Omega-3 fatty acids are good for you!
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A new study showed omega-3 supplement use was associated with an increased probability of conceiving.
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The COVIDSafe App
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The COVIDSafe app was developed as a means of tracing interactions between the community and individuals who test positive to COVID-19. This means if you have come in contact with a known case, you will be notified sooner, giving you time to get tested and decreasing the risk that you may pass on the virus to your family and friends or other members of the community.
Read MoreWhat you need to know about AMH
/In this ABC Online article Anna Saleh puts the hype around AMH or the ‘Egg Timer Test’ in the spotlight. Read more …
Acupuncture
/A recent Australian study published in one of the world-leading medical journals has concluded that acupuncture does not increase the likelihood that an IVF cycle will result in a baby. Despite the negative result, the stress experienced during the cycle appears to be reduced in some women and that may be worth the extra cost.
Read more here ...
Endometriosis: The Deepest Cut→
/A link here to a blog post I wrote for Endometriosis Australia.
Should I have my embryos tested?
/It is a question patients often ask. With the advancing techniques in pre-implantation genetic testing (PGT) there has been much hype around embryo testing. So, should you consider paying extra for this option? It depends because there are two types of PGT.
PGT-A stands for pre-implantation genetic testing to detect aneuploidy. Simply put, it is testing embryos to see whether they carry chromosome abnormalities such as Down syndrome. As a simple analogy, it's like checking if the right number of books (chromosomes) are present in a library (karyotype). Embryos with the normal number of chromosomes are called euploid, those with an abnormal number of chromosomes are aneuploid.
Then there is also PGT-M. This stands for pre-implantation genetic testing to detect monogeneic diseases. This means that the embryos will be screened for the presence of a mutation in a gene, like the mutation that causes cystic fibrosis. To follow the previous analogy, here the geneticists will be checking the individual letters in one sentence from one of the books of the library. Because there are so many letters, the tests are currently designed to pick up mutations in parents known to be at risk.
Most people will need to consider PGT-A and we will explain the pros and cons a bit further. It is important to remember that PGT cannot make an abnormal embryo into a healthy one. So what's the point then?
If no test is carried out and an abnormal (aneuploid) embryo is replaced, it will either 1) not implant, 2) miscarry at a later stage or 3) lead to the birth of an abnormal baby if no screening is carried out during pregnancy.
The key advantage of PGT-A clearly is that only embryos that can lead to a healthy outcome will be transferred. This reduces the time-to-pregnancy (TTP). In other words, having your embryos tested or not won't change the total number of healthy babies that will be produced from one egg collection but with PGT-A a healthy live birth can be achieved in a shorter period of time.
This is the main conclusion from a large and well-conducted American study in women over 38 years of age. No differences were seen in the total number of babies born per patient 6 months after closing the study. However, the number of embryo transfers needed per live birth was lower in the PGT-A group compared with the control group (1.8 vs. 3.7), as was the time to pregnancy (7.7 vs. 14.9 weeks). This is mainly because the number of miscarriages was much lower in the PGT-A group (2.7% vs 39.0%). While it was not mentioned in the study, another implication is that the cost of testing is often outweighed by the saving of not having to undergo unnecessary embryo transfers.
It is, however, less clear whether the benefits are still this obvious for younger women (<34 years). The reason is that the eggs of younger women are a lot less likely to have already developed chromosome problems. Aneuploidy in eggs dramatically increases with age. Read more about the STAR trial here.
Click here to watch the Monash IVF Genetic Screening Information Webinar.
Advice on adjuvants
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Patients are often overwhelmed by the range of optional treatments some fertility specialists offer. These treatments are not part of the standard IVF treatment and are often referred to as adjuvants. Unfortunately, many of these treatments cost a lot of extra money, are not proven to work and may expose the patient or her unborn baby to unnecessary risk.
