Perfluorinated chemicals (PFCs) - found in everyday household materials such as shampoo, food wrappings, non-stick frying pans and upholstery - may be linked to infertility, according to a study published in the Journal of Human Reproduction this week. The study showed that women with high levels of the chemical in their blood were up to one and a half times more likely to have taken more than a year to conceive or required fertility treatment than those with low levels.
The researchers measured the levels of two chemicals - perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) - in the blood of 1240 Danish women who became pregnant between 1996 and 2002. Those with PFOS blood levels exceeding 26 nanograms/millilitre were at least 70 per cent more likely to be infertile, and those with more than 3.9 ng/ml of PLOA in their blood were at least 60 per cent more likely to take longer to get pregnant.
Dr Chunyuan Fei, from the University of California, who co-authored the study, said that findings from previous studies on humans had alerted him to the potential impact of PFOA and PFOS on fetal development.
'Very few human studies have been done, but one of our earlier studies showed that PFOA, although not PFOS, may impair the growth of babies in the womb, and another two epidemiological studies linked PFOA and PFOS to impaired fetal growth', he told the Daily Telegraph.
Animal studies have also raised concerns, said Fei, with high levels of PFCs proving toxic to the liver, immune system and developmental and reproductive organs.
Previous studies highlighting the toxicity of PFCs have triggered their phasing out in Europe and the US, however further research will be needed to establish whether the link to infertility is genuine or whether other factors are at play, for example obesity may provide a link between high PFC levels in the blood and low fertility.
Speaking to the Times, David Coggon, Professor of Occupational and Environmental Medicine at the University of Southampton, commented: 'This is an interesting preliminary finding that may or may not turn out to be important. We first need to see whether it can be confirmed in other studies. It would also be helpful to establish the main determinants of exposure to the chemicals in the general population'.
A special class of adult stem cells, known as human induced pluripotent stem (iPS) cells, has for the first time been reprogrammed into cells that develop into human eggs and sperm. The research, carried out by members of the University of California, Los Angeles (UCLA)'s Broad Stem Cell Research Center, was published in the January 27 online edition of the journal Stem Cells.
Derived from adult body cells that have been engineered to return to an embryonic state, iPS cells have the ability to become every cell type in the human body - a characteristic they share with embryonic stem (ES) cells. In this study the iPS cells were coaxed into forming the germ line precursor cells that are capable of giving rise to sperm and eggs.
'This finding could be important for people who are rendered infertile through disease or injury'. said Amander Clark, the senior author of the study. 'We may, one day, be able to replace the germ cells that are lost, and these germ cells would be specific and genetically related to that patient'. Many infertile couples would see this process as preferable to using eggs or sperm from a donor who would then become one of the child's genetic parents.
However, Clark cautioned that scientists are still many years from offering treatments involving iPS cells to infertile patients. There are many uncertainties and dangers that need to be resolved. For example, the process of reprogramming involves using viruses to deliver genes to the cells, potentially increasing the likelihood of genetic abnormalities and cancers.
Crucially, Clark's team found that the germ line cells derived from iPS cells did not perform certain key regulatory processes as well as those generated from ES cells. The associated increased risk of chromosomal errors, or abnormal growth, could have serious health consequences for any child conceived using egg or sperm obtained in this way.
Therefore Clark believes that it is vital that research using human ES cells continues. These cells can be derived from left over embryos used during in vitro fertilisation, and would otherwise be destroyed, yet their use is controversial and the topic remains fiercely debated. Despite this President Obama is expected to reverse President Bush's restrictive policies on ES cell research in the next few weeks.
The UK's Royal College of Obstetricians and Gynaecologists and the British Fertility Society have released a joint statement expressing serious concerns about women who freeze their eggs for non-medical reasons such as pursuit of their career. The success rate for pregnancies involving eggs that were frozen is very low and babies conceived in this manner may be less healthy than those from fresh eggs.
'The image that's portrayed is that a woman in her late 20s or early 30s can establish a relationship 10 or 15 years later and then take the eggs out of the freezer, fertilise them with the partner's sperm and have the baby', says Professor Bill Ledger, a professor of obstetrics and gynaecology at Sheffield University and a member of the Human Fertilisation and Embryology Authority (HFEA). 'The chance of a baby from a frozen egg with vitrification is less than 6 per cent per egg. By doing the egg freezing for social reasons, they are taking a huge gamble for their future', he added.
As well as low success rates Professor Ledger pointed out that babies that are born from frozen eggs could be less healthy than those conceived from fresh eggs and warned that: 'We should be very careful about performing medical procedures on healthy people'. He believes that is ethically questionable for women to freeze their eggs purely for 'lifestyle reasons' but added that it was legitimate, for example, for a young woman with cancer to have her eggs frozen before chemotherapy seriously damaged her potential to bear children.
