Wednesday, 20 July 2016

IVF Does Not Raise Breast Cancer Risk

Study Shows
A series of studies over the past decade suggested that these former patients may have little to worry about. Experts remained cautious, however, because women who had undergone I.V.F. in the 1980s had not yet reached menopause by the time of the research.But the largest, most comprehensive study to date, published Tuesday, provides further reassurance: It finds no increased risk among women who have undergone I.V.F.

“The main takeaway is there’s no evidence of an increased subsequent risk of breast cancer, at least in the first couple decades,” said Dr. Saundra S. Buys, an oncologist at the Huntsman Cancer Institute at the University of Utah, who was not involved in the new study. Women undergoing in vitrofertilization have long worried that the procedure could raise their risk for breast cancer. After all, the treatment requires temporarily increasing levels of certain sex hormones to five or 10 times the normal. Two of those hormones, estrogen and progesterone, can affect the course of certain kinds of breast cancer.

The issue has nagged at specialists in reproductive medicine for some time. In 2008, a retrospective analysis of medical records, which the authors called “preliminary,” found a potential increase in breast cancer among IVF patients older than 40.

Another small study of participants at a treatment centre in Israel reported an increased risk of breast cancer among women who start IVF after 30. Maddeningly, later findings went the other way, seeming to suggest the danger — if there was one — may be greater for younger women. A study with roughly 21,000 participants, published in 2012, found that women in Western Australia who began IVF at 24 or younger had an increased risk of breast cancer. No such link was found among women in their 30s or 40s.

In 2013, though, researchers published a meta-analysis of eight smaller studies tentatively suggesting that IVF did not seem to raise breast cancer risk over all. But it did not rule out the possibility that breast cancer might turn up in a bigger group of women tracked more closely for an even longer period. Experts also worried that infertility itself, not only its treatment, might somehow be linked to breast cancer.

Tuesday’s report, published in JAMA, goes a long way toward answering the lingering questions. The huge study not only found no increased risk among women receiving IVF, but also found no greater risk among women who had various types of less intensive treatments to improve fertility.

Every week, we'll bring you stories that capture the wonders of the human body, nature and the cosmos. More than 25,000 Dutch women, with an average age of 32.8 when they started treatment from 1980 to 1995, were followed for a median period of 21 years.The researchers took into account an exhaustive list of factors linked to higher risk of cancer, including each woman’s age at the time she gave birth to her first child, her overall number of births and the number of IVF attempts.

Because IVF patients tend to have babies later in life than women who do not need assistance, “you have to take that into account,” said Alexandra van den Belt-Dusebout, the study’s first author and an epidemiologist at the Netherlands Cancer Institute in Amsterdam. More than five million babies have been born worldwide through IVF and other assisted reproduction.

Perhaps the study’s most surprising finding was that breast cancer risk was significantly lower among those women who underwent seven or more cycles of IVF, compared with those who received one or two cycles. “That’s reassuring, because you would think if you did IVF 10 times, your risk would be higher,” said Dr. Owen K. Davis, the president of the American Society for Reproductive Medicine.

The study also showed that women who responded poorly to ovarian stimulation in the first I.V.F. attempt also had decreased breast cancer risk. Louise M. Stewart, a researcher at the Center for Population Health Research at Curtin University in Perth, Australia, speculated that the finding might explain why women who had IVF at 24 or younger have an increased risk of breast cancer.

“Young women generally respond well to IVF treatment,” said Dr. Stewart, who was the first author on the Australia study. She suggested the “increased risk we observed in young women may be related to their response to IVF treatment.” Mia Gaudet, the strategic director of breast and gynecologic cancer research at the American Cancer Society, applauded the study for adding a “significant amount of evidence that there is no link between IVF and breast cancer.”

But she warned, “It’s still not conclusive.” For one thing, today’s protocols for IVF differ slightly inthe kinds of drugs given and for how long, the researchers noted. The researchers have recruited an additional 10,000 Dutch women who had the latest IVF regimen and 5,000 who received other fertility treatments. They will be tracking their health, as well.

Also, only 14 percent of participants had reached age 60, so this study cannot say much about postmenopausal breast cancer risk.

“We just may not be seeing breast cancer in these women yet,” Dr. Gaudet said.


Wednesday, 13 July 2016

Having a failed IVF cycle? Know what went wrong to have a positive 2nd IVF cycle

I have seen couples visiting clinic who have had failed IVF cycles before because of an improper execution of the IVF process by the concerned physician or are unsatisfied because of the poor lab quality and are hoping for a miracle. Their pain and grief is evident on their faces and I desperately wish to make every couple have a baby of their own and lead happier lives.

Even couples who succeed in the very 1st IVF cycle rarely come out unscathed. It is a fact that out of all those who embark on an IVF journey, only 40% receive positive results in the first cycle, while others question why this happened and what went wrong. The responsibility lies with the treating doctor to explain and address all the possible reasons for the failure. Usually, there are 3 basic reasons causing IVF failures. The foremost reason is that the embryo transferred into the intended mother’s uterus is abnormal or incompetent to result in a pregnancy. In most of these cases, an IVF fails due to an inconsistent number of chromosomes present in the embryo and the remainder is due to genetic or molecular embryo abnormalities.

Another possible reason is an implantation dysfunction that inhibits the embryo to attach to the uterus lining. This could happen due to the following:
a) A thin endometrium of less than 9 mm at the peak of estradiol stimulation
b) Surface lesions protruding into the uterine cavity
c) Immunologic dysfunction leading to implantation failure

Other reasons can be technical difficulties during the embryo transfer process, however, this occurs rarely.