For that reason, the Human Fertilisation and Embryology Authority, which oversees the licensing of IVF units in the UK, has now released a very helpful patient information sheet that can help patients decide which adjuvants are effective and safe to use.
Read more here ...
Flushing tubes helps
/Radiologists need special liquids to inject in the uterus and the tubes to make them stand out on an X-ray. A study recently published in the prestigious journal New England Journal of Medicine shows that flushing the Fallopian tubes with an oil-based contrast medium leads to much higher pregnancy rates following the X-ray than a water-based contrast medium.
The lead investigator of the study, Professor Ben Mol, announced the results at the World Congress of Endometriosis held in Vancouver this week.
Professor Ben Mol and Professor Luk Rombauts at the World Congress of Endometriosis in Vancouver
How many eggs should I freeze?
/A large IVF unit in the US has used its extensive database to calculate how many eggs women should freeze to have a reasonable chance of a having a live birth when they return to use the eggs later.
The figure below illustrates by how much the chance of a live birth rate increases with the number of frozen eggs that are available. That chance declines with a woman's age. The highest chance is achieved when using donor eggs (usually from young fertile egg donors).
The following link takes you to an online calculator developed by the same researchers who published this graph. The calculator allows you to predict the likelihood of having 1, 2 or 3 children with a given number of frozen oocytes collected at a specified age.
Source: Human Reproduction, Vol.32, No.4 pp. 853–859, 2017
Don't skip your flu shots!
/Can flu shots help women get pregnant? That is the question being discussed in the top journal Science this week. Professor Sarah Robertson, a world expert on immunology in reproduction from the University of Adelaide, is excited. She has previously warned that the indiscriminate use of corticosteroids in IVF is unsafe and ineffective but she can see how the flu shots may deliver on two fronts: protecting women against the flu and improving their chances to get pregnant.
Careful with corticosteroids!
/Yesterday the Sydney Morning Herald picked up on an article By Prof Sarah Robertson, Australia's most eminent reproductive immunologist. In her article Prof Robertson warns against the use of corticosteroids such as prednisolone in IVF. There is virtually no evidence that corticosteroids improve live birth rates but we know they are associated with significant risks.
Work visit to famous IVF unit in Brussels
/I have spent some time with other IVF specialists visiting the IVF unit in Brussels where the sperm micro-injection technique, aka ICSI, was invented in 1992.
It was great catching up with friends and colleagues and having the opportunity to discuss some of the latest developments in our field.
Vigorous exercise is good for IVF
/Researchers conducting a study in 273 women undergoing IVF at Massachusetts General Hospital Fertility Center in Boston, USA, report that there was a beneficial effect on live birth rates after certain types of vigorous exercise such as aerobics, rowing, and on the ski or stair machine.
Thrush meds and miscarriage risk
/Women treated for vaginal thrush had an increased risk of miscarriage if they had been taking the antifungal drug fluconazole by mouth. An analysis of 1.4 million pregnancies in Denmark published in JAMA compared women taking the drug by mouth or vaginally. Oral use of this drug was associated with a 60% increase risk of a miscarriage compared to women taking the vaginal medication. The intravaginal formulations of antifungals are usually the first line treatment for pregnant women, but oral fluconazole is used in cases of recurrence or severe symptoms or when topical treatment has failed.
Chinese herbs can contain poison
/Traditional Chinese medicines are considered by some as a more natural, herbal approach to treating medical conditions, including fertility problems. It is estimated 50 per cent of Australians have used alternative therapies at some point. But there are renewed concerns about the safety of the multi-billion-dollar business.
An ABC news story reports on a study carried out by Curtin University, Murdoch University and the University of Adelaide which has now found that 90 per cent of 26 widely available Chinese medicines tested were not fit for human consumption.
Half contained illegal substances, including toxic metals, prescription medications, stimulants and animal DNA, none of which were listed on the product's label.
