A study performed in Belgium has shown that low-cost IVF for developing and poor resource countries is feasible and effective, with delivery rates not much different from those achieved in conventional IVF programmes. This proof-of-principle study, say the investigators, suggests that infertility care may now be “universally accessible”. “We showed that the IVF methodology can be significantly simplified and result in successful outcomes at levels that compare favourably to those obtained in high resource programs,” they note. “We estimate that the cost of our simplified laboratory system is between 10% and 15% of current costs in Western-style IVF programs.”
They calculate that a cycle of in vitro fertilization with the simplified procedure can be performed for around 200 euro.
Doctors need the evidence to make informed decisions about medicines
From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path. The AllTrials campaign asks for all trials to be registered and their results published. John Castellani says mandatory disclosure could affect patient privacy, stifle discovery, and allow competitors or unscrupulous actors to use the information. Ben Goldacre says we need the evidence to make informed decisions about medicines.
Third-generation of DES-exposed women: menstrual irregularity and possible infertility
DES Follow-up Study Summary
We examined menstrual and reproductive characteristics in a unique cohort consisting of the daughters of women prenatally exposed (or not) to Diethylstilbestrol DES (i.e., the third generation). The menstrual and reproductive characteristics of 793 third generation women were assessed by mailed questionnaires. The study showed a comparable average age of menarche (12.6 years) in the daughters of prenatally DES-exposed and unexposed women. The daughters of the exposed women reached menstrual regularity later compared to the daughters of the unexposed, and were more likely to report irregular menstrual periods, odds ratio. A possible association between mothers’ DES exposure and daughters’ infertility was compatible with chance. For the most part, daughters of the prenatally DES-exposed and unexposed had similar reproductive outcomes, but daughters of exposed women had fewer live births than the unexposed. The high risk of reproductive problems seen in women exposed prenatally to DES was not observed in their daughters, but most third generation women have not yet attempted to start their families. Consequently, further follow-up is needed to assess their reproductive health.
2006 Study Abstract
In women, prenatal exposure to diethylstilbestrol (DES) is associated with adult reproductive dysfunction. The mouse model, which replicates many DES outcomes, suggests DES causes epigenetic alterations, which are transmissable to daughters of prenatally exposed animals. We report menstrual and reproductive characteristics in a unique cohort comprising daughters of women exposed prenatally to DES.
Menstrual and reproductive outcomes and baseline characteristics were assessed by mailed questionnaire in 793 women whose mothers had documented information regarding in utero DES exposure.
Mean age at menarche was 12.6 years in both groups, but daughters of the exposed women attained menstrual regularization later (mean age of 16.2 years vs. 15.8 years; P = 0.05), and were more likely to report irregular menstrual periods, odds ratio (OR) = 1.54 [95% confidence interval (95% CI 1.02-2.32)]. A possible association between mothers’ DES exposure and daughters’ infertility was compatible with chance, age, and cohort adjusted OR = 2.19 (95% CI 0.95-5.07). We found limited evidence that daughters of the exposed had more adverse reproductive outcomes, but daughters of exposed women had fewer live births (1.6) than the unexposed (1.9) (P = 0.005).
The high risk of reproductive dysfunction seen in women exposed to DES in utero was not observed in their daughters, but most women in our cohort have not yet attempted to start their families, and further follow-up is needed to assess their reproductive health. Our findings of menstrual irregularity and possible infertility in third-generation women are preliminary but compatible with speculation regarding transgenerational transmission of DES-related epigenetic alterations in humans.
Menstrual and reproductive characteristics of women whose mothers were exposed in utero to diethylstilbestrol (DES),NCBI, PMID: 16723367, 2006 Aug;35(4):862-8. Epub 2006 May 24. Full text Oxford Journals Medicine & Health International Journal of Epidemiology link.
Endocrine and metabolic diseases are common, includes diseases such as diabetes, thyroid disease, and obesity. Endocrinologists, including diabetes professionals, internal medicine and primary care practitioners, obstetricians and gynecologists, and others will find this book useful when treating endocrine or metabolic diseases.
Drug names have usually been designated by their recommended or proposed International Non-proprietary Names (rINN or pINN); when those are not available, clinical names have been used. In some cases, brand names have been used. This volume is critical for any health professional involved in the administration of endocrine and metabolics mediations.
Dr Jeffrey K. Aronson is a consultant clinical pharmacologist and physician in the Department of Primary Health Care in the University of Oxford and a consultant physician in the Oxford Radcliffe Hospitals Trust. He has been associated with the Meyler series since 1977 and has published many research papers on adverse drug reactions. He is President of the British Pharmacological Society and serves on many committees concerned with drug therapy, including the Technology Appraisal Committee of the UK’s National Institute for Health and Clinical Excellence (NICE) and the Joint Formulary Committees of the British National Formulary and the British National Formulary for Children.
Exposure to several factors in utero and in early life may lead to reduced semen parameters in adulthood and potentially to a decline in male fertility
On the question of environmental “endocrine disruptors” as an explanation for a decline in semen quality, Professor Hart added:
“The extent of the risk posed by environmental endocrine disrupters is still unclear, but some researchers do attribute the perceived decline in sperm counts to these chemicals within the environment. We do not have any evidence to suggest such a link in our study, but we do intend to measure the fetal exposure to endocrine disrupting chemicals from maternal blood that was stored in 1990, prior to the study recruits’ birth, and to relate these chemical exposures to the men’s semen counts in 2012-3.”