REPOST: Immune regulation of ovarian development: Programming by neonatal immune challenge

This article mentions that immune factors may be major regulators of ovarian development.
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Bacterial infections during early life, such as Chlamydia which is present in 15% of newly born babies, may reduce reproductive success in adult women. For example, exposure to bacteria can lead to a change in the onset of puberty, as well as in ovarian morphology and sexual behavior.

Luba Sominsky and colleagues from the University of Newcastle, Australia, here show that when infant rats are injected with lipopolysaccharide molecules that are normally found on the exterior of bacteria, the expression of genes in their ovaries changes, especially for genes implicated in immune-mediated inflammatory disease.

Sominsky et al. propose that during early development, immune factors are major regulators of ovarian development, so that an immune imbalance during this period may interfere with the formation of ovarian follicles, compromising fertility later in life. This link between adult fertility and infections during critical periods of development may help explain the ongoing trend for declining fertility in young women worldwide.

More articles on gynecology and obstetrics can be found at this Facebook page for Cristian Andronic.

REPOST: Will You Still Be Fertile in 5 Years?

Are you beginning to wonder if you can still get pregnant? This Parenting.com article will help you detect your fertility rate, which can boost your chances of getting pregnant.

Image Source: parenting.com

Thinking of having another child? You may have less time than you imagine to conceive without difficulty. Still, you may be able to take steps now to improve your chances.

To help judge the state of your fertility, consider these questions:

1. How old are you? 

Age is by far the biggest factor in fertility, and even the most advanced infertility treatments aren't always able to turn back the clock. "Women are postponing childbearing until later in life - that's the very reason we see more problems today," says Pamela Madsen, executive director of the American Infertility Association.

Some researchers believe that fertility peaks as early as a woman's late 20s, and there's a consensus that by her early 30s, both the quantity and the quality of her eggs have begun to decline.

It's a gradual process, so there's certainly no need to panic. But if you're 30, you may not want to wait ten years to start trying to get pregnant again. At age 35 about three-quarters of women will be able to conceive without treatment, but by age 40 only half will, says Owen Davis, M.D., director of the IVF Program at Cornell Medical Center in New York City. By age 45 it's under 10 percent.

The risk of miscarriage also goes up with age. At 35, about one in five pregnancies doesn't result in a live birth; by age 42 more than half fail, according to a study of over 500,000 women million women in Denmark. An older egg becomes an embryo that's more prone to genetic damage, researchers believe.

Infertility is traditionally defined as the inability to conceive after one year of unprotected sex. "In my opinion, a woman under thirty-five should try to conceive for that amount of time before she seeks medical help to find out why she's not getting pregnant," says Magdy Milad, M.D., a reproductive endocrinologist and an associate professor of obstetrics/gynecology at Northwestern University Medical School, in Chicago. "Between the ages of thirty-five and thirty-nine, she should try for six months. And after the age of forty, she should try for three months and then see a doctor for an evaluation, just to make sure that nothing's wrong and she doesn't run out of time to try treatment."

2. Do you smoke? 

If so, you're hurting your chances of getting pregnant at any age. Exposing your eggs to nicotine will not only affect the quality of your eggs but decrease your ovaries' supply. The more cigarettes a woman smokes daily, the lower her chances of conceiving. Smoking can also speed up the age at which menopause begins, prematurely closing your lifetime window of fertility.

The good news is that quitting now can restore much of your fertility. It's not immediate, though. "Once a woman quits, it can take several months for smoking-related toxins to be cleared from the body," says Dr. Milad.

Passive smoking interferes too: In one study, women exposed to smoke at work or at home were less likely to conceive within a year than peers who were exposed to little or none.

3. Are you at a healthy weight? 

Being seriously over- or underweight - for a woman who's 5 foot 4, for instance, being heavier than 175 pounds (a body mass index of 30) or lighter than 105 pounds (a body mass index of 18) - may have a bearing on fertility, but only if it affects ovulation.

