New Test Can Detect Infertility Genes

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April 25th, 2016

Around 15% of couples have difficulty conceiving. 50% of the time the problem lies with the man. In many cases, faulty genes are the root cause of the problem. But up until recently, there was no way of knowing what these genetic issues were. Cornell University researchers have now come up with a way to detect mutations in genes affecting fertility. Their findings were published in the Proceedings of the National Academy of Sciences. Common genetic variations are known as single nucleotide polymorphisms (SNPs). Every SNP affects a specific nucleotide or building block of DNA. Researchers say patients struggling with infertility can have their DNA sequenced. If doctors can figure out which SNP is defective, they can provide a genetic diagnosis. This may someday lead to intervention on the genetic level. Fertility specialists could simply detect faulty SNP’s and repair or replace them.

shutterstock_290143400To locate the SNP causing the problem today, the genomes of healthy people are placed side-by-side with those having fertility problems, to locate where differences occur. But this method has been ineffective so far. There are too many genes responsible for fertilization, and the process is too complex. John Schimenti the director of the Center for Vertebrate Genomics along with Priti Singh, a postdoctoral fellow in Schimeti’s department, came up with this new method. These researchers used laboratory mice. They looked at a database of all known mice genes responsible for infertility. These have been arrived upon through testing which is not possible in humans. Then these genes were compared to genetic variation within the human genome. They found SNPs associated within four different genes that are thought to cause fertility problems in our species. Then these SNPs were tested in mice. Through this practice, researchers are beginning to identify those SNPs that cause human infertility. Though this genetic testing is not available yet, couples trying for six months to a year without conceiving should consult a physician. Both partners should be tested. Men should see an urologist or fertility specialist.

Special Underwear Safeguards Male Fertility

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March 16th, 2016

What underwear you wear can affect your fertility. Most men know that when they are trying to conceive with their partner, they should avoid anything that makes the testicles warmer. Sperm is produced at a lower temperature than the body naturally resides, which is why they hang away from the body and adjust themselves according to the ambient temperature. That means when trying to conceive, one should wear boxers over briefs, avoid hot baths, Jacuzzi’s, the steam room, and the sauna. One place men often fail to consider is their cell phone. How does radiation emitted from a smart phone affect male fertility? This issue has been debated for some time in the medical community. One 2014 University of Exeter study found a link between electromagnetic radiation and a low sperm count. But it was not definitive. Most experts say not to leave your phone in your pocket for long periods of time, just in case. Instead, when you are working or at rest place it on a table, or other hard surface some distance away from you, so as to limit the amount of radiation exposure, particularly the sex organs. The same goes for your tablet or laptop. Work at a table or place a hard surface between you and your lap.

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If this doesn’t sound appealing, hit the internet and buy yourself some new drawers. A line of special male undergarments to safeguard male fertility is now available for purchase. It is called Wireless Armour underwear. Sir Richard Branson called them “underpants for superheroes.” The manufacturer says this underwear line protects the male sex organs from the kind of radiation emitted from laptops, tablets, or cell phones. A pure silver mesh has been woven into each pair, making them 99.9% effective against such radiation. British scientist Joseph Perkin invented them. Perkin said he became increasingly aware over the years that his personal electronic devices were exposing him to more and more radiation. With his background in physics, he went to work devising a simple solution. Radiation exposure is not the only possible cause of male infertility. Many things may cause it. Couples who haven’t conceived after six months to a year of unprotected sex should each seek out a physician. The man should check his wardrobe, but also with an urologist.

Bacteria swabbing trend for newborns medically in doubt

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February 29th, 2016

‘re getting ready to give birth. Should the mother get an epidural? Is saving umbilical cord blood worth it? They may even ponder eating the placenta.

Now add to the list whether to follow a trend known as “vaginal seeding.” The practice involves swabbing the vagina of women who are going to have a cesarean delivery and then wiping the fluids on the baby. The hope is to give the baby the bacteria it would have been exposed to during vaginal delivery and help kickstart a healthy gut microbiome.

