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Media coverage of health news can seem to consist of a steady diet of research-based stories, but making sense of what may be relevant or important and what is not can be a tall order for most patients. Headlines may shout about dramatic breakthroughs, exciting new advances, revolutions, and even cures but there may be scant details of the evidence base of the research.

The post How fertility patients can make informed decisions on treatment appeared first on OUPblog.

Does preconception stress increase the risk of infertility? Dr Courtney D. Lynch will be presenting the results from a couple-based prospective cohort study, the LIFE study, at this year’s Human Reproduction Keynote Lecture in Lisbon. We meet Dr Lynch to learn more about how she came to specialise in reproductive medicine and the findings of her research.

The post Preconception stress and infertility: a Q&A with Dr. Courtney D. Lynch appeared first on OUPblog.

The news that Britain is set to become the first country to authorize IVF using genetic material from three people—the so-called ‘three-parent baby’—has given rise to (very predictable) divisions of opinion. On the one hand are those who celebrate a national ‘first’, just as happened when Louise Brown, the first ever ‘test-tube baby’, was born in Oldham in 1978. Just as with IVF more broadly, the possibility for people who otherwise couldn’t to be come parents of healthy children is something to be welcomed.

The post The third parent appeared first on OUPblog.

A new study shows that women who have difficulty accepting the fact that they can’t have children following unsuccessful fertility treatment, have worse long-term mental health than women who are able to let go of their desire for children. It is the first to look at a large group of women (over 7,000) to try to disentangle the different factors that may affect women’s mental health over a decade after unsuccessful fertility treatment. These factors include whether or not they have children, whether they still want children, their diagnosis, and their medical treatment.

It was already known that people who have infertility treatment and remain childless have worse mental health than those who do manage to conceive with treatment. However, most previous research assumed that this was due exclusively to having children or not, and did not consider the role of other factors. Alongside my research colleagues from the Netherlands, where the study took place, we found only that there is a link between an unfulfilled wish for children and worse mental health, and not that the unfulfilled wish is causing the mental health problems. This is due to the nature of the study, in which the women’s mental health was measured at only one point in time rather than continuously since the end of fertility treatment.

We analysed answers to questionnaires completed by 7,148 women who started fertility treatment at any of 12 IVF hospitals in the Netherlands between 1995-2000. The questionnaires were sent out to the women between January 2011 and 2012, meaning that for most women their last fertility treatment would have been between 11-17 years ago. The women were asked about their age, marital status, education and menopausal status, whether the infertility was due to them, their partner, both or of unknown cause, and what treatment they had received, including ovarian stimulation, intrauterine insemination, and in vitro fertilisation / intra-cytoplasmic sperm injection (IVF/ICSI). In addition, they completed a mental health questionnaire, which asked them how they felt during the past four weeks. The women were asked whether or not they had children, and, if they did, whether they were their biological children or adopted (or both). They were also asked whether they still wished for children.

The majority of women in the study had come to terms with the failure of their fertility treatment. However, 6% (419) still wanted children at the time of answering the study’s questionnaire and this was connected with worse mental health. We found that women who still wished to have children were up to 2.8 times more likely to develop clinically significant mental health problems than women who did not sustain a child-wish. The strength of this association varied according to whether women had children or not. For women with no children, those with a child-wish were 2.8 times more likely to have worse mental health than women without a child-wish. For women with children, those who sustained a child-wish were 1.5 times more likely to have worse mental health than those without a child-wish. This link between a sustained wish for children and worse mental health was irrespective of the women’s fertility diagnosis and treatment history.

Our research found that women had better mental health if the infertility was due to male factors or had an unknown cause. Women who started fertility treatment at an older age had better mental health than women who started younger, and those who were married or cohabiting with their partner reported better mental health than women who were single, divorced, or widowed. Better educated women also had better mental health than the less well educated.

This study improves our understanding of why childless people have poorer adjustment. It shows that it is more strongly associated with their inability to let go of their desire to have children. It is quite striking to see that women who do have children but still wish for more children report poorer mental health than those who have no children but have come to accept it. The findings underline the importance of psychological care of infertility patients and, in particular, more attention should be paid to their long-term adjustment, whatever the outcome of the fertility treatment.

The possibility of treatment failure should not be avoided during treatment and a consultation at the end of treatment should always happen, whether the treatment is successful or unsuccessful, to discuss future implications. This would enable fertility staff to identify patients more likely to have difficulties adjusting to the long term, by assessing the women’s possibilities to come to terms with their unfulfilled child-wish. These patients could be advised to seek additional support from mental health professionals and patient support networks.

It is not known why some women may find it more difficult to let go of their child-wish than others. Psychological theories would claim that how important the goal is for the person would be a relevant factor. The availability of other meaningful life goals is another relevant factor. It is easier to let go of a child-wish if women find other things in life that are fulfilling, like a career.

We live in societies that embrace determination and persistence. However, there is a moment when letting go of unachievable goals (be it parenthood or other important life goals) is a necessary and adaptive process for well-being. We need to consider if societies nowadays actually allow people to let go of their goals and provide them with the necessary mechanisms to realistically assess when is the right moment to let go.

Featured image: Baby feet by Nina-81. Public Domain via Pixabay.

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OB/GYN Reveals Steps to Avoid Using Fertility Drugs To Become Pregnant

• As you might already know, in order for conception to take place, you must ovulate and at least one vital sperm needs to fertilize the egg within 12-24 hours of the egg being released from the ovary. Because sperm can only live for 5-6 days in the female reproductive tract and only a small number of sperm will even survive the long journey, it is recommended that couples plan to have intercourse several times in the days leading up to ovulation as well as on the day of ovulation. To do this optimally requires that you have a good idea of when you will ovulate each cycle. Ovulation Predictor Kits (http://www.early-pregnancy-tests.com/) are a popular method for predicting ovulation. OPKs detect the presence of luteinizing hormone (LH) in your urine. Approximately 12-36 hours before ovulation occurs, the amount of LH in your body "surges". By testing with OPKs, you can identify this LH surge, which allows you to know that ovulation is just around the corner and that you are in your fertile window.