If your periods are normal, your weight is unlikely to impact your ability to get pregnant, says Bryan Cowan, M.D., chairman of the department of obstetrics and gynecology at the University of Mississippi Medical Center, in Jackson. But if you're overweight and your periods are irregular, talk to your doctor. On the other hand, if you're very thin or have recently lost a lot of weight and your periods have become irregular or have stopped, gaining weight may be the first step toward fertility.

4. What medications or remedies are you taking? 

Thousands of prescription and over-the-counter medications - as well as herbal remedies - can have an effect on fertility. But the main concern is a class of drugs that affect your body's production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) - key players in your ovulatory cycle. These include steroids (for asthma and rheumatoid arthritis), as well as prescription medicines that contain metoclopramide (for gastrointestinal upset) or phenothiazines (for anxiety.) It's always a good idea to talk with your doctor about which medications you are taking - or have taken - that might have an impact on fertility.

Contraceptives may also have an effect. If you've been on the Pill for a long time, it may take two to five months for your body to start ovulating normally once you go off it; that's also true for the newer hormone-based contraceptives like the Mirena IUD or the Nuva ring. "It's a myth that taking the Pill will prevent you from getting pregnant in the future," says Helane Rosenberg, Ph.D., egg donor coordinator at IVF New Jersey, in Somerset "But if you've been taking it for a long time, it could be masking a problem that would make you ovulate irregularly if you weren't taking the contraceptive."

The exception is if you've been treated with Depo Provera - in that case, the wait could be much longer. "Since the drug is injected into muscle, the hormone absorption may be so slow that it could take as long as a year for your fertility to return to normal," says William Gibbons, M.D., chairman of the department of obstetrics/gynecology at Eastern Virginia Medical School, in Norfolk. Norplant, though, has no adverse effect on fertility once it's removed.

If you're using herbal remedies, be wary: They're not regulated, so there's no requirement that their effects on conception and pregnancy be properly researched. Some reports have suggested that popular supplements - Saint-John's-wort, ginkgo, Echinacea - may negatively affect fertility, but other studies have found no effect, so there's no way to tell yet. "If you're having trouble conceiving and you're taking herbal supplements, you might want to stop, just in case," says registered dietitian Paul Thomas, editor of The Dietary Supplement, a newsletter for health professionals and consumers.

5. Have you ever had a sexually transmitted disease (STD)? 

If it was caught early and treated, an STD will probably not affect your ability to get pregnant. But one that was untreated for a long period of time may cause problems; untreated chlamydia, for instance, can lead to pelvic inflammatory disease, which may make you infertile. Chlamydia and gonorrhea can also cause scarring of the fallopian tubes or low-grade infections that can change how receptive your uterine lining is, says Carolyn Salafia, M.D., director of EarlyPath Diagnostics, a research facility in Larchmont, NY.

That's why it's important to be checked for STDs by your doctor before you try to get pregnant. Your partner should get checked too: STDS can also block production of sperm.

6. Was your last delivery difficult? 

Even if you've had a c-section, you won't necessarily find it harder to conceive your next child, unless there was tissue scarring, which can potentially impair fertility. (Nor do the vast majority of abortions affect conception.)

On the other hand, even a problem-free pregnancy doesn't mean it'll be easy to get pregnant the next time. "If your first pregnancy was uneventful, it excludes certain problems in the future, such as specific congenital abnormalities, but it's not a guarantee - other factors, like age, can affect your chances," says Dr. Davis.

7. Is your period regular? 

If you have an irregular cycle that is very long (more than 36 days) or short (less than 22 days), it's possible that your ovaries aren't functioning normally, and that could have an impact on the viability of your eggs when you try to get pregnant. Every woman's cycle is different, but see your doctor to rule out possible medical causes, such as thyroid disease or polycystic ovarian syndrome; both can be detected by blood tests and treated. Fibroids, which can cause heavy periods, may also interfere with fertility and are also easily treated. Fortunately, if you are not ovulating normally when you want to conceive, there are a number of medications that can correct the problem.

