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The American Fertility Association’s Monthly Newsletter

June 30, 2008

UpFront: NEWS IN BRIEF

New! Improved! And Controversial

A much-heralded advance in chromosome screening in embryos before transferring them into the uterus called preimplantation genetic screening (PGS), got a black eye from the British Fertility Society (BFS). In a recent statement, the society said there is no evidence that it improves IVF outcomes or diminishes the miscarriage risk in older women, reports the BBC.

Unlike Preimplantation Genetic Diagnosis (PGD), which screens for a very limited number of disease-associated anomalies, PGS checks for a broader range of commonly missing, or extra copies of chromosomes. If aneuploidies are detected in a given embryo, then that one isn’t transferred.

The pitch is that by using only “normal” embryos, it boosts the chances for successful implantation and normal development, especially during the crucial first trimester. PGS held out promise for older women precisely because with age comes increasing chromosomal abnormalities and miscarriage. It was also thought to benefit women who suffered recurrent miscarriages.

"It is clear there is no compelling evidence that PGS improves the clinical pregnancy rate, live birth rate, or that it reduces the miscarriage rate," the BBC quoted Professor Richard Anderson, who wrote the guidelines, after the British Fertility Society reviewed all the available studies.

Given that PGS adds a significant cost to already expensive IVF cycles, the BFS wants patients to know exactly what they’re getting for their money – which may be nothing.

The Upside of the Virginity Vow

A recent study of 1,461 teens by the non-profit research group, RAND, found that those who pledged virginity until marriage were less likely to engage in sexual activity for the period of the study than their demographically similar peers who didn’t take the oath.

"These findings do not suggest that virginity pledges should be a substitute for comprehensive sexual education programs, or that they will work for all kinds of kids", said Steven Martino, the study's lead author and RAND psychologist. "But virginity pledges may be appropriate as one component of an overall sex education effort."

The research team interviewed the 12-17 year olds in 2001 and followed up three years later. The bottom line: 42% of those who did not make virginity pledges reported starting sexual intercourse within three years, compared to the 34% of those who pledged.

Martino said virginity pledges are unlikely to be a viable means to encouraging all adolescents to delay the initiation of sexual intercourse.

"(They) must be made freely for them to work," Martino said. "If young people are coerced or are unduly influenced by peer pressure, virginity pledges are not likely to have a positive effect."

The Fertility Regulatory Agency

No need to panic. This isn’t some big brother operation. Rather, a Washington University School of Medicine research group has discovered that altering the sugars that attach a key fertility hormone produced in the pituitary gland, might have a very positive effect on procreative capacity. At least in mice.

The team found the change appears to alter a reproductive "thermostat," unveiling part of a complex regulatory system, reports Science Daily.

Researchers identified a unique set of sugars consistently added to luteinizing hormone, which is part of a feedback loop between the pituitary, the reproductive organs and the liver. The loop waxes and wanes over time, producing periodic peaks in other reproductive hormones and triggering regular events, such as the ovaries' release of eggs.

Researchers effected the change by disabling one of the enzymes that attaches sugars to luteinizing hormone in mice. This enzyme isn't the only one to add sugars to the hormone, so the alteration changes the mix of sugars, rather than eliminating them.

The net effect was a leap in fertility, with mice having nearly 50% more babies than normal. The liver removed the altered hormone from the blood more slowly. Females were maturing earlier and were always receptive to male mating. Males had higher testosterone levels and females had higher levels of estrogen.

The speculation is that human fertility problems, at least in part, may be related to a defect in the fertility regulatory system, perhaps the wrong proportion of some of these sugars, or in the receptors, that clear the sugar-hormone combination from the blood, according to Jacques Baenziger, MD, PhD, Professor of Pathology and Immunology and of Cell Biology and Physiology, and research team leader.

The Caesarean Cut

Beware: obtaining individual health insurance may be tough if you’ve had a prior C-section. According to The New York Times, some insurers have recently denied individual health coverage to women who have had Caesarean sections because they’re likely to have another one, if they become pregnant again. Just how many such women have been denied coverage is unknown, but the number is "likely to increase" because the number of people seeking individual health insurance has been steadily growing, according to the Times.

The percentage of babies delivered via C-section in 2006 was 31.1%, an all-time high. That’s 1.2 million procedures, with the average cost of each running at about $2,700 more than a vaginal birth. The controversy comes into play when elective Caesareans are increasingly popular. The International Caesarean Awareness Network’s president said, “Obstetricians are rendering large numbers of women uninsurable by overusing this surgery.”

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