Although few doctors in the United States seem to be offering this simple procedure, a growing number of women are inquiring about it.

“It’s certainly happening more frequently (whereas) maybe like five or 10 years ago, I don’t think anybody really asked about this,” said Dr. Leonardo Pereira, chief of maternal-fetal medicine at Oregon Health & Science University.

Interest in the practice seems to be percolating overseas as well. “(By) taking a straw poll amongst colleagues at our hospital and other hospitals (in the United Kingdom), it seems in the last year or two almost all of the obstetricians and neonatologists here have encountered women asking for this to be done,” said Dr. Aubrey J. Cunnington, a pediatrician at Imperial College London.

large body of research points to an association between C-section delivery and increased risk of asthma, obesity and other health conditions. On the other hand, there has been an “absolute explosion of research on the role of the microbiota in health and disease,” Cunnington said.

However, experts say it is far too soon to say whether the vaginal microbiome gives babies a healthier start, and if so, whether seeding has the same beneficial effect as a vaginal delivery. Of greater concern is whether the practice could expose babies to some disease-causing bacteria in the bypassed birth canal.

In spite of the growing interest in vaginal seeding, there is a lack of data on its safety and benefits, and a lack of guidance for women and their doctors, Cunnington said. He and his colleagues in the United Kingdom and Australia took a close look at the issues surrounding the practice in an article that was published on Tuesday in the British Medical Journal.

“I think it would be helpful to have some guidelines on this, [but] it’s very hard to make guidelines when you have almost no evidence,” said Cunnington, who delivered babies before he started specializing in pediatric infectious disease. “Hopefully (the article) will help the medical profession to feel they have a little support,” whether they decide to practice vaginal seeding or not, he said.

Seeding a bad infection?

 

The main qualm doctors have with vaginal seeding is that it could infect babies with dangerous bugs at the same time it is bestowing them with potentially healthy bacteria. Topping the list of pathogens of concern are group B streptococcus, chlamydia and gonorrhea.

The Centers for Disease Control and Prevention recommends testing all pregnant women for these bacteria, as well as a number of other pathogens. About a quarter of all women harbor group B streptococcus, and while they may not experience symptoms, the bacteria could cause pneumoniaand meningitis in their newborns.

All women should get screened, even those planning to have a C-section, in case they end up having an unexpected vaginal delivery, Pereira said. If they are infected, women can receive antibiotics during labor to prevent passing the infection to their baby. However, some women decline screening, even those who are interested in vaginal seeding, Pereira said. “(In those cases) there’s a concern of taking group b strep from the birth canal and wiping it all over the baby,” he added. In addition to bacterial infections, experts worry vaginal seeding could infect babies with herpes virus if the mother has genital herpes.

While it is true that vaginal seeding probably only exposes babies to the same pathogens they would have gotten had they been delivered vaginally, these pathogens could have been avoided by C-section delivery. “If they had [a C-section] because it was the way they had to be delivered for the safety of the baby or the mother, why would you want to impose on them an increased risk of infection if it’s not going to benefit them?” Cunnington said.

What doctors should tell mothers

 

While doctors might not be doing a lot of vaginal seeding themselves, some mothers are taking the matter into their own hands. In one report, a woman in Brooklyn planned to insert a piece of gauze in her vagina before her C-section operation that her husband would wipe on their newborn shortly after delivery. Although there are no guidelines for how to perform vaginal seeding, the studies of the practice generally insert the gauze one hour before delivery and then wipe the fluids around the baby’s mouth, face and body.

It is important to tell these mothers that seeding might not have any benefit and might be increasing the risk of infection, Cunnington said. If they still want to do it, “They just need to be very aware that if their baby is unwell and they go to see a doctor, they should tell them they have performed vaginal seeding because it may change the doctor’s assessment,” he said. For example, a doctor may otherwise have ruled out the likelihood of a group B strep infection knowing that the baby was delivered via C-section.

Even though there is little evidence so far, it is also too soon to close the book on vaginal seeding. A small study recently provided the first evidence the practice might be able to give babies gut microbiomes that more closely resemble those of vaginally delivered infants.