8. Are you under a lot of stress? 

It isn't clear whether daily stress has an effect on one's chances of getting pregnant. Some experts think it may decrease the production of estrogen, but others find no link. It's a bit of a chicken-and-egg issue: Infertility itself is stressful, so it's not surprising that women who seek help may report feeling tense.

Depression is another matter: "A number of studies link depression and trouble conceiving," says Alice Domar, Ph.D., director of the Mind/Body Center for Women's Health at Boston IVF, Harvard Medical School, and coauthor of Conquering Infertility. "If you want to conceive in the future and you're having emotional problems, try to see a mental health professional," says Dr. Domar. But if you're sure that your emotional stress is related to pregnancy worries, you may want to join a fertility support group. It will not only give you a place to talk about your experiences but also teach you coping techniques for stress management and relaxation. To find a group in your area, visit, the website of the National Infertility Association, and click on Local Chapters.

9. Are you a healthy eater? 

A well-balanced diet with plenty of fruits and vegetables is always a good idea, but the average American diet provides the necessary vitamins and minerals for fertility, says Dr. Cowan. Of course, every woman of childbearing age should take a multivitamin with at least 400 micrograms of folic acid - it helps prevent neural tube defects only if you take it before you get pregnant.

Caffeine remains controversial. Some studies indicate that it can delay conception, but others show - you guessed it - no effect. Once you do become pregnant, though, caffeine matters: As little as two cups a day can double your risk of miscarriage. Says Dr. Milad, "I give my patients who are trying to get pregnant the same advice I give those who are pregnant - keep caffeine intake in check and take your vitamins."

So, will you be fertile in five years? There's no way to be absolutely sure, of course. The more you know, the easier it is to plan your future. And the healthier your lifestyle, the better your chances will be.

Kristyn Kusek writes about women's health issues for a number of magazines. This is her first feature for PARENTING.

The Dad Factor 

The male contribution to infertility has only recently received the scientific attention it deserves. Here are some questions worth asking about the aspiring father:

Does he smoke? 

Infertility rates are three times higher in men who smoke compared with those who don't. Just as tobacco use affects a woman's eggs, it can also cause a reduction in the number of sperm as well as damage those being formed. After a man quits, it takes about three months for his sperm to return to normal, says Dr. Davis. If he was a heavy smoker, it can take longer. What's his health history? Mumps can cause sterility, according to Dr. Davis. Also, about 1 in 500 men have Klinefelter's syndrome, a genetic disorder that causes them to be born sterile.

How old is he? Although a man can impregnate a woman into his 70s and older, new studies make it clear that a man's fertility declines with age, beginning around 35. Both the quality and the quantity of sperm are affected.

Is he okay "down there"? One of the biggest causes of male infertility is varicoceles - varicose veins in the scrotum. These affect one in ten men. Some get them around their testicles, which can reduce sperm production. Have him see a urologist for treatment options.

How's his diet? Men who get enough folic acid, vitamin C, and zinc produce more sperm, studies show. The amounts for each in a healthy diet - or a standard multivitamin - are fine.

Is he regularly exposed to heat? For men who use hot tubs often - or truck drivers who spend a lot of time sitting above a vehicle's engine - there may be a reduction in the number of sperm produced.

Does he drink a lot or smoke pot? In some men, even moderate drinking affects fertility; some researchers believe men should limit themselves to one drink a day for optimal fertility. Marijuana use can reduce the production of sperm, and heavy use is associated with infertility, says Dr. Davis.

Timing the Test for Pregnancy 

If you're using a home pregnancy test, wait at least ten days after your period is due to try it. If you test too soon, the result may signal that you're not pregnant when you really are, says epidemiologist Donna Day Baird, Ph.D. "The fertilized egg may not yet be implanted in the uterus by the time a woman expects her period," she says, "so the test can't detect the pregnancy." - Rachelle Vander Schaaf

Follow this Twitter page for Dr. Cristian Andronic for more links to articles on fertility and pregnancy.

