Mythbusters in Oncofertility: In Vitro Fertilization Causes Birth Defects

In preparing for fertility preservation, cancer fighters may worry about the risks of fertility preservation on the health of their future children. Fertility techniques, such as in vitro fertilization (IVF), produced more than a million babies over the past 30 years. As such, it is important to know whether egg banking , embryo banking, or other forms of fertility preservation cause birth defects in children ranging from cleft palate to neurodevelopmental disorders.

Studies do report that congenital malformations and birth defects increase slightly in couples using infertility treatments. Two other issues may be at play in these cases. First, parental factors affect the likelihood of birth defects. A Swedish study found that babies born to infertile couples (those who failed to get pregnant within a year of trying) had higher rates of congenital malformations, whether or not they used assisted reproductive technologies. This suggests that parental background may play a greater role than infertility treatment in the risk of childhood birth defects.

In addition, couples using fertility treatments often give birth to two or more children at one time. Multiple births in one pregnancy are associated with low birth weight and increased risks for growth problems. Some studies that find a rise in birth defects after infertility treatment also determine that these risks are minimized or eliminated when only one baby is born from each pregnancy. (Interestingly, there is a correlation between mandated health insurance coverage for infertility treatment and birth number that I will discuss at a later date).

There is evidence that infertility treatment may increase the risk of specific types of genetic diseases, called imprinting disorders. Some genes are expressed in a parental-specific manner. For example, a child may express the copy of a gene that they received from their mother but not their father. If, for some reason, the paternal gene is expressed, the child may develop abnormally. Some of the most well-know imprinting disorders are Beckwith-Wiedmann and Angelman syndromes, which normally occur in one out of every 10,000-20,000 children. While some studies did not find an increased risk of imprinting disorders after assisted reproductive technologies, others estimate that the risk may be as high as 4 times the risk in the general population. Further investigation is still ongoing to determine the likelihood of these disorders after fertility preservation and to find whether some techniques have higher risks than others.

Overall, birth defects occur in just under 2% of all births conceived naturally. When using fertility treatments such as IVF, this number increases to about 3%. Cancer survivors who understand the risks can also do their part in making the healthiest baby possible after fertility preservation, such as getting appropriate prenatal care and medical advice.

Mythbusters in Oncofertility: Can Cell Phones Cause Cancer & Infertility?

Poor cell phones. Having been blamed for everything from plane crashes to malfunctioning hospital equipment and exploding gas stations, it is a surprise that people still use them. Of special interest to the Oncofertility Consortium, cell phones have also been held responsible for causing cancer and infertility in men! So we are here to separate fact from fiction about your mobile device.

Cancer. Mobile phones give off electromagnetic radiation in the same range as microwaves. While some people believe that such low-intensity waves induce DNA mutations, there is no consistent evidence that cell phones cause cancer. Because most people hold their cell phones to their heads (I can’t with my new iPhone but that is a different story) special interest is given to the relationship between cancer and mobile devices. A recent study from the National Cancer Institute looked at brain cancer rates from 1977, before widespread cell phone use, to 2006. In addition to not seeing an increase in brain cancers as cell use became popular in the mid-1990s, the group actually noticed that brain cancers were either unchanged or decreased between 1992 and 2006!

The information about male infertility and cell phones is a little more complicated than the cancer myth.  Some studies do find differences in sperm movement and speed between cell phone users and non-users. However, the most significant findings in these studies compared people who don’t use cell phones to those who use cell phones for more than 4 hours per day. In addition, some studies suggest that carrying cell phones in a hip pocket or on a belt while using a hands-free headset may have a greater effect on sperm quality. It is important to note that most studies looking at this relationship examined relatively few people and further investigation is needed. In the meantime, it is probably wise to restrict your cell phone use to a reasonable amount of time. Who talks for 4 hours a day anyway?

Mythbusters in Oncofertility: Geriatric Pregnancy

Now before you start imagining Grandma with a bump, let me explain. Originally the term “geriatric pregnancy” was meant to describe the pregnancy of a woman who was 35 years or older. At some point (probably after being verbally and physically assaulted by hormonal mommies-to-be) the medical community decided to change that term to “advanced maternal age.” Now on to the mythbusting!

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In recent years, women have started childrearing later in their lives due to multiple reasons. From increased birth control and higher career goals to longer life expectancy, women are choosing to have children later. In the ten years prior to 2000, the average age a woman gave birth to her first child increased from 25 to 27 years old. As pregnancies in older women become more common, so do the myths about these pregnancies.