The draft regulations to implement the Human Fertility and Embryology Act, as
amended in relation to the storage of gametes, state that gametes (oocytes in this scenario) can only be stored for ten years. Unless during that period the person for whom the eggs are stored has, or is likely to develop, significant and premature infertility, this period cannot be extended. Egg freezing beyond this time at any of the 41 infertility clinics in the UK where this service is offered is therefore excluded for any non-medical reason.
Despite this time limit, 33 women chose to freeze their eggs for non-medical reasons in 2006, according to official figures from the HFEA. However, this figure more than doubled to 78 in 2007, even though the procedure is expensive at a cost of about £5,000.
Public outrage over the IVF-conceived octuplets born in January to Nadya Suleman in California has led US legislators in Missouri and Georgia to propose laws that would limit the number of embryos a woman may have implanted when receiving a single fertility treatment. Georgia Senator Ralph Hudgens criticised Suleman's case, saying it is 'unforgiveable that she is unemployed and having 14 children on the backs of the taxpayers...' Supporters hope these measures will prevent rogue fertility clinics from unethically transferring a high number of embryos into women to increase their pregnancy success rates.
Critics argue that assisted reproduction is not an exact science and a blanket limit removes clinicians' flexibility to provide the best medical care. Dr Andrew Toledo, medical director of an Atlanta-based fertility clinic, warns that the measures are a 'cookie-cutter, one size-fits-all approach' and disregard important individual circumstances that determine the optimum number of embryos transferred for increased chances of pregnancy. Legal experts have voiced constitutionality concerns against the legislation impinging fundamental reproductive freedom and use of own genetic materials. A spokesman for the American Society of Reproductive Medicine (ASRM) specifically decried the Georgia bill as using the octuplets as 'an excuse to pass an extreme anti-abortion measure'. The Center for Genetics and Society called for a federal solution to prevent the state 'mishmash of policies' allowing patients to shop state-to-state for their desired treatment law.
The ASRM national guidelines recommend that a certain number of embryos be transferred depending on a woman's age and medical prognosis for successfully responding to IVF treatment. These recommend that women under 35 should have no more than two embryos transferred and women between 35 and 40 should have no more than three embryos transferred. Women over forty may have up to five embryos transferred during a single treatment due to their increased difficulty to conceive.
Missouri Republican Dr Robert Schaaf has tabled a measure that would convert these guidelines into state law. He acknowledges that it is a self-regulating industry wherein most specialists already comply with these standards, and the incidence of multiple-birth pregnancies has significantly decreased in the last decade. Still, he wishes that doctors be legally prevented from complying with patient requests to participate in harmful procedures as with Suleman, 33, who requested that five embryos be transferred despite the risks. California's medical board is currently investigating Suleman's fertility doctor and has proposed legislation empowering its Medical Board to supervise California-based fertility clinics.
The Georgia bill limits women under forty to having at most two embryos transferred and women over forty to three embryos maximum. The bill, titled The Ethical Treatment of Human Embryos Act, also outlaws the disposal of frozen embryos - similar to Louisiana law - and defines an embryo as a 'biological human being'. It was drafted by lawyers from the Bioethics Defense Fund, an anti-abortion and anti-embryonic stem cell research group and is supported by the Georgia Right to Life. Republican Senator Hudgens, who sponsored the bill for committee review last Thursday, denied it impacts on abortion and claims it only aims to prevent 'what happened in California from happening in Georgia'.
Suleman's story also attracted international fascination and highlighted the relevance of an ongoing UK debate that ultimately has led to the Human Fertilisation and Embryology Authority, the government's fertility watchdog, rolling out a new multiple birth policy that strongly encourages single embryo transfer (SET) where medically appropriate. The HFEA wrote a letter at the end of February to the NHS Directors of Public Health outlining the importance that individual clinics devise consistent policies of their own implementing the HFEA policy initiative for each clinic to reduce its annual percentage of multiple birth rates over three years to a target 10 per cent from a 24 per cent limit in 2009.
A group of scientists at Imperial College London have found that administration of the recently discovered protein 'kisspeptin' could 'restore fertility' for some women and form the basis for a new fertility treatment.
The findings of the research, presented at the annual Society for Endocrinology BES (British Endocrine Societies) meeting in Yorkshire and led by Dr Waljit Dhillo, showed that after receiving kisspeptin, women whose infertility was caused by the cessation of their menstrual periods began producing reproductive hormones again. Having discovered two years ago that kisspeptin treatment stimulated reproductive hormone release in fertile women, Dr Dhillo turned his research to infertile women.
Kisspeptin is produced during puberty and triggers the release of sex hormones, without which humans and animals would miss puberty and remain sexually immature. Conversely, over-activation of kisspeptin's receptor GPR54 causes early onset puberty.