REPOST: Breast Cancer's Dirty Little Secret: Fertility Loss

How does breast cancer affect one's future offspring? This Health.com article elaborates the risks posed by cancer treatments and ways on how they might affect fertility.

Image Source: health.com

I recently edited a story for Health magazine about what it’s really like to have breast cancer. The survivor stories were both inspiring and heartbreaking. But the women who haunted me most were those who were not only worrying about staying alive, but about whether they could get pregnant.

"Learning that I may not be able to have a baby was the hardest thing I had to deal with," says Stephanie Gensler, a 39-year-old ad executive who was diagnosed with stage II aggressive breast cancer at age 34. She underwent a lumpectomy, six months of chemo, and 36 radiation treatments. "My doctor says it's possible," says Gensler, "but I’m not sure it is."

That kind of uncertainty drove many women to a recent Web seminar hosted by BreastCancer.org on breast cancer and fertility. Their questions were wide-ranging:

I’m having chemotherapy treatment for six months. Can I still hold out hope for a pregnancy after treatment? Does insurance pay for freezing my eggs if I have breast cancer? If I do get pregnant, will my child have a higher risk of breast cancer? Fertility experts answered them: Kutluk Oktay, MD, a professor of obstetrics and gynecology and the director of the Division of Reproductive Medicine & Infertility at New York Medical College; and psychologist Leslie R. Schover, PhD, a professor of behavioral science at the University of Texas M.D. Anderson Cancer Center in Houston, who helps cancer survivors make decisions about fertility preservation, cope with fertility-related distress, and resolve cancer-related sexual problems.

There is good news

There have been great advances in the fertility-after-breast-cancer field—from freezing embryos (fertilized eggs) and oocytes (unfertilized eggs) for later in vitro fertilization, to experimental procedures such as removing and freezing some ovarian tissue so that it can be re-implanted once treatment has been completed. Dr. Oktay pioneered some of these developments as founder of the Institute for Fertility Preservation at the Center for Human Reproduction in New York City.

But for some, it’s too late

Most of the women getting the information via the Web seminar were getting it way too late. It was painful to see these women's fertility hopes dashed because they had already undergone treatment that put them into permanent early menopause or otherwise compromised their ability to conceive.

When one woman undergoing chemotherapy asked if she would be able to get pregnant afterward, Dr. Oktay said, "If you’re receiving one of the standard chemotherapy regimens...your ovaries will behave after chemotherapy as if you’re in your 40s. And based on my experience and studies, you will have a very small chance of conceiving. If there’s a possibility, any woman in this situation should consider freezing eggs or embryos before treatment has begun."

That means it’s critical for women to get this information before they undergo treatment, and many don't.

"I didn’t get it," says Stephanie Gensler, who wishes someone had put egg preservation on her radar. "No one said anything about it, and I wasn’t thinking about it."

Finding out what you need to know 

Since oncologists are focused on saving lives first, and fertility second, breast cancer survivors need to find other sources of information to fill the void.

FertileHope.org offers reproductive information and support to cancer patients and survivors whose medical treatments present the risk of infertility.

The American Cancer Society offers comprehensive information on preserving fertility in men and women who undergo treatment.

MyOncoFertilty.org intersperses the advice of experts with much-needed friendliness, such as comforting videos from survivors like Laurie.

"When I met with my oncologist the first two times, I didn’t even think to ask her about fertility. It was all about me. It was about saving my life," says Laurie. She was lucky to get fertility advice after her mastectomy but before her chemotherapy began, and she is now pregnant. That’s the kind of happy ending that I hope we’ll be hearing more of in the future.

Dr. Cristian Andronic is known for his expertise in all aspects of general gynecology and obstetrics. More links to articles on women's health, pregnancy, and child birth are available on this Facebook page.

REPOST: Fertility Concerns for Young Women on Chemo

Can chemotherapy make women infertile? In this Health.com article, witness how Elissa Thorner, a breast cancer patient, faced the biggest challenge in her life.