Women have to deal with common misconceptions including infertility. Media reports often suggest that decreased fertility is a severe problem as early as the late 20s. In reality, the risk of sterility is present at low rates even in the early 20s and increases slowly over time. At age 34 only 10% of women are sterile and that increases to 85% by age 44. In contrast to female infertility, it is rarely mentioned that male age also has an effect on infertility. It may be of interest to cougars everywhere that younger men have lower rates of infertility than older ones.

Once a woman over age 35 gets pregnant, she must often deal with assumptions about the health of her pregnancy and child. Maternal or fetal health complications can lead to early labor. Some studies have found that older mothers are at higher risk for preterm labor but these reports are conflicting. Generally, older women are not at increased risk for early labor before 32 weeks (37 weeks is considered normal for delivery). However, very preterm birth (before 28 weeks) is increased in older women. Interestingly, low-birth-weight babies have increased survival rates when they are born to older women-possibly due to better emotional, financial, and medical support.

Another common myth is that mothers with advanced maternal age are at very high risk for birth defects, such as Down syndrome. While this risk does increase over time, only 0.8% of babies born to 40-year-old mothers have Down syndrome. By age 45, this risk increases to 3.5%. It is also important to note that 80% of children with Down syndrome are born to women under age 35, since that is when most women have children.

As usual, the myths tossed around about older women and pregnancy are never as simple as they seem. However, women of any age that have been trying to get pregnant for a year should see a fertility specialist. By age 35, it is suggested that women see a health care practitioner about their fertility if not pregnant after 6 months of trying.

Mythbusters in Oncofertility

This week we will explore some common and not-so-common misconceptions in fertility, cancer, and oncofertility.

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Mythbuster: The Day “The Rabbit Died”

Nope, this is not a new rendition of “Bye-bye, miss American pie” by Don McLean. “The Rabbit Died” used to be a common phrase referring to a positive pregnancy test and originates from the first tests that were developed in the 1920s. The initial pregnancy tests involved injecting a woman’s urine into a female rabbit-strange but true!

If the woman were pregnant, her urine would contain trace amounts of the hormone, human chorionic gonadotropin (but most people call it hCG). Interestingly, hCG in the urine of a woman can also affect female rabbits. In response to hCG, the ovaries of a rabbit respond by swelling in size and turning a bright yellow color, essentially what happens to the woman’s own ovaries. To investigate the rabbit’s ovaries, scientists originally had to kill all of rabbits that were injected with urine. As such, the rabbit died whether or not a woman was pregnant. So, literally, the day the rabbit died, would have had absolutely no relevance to pregnancy.

Rabbits were not the only animals sacrificed during these early tests. Mice and frogs were also used. During later renditions of the test, clinicians learned how to investigate ovaries without killing the animals at all. While we no longer have to rely on animals to determine pregnancy, modern day tests still measure the hCG in urine.

It is not understood how this fallacy became part of the American lexicon but a large number of television shows and movies make allusions to rabbits and pregnancy. In 1978, a young Billy Crystal even played a pregnant man in the movie “Rabbit Test.” More recently, an episode of House also made an obscure reference to the rabbit test in pregnancy. Tell us if you see other allusions to the rabbit test in movies and television!

Fertility Techniques: Surrogates and Gestational Carriers

Advances in oncofertility can help preserve the fertility of many cancer patients but women who receive cancer treatment to the pelvis, including radiation and surgery, may lose the ability to carry a child to term. A few weeks ago, we also discussed how radiation to the ovaries and uterus can increase a cancer survivor’s risk for stillbirth and neonatal death. In these cases, women who preserve their fertility through egg or embryo banking may need to use surrogacy.

There are two common types of surrogacy arrangements. In traditional surrogacy, an infertile couple finds a surrogate mother to be artificially inseminated with the husband’s sperm. In this case, the surrogate is also the biological mother of the child. Traditional surrogacy was popularized in the mid-1970s in the US and was the only available type of surrogacy until the advent of in vitro fertilization (IVF) in the 1980s. The development of IVF allowed women with healthy eggs to fertilize them in a laboratory and have them implanted in another woman, called a gestational surrogate, who will not be genetically related to the child. Cancer survivors who have preserved their fertility but are unable to carry a child to term can employ this type of surrogacy.

Going through pregnancy to give someone else a child is a generous act no matter what. Some women find friends or family members who are willing to carry their child without compensation. In addition, couples can also find women who are willing to be a surrogate or gestational carrier for a fee. In the US, costs for surrogacy are high and can easily run up to $70,000.