If I were to distinguish among the above-mentioned factors, I would say “embryo abnormality” is the most common factor for IVF failures.

The latest introduction in genetic embryo selection technology is Comparative Genomic Hybridization (CGH), which enables us to distinguish those embryos which are chromosomally undamaged and are competent enough. However, CGH does not play any role in the chances of improving pregnancy rates. It only contributes to identifying embryos that are capable of promoting a possible pregnancy, reducing miscarriage risks, and decreased chromosomal birth defects like Down syndrome.

Who requires a CGH embryo analysis?
A CGH embryo analysis can be beneficial in cases with the following conditions:
a) Unexplained IVF failure
b) Recurrent miscarriages
c) Chances of multiple births, chromosomal miscarriages or birth defects
d) Women who do not want to preserve abnormal embryos

What are the success rates of 2nd cycle IVF?
Couples usually come up with reasonable questions with unexplainable answers. The chances of couples having a successful second IVF cycle depend on upon the following factors:
• Intended female partner’s age
• Quality and quantity of egg
• Quality and Quantity of Sperm
• Quality of IVF lab
• Expertise of the physician to perform Egg retrieval and efficiency in the embryo transfer process
• Quantity of eggs retrieved
• Uterine issues
• Genetic and chromosomal capabilities of embryo

If you wish to improve your chances of having a successful second IVF cycle, make sure that your concerned fertility doctor has considered the conditioned mentioned above. You can also consult another fertility specialist if you are not satisfied with the present one.

Closing Thoughts
• Get an honest idea about the chances of success with a 2nd IVF cycle from your fertility specialist
• If there are complications in the ovarian stimulation process then consider revising your medication protocol
• Abnormalities in the egg or embryo, then opt for an IVF clinic with highersuccess rates if the reason was poor IVF lab standards
• You can consider using donor sperm or donor eggs after a failed IVF cycle
• In the case of uterine issues, implantation failure is a common result as the embryos are not able to attach. In such cases, you might have to look at options such as surrogacy


Wednesday, 6 July 2016

Acupuncture 'doubles the chances of getting pregnant through IVF'

  • Over 46 per cent of women undergoing acupuncture treatment conceived
  • While only 21.7 per cent of the women became pregnant in the o
    ther group 
  • Treatment may be offered as a possible method of improving IVF outcome
  • Expert says it may only work due to patient spending time with practitioner
Acupuncture may double the chances of a woman conceiving with IVF, a study has found. Among couples undergoing the fertility treatment, the likelihood of pregnancy was greatly improved if the woman also had acupuncture. Scientists at Homerton University Hospital studied 127 women aged between 23 and 43, on their first or second cycle of IVF.

They were split into two groups – one having four sessions of acupuncture while undergoing IVF, and the other having none. Among the treatment group, 46.2 percent conceived – more than twice as many as in the other group, where only 21.7 per cent of the women became pregnant.

The needle technique was used before any eggs were retrieved from the woman’s body – and then again before and after the fertilized embryo was implanted. 

Among the acupuncture group assessed at London's Homerton Hospital, 46 per cent conceived after four sessions – more than twice as many as those who had no treatment. The researchers, led by Karin Gillerman, said previous clinical trials have ‘precluded any firm conclusion’ about the treatment. But they added: ‘The results of this study imply acupuncture may be offered as a possible method of improving IVF outcome.’ 

However, they warned that simply the act of paying more attention to the group who had acupuncture may have acted as a placebo effect. In research presented at the European Society for Human Reproduction and Embryology, the authors wrote of the study’s limitations: ‘The additional attention paid to the acupuncture group as opposed to controls may have had a positive psychological influence.’ The NHS advises on its Choices website that acupuncture is safe when practised with good hygiene by a qualified practitioner.

The main risk to pregnant women having the treatment is from blood-borne diseases caused by unclean needles – similar to the risks from getting a tattoo or a body piercing – and the chance that these could infect the baby. Local authorities have bylaws that govern the cleanliness of acupuncture premises, their instruments and equipment. Mild side effects include pain, bleeding or bruising where the needles puncture the skin, drowsiness, and feeling sick or dizzy.

Gynaecology consultant Stuart Lavery, who was not involved in the research, said there was strong patient demand and interest in acupuncture among many couples attending IVF clinics.‘It is an area sadly lacking in the area of rigorous assessment,’ he said. ‘The study is interesting as it does seem to show a significant difference.’

Acupuncture could be offered as a possible method of improving IVF outcomes, according to the researchers. But he added: ‘The most important thing is it doesn’t control for the placebo effect. One would like to see in the clinical trial a test of “sham acupuncture”.’

This attempt to eradicate any placebo effect would involve making the patient think they are undergoing acupuncture, when really the needles retract without piercing the skin. Alternatively, needles are placed randomly, rather than at the pressure points usually specified for the treatment. 

Mr Lavery said: ‘The placebo effect is very real and we see it in every branch of medicine. ‘The power of the human mind to produce improvement is very real and everybody who works in medicine understands that.’He added that acupuncture may only be effective because it involves a practitioner spending time with the patient, and listening to them, something that is difficult in much of the NHS. ‘Patients are looking for someone who can give them that time and listen to what’s going on in their lives, and that may have some therapeutic benefits,’ 

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