The study at Imperial College included ten women who were not menstruating, five of whom were given kisspeptin, and the other five were given saline solution. Blood tests of those who received the kisspeptin revealed that there had been a 48-fold increase in the production of lutenising hormone, and a 16-fold increase in follicle stimulating hormone, both key sex hormones for ovulation and fertility. These results were far higher than those previously gathered for fertile women.
'This is a very exciting result and suggests that kisspeptin treatment could restore reproductive function in women with low sex hormone levels. Our future research will focus on determining the best protocol for repeated administration with the hope of developing a new therapy for infertility' said Dr Dhillo.
Professor Richard Anderson, a fertility expert from the University of Edinburgh said that the research held the promise of a more subtle way of treating women whose reproductive systems had 'shut down'. Where most current treatments involve the direct stimulation of a woman's ovaries which carries a risk of multiple births and side effects, kisspeptin would potentially address the underlying problem and maintain the body's own protective regulatory mechanisms. Professor Anderson believes the hormone 'may well become a mainstream part of therapy'.
Certificatecourse in Reproductive Medicine Nursing.
Nurses form the backbone of any health care delivery system. Reproductive Medicine services are being offered all over the world, often with nurses with no special training in Reproductive Medicine. This course is tailor made to fill up this lacuna.
Objectives:
Train nurses to help doctors establish and run an efficient, cost effective and ethical reproductive medicine unit.
At the end of the course, candidates will
1.be able to counsel reproductive medical problems both in men and women.
2.have good working knowledge in the field of and reproductive medicine.
3.assist in reproductive medical procedures.
Eligibility:
Postgraduate Degree or degree or diploma in nursing.
Duration:
6 months.
Mode of Teaching:
Lectures, Power point presentations and interactive sessions.
Practical demonstrations. Hands on – wherever applicable
Frequent examinations conducted throughout the course. MCQ’s, Short notes and Essay type Questions.
The students will not receive any stipend or any other form of financial support from the institution. However they may utilize the existing infrastructure in the department and institution.
A joint study conducted by Calcutta University and Fertility Clinic & IVF Div. of AMRI Medical Centre, India and Center for Reproductive Medicine, Cleveland Clinic, Ohio, has revealed a decline in semen quality in the last two decades in Kolkata- a major metro city in India.
�It was a first-of-its-kind study in the subcontinent and appeared online in Fertility and Sterility, a research journal of the American Society for Reproductive Medicine,� said a scientist associated with the project.
The examination of 3,729 sperm samples � 1,752 in the 80s (1981-85) and 1,977 in the last decade (2000-07) � revealed a nearly 10 per cent drop in semen volume and a corresponding decline in motility (a measure of the percentage of sperm that can move towards an ovum for fertilization) over 20-odd years.
Alex C. Varghese, the scientific director of the in-vitro fertilization division of AMRI and a co-author of the study, said the changes in infertility patterns were significant because �such a decline has taken place in a very short duration�. According to Dr Alex Varghese, there is a co-relation between urbanisation and growing vehicular pollution and the increasing number of infertility clinics in Asia and the Indian Sub-Continent. That's why it had become imperative to conduct such a study.
�In the last two decades, fertility patterns in the city have undergone tremendous changes and we found a strong correlation between the trend and worsening pollution levels in the city,� said Ashok Bhattacharyya, professor of biochemistry at Calcutta University and a co-author of the paper.
Dyutiman Mukhopadhyay, the first author of the paper, and the other scientists had taken care to avoid �regional variation� in the selection of samples.
According to the report, the root cause of male infertility was regular inhalation of noxious gases belched out by polluting vehicles and the increasing presence of heavy metals such as lead and cadmium in the environment.
The experts attributed the decrease in semen volume mainly to chemicals that adversely affect male sex hormones. Several studies have established that these toxins � released in the air mainly by polluting vehicles � directly affect the functioning of �accessory sex glands� that help produce sperm.
The paper quotes a World Bank study as saying that in 2002 Calcutta was the third most polluted city in the world in terms of concentration of particulate matter. �Transport emissions in Calcutta rose from an estimated 1,825 tonnes per annum in 1970 to 25,550 tonnes in 1990.�
According to Dr. Alex Varghese, increasing seasonal air pollution has also been reported in decreased motility in males in Salt Lake area of Utah in United states. Animal studies indicate DNA mutations in spermatozoa in mice exposed to high air pollution. Some recent European study also indicates high sperm DNA damage due to air pollution without any significant changes in other classical semen parameters.
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Benzo[a]pyrene significantly affected sperm functional competence as evidenced by increased hyperactivation as well as premature acrosomal reaction in vitro- according to a collaborative study published in Fertility & Sterility done by Institute of Reproductive Health & Toxicology, University of Calcutta and IVF Div, AMRI Medical center, Kolkata, India. Content: The polycyclic aromatic hydrocarbon benzo[a]pyrene is one of the most harmful components of tobacco and its other environmental sources are automobile exhausts and coal tar.