The high costs of surrogacy in the US led to the popularization of surrogacy tourism, where couples employ surrogates and gestational carriers in other countries. Surrogacy costs in India, which run around $25,000, are considerably less than the US. In fact, the Indian Council of Medical Research predicts that surrogacy in that country may soon make $6 billion each year.

The advent of surrogacy has raised many legal issues surrounding parenthood. Some court cases received much media attention and changed state laws. Since each state has its own laws about surrogacy, it can be quite complex for a couple to determine the laws of their individual state. This complexity has led to some surrogacy scams that take advantage of needy couples. The FERTLINE (866/708-3378) has experience helping couples find local resources that can explain the laws and practices in their states.

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Update: The National Fertility Law Center blog recently posted on health insurance for surrogates in Wisconsin.

What Makes a Good Egg and Healthy Embryo?

Discovery about zinc’s role may help in future fertility treatments

By Marla Paul

CHICAGO — Scientists as well as fertility doctors have long tried to figure out what makes a good egg that will produce a healthy embryo. It’s a particularly critical question for fertility doctors deciding which eggs isolated from a woman will produce the best embryos and, ultimately, babies.

New research reveals healthy eggs need a tremendous amount of zinc to reach maturity and be ready for fertilization — a finding that may ultimately help physicians assess the best eggs for fertility treatment, according to a study from Northwestern University.

“Understanding zinc’s role may eventually help us measure the quality of an egg and lead to advances in fertility treatment,” said Alison Kim, a postdoctoral fellow in obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “Currently we can’t predict which eggs isolated from a woman produce the best embryos and will result in a baby. Not all eggs are capable of becoming healthy embryos.“

There’s no link yet to zinc content in the egg and the nutritional status of women, but Kim plans to research that area.

Kim is the lead author of a paper that will be published in the September issue of the journal Nature Chemical Biology. The article will be featured on the cover. Co-senior authors are Tom O’Halloran, director of the Chemistry of Life Processes Institute at Northwestern and associate director of basic sciences at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and Teresa Woodruff, the Thomas J. Watkins Professor of Obstetrics and Gynecology and executive director of the Institute for Women’s Health Research at Feinberg. Woodruff also is a member of the Lurie Cancer Center.

Northwestern scientists, working with mice, discovered the egg becomes ravenous for zinc and acquires a 50 percent increase in the metal in order to reach full maturity before becoming fertilized. The flood of zinc appears to flip a switch so the egg can progress through the final stages of meiosis. Meiosis is when the egg sheds all but one copy of its maternal chromosomes before it can be fertilized by a sperm and become an embryo.

“Zinc helps the egg exit from a holding pattern to its final critical stage of development,” said O’Halloran, the Charles E. and Emma H. Morrison Professor of Chemistry in the Weinberg College of Arts and Sciences at Northwestern. “It’s on the knife’s edge of becoming a new life form or becoming a cell that dies. It only has 24 hours. Zinc seems to be a key switch that helps control whether the egg moves forward in its development stage. “

Kim found there were approximately 60 billion zinc atoms in a mouse egg just before the egg was ready to be fertilized. She measured the zinc content of the eggs using a technique called synchrotron-based X-ray fluorescence microscopy through collaboration with the Advanced Photon Source at Argonne National Laboratory. This method allowed detection of multiple metals in single eggs using the characteristic X-ray signature of each element.

Dynamic Iron, Copper, and Zinc Distribution in Eggs and Early Embryos

Zinc levels were significantly higher in eggs than other important metals such as iron and copper. Zinc was the only metal to change significantly in concentration during the maturation process.

Northwestern scientists also used small molecules to block the accumulation of zinc by the maturing egg. They found an insufficient accumulation of zinc caused all the eggs to pause prematurely at the beginning stage of meiosis. The progression of meiosis was restored by returning zinc to the eggs.

Research on the role of zinc was funded by a W.M. Keck Foundation Medical Research Award, the Center for Reproductive Science through the NIH/National Institute of Child Health and Human Development and the Chemistry of Life Processes Institute at Northwestern University through NIH/National Institute of General Medicine. Use of the Advanced Photon Source at Argonne National Laboratory was supported by the Office of Basic Energy Sciences in the Office of Science of the U.S. Department of Energy.

Marla Paul is the Senior Health Sciences Editor at Northwestern University. Contact her at marla-paul@northwestern.edu

Tenth Annual Goombay Bash at Navy Pier in Chicago

The H Foundation is a non-profit organization that raises money to further the fight against cancer. According to Director Julie Jandris, the foundation was started when two Chicago-based entrepreneurs both had “employees pass away from cancer within one month of each other.” A group of community leaders then decided to “celebrate the loved ones who have passed away from cancer,” by hosting a party to raise money for cancer research, says Jandris. But this wasn’t going to be a stuffy, formal fundraising event. Instead the group decided to hold a Caribbean-themed party inspired by a cocktail called the Goombay Smash and call it the Goombay Bash.