However, “even if you can show their gut is colonized preferentially with labtobacillus or other organisms if you do that swab, you don’t really know if that really has any clinical health benefits, or if in a year from now that really matters,” Pereira said. More studies are needed, following babies who received vaginal seeding for years, to answer that question.

“It’s a fascinating area of research and it holds a lot of promise,” said David Hackney, assistant professor and medical director of labor and delivery at University Hospitals Case Medical Center.

“If someone said to me 10 to 15 years down the road this would be a routine thing we’ll be doing, that would be great and I don’t even know that I’d be surprised. But you can also imagine that in 10 to 15 years, we’ll look back and say what is that crazy thing we were doing,” Hackney said.

Giving babies healthier microbiomes

Until we have more answers about vaginal seeding, the potential for passing along healthy bacteria from the birth canal — while treating women to avoid passing along disease-causing bugs — could be just one more reason to encourage vaginal deliveries, Hackney said. C-sections are known toincrease the risk of complications for both mother and baby, and increase the recovery time for the mothers.

And while vaginal seeding might not be ready for prime time just yet, there are other well-studied practices that could help ensure babies start life with a healthy microbiome. Breastfeeding and skin-to-skin contact between mother and baby are known to “help newborns be colonized with healthy bacteria pretty quickly,” Pereira said.

Cleveland Clinic performs first uterus transplant in the U.S.

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February 29th, 2016

A team of surgeons at the Cleveland Clinic performed the first uterus transplant in the United States this week.

A 26-year-old woman received the new womb in a nine-hour operation, the hospital said in a statement. She was reported in stable condition Thursday.

The transplanted uterus came from a deceased organ donor.

Clinical trial

The Cleveland Clinic announced a research study in November in which it would perform uterus transplants on 10 women with uterine factor infertility.

UFI is a condition where a woman cannot carry a pregnancy because she was born without a uterus, has lost her uterus, or has a uterus that no longer functions. It’s an irreversible condition affecting 3% to 5% of women worldwide.

“Women who are coping with UFI have few existing options,” Tommaso Falcone, chairman of the Department of Obstetrics-Gynecology at Cleveland Clinic, said when the clinical trial was announced. “Although adoption and surrogacy provide opportunities for parenthood, both pose logistical challenges and may not be acceptable due to personal, cultural or legal reasons.”

The transplant is one of many steps in a complex process.

Before it takes place, the woman’s eggs are harvested, fertilized and frozen for implantation later in the new uterus.

These are some of the other steps, according to the Cleveland Clinic:

– Over 12 months, the transplanted uterus fully heals.

– One year after transplant, the frozen embryos are then thawed and implanted, one at a time, into the patient until she becomes pregnant.

– During her pregnancy, she takes anti-rejection drugs.

– She is monitored by a high-risk obstetrics team throughout pregnancy and delivery.

– She has a monthly cervical biopsy to check for organ rejection.

– The baby is delivered by cesarean section.

– After one to two babies, she has a hysterectomy to remove the transplanted uterus.

– Her anti-rejection drugs are stopped after the hysterectomy.

Pioneered in Sweden

 

While this is the first uterus transplant in the United States, a team of doctors at the University of Gothenburg in Sweden has performed nine of them.

Five of the women have gotten pregnant, resulting in four live births.

The Cleveland Clinic is hopeful for its own program after taking part in the Swedish trials.

“The exciting work from the investigators in Sweden demonstrated that uterine transplantation can result in the successful delivery of healthy infants,” said Andreas Tzakis, the lead investigator in the Cleveland study.

Indonesian Youths Want to Be Heard on Family Planning

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February 24th, 2016

Jakarta. Years ago, when Angraini Sari Astuti was diagnosed with ovarian cancer, she experienced first-hand how difficult it can be for Indonesian adolescent girls to visit a qualified health professional when they desperately need one. Not because there were no doctors where Angraini lived, near Solo in Central Java, but because of the stigma associated with anything related to premarital sex in the world’s most populous Muslim-majority nation.

