A Critical Link: The Environment and Women's Health Conference

A Critical Link: The Environment and Women's Health Conference
In recent years there has been an increased awareness of the connections between environmental contaminants, fertility, and health -- and a growing body of evidence supporting these concerns that link reduced fertility to pregnancy loss, adverse birth outcomes, reproductive tract abnormalities, learning disabilities in children, and various cancers to environmental contaminants. It is becoming increasingly clear to those of us who work for women's health that we must begin to turn our attention to the environmental toxicants that are affecting the ability of couples to become pregnant, have healthy pregnancies, and give birth to healthy babies.

At Planned Parenthood of Northern New England, we feel a responsibility as a health care organization to help our patients and communities make the link between human health and the products we put in our bodies, and in our homes and schools.

On September 10, 2009, PPNNE is presenting A Critical Link: The Environment and Women’s Health, in Burlington, VT. This ground-breaking conference will feature a keynote address by ecologist, author, and cancer survivor Sandra Steingraber. Steingraber and other environmental health experts, will participate in a panel discussion moderated by Dave Rapaport, Seventh Generation’s senior director of corporate consciousness, and Mia Davis, national grassroots coordinator for the Campaign for Safe Cosmetics, Planned Parenthood Federation of America President Cecile Richards will kick off the conference and share the Planned Parenthood perspective on providing greener, healthier choices to patients. For more information go to http://www.good-chemistry.org/

Extending a woman's fertility indefinitely

In a quick and driveby post, a colleague and friend had commented that he and his wife were trying for another child, but they not had success recently -- he was still optimistic, though, and said that they would try again in another ten years -- and it looks like they might be able to!:

"Scientists have produced strong new evidence challenging one of the most fundamental assumptions in biology: that female mammals, including women, are born with all the eggs they will ever have.

In a provocative set of experiments involving mice, Chinese researchers have shown for the first time that an adult mammal can harbor primitive cells in her ovaries that can become new eggs and produce healthy offspring, they reported yesterday.

While much more research is needed to confirm and explore the findings, the work raises the tantalizing possibility that it could someday lead to new ways to fight a woman's biological clock, perhaps by stockpiling her egg-producing cells or by stimulating them to make eggs again.

The findings could also help speed stem cell research by providing scientists with a new source of eggs, which are crucial for producing embryonic stem cell lines tailored to individual patients and diseases but are difficult to obtain.

"This is a very big deal," said Roger G. Gosden, director of reproductive medicine at Cornell Weill Medical Center in New York, who was not involved in the research, published online by the journal Nature Cell Biology. "It is quite dramatic."

Full article here.

Octuplets Mother Speaks Out

Nadya Suleman, mother of the recent octuplets born in California, has done her first interview with a major news outlet. (Although Suleman was seeking USD 2 million for the interview, NBC maintains that they did not pay her. However, that doesn't rule out "compensation" in other forms.)

Unfortunately, Suleman's interview has continued to raise, rather than answer, questions. Foremost among them, for me, is her claim that she had six embryos implants per IVF procedure. This... simply does not ring true. Or at least plausible, if she was using a US fertility expert.

Consider this: in order to have done so, this means Suleman would have needed to find, at age 26, a fertility doctor who would implant six embryos. ASRM guidelines are no more than 3 embryos for a woman under the age of 35, and that's if she has a history of problems with conception. With a 'clean' history, only 2 embryos are recommended. Now, it sounds like Suleman might have qualified as having difficulty conceiving, with several ectopic pregnancies and miscarriages prior to IVF. But even accounting for that, it's double the recommended standard. For each pregnancy.

But stop to do the math. While one vial of donor sperm would be more than enough for all of this, it means that they collected at least 36 eggs from Suleman, and that all of those eggs were viable enough to implant once fertilized. Realistically, not every egg retrieved is going to be mature, and not every egg is going to fertilize (unless you're using something like ICSI). Realistically, you're looking, at the very least, at 1/3rd more eggs than that being pulled out (and even that is a very, very low number - remember, they're saying that there were six viable eggs to implant per cycle. A quick web search shows that 1/3 of the eggs removed at any time are not mature, and of the ones that are mature, only half reach the point of being "good enough" to implant).

Now let's go over to CDC stats. While the last data is from 2005, which was going on 5 years ago, Suleman started her IVF course in 2001, so some of this data is specifically applicable (and some of it only extrapolation). According to the CDC, only 35% of ART cycles resulted in a pregnancy, and of those, 82% resulted in a live birth. So again, Suleman seems to have defied the odds. A lot. And as the CDC says about frozen eggs, "[b]ecause some embryos do not survive the thawing process, the percentage of thawed embryos that resulted in live births is usually lower than the percentage of transfers resulting in live births." While only 15% of embryos transferred were frozen, of those 15%, only slightly more than 1/4 ended up in live births.

Again, the odds make this seem incredibly unlikely.

