Prevalence of infertility higher among those delaying parenthood

A fifth of women aged 35 to 44 have struggled to conceive

Almost a fifth of women aged 35 to 44 have struggled to conceive, with those settling down later in life more likely to report infertility, a large study suggests.

Abstract

STUDY QUESTION
What is the prevalence of infertility and of help seeking among women and men in Britain?

SUMMARY ANSWER
One in eight women and one in ten men aged 16–74 years had experienced infertility, defined by unsuccessfully attempting pregnancy for a year or longer, and little more than half of these people sought medical or professional help.

Prevalence of infertility and help seeking among 15 000 women and men, Human Reprodroduction, doi: 10.1093/humrep/dew123, June 30, 2016.

WHAT IS KNOWN ALREADY
Estimates of infertility and help seeking in Britain vary widely and are not easily comparable because of different definitions and study populations.

STUDY DESIGN, SIZE, DURATION
A cross-sectional population survey was conducted between 2010 and 2012 with a sample of 15 162 women and men aged 16–74 years.

PARTICIPANTS/MATERIALS, SETTING, METHODS
Participants completed the Natsal-3 questionnaire, using computer-assisted personal interviewing (CAPI) and computer-assisted self-interview (CASI).

MAIN RESULTS AND THE ROLE OF CHANCE
The reported prevalence of infertility was 12.5% (CI 95% 11.7–13.3) among women and 10.1% (CI 95% 9.2–11.1) among men. Increased prevalence was associated with later cohabitation with a partner, higher socio-economic status and, for those who had a child, becoming parents at older ages. The reported prevalence of help seeking was 57.3% (CI 95% 53.6–61.0) among women and 53.2% (CI 95% 48.1–58.1) among men. Help seekers were more likely to be better educated and in higher status occupations and, among those who had a child, to have become parents later in life.

Nearly half of women and men do not seek medical help for infertility, London School of Hygiene & Tropical Medicine, 01 July 2016.

LIMITATIONS, REASONS FOR CAUTION
These data are cross-sectional so it is not possible to establish temporality or infer causality. Self-reported data may be subject to recall bias.

WIDER IMPLICATIONS OF THE FINDINGS
The study provides estimates of infertility and help seeking in Britain and the results indicate that the prevalence of infertility is higher among those delaying parenthood. Those with higher educational qualifications and occupational status are more likely to consult with medical professionals for fertility problems than others and these inequalities in help seeking should be considered by clinical practice and public health.

Infertility: Fifth of women between 35 and 44 take longer than a year to conceive, independent, 1 July 2016.

Infertility by Argyropoulos.

STUDY FUNDING/COMPETING INTEREST(S)
Funding was provided by grants from the Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health. AMJ is a Governor of the Wellcome Trust. Other authors have no competing interests.

Most fertility awareness apps do not employ evidence-based methodology

Smartphone apps not so smart at helping users avoid or achieve pregnancy

You might not want to depend on your smartphone app alone to help you avoid or achieve pregnancy, say the authors of a new study. A review of nearly 100 fertility awareness apps finds that most don’t employ evidence-based methodology.

The findings, published in the Journal of the American Board of Family Medicine, also found that many apps include a disclaimer discouraging use for avoiding pregnancy.

New Fertility App Study – Coming Soon!, factsaboutfertility.

The study was led by Marguerite Duane, MD, MHA, FAAFP, adjunct associate professor at Georgetown University School of Medicine and executive director of Fertility Appreciation Collaborative to Teach the Science (FACTS). Additional researchers include Alison Contreras, PhD, FCP, of FACTS, Elizabeth T. Jensen, MPH, PhD, of Wake Forest School of Medicine, and Amina White, MD, MA, of University of North Carolina at Chapel Hill.

says Duane, a family physician.

But as the authors write,

“The effectiveness of fertility awareness based methods (FABMs) depends on women observing and recording fertility biomarkers and following evidence-based guidelines. Apps offer a convenient way to track fertility biomarkers, but only some employ evidence-based FABMs.”