Murdoch University biochemist Dr Garth Maker said that over-the-counter drugs like paracetamol and ibuprofen were found in the Chinese herbs but also steroids, blood thinner warfarin and even sildenafil, the active ingredient in Viagra. "We were surprised but at the same time, there definitely seems to be an element of deception in designing these things to have a specific outcome," he said. "They may contain ephedrine, which will give a lot of people a buzz, and therefore they feel good and they think 'this is fantastic medicine, I should keep taking it'."
Professor Bunce of Curtin university added "One herbal medicine that's for sale had trace amounts of snow leopard DNA in it. We also found DNA from pit vipers, frogs and trace amounts of cat and dog DNA." It is unclear whether manufacturers intended these extra ingredients to be mixed in or whether they are contaminations resulting from poor manufacturing processes.
Professor Bunce also said that each herbal medicine sold in Australia needs to be listed with the Therapeutic Goods Administration (TGA), but only 12 of the products tested were registered with the agency and are deemed "low-risk". The remaining 14 were not registered by the TGA and therefore should not be available to Australian consumers in a commercial quantity.
Read more here. And click here for a contribution from the study's authors in The Conversation.
New endometriosis drug finally coming here.
/Visanne, a drug developed by Bayer, has been available to endometriosis patients overseas for quite a while now. Unfortunately, for a variety of reasons, including commercial ones, Bayer decided not to bring the drug to Australia despite having had the drug successfully registered with the Australian Therapeutics Goods Administration.
Now a public awareness campaign by Syl Freedman, a long-suffering endometriosis patient, has been successful in persuading Bayer to reverse their decision. The drug is expected to be available early 2015.
Good ideas don't always work.
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The U.S. research group of Richard Scott Jr. has published a well-designed randomised controlled study that looked at the potential benefit of a small intra-uterine infusion of the pregnancy hormone, hCG.
The idea behind this study was that the embryo secretes hCG to tell the endometrium to become more receptive. The researchers hoped that by infusing extra hCG in the uterine cavity they could make the endometrial lining even more receptive.
A logical and promising idea but ...
Read MoreInfertile women more willing to take risks
/Our research project on health numeracy and risk behaviour was presented at the annual Congress of the Asia Pacific Initiative on Reproduction in Brisbane last week.The study explored how much a person's ability to understand health statistics, such as the risk that a complication may occur, would influence their decision making in IVF.The findings suggest that being comfortable with numbers and statistics helps patients make better informed decisions. Another significant finding is that infertile women tend to be more worried about complications during pregnancy and they also overestimate those risks.
Despite these concerns, women with infertility are more likely to take extra risks, such as transferring two embryos at the same time. Double embryo transfers are associated with a higher risk of multiple pregnancy and this leads to poorer outcomes for the mother but also for the baby. Multiple pregnancies increase the risk of miscarriage, stillbirth and cerebral palsy.
The importance of the study is that a better understanding of what influences risk behaviour can help IVF specialists and counsellors tailor the information that is provided to the needs of the patient.
Exercise without weight loss still a winner
/A new Italian study has shown that women who are obese can achieve a 3-fold higher chance of a live birth if they do regular physical exercise before they start an IVF cycle. What was really surprising is that this was true even if no weight was lost following the exercise.
This is very good news for many women with a weight problem because it means that their efforts will be rewarded even if they don't manage to shed some kilos.
Lifestyle factors and miscarriage
/A Danish nationwide study has found that perhaps as many as 1 in 4 miscarriages can be prevented by changes in lifestyle. The study identified the risk factors in more than 90,000 pregnancies and found that older age, being underweight or overweight before pregnancy, and alcohol consumption, lifting heavy weights (> 20 kg), and night work during pregnancy were all linked to an increased risk of miscarriage before 22 weeks of pregnancy.
Most of these are lifestyle factors that can be adjusted before trying for a baby. We can't turn back time of course and one of the highest risk factors of all, older age, is not something that can be reversed. Nevertheless, the investigators of the study point out that the trend for women to delay childbearing is something that can be changed through good education programmes.