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The American Fertility Association’s Monthly Newsletter

October 30, 2007

This Just In

Chalk Up Another One—Make That Two—For The AR of IVM

In Vitro Maturation (IVM) scored another two small victories with the delivery of fraternal twins in the UK, reports the BBC. IVM, heralded as an one-injection alternative to the pharmaceutical-heavy ovarian stimulation protocols associated with IVF, is a process of extracting immature eggs from the mother and maturing the ova ex-vivo. When they’re sufficiently ripe, they’re fertilized in the lab and transferred back to the mother, following the same protocols as “vanilla” IVF.

In vitro maturation is cheaper and faster than conventional IVF, but its success rates are lower.

The October 18th birth of the brother and sister was a first in the UK using this technique and an important achievement for the Oxford Fertility Center, the only clinic licensed by British health authorities to perform the procedure.

Given that the number of babies born via IVM is still miniscule, 400 globally compared to the 2 million born through conventional IVF, the safety of the procedure is still open to question: Do the immature eggs sustain damage during the lab maturation process? Are the resulting IVM children healthy? To date, the empirical evidence seems reassuring. All the IVM kids are normal and robust.

FDA Gets Hard On ED Drugs’ Hearing Loss Risk

The next time you reach for the little blue pill, think above your belt, not below it. It seems that drugs targeting erectile dysfunction have the unintended, and most definitely undesirable side effect of knocking out hearing. The Food and Drug Administration is requiring manufacturers of Viagra, Levitra and Cialis to change their labels to “display more prominently the potential risk of sudden hearing loss.”

The FDA is cast the net for the label changes to capture the entire class of drugs called Phosphadiesterase Type 5 Inhibitor., aka PD-5 Inhibitors, That captured the blood medication, Revatio, as well.

The possibility of the link between sudden hearing loss and ED drugs caught the FDA’s attention after a study appeared in a professional journal for ear, nose and throat specialists last April. The agency looked for other reports involving hearing loss and found 29 that chronicled patients with ringing in their ears, vertigo and/or dizziness.

Although the number of cases is small and the hearing loss in about one-third of them is temporary, the FDA issued its ruling to give a heads up to the millions of men who regularly use ED drugs.

The Gene-y In The Sperm: Unlocking One More Clue to Male Infertility

It’s an unmemorizable jumble of letters and numbers, Jhdm2a. But researchers at the Howard Hughes Medical Institute in North Carolina have discovered that Jhdm2a is a gene crucial in the final step of sperm formation that involves the compaction of DNA into a tight ball in the sperm head so it can penetrate an ova. In mouse studies, those that lacked the gene didn’t produce many mature sperm and most of those were defective.

The team recently reported the results of their mouse studies in the journal Nature. The study’s senior author,Yi Zhang, Ph.D., noted that, “There are several mouse models that exhibit the male infertility seen in human syndromes such as azoospermia (absence of sperm) or globozoospermia (sperm with round heads),"
He noted that most of the genes required for normal spermatogenesis in mice are intact in human patients, raising the possibility that it’s mportant to consider the jhdm2a gene as a culprit in these human male infertility syndromes."
Zhang and colleagues are looking for Jhdm2a mutations in infertility patients at the same time they’re interested in identifying the cell cofactors that help this gene function properly.

SPECIAL: Insights gleaned at American Society of Reproductive Medicine, the mega-conference at which cutting edge thinking, scientific and clinical research go on parade.

A Moment of Silence: Quieting The Fertilization Gene

Is it possible to side-step the nausea, headaches, and low sex drive and the slightly elevated risk of strokes sometimes association with The Pill and still have an effective oral contraceptive? Well, according to a research team at Brigham and Women's Hospital in Boston it very well may be. They’re working on a new oral contraceptive that relies on a technique called “RNA Interference” to block the sperm from entering the egg.

Basically, RNA interference “silences” a gene to keep it from working as it should. This team isolated the gene that is active in ova, ZP3, just before they’re fertilized. ZP3 produces a protein that allows sperm to bind to the surface of the egg. No protein, no finding, no fertilization. So far, mice with the silenced ZP3 gene don’t conceive.
While RNA interference holds huge potential, a great deal of research remains to be done because of potential off-target effects –that is unintended interference elsewhere in the body.

The good news: there are no off-target effects associated with silencing the ZR3 gene.
The bad news, if you could call it that: Such a longed-for birth control pill is still about a decade out.

Needless Needles?
Study Links Acupuncture to Lower IVF Success Rates

The somewhat baffling results of a study of 97 patients undergoing IVF revealed that the group that had acupuncture in conjunction with treatment had a significantly lower pregnancy rate than those who did not go under the needle.

Researchers at the University of Oklahoma found that one group of women who underwent an acupuncture treatment 25 minutes before and after an embryo transfer had a 43.8% pregnancy rate compared to 69.9% among the group that did not.
The team leader, Dr. LaTasha Craig, acknowledged that the findings flew in the face of previous studies, urged more research, and suggested that the possible benefits of acupuncture might be undone by the stress of having treatments immediately before and after IVF.

Eggs On (Thin?) Ice: The Ovum Freezing Debate Heats Up

The American Society of Reproductive Medicine’s Practice Committee issued a strong warning against offering healthy women of reproductive age the option of oocyte cryopreservation today as a sure-fire way to rewind the biological clock.
Stressing the still experimental nature of the procedure and the very low success rates, the committee drafted 10 points of information that should be provided to women interested in fertility preservation via egg freezing. These include disclosure about treatment methods, fees, success rates and policies about disposition of unused eggs.

Acknowledging the social and economic pressures that force many women to delay childbearing, ASRM urged extensive counseling for those who choose to pursue that route. The goal is to prepare women for the expense and the real possibilities of a disappointing outcome given that the technology is still in its infancy. ASRM estimates that the live birth rate from frozen eggs is a mere 2%, warning that the figure for women over 35 years, the age at which fertility’s decline becomes precipitous, may be even lower.

This is in contradistinction to egg freezing for young women in reproductive jeopardy – such as those suffering from cancer or severe endometriosis. In those cases, medical wisdom has coalesced around this technique as their best hope to have biogenetic offspring.

For more on the state of the oocyte cryopreservation debate, please read Dr. Mark Trolice’s OpEd in this issue of Connections.)

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