Success using FABMs depends on many factors, including the ability to accurately make and classify daily observations. But the authors say relying solely on an FABM app may not be sufficient to avoid pregnancy.

“Smartphone apps are increasing in popularity because more and more women are interested in using natural or fertility awareness based methods of family planning because they want to feel empowered with greater knowledge of their bodies,”

For the review, more than 95 apps were identified on iTunes, Google, or Google play. Of those, 55 were excluded from evaluation because they either had a disclaimer prohibiting use for avoiding pregnancy or did not claim to employ an evidence-based FABM.

Smartphone contraceptive apps rarely work and can cause unplanned pregnancy, scientists warn, independent, 30 June 2016.

The researchers evaluated the remaining 40 apps for accuracy using a rating system based on criteria used by Family Practice Management. Each app was rated on a five-point scale for 10 clearly defined criteria, which were weighted based on their level of importance for avoiding pregnancy.

“Of those reviewed, 30 apps predict days of fertility for the user and 10 do not. Only six apps had either a perfect score on accuracy or no false negatives (days of fertility classified as infertile),”

the researchers wrote.

Apps that do not predict fertile days scored high on accuracy only if they required women receive training in an FABM prior to using the app.

“When learning how to track your fertility signs, we recommend that women first receive instruction from a trained educator and then look for an app that scored 4 or more on mean accuracy and authority in our review,”

says Dr. Duane.

Information about evidence based FABMs and a list of all the apps reviewed can be found at the FACTS website.

Top Doctors, Scientists, Health Advocates calling for Stronger Action on Toxic Chemicals

Targeting Environmental Neuro-Developmental Risks : Project TENDR

A unique coalition of top doctors, scientists and health advocates is calling for more aggressive regulation on chemicals found in common household items. The goal is to protect expectant mothers, infants and children from neurotoxic chemicals by stepping up efforts to curb air pollution, remediate old lead pipes, phase out certain pesticides, ban endocrine-disrupting chemicals used in food packaging and plastics and come up with a plan for getting rid of furniture laden with fire retardants.

Abstract

SUMMARY:
Children in America today are at an unacceptably high risk of developing neurodevelopmental disorders that affect the brain and nervous system including autism, attention deficit hyperactivity disorder, intellectual disabilities, and other learning and behavioral disabilities. These are complex disorders with multiple causes—genetic, social, and environmental. The contribution of toxic chemicals to these disorders can be prevented.

Project TENDR: Targeting Environmental Neuro-Developmental Risks. The TENDR Consensus Statement, Environtal Health Perspectives, DOI:10.1289/EHP358, July 2016.

APPROACH:
Leading scientific and medical experts, along with children’s health advocates, came together in 2015 under the auspices of Project TENDR: Targeting Environmental Neuro-Developmental Risks to issue a call to action to reduce widespread exposures to chemicals that interfere with fetal and children’s brain development. Based on the available scientific evidence, the TENDR authors have identified prime examples of toxic chemicals and pollutants that increase children’s risks for neurodevelopmental disorders. These include chemicals that are used extensively in consumer products and that have become widespread in the environment. Some are chemicals to which children and pregnant women are regularly exposed, and they are detected in the bodies of virtually all Americans in national surveys conducted by the U.S. Centers for Disease Control and Prevention. The vast majority of chemicals in industrial and consumer products undergo almost no testing for developmental neurotoxicity or other health effects.

A Call for Action on Toxic Chemicals, The NY Times, 2016/07/01.

Perfume, scented lotions and shower gels little bottles by Jen R.