“In 2008, when I checked into [the office of] a gynecologist in preparation of my tumor surgery, other patients stared at me,” now-25-year-old Angraini said at a youth event on the sidelines of the International Conference on Family Planning held in Nusa Dua, Bali, late last month. “They were wondering: why would such a young girl come to a gynecologist?”

Angraini, who fully recovered, is now an energetic and outspoken youth activist working with the United Nations as a volunteer to call on the Indonesian government to give youngsters a seat at the table when policies are made that directly affect them.

Activists like her say empowerment and education are more necessary now than ever before, because while the country’s family planning program has been widely hailed as a great developing-world success story, the numbers on adolescent sexual and reproductive health in Indonesia remain disheartening.

65 million young people  

Indonesia’s successful family planning program, which lowered the country’s total fertility rate from 5.6 in 1967 to 2.6 in recent years, has cleared the way for a much-anticipated demographic dividend.

There are over 65 million people in Indonesia today aged between 10 and 24: almost 30 percent of the population. But even as this may be good news in terms of economic growth potential, illegal abortions abound and HIV transmission rates are on the rise, while the government is not legally allowed to provide any means of contraception to people who are not married. Regular health clinics tell youngsters that abstinence until marriage is the only way to stay out of trouble.

According to data from the United Nations Population Fund (UNFPA), people between the ages of 20 and 29 account for almost 40 percent of newly confirmed cases of AIDS in Indonesia. These numbers suggest that many get infected with HIV between the ages of 15 and 24.

UNFPA also notes that more than half of reported HIV cases in the country are due to unprotected sexual intercourse, with intravenous drug abuse being another major cause.

Maternal mortality

Reliable numbers are hard to come by, but experts estimate there are at least two million abortions per year in Indonesia. The fact that these abortions mostly involve married women in Indonesia indicates that access to contraception is hardly something that only affects adolescent girls.

As abortion is illegal in Indonesia except in cases of rape, foetal abnormality or when the pregnancy threatens the mother’s life, most of these procedures are carried out unsafely. Indonesian girls and women with an unwanted pregnancy ingest menstruation-inducing herbs, are given a uterine massage or even have foreign objects inserted into their uterus.

Indonesia’s maternal mortality ratio (MMR), or the number of maternal deaths per 100,000 live births, remains high, at an estimated 126, and unsafe abortions cause an estimated 16 percent of these deaths.

In other words: some 6,400 women died from pregnancy-related causes throughout the archipelago last year, and over 1,000 of these women died because of an unsafe abortion.

Even though Southeast Asia’s largest economy is performing better than countries like Laos (197) and Cambodia (161) in terms of MMR, it still lags far behind neighbors such as Vietnam (54), Malaysia (40), Thailand (20) and Singapore (10).

Child marriage

One of the ways Indonesian authorities are trying to prevent unwanted pregnancies and stem the rise of sexually transmitted infections such as HIV/AIDS, is by promoting abstinence until marriage, for instance by limiting the availability of contraceptives for unmarried people.

However, one of the consequences of this policy – which is generally accepted by people across the country because it is considered to be in line with religious teachings and tradition – is that many people marry young.

In many parts of Indonesia, unmarried girls are being labeled perawan tua, or “old virgin,” as early as in their late teens andchild marriage remains very common, despite the many dangers associated with the practice.

Humairah Samad, a senior high school student from Makassar, in South Sulawesi, confirmed that where she lives, too, many tie the knot at a young age.

“Our culture has been like that for generations,” she told the Jakarta Globe at the family planning conference in Bali, citing the need for better education on issues of sexual and reproductive health to break that tradition.

Another Indonesian youth activist, Nanda Fitri Wardani, a young MD from Lampung who studied at Bandung’s Padjadjaran University, says many girls in Indonesia have plenty of dreams but are often not empowered by their parents and sometimes end up getting married as early as age 13.

Such a young marriage usually means the end of school and any prospect of a career beyond motherhood.