• If you have irregular periods, your path to parenthood might end up being a long, tiresome journey. For women with chronic irregularity, it is likely that there is an underlying hormonal imbalance that is impacting the frequency of ovulation and/or menstruation. The herb commonly known as Chasteberry (Vitex agnus-castus), included in the fertility-enhancing supplement FertilAid for Women, is frequently used to help women restore hormonal balance and cycle regularity. The active compounds found in Chasteberry help to promote fertility by decreasing prolactin levels in the body.

• Did you know that up to 40 percent of males suffer from low sperm count? Now, if the idea of heading to the urologist for a sperm count test is a bit intimidating to your partner, you might suggest that he get an at-home sperm test, like SpermCheck Fertility (www.fairhavenhealth.com). SpermCheck, is a fast, accurate, affordable and simple method for determining if his sperm count is within "normal" range (above 20 million sperm per milliliter of semen is the accepted standard for "normal" sperm count) in the privacy of your own home.

• Leave those junk foods on the shelf, and try to incorporate more whole grains, vegetables, colorful fruits (for the antioxidant compounds found in these foods) and lean sources o
  2 Comments on Making Babies the Old-Fashioned Way, last added: 9/28/2011
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  PebblesGood said, on 9/27/2011 6:09:00 PM
  

  Great article! I hope to one day have another baby and these are great tips! I'm a new follower. Have a great week! Please stop by and follow me back. http://agigglesaysitall.blogspot.com/

  Teresa Wilkinson 1984 said, on 9/28/2011 10:22:00 AM
  

  I agree GREAT ARTICLE I at one time struggled with infertility. I am one of the lucky ones that finally became pregnant and had two healthy children. My daughter now suffers from this. I so want to send her this article but she is in a fragile state (I understand all to well to listen to this. So I am bookmarking this for future use.)
  
  Thanks

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By Helen Berry I happened to be in New York at the end of June this year when the State legislature passed the Marriage Equality Act to legalise same-sex marriage. By coincidence, it was Gay Pride weekend, and a million people waved rainbow flags in the streets of Manhattan, celebrating this landmark ruling in the campaign for gay rights, and I was one of them. What struck me as a visitor from the UK – where civil partnerships for same-sex couples have been legal since 2004 – was the way in which gay marriage is still such a divisive issue in American politics.

By Allen J. Wilcox

On making boy babies, and other pregnancy myths

In her novel, Prodigal Summer, Barbara Kingsolver celebrates the lush fecundity of nature. The main character marvels at the way her ovulation dependably comes with the full moon.

It’s a poetic image – but is there any evidence for it?

Actually, no. It’s true that the length of the average menstrual cycle is close to the length of the lunar cycle. But like so many notions about fertility, an effect of the moon on ovulation is just a nice story. The menstrual cycle is remarkably variable, even among women who say their cycles are “regular.” This is not surprising – unlike the movement of stars and planets, biology is full of variation. The day of ovulation is unpredictable, and there is no evidence (even in remote tribal cultures) that ovulation is related to phases of the moon or other outside events.

We humans are susceptible to myths about our fertility and pregnancy. These myths also invade science. One scientific “fact” you may have heard is that women who live in close quarters synchronize their menstrual cycles. The paper that launched this idea was published forty years ago in the prestigious journal Nature¹. Efforts to replicate those findings have been wobbly at best – but the idea still persists.

Another scientific myth is the notion that sperm carrying the Y male chromosome swim faster than sperm carrying the X female chromosome. It’s true that the Y chromosome is smaller than the X.  But there is no evidence that this very small addition of genetic cargo slows down the X-carrying sperm. As often as this idea is debunked, it continues to appear in scientific literature – and especially the literature suggesting that couples can tilt the odds towards having a baby of a particular sex.

Choosing your baby’s sex

Many couples have a definite preference for the sex of their baby. The baby’s sex is established at conception, which has led to a lot of advice on things to do around the time of conception to favor one sex or the other.  Recommendations include advice on timing of sex in relation to ovulation, position during sex, frequency of sex, foods to eat or avoid, etc. The good thing about every one of these techniques is that they work 50% of the time. (This is good enough to produce many sincere on-line testimonials.) Despite what you may read, there is no scientific evidence that any of these methods improves your chances for one sex or the other, even slightly. The solution? Relax and enjoy what you get.

When will the baby arrive?

Everyone knows that pregnancies last nine months – but do they? Doctors routinely assign pregnant women a “due-date,” estimated from the day of her last menstrual period before getting pregnant. The due-date is set at 40 weeks after the last menstrual period. You might think the due-date is based on scientific evidence, but in fact, 40 weeks was proposed in 1709 for a rather flaky reason: since the average menstrual period is four weeks, it seemed “harmonious” for pregnancy to last the equivalent of ten menstrual cycles.

So what are a woman’s chances of actually delivering on her due date?  Fifty percent? Twenty percent?

Try four percent. Just like the length of menstrual cycles (and every other aspect of human biology), there is lots of variation in the natural length of pregnancy. If the due-date is useful at all, it is as the median length of pregnancy – in other words, about half of women will deliver before their due-date, and about half after. So don’t cancel your appointments on the due-date just because you think it’s The Day – there’s a 96% chance the baby will arrive some other time.

1. McClintock MK. Menstrual synchorony and suppression.