CONCLUSION:
Based on these findings, we assert that the current system in the United States for evaluating scientific evidence and making health-based decisions about environmental chemicals is fundamentally broken. To help reduce the unacceptably high prevalence of neurodevelopmental disorders in our children, we must eliminate or significantly reduce exposures to chemicals that contribute to these conditions. We must adopt a new framework for assessing chemicals that have the potential to disrupt brain development and prevent the use of those that may pose a risk. This consensus statement lays the foundation for developing recommendations to monitor, assess, and reduce exposures to neurotoxic chemicals. These measures are urgently needed if we are to protect healthy brain development so that current and future generations can reach their fullest potential.

New technology may help identify aggressive early breast cancer

Imaging and math combine to illuminate aggressive biomarkers in DCIS

Researchers at the University of Michigan have developed a new technology that can identify aggressive forms of ductal carcinoma in situ, or stage 0 breast cancer, from non-aggressive varieties.

Abstract

Although epidemiological studies propose aggressive and non-aggressive forms of ductal carcinoma in situ (DCIS), they cannot be identified with conventional histopathology.

We now report a retrospective study of human biopsy samples using biomarker ratio imaging microscopy (BRIM). Using BRIM, micrographs of biomarkers whose expression correlates with breast cancer aggressiveness are divided by micrographs of biomarkers whose expression negatively correlates with aggressiveness to create computed micrographs reflecting aggressiveness.

The biomarker pairs CD44/CD24, N-cadherin/E-cadherin, and CD74/CD59 stratified DCIS samples. BRIM identified subpopulations of DCIS lesions with ratiometric properties resembling either benign fibroadenoma or invasive carcinoma samples.

Our work confirms the existence of distinct subpopulations of DCIS lesions, which will likely have utility in breast cancer research and clinical practice.

Study and Press Releases
  • New technology helps ID aggressive early breast cancer, UNIVERSITY OF MICHIGAN HEALTH SYSTEM, 30-JUN-2016.
  • Identification of lesion subtypes in biopsies of ductal carcinoma in situ of the breast using biomarker ratio imaging microscopy, Nature Scientific Reports, doi:10.1038/srep27039, 01 June 2016.
  • Aggressive breast cancer identified with new technique, medicalnewstoday, 03 July 2016.

Diethylstilbestrol in Oil

DES ampoules 1 mg 1 cc, manufactured by Eli Lilly

DES was sold under many names including Distilbène®, Stilbetin®, Stilboestrol-Borne®, Benzestrol®, Chlorotrianisene®, Estrobene® and Estrosyn® to name just a few.

Many different companies manufactured and marketed this drug under more than 200 different brand names.

These ampoules 1 mg 1 cc. – Diethylstilbestrol in oil – were manufactured by: Eli Lilly & Co, Indianapolis, USA.

DES Drugs Pictures
More DES DiEthylStilbestrol Resources

X chromosome dosage compensation and sex-biased gene expression relashionship

Sex-Biased Expression of the Caenorhabditis elegans X Chromosome is a result of Both X Chromosome Copy Number and Sex-Specific Gene Regulation

Abstract

Dosage compensation mechanisms equalize the level of X chromosome expression between sexes. Yet the X chromosome is often enriched for genes exhibiting sex-biased, i.e. imbalanced expression. The relationship between X chromosome dosage compensation and sex-biased gene expression remains largely unexplored. Most studies determine sex biased gene expression without distinguishing between contributions from X chromosome copy number (dose) and the animal’s sex.

Sex-Biased Expression of the Caenorhabditis elegans X Chromosome is a result of Both X Chromosome Copy Number and Sex-Specific Gene Regulation, Genetics, NCBI pubmed/27356611, 2016 Jun 29.

Here, we uncoupled X chromosome dose from sex-specific gene regulation in C. elegans to determine the effect of each on X expression. In early embryogenesis, when dosage compensation is not yet fully active, X chromosome dose drives the hermaphrodite-biased expression of many X-linked genes, including several genes that were shown to be responsible for hermaphrodite fate. A similar effect is seen in the C. elegans germline, where X chromosome dose contributes to higher hermaphrodite X expression, suggesting that lack of dosage compensation in the germline may have a role in supporting higher expression of X chromosomal genes with female-biased functions in the gonad. In the soma, dosage compensation effectively balances X expression between the sexes. As a result, somatic sex-biased expression is almost entirely due to sex-specific gene regulation. These results suggest that lack of dosage compensation in different tissues and developmental stages allow X chromosome copy number to contribute to sex-biased gene expression and function.