Present study has shown that Benzo[a]pyrene significantly affected sperm functional competence as evidenced by increased hyperactivation as well as premature acrosomal reaction in vitro. A person who smokes a pack of 20 tobacco cigarettes per day is expected to inhale anything from 0.067 mg to 0.568 mg of benzo [a] pyrene per day.
According to Dr. Dyutiman Mukhopadhyaya, a scientist in the team who did the present study, hyperactivation of human spermatozoa is characterized by high amplitude and asymmetrical flagellar bending. Computer assisted semen analyzers can be used to identify hyperactivated sperm by setting minimum thresholds for curvilinear velocity and lateral head movement and a maximum threshold for linearity of path. One of the important parameters of the CASA-based study is the hyperactivation module in recent CASA system in the market whereby one can analyze the percentage of hyperactivated spermatozoa. Mammalian sperm hyperactivation is calcium dependent and is typified by a change in normal motility parameters during capaciation.
It is worth mentioning here that epidemiologic surveys on smoking have revealed that the seminograms of smokers differ considerably from those of nonsmokers, and that the parameters affected include spermmotility andmorphology
According to Dr. Alex Varghese, Scientific Director, AMRI IVF and a co-author of the paper, in a previous study by our group we noted that heavy smokers (more than 20 tobacco cigarettes per day) showed an increased percentage of hyperactivated spermatozoa compared with nonsmokers.
Earlier studies have shown that polycyclic aromatic hydrocarbons can alter intracellular calcium homeostasis. The Ca rise is coupled with increased tyrosine phosphorylation, and it has also been shown that benzo[a]pyrene and especially its metabolites can increase intracellular Ca with an increase in tyrosine phosphorylation activity. Recently, Harvard researchers have zeroed in on a protein called CatSper1-, which appears to hold a key to this whole process. In a paper published in the journal Nature, the researchers showed that the protein plays a key role in the flow of calcium ions into the sperm cell. Studies on Ion-channel complexes in germ cells exposed to environmental toxicants hence may throw light on molecular defects associated with increasing cases of male infertility. According to Dr. Varghese, although the sperm hyperactivation assay using modern CASA systems, an important test in the functional as well as fertilization potential of spermatozoa population, pre! sence of higher proportion of hyperactivated sperm fraction in neat semen may indicate functional incompetence of germ cells.
At 66 years old, Elizabeth Adeney is set to become Britain's oldest mother when she gives birth to a child conceived following fertility treatment at a clinic in Ukraine. The example highlights the growing trend among fertility patients to travel abroad to access treatment which in Britain often involves high cost and a long wait.
A new study funded by the Economic and Social Research Council (ESRC) and the first academic inquiry of its kind, is being undertaken by Lorraine Culley, professor at the Health and Social Sciences department of De Montfort University, UK. It aims to give a clearer indication of the number of British 'fertility tourists' visiting clinics in countries like Spain, Greece, Russia, the US and India. 'Women here do this for all sorts of reasons. There is a serious shortage of eggs, donated sperm is in shorter supply than before, the cost can be cheaper abroad and some people want IVF which they can't get on the NHS', said Culley.
The only previous study into fertility treatment abroad was conducted in 2008 by patient support group Infertility Network UK (IN UK) and surveyed more than 300 fertility patients, some of whom had already received foreign services. More than three quarters of respondents said that they would consider treatment abroad, with lower costs and shorter waiting times being cited as deciding factors.
Dr Allan Pacey, secretary of the British Fertility Society (BFS) also estimates that thousands of women travel abroad for treatment every year because of frustration with waiting times for donated gametes. Professor Culley believes that couples who go abroad are able to exploit the fact that in some countries women can be paid to donate their eggs.
Of the 24 per cent in the IN UK survey who said they would not consider going abroad to be treated, language difficulties and a lack of regulation were the main concerns. However, those respondents who had already been treated abroad said that in addition to lower cost and speedier treatment, high success rates, staff attitudes and the atmosphere and facilities in clinics abroad were the main attractions; 88 per cent were happy with the treatment they received.
British fertility regulator the Human Fertilisation and Embryology Authority (HFEA) has warned that procedures at foreign clinics may not be safe, that success rates may be exaggerated and children born may never be able to discover anything about their half-siblings: 'there are clear risks' said a spokesman.
However, chief executive of Infertility Network UK Clare Lewis-Jones said that 'if the NHS funded three full cycles of treatment as recommended by NICE, many couples would not be forced to consider going abroad for treatment... I do hope clinics in the UK take into consideration the findings of this survey and learn from the good experiences many couples have had at clinics abroad'.