That first party was so successful that the Goombay Bash became an annual event. This weekend is the tenth anniversary of the Goombay Bash, which is held at Navy Pier in Chicago, IL. To keep with the fun theme, the Bash includes an outdoor band, fireworks, and live auction in the Grand Ballroom at Navy Pier. According to Jandris, the party will include “new touch pad technology for the auction so everything is really state of the art.”

The Bash will also highlight the work of Dr. Teresa Woodruff and the Oncofertility Consortium with a short movie. Years ago, the H Foundation gave a $20,000 grant for Dr. Woodruff to research new fertility options for cancer patients. The video is “an example of how our money gets parlayed and matched into larger grants,” such as the $21 million that Dr. Woodruff received from the NIH to establish the Oncofertility Consortium.

The fun event occurs from 5pm to midnight on Saturday, August 7 and standing room tickets are still available. Throughout all the festivities, participants can also appreciate the work that they are doing to raise money for cancer research. Jandris reminds up, “Cancer is such a personal disease that no matter who you are and what your background is it somehow affects you.”

San Diego Girls Learn About Oncofertility

The Oncofertility Saturday Academy is an educational program for young high school women to learn about the science behind cancer and fertility. After beginning in Chicago in 2007, educators at the Better Education for Women in Science and Engineering (BE WiSE) program started a San Diego-based Oncofertility Academy in 2008.

In San Diego, the Oncofertility Academy is a summer program works that works with high school girls to teach many facets of science including cancer and reproductive biology, clinical applications, and bioethics. These diverse subjects are then combined to incorporate the emerging field of oncofertility. The lead instructor of the program, Dr. Ericka Senegar-Mitchell, is also a full-time teacher at “a public school in San Diego and hosts an after school program called Science in the City,” says Patricia Winter, the founder of BE WiSE.

The young women in the program also perform experiments in scientific laboratories at research institutes across San Diego, including the lab of Oncofertility Consortium member Dr. Jeffrey Chang at the University of California San Diego, and Scripps Institution of Oceanography. According to Winter, “We wanted this to be a, hopefully, life-changing experience for the kids.”

The students in the 2010 Oncofertility Academy are comprised of 10th, 11th, and 12th grades. Winter stressed, ““Our 12 girls are from 10 different schools so we have this very broad mix” of participants.  This year’s students will have their closing ceremonies on August 14th, where they will present and defend posters about their summer activities. According to Winter, “Parents, teachers, board members, and donors,” participate in this event to celebrate the accomplishments of each young woman and encourage future learning in the sciences.

Dana-Farber Cancer Institute Uses MyOncofertility.org

The Dana-Farber Cancer Institute, in Boston, Massachusetts uses MyOncofertility.org to explain reproductive options to their patients. The Survivorship Program at Dana-Farber is developing online tools to discuss the fertility concerns that men and women face when being treated for cancer. In order to clearly explain some of the biology and techniques, the website links to animations on MyOncofertility.org. We hope that the institute and their patients enjoy the videos!

Imerman Angels Provides Support for Cancer Fighters

Jonny Imerman is a two-time testicular cancer survivor and founder of the cancer advocacy group, Imerman Angels, which connects cancer patients and their caregivers with the one-on-one support of cancer survivors. Last Friday, Jonny visited the Oncofertility Consortium and discussed his motivation behind Imerman Angels.

Imerman understands that people undergoing cancer treatment benefit from developing relationships with cancer survivors who understand what they are experiencing. In fact, he calls people currently undergoing treatment, cancer fighters, not patients. According to Imerman, it indicates, “You can do something about your cancer. You are not passive in your treatment.”

Imerman founded Imerman Angels after he completed treatment for his own cancer and returned to the hospital to help young patients who were undergoing treatment. “I would end up talking to these cancer fighters for hours and could see the effect that talking had on them,” says Imerman. With a passion for the cause, Jonny established Imerman Angels in 2003. In just a few years, “We developed the largest group of cancer survivors dedicated to one-on-one support of cancer fighters,” says Imerman.

Cancer survivors, called Mentor Angels, interested in getting involved with the organization fill out a questionnaire online or over the phone discussing a wide variety of topics about themselves and their cancer. This allows cancer fighters who call Imerman Angels to be matched up with an Angel within 24 hours. Once the group brings people together, they also follow up within one week to make sure the cancer fighter gets the support needed.