DES-related studies

Brexit, UK Healthcare and The NHS

Where does the Brexit vote leave the NHS, the health workforce, science, and research?

Where does the vote for the United Kingdom to exit the European Union leave the NHS, the health workforce, science, and research?
The BMJ asked a range of people for their thoughts.

This post content was originally published by The BMJ :

advancing healthcare worldwide by sharing knowledge and expertise to improve experiences, outcomes and value.

Image via Gareth Iacobucci.

On 23 June 2016 the UK government held a referendum on EU membership. Vote Leave won with 52% of the votes.

In the immediate aftermath of the vote, we set up a live blog to track reactions from health experts and scientists, and in the week that followed asked a range of people for their thoughts.

Journalist Anne Gulland followed this with a deeper assessment of the outlook for UK science and health outside the EU, considering how Brexit will affect NHS finances, the pharmaceutical sector, key public health legislation, and other sectors.

In related news stories, scientists and researchers ask what next after the vote, and BMJ journalists Tom Moberly and Gareth Iacobucci report, respectively, on how Brexit threatens the stability of the medical science workforce and NHS staffing.

Martin McKee has written two blogs: one looking at the impact that this vote might have on health, and a second blog discussing the growing confusion as Britain has been thrown into political turmoil. US doctor Bill Cayley says this sends out a warning signal to the US for their forthcoming presidential elections. Margaret McCartney discusses our messy divorce from the EU.

The Brexit Debate

The articles listed below are a collection of free articles and other resources published in the run up to the referendum from The BMJ about the pros and cons of “Brexit” in relation to medicine, pharma, research, the law, the NHS, and global trade agreements.

The BMJ’s editors believe the UK should stay in Europe. Their article arguing for Remain was published on 14 June. A second article was published at the same time by Conservative MP and former GP Sarah Wollaston. Wollaston, chair of the UK Parliament’s health select committee, explained why she had switched from supporting Brexit to supporting the Remain campaign.

The journal’s regular columnist Margaret McCartney also joins the debate, concluding:

“I wouldn’t wish to leave a union where the NHS and research community benefit from close ties with colleagues across the EU. We should not want to be Little Britain.”

What Brexit could mean for . . . The NHS?

David OwenThe launch of the Vote Leave group’s Save Our NHS campaign in April 2016 warned of the growing control and influence the European Union would have over the NHS if the country voted to remain in the EU. Pro-EU campaigners accused the group of “scaremongering” and said that the NHS would be protected from trade deals.

In a letter to The Times newspaper published on 14 June, 60 former presidents and chairs of medical royal colleges and the BMA set out why the UK should remain in the EU.

This article examines what the leave campaign said about the NHS, and how the experts answered. Stephen Dorrell, a former Conservative health secretary, and now chair of the NHS Confederation, told the Confederation’s annual conference on 15 June:

“We need a strong economy to guarantee the growth in funding that the health and care service requires and evidence suggests leaving the EU would undermine this.”

Not all prominent doctors share their views. David Owen, the former Labour foreign secretary who was health minister at the time of the last European referendum in 1975, said:

“We in the cross-party Vote Leave campaign, however, share a common democratic commitment. We will restore legal powers and democratic control of the NHS to voters in the UK. If we vote to leave, we will be able to protect our NHS from EU interference.”

But would a post-Brexit NHS look any different? Anne Gulland investigates.

Public health

EU legislation covers everything from food labelling to disease control, so how might a Brexit affect policies and activities that promote the UK’s health? Anne Gulland assesses the effects of leaving in key public health battlegrounds, including marketing and pricing of alcohol and tobacco, food standards and legislation, and environmental health. Retired civil servant Bernard Merkel offers a personal perspective, based on his experience of working with the European Commission on its public health programmes.