Finally, fertility clinics are required by law to report their ART data, under the Fertility Clinic Success Rate and Certification Act. This gives us a decent way of tracking ART results - and also who is doing ART. In 2005, eleven clinics in California did not report their ART data (which would include embryo transfers/live birth data/etc). Of those eleven places, it looks like seven were within an hour of her home (keeping in mind her back injury likely limited the distance she could travel). Of the clinics that did report their data, 35 are within an hour of Whittier, California. However, given these clinics are compliant with reporting their data, it seems safe to eliminate them from immediate suspicion. (As for the potential Mexcio connection, Tijuana is approximately two hours away. Certainly not out of the question; an hour was a random number drawn from thin air. Suleman has certainly shown herself to be willing to go to significant length, and pain, to achieve her goals.)

All in all, what does this mean? Not much. Over 300 pages of records on Suleman have been released to the press, under a public records request to California's Division of Workers' Compensation. While it doesn't appear that the fertility clinic (or doctor) that treated her is in those records, there is ample evidence to support that she did have problems conceiving, and that she had known psychiatric issues, including what was diagnosed as either postpartum depression or PTSD. Issues that should have limited, if not prevented, future implantations.

Ultimately, until Suleman names her doctor, or said doctor speaks out, little will be conclusively known. But the facts remain simple: the facts do not add up.
-Kelly Hills

More on the Octuplets

Our friend and supporter, Art Caplan, sheds some more light on the ethical implications of the octuplets in his Philly op-ed:

"Something has gone terribly wrong when a 33-year-old single woman - who has no home of her own, no job, and a mother who worries her daughter is "obsessed" with having children - winds up with 14 of them. And all are under age 8, including eight newborn babies now in a neonatal nursery in various states of prematurity.
Examining what exactly went wrong may shed some light on what ought to be done. If doctors cannot prevent such a shambles from recurring, then society must.

The woman in question, Nadya Suleman, lives with her parents in a small home near Los Angeles. She has had infertility problems linked to blocked Fallopian tubes. She can make eggs, but they cannot be fertilized naturally because of the blockage.

Suleman apparently used donated sperm and in vitro fertilization to create all the embryos that became her children. She underwent treatment to cause her to produce many more eggs than the normal one per month, and they were surgically removed from her body and fertilized in lab dishes. Some of the resulting embryos were put back into her body, and that is how her first six children were made.

Unhappy with only six, Suleman sought further fertility treatment and had an additional eight of her embryos defrosted and implanted. They produced the now famous octuplets who, after a Caesarean section, are in intensive care at Kaiser Permanente Medical Center in Bellflower, Calif. Sadly, there is no known case of octuplets in which all escaped severe disabilities.

The most obvious questions raised by this sad saga include: How did Nadya Suleman become a fertility patient? And how did she get eight embryos implanted when she already had six young children to care for in a tiny house, with no partner and no income?
Some fertility doctors would answer that it's not their job to decide how many children a person can have. Jeffrey Steinberg, medical director of the Fertility Institutes, which has clinics in Los Angeles, Las Vegas and New York City, was quoted as saying: "Who am I to say that six is the limit? There are people who like to have big families."

James Grifo, a renowned fertility specialist at New York University, had little time for those wondering why Suleman was a patient. "I don't think it's our job to tell them how many babies they're allowed to have," he reportedly said. "I am not a policeman for reproduction in the United States."

With all due respect, the idea that doctors should not set limits on who can use reproductive technology to make babies is ethically bonkers.

If someone comes to a clinic with a history of child abuse, active drug addiction, and a rap sheet with serious felonies, should the doctor simply say: "If you have the money, I will make all the babies you want"? That gives cash and carry a whole new meaning.

Doctors have an obligation to consider patients' requests for treatment, but they do not have to honor them. One very good reason not to do so is if a doctor believes that what the patient wants would put children at grave risk.

Putting eight embryos into a woman is exactly that - putting kids at grave risk. Putting eight babies into the family of a single mom already trying to cope with six other young kids, with no money and little help, is putting kids at grave risk. The doctors who allowed Nadya Suleman to receive multiple embryos engaged in grossly unethical conduct.

The other major ethical problem raised by this story is the hijacking of health-care dollars by someone acting irresponsibly.

Suleman had to know that starting a pregnancy that might create eight tiny lives was to risk killing herself, as well as killing or severely disabling one or more of the babies. Fortunately, she made it through the pregnancy. But the cost of neonatal care for her eight new children probably will exceed $1 million.

When they are discharged from intensive care, more millions of dollars in medical costs likely await, not to mention the help Suleman will need just to handle all of her children's basic needs.

Society needs to discourage mega-multiple births. And it is clear what needs to be done to accomplish that.

If the medical profession is unwilling or unable to police its own, then government needs to get involved. We already have rules governing who can get involved with adoption and foster care. Shouldn't these minimal requirements be extended to fertility treatment? And shouldn't some limit be set on how many embryos can be implanted at one time, along with some rules about what to do with embryos that no one wants to use?

Other nations, such as Britain, keep a regulatory eye on reproductive technologies and those who wish to use them, knowing their use can put kids at risk in ways that nature never envisioned. We owe the same to children born here."

Original article here.

The Real Science Behind Fertility

You are what you eat...and so apparently is your ability to become fertile. That's according to a recent study done by Harvard doctors, whose findings suggest an apparent connection between women's diets and fertility.

Published last month in the journal Obstetrics & Gynecology, the study found a growing body of evidence linking diets to hormone levels particularly insulin, which impacts fertility.

This Los Angeles Times article details the study's findings and recommendations.