other groups, and also lower rates of miscarriages and abortions. They had a 4.7-10-fold increased risk of further ectopic pregnancies."

Women who had had an ectopic pregnancy had the lowest long-term rate of subsequent deliveries of 69 per 100 women, compared with 126 per 100 among women who had a first miscarriage, 77 per 100 among women who had a first abortion, 73 per 100 among women whose first pregnancy ended in a delivery, and 101 per 100 among the women who were not pregnant in the year the women were matched with each other.

Original post:
Women whose first pregnancy was ectopic have fewer children

ScienceDaily (Oct. 16, 2012) To whom a man's possessions go when he dies is both a matter of cultural norm and evolutionary advantage.

In most human societies, men pass on their worldly goods to their wife's children. But in about 10 percent of societies, men inexplicably transfer their wealth to their sister's sons -- what's called "mother's brother-sister's son" inheritance. A new study on this unusual form of matrilineal inheritance by Santa Fe Institute reseacher Laura Fortunato has produced insights into this practice.

Her findings appear October 17 in the online edition of Proceedings of the Royal Society B.

"Matrilineal inheritance is puzzling for anthropologists because it causes tension for a man caught between his sisters and wife," explains Fortunato, who has used game theory to study mother's brother-sister's son inheritance. "From an evolutionary perspective it's also puzzling because you expect an individual to invest in his closest relatives -- usually the individual's own children."

For decades research on the practice of matrilineal inheritance focused on the probabilities of a man being the biological father of his wife's children -- probabilities that lie on a sliding scale depending on the rate of promiscuity or whether polyandrous marriage (when a woman takes two or more husbands) is practiced.

Of special interest has been the probability value below which man is more closely related to his sister's children than to his wife's children. Below this "paternity threshold" a man is better off investing in his sister's offspring, who are sure to be blood relatives, than his own wife's children.

In her work modeling the evolutionary payoffs of marriage and inheritance strategies, Fortunato looked beyond the paternity threshold to see, among other things, what payoffs there were for men and women in different marital situations -- including polygamy.

"What emerges is quite interesting," says Fortunato. "Where inheritance is matrilineal, a man with multiple wives 'wins' over a man with a single wife." That's because wives have brothers, and those brothers will pass on their wealth to the husband's sons. So more wives means more brothers-in-laws to invest in your sons.

The model also shows an effect for women with multiple husbands. The husband of a woman with multiple husbands is unsure of his paternity, so he may be better off investing in his sister's offspring.

"A woman does not benefit from multiple husbands where inheritance is matrilineal, however," Fortunato explains, "because her husbands will invest in their sisters' kids." Family structure determines how societies handle relatedness and reproduction issues, Fortunato says. Understanding these practices and their evolutionary implications is a prerequisite for a theory of human behavior.

Read the rest here:
When leaving your wealth to your sister's sons makes sense

Sunday, Oct. 14, 2012

It's easy to take for granted the epic scale of what some scientists are attempting these days. When the news broke a couple of weeks ago that Japanese scientists had turned normal cells from a mouse into eggs, and then fertilized them and seen them develop into baby mice, I thought it was pretty cool.

But I wasn't that surprised.

I knew that Katsuhiko Hayashi one of the scientists involved was doing fascinating research on stem cells at Kyoto University, and so this seemed a natural progression for his work to take.

Then I spoke to him and his boss. What they said reminded me that they are attempting to do something that, until recently, would have blown the mind of almost any scientist, philosopher or other kind of intellectual there's ever been throughout the whole of human history.

Mitinori Saitou, who is head of Hayashi's lab at the Department of Anatomy and Cell Biology in the Graduate School of Medicine, was highly ambitious from an early age, and became particularly focused when he was doing his PhD as a young man.

"I got interested in germ-cell biology and the regulation of the cell fates," he told me, "hoping that one day it may be possible to develop a methodology to control cellular fate at will."

To control fate: It's like something out of a Greek myth.

Hayashi too has long been interested in pushing the boundaries of human reproduction. "When I was child, there was news about animal cloning," he told me. "That was one reason why I got interested in this field."

The atmosphere for research in Japan allows ambitions such as these to flourish.

More here:
Why stem-cell science thrives in Japan

Exposure to the chemical bisphenol A (BPA) may reduce fertility among women who already have fertility problems, a new study suggests.

The study involved women trying to conceive children through in vitro fertilization (IVF), a fertility treatment that includes taking hormones to stimulate egg production. These eggs are then collected, and researchers attempt to fertilize them in a laboratory.

In the study, doctors collected 24 percent fewer eggs from women with high levels of BPA in their bodies, compared with women who had low levels of the industrial chemical.

Women with high BPA levels also had fewer eggs that were successfully fertilized.

BPA is found in many products, including canned foods, plastics, dental sealants and credit card receipts. The chemical does not stay in the body for a long time, so a person's BPA levels can vary substantially depending on his or her exposure in a given day.

The new findings agree with animal studies suggesting that BPA exposure reduces fertility. For example, a study published last month found BPA exposure increased the risk of abnormal egg development in monkeys.

The new study found only an association, not a direct cause-effect link. In addition, the researchers did not look at how many women became pregnant, so they can't say whether BPA affects pregnancy rates, said Dr. Avner Hershlag, chief of the Center for Human Reproduction at North Shore University Hospitalin Manhasset, N.Y., who was not involved in the study.

However, if the results are confirmed by future research, doctors could one day measure BPA levels in women who fail to become pregnant through IVF, or who have low egg yields during the process, Hershlag said. Doctors could look at whether reducing BPA exposure in women with high levels makes a difference, he said.

In the new study, Dr. Russ Hauser, of Harvard School of Public Health, and colleagues analyzed information from 174 women who underwent IVF between 2004 and 2010. The researchers measured BPA levels in two urine samples from the women: one taken during hormone treatment and one taken two weeks later, on the day the eggs were collected. Nearly 90 percent of participants had BPA in their urine.

On average, about 12 eggs were collected from women with the lowest BPA levels, whereas nine eggs were collected from women with the highest BPA levels.

Link:
BPA May Worsen Women's Fertility Problems

8 October 2012 Last updated at 22:25 ET By Regan Morris BBC News, Los Angeles

US researchers say they will redouble their efforts to create human sperm from stem cells following the success of a Japanese study involving mice.

A Kyoto University team used mice stem cells to create eggs, which were fertilised to produce baby mice.

Dr Renee Pera, of Stanford University in California, aims to create human sperm to use for reproduction within two years, and eggs within five years.

Infertility affects up to 15% of reproductive-aged couples worldwide.

"I know people think it's Frankenstein medicine, but I think it's not an imagined or lessened health problem - infertility affects your whole life," Dr Pera says.

"To have sex and have a baby would be a super simple decision, but not everybody can do it."

But using embryonic stem cells for research - as Dr Pera's lab at the Institute for Stem Cell Biology and Regenerative Medicine does - is controversial because the embryos are destroyed in order to use them.

Dr Pera's lab uses embryos left over from IVF treatments.

Stem cells have the potential to grow into any cell in the body. Creating eggs in a lab could become mainstream, much like IVF is viewed today.

Read more:
US team aim to make human sperm