Pharma

Big UK based drug companies have said they want the country to remain in the EU. Would a Brexit affect access to medicines? Anne Gulland investigates.

Finance

John Appleby

Economist John Appleby’s analysis concludes that after 43 years of membership of the EU, unwinding agreements, obligations, and laws, and then renegotiating trade, security, legal, and other relationships with the EU is unlikely to be a snappy or straightforward process. He adds:

“The problem for referendum voters keen on evidence is that there is no comprehensive and reliable cost-benefit analysis that weighs up the facts, the positives and negatives, over the short, medium, and long term and across different groups in society of exiting or remaining in the EU.”

Trade

Martin McKee Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, asks if the survival of the NHS is threatened by continued British membership of the European Union, with a particular focus on the Transatlantic Trade and Investment Partnership (TTIP), which if agreed would ease trade between the EU and the United States.

Employment law

Chris CoxWhat would a Brexit mean for employment law in the UK? Christopher Cox, director of membership relations at the UK Royal College of Nursing, says the EU has been the source of many employment rights, including working time, work-life balance, key areas of equality including equal pay for work of equal value, and the treatment of part time, fixed-term contract, and temporary agency workers. He concludes:

“If there was a vote in favour of leaving, many complex issues would have to be resolved. It would take at least two years, if not longer, to serve notice of withdrawal and agree terms with the remaining Member States.”

Looking specifically at doctors, Anne Gulland assesses how leaving the EU would affect working conditions, and in a separate article, asks if Brexit would stop the flow of doctors and patients between EU countries.

Science and research

Paul NurseIn April 2016 a report by the House of Lords Science and Technology Committee warned that leaving the European Union would cost UK scientists money and influence. Research funding is one of the few areas where the United Kingdom gains more money than it spends, said Nigel Hawkes in his news article, adding:

“Of the country’s gross contribution to the EU, £5.4bn (€6.84bn; $7.77bn) can be attributed to the community’s research, development, and innovation activities. But the UK gets back £8.8bn in research grants, so exiting the EU would in theory leave a gap of £3.4bn to be filled.”

Paul Nurse, director of the Francis Crick Institute and former president of the Royal Society, had earlier said that anyone in the UK science and research disciplines who supported the so called “Brexit” was displaying “naivety” and “intellectual laziness.” A letter published in The Sunday Times, signed by more than 100 university leaders, claimed an exit would harm UK research and damage universities’ education alliances.

External links

Big Pharma Manipulates Physicians and Corrupts “Best Practices”

Pharmaceutical companies have relationships with the regulatory agencies, and then they also heavily influence the education the physicians are getting

Ben Swann‘s channel, 29 Jun 2016.

Episode 3 of 4 in Truth in Media series on Big Pharma manipulation of healthcare.

More Information

  • The third episode of this serie, How Big Pharma Manipulates Physicians and Corrupts “Best Practices,” discusses how companies in the pharmaceutical industry influence doctors’ “best practices” as well as offer funding for research and court physicians and their staff in hopes of gaining loyalty.
  • How Big Pharma Manipulates Physicians and Corrupts ‘Best Practices’, Truth In Media, Jun 29, 2016.
More Videos

Understanding Big Pharma’s Propaganda Machine

Corrupting Science : More and More Bias introduced into Medical Research

Ben Swann‘s channel, 21 Jun 2016.

Episode 2 of 4 in Truth in Media series on Big Pharma manipulation of healthcare.

More Information

  • The second episode of this serie, Understanding Big Pharma’s Propaganda Machine, Ben Swann discusses the how companies within the pharmaceutical industry are able to attract positive media surrounding its drugs, regardless of whether or not their claims are founded.
  • Understanding Big Pharma’s Propaganda Machine, Truth In Media, Jun 21, 2016.
More Videos