Harm reduction

Nanda says she believes the Indonesian government should be supported in its decision to not provide contraceptives to unmarried people, citing the state ideology of Pancasila and its first principle: belief in God.

“Having sexual intercourse before marriage is forbidden based on the religions that we follow here,” Nanda said in Bali, stressing that abstinence remains the best way to stop the spread of HIV/AIDS among young people.

Siswanto Agus Wilopo, a professor of reproductive health at Gadjah Mada University (UGM)’s faculty of medicine, however, says the government needs to approach the issue differently.

Siswanto told the Globe he was quite confident that the legal situation would not change anytime soon, as a majority of legislators in the House of Representatives believes that the law can prevent unmarried people from engaging in sexual intercourse.

Faced with such unfavorable odds, the professor says the country needs a harm reduction policy, because the numbers suggest there clearly is a problem, regardless of what politicians say. A start would be the provision of contraceptives to unmarried couples, as part of an emergency regulation, he said.

“You have to go step by step,” said Siswanto.

“One kind of harm reduction policy is the availability of ECP [emergency contraception pills] which will prevent unprotected sex ending in abortion. It is better to use a pill compared to having an abortion, isn’t it?”

“We start with that, campaign about it. If you present the facts, if you present the data – people in Indonesia are smart … I believe that at least harm reduction can be promoted.”

For now, however, the Indonesian government is adopting a hands-off approach. Although some believe the sale of such prophylactics needs to be limited to prevent people from engaging in premarital sex, condoms are still available in supermarkets and convenience stores in major urban areas.

Youth-friendly services

UNFPA in 2014 launched an initiative in cooperation with the private sector that is aimed specifically at helping adolescents. As part of the Unala program, which is being piloted in Yogyakarta, affiliated clinics specialize in providing youth-friendly physical and mental health services.

At the Unala clinics, selected GPs offer health services for youngsters who might be afraid of the social stigma attached to extramarital sexual activity, real or perceived. One way of doing this, for instance, is by using an appointment-only system – which is very unusual in the Indonesian health sector – to avoid prying eyes in the waiting room.

Besides Unala, there are other initiatives to help people in need, such as a hotline run by Yogyakarta-based activists that allows girls and women with an unwanted pregnancy to discuss – free of charge and judgment – what options are available.

Such sessions are aimed at preventing tragic but all-too-common situations where girls or women end up having unsafe abortions at one of the many illegal clinics in Jakarta or at the hands of a local midwife.

Meaningful participation

Babatunde Osotimehin, the executive director of UNFPA, says youngsters all over the world should be given the space to express themselves, so that governments and NGOs understand what they want, and what they need.

And one of the most important things that young people need, is comprehensive sexuality education (CSE), he says, stressing that this in fact is the right of every young person.

In Indonesia, only few schools offer such programs, however. Some others do teach children about sexuality, but take a fear-based approach instead of one that stresses a young person’s rights.

Apart from CSE, another important step is greater involvement of men, the UN under-secretary-general said, speaking at the family planning conference in Bali.

“There is no man in this world who would like to see his daughter die,” said Babatunde, “or see his wife die.”

Angraini, the Indonesian youth activist, told the Globe that for family planning and sexual and reproductive health programs to work, meaningful participation of young people at all levels of the policy-making process is essential.

“Listen to the young people themselves,” she said. “Don’t just ask them to attend a seminar when everything is already settled.”

Apart from empowerment, there is a clear need for adequate, youth-friendly health services across the country, she said, to clear all hurdles for young people “concerned about confidentiality and judgmental opinions from others.”

“Involving young people, both married and unmarried, in family planning education, and raising their awareness on this issue, will have a positive impact in lowering maternal and child mortality and morbidity,” Angraini said, “as well as equip young people with the information they need to make their own decisions.”

But she stressed that young Indonesians should not just remain passive while waiting for change to happen.

“Let us … work together with parents, families, government health personnel, teachers [and] educational institutions … [so that they all] fully recognize young people’s need for non-judgmental understanding, the right information, adequate health services and comprehensive sexuality education,” Angraini said.

“We are the future of family planning.”