Image Source: health.com

Elissa Thorner battled breast cancer at 23 and ended up facing one of the biggest issues for many young women with the disease: the potential effects of chemotherapy on fertility.

"I always wanted a houseful of children, and I thought my dream was gone after my diagnosis," recalls Thorner, who lives outside Baltimore. "I talked to several doctors, all of whom had no interest in speaking to me about fertility. When I pushed one oncologist about the topic, he said, 'Do you want to live or do you want to have children?' I responded, 'I want to live so I can have children.' "

Thorner talked to more and more doctors about her options, weighing her age and family history, but no consensus emerged. "Usually oncologists are pretty sure of themselves," Thorner says. "But for me they said, 'We don't really know what to do.' No doctor could say whether chemo would make me infertile."

The fact that Thorner had at least 20 more years of exposure to natural estrogen and progesterone to look forward to—which could be a risk factor for other cancers—led some doctors to advocate chemo. But because chemo effectively shuts down those hormones, there's always the risk that the hormones—and one's fertility—will never come back after treatment.

After many sleepless nights, Thorner decided not to have chemo. She got married in spring 2008 and plans to begin trying for a baby.

"It's important that I do so sooner rather than later," Thorner says, adding that given her profile, an oophorectomy and hysterectomy may be in her future.

Many doctors find it challenging to manage the precarious balance of powerful treatment with fertility concerns in younger patients. "We're not great at predicting" whose fertility will return after chemo and whose won't, says Ann H. Partridge, MD, a medical oncologist specializing in breast cancer in young women at Dana-Farber Cancer Institute in Boston.

But some chemo regimens are less toxic than others to the ovaries. For instance, Partridge says she doesn't recommend the so-called CMF combination (cyclophosphamide, methotrexate, and 5-fluorouracil) because there are regimens that are equally or more effective but less harmful. A woman who wants to be able to have children might instead be given Adriamycin and Cytoxan (AC) for a shorter period of time, maybe with a taxane drug like Taxol or Taxotere.

An alternative method for younger women that is the subject of ongoing research involves combining tamoxifen treatment with ovarian suppression, a therapy that temporarily stops the functioning of the ovaries and halts the production of estrogen. Because the risks involved in the combination are not fully understood, doctors usually recommend that it be done in the setting of a clinical trial.
  
Cristian Andronic is one of the leading practitioners of gynecology in Delaware. Visit this Facebook page for more updates.

Reproductive aging: Knowing egg freezing before it’s too late

Image Source: learnvest.com

Freezing eggs so that they may be fertilized and implanted at a future time is now an option for women who plan to delay pregnancy. Egg freezing is a modern method used to preserve a woman's reproductive potential. It helps women take advantage of their body’s fertility at a time when eggs are at their prime age.

As the National Infertility Awareness has just concluded, more and more women have become aware that egg freezing is one of the easiest ways to radically slow down the biological clock. What should women know about this method? Dr. Jeffrey Steinberg shares and answers via CNN news two of the most common queries about egg freezing:

What’s the best age for a mother to undergo egg freezing?

Dr. Steinberg says that the younger the eggs the better, since they have the capacity to endure the freezing process. Hence, a mother in her 20s or 30s is the best candidate to undergo such procedure. Beyond that age range may be a little too late.

Image Source: edition.cnn.com

Will a young mother run out of eggs due to egg freezing?

“This is a common misconception that could not be further from the truth. We're using eggs that you would have otherwise lost,” explains Dr. Steinberg.

A woman reproduces eggs, but she is only able to produce enough fertility hormones to ovulate an egg. This means that the eggs that didn’t get the fertility hormone just die naturally.

Ob-gyns, like Cristian Andronic and Michael R. Leb, can help mothers understand how egg freezing works, what the potential risks are, and whether this fertility method is right for all.

Image Source: edition.cnn.com

This Twitter page links to more articles on reproductive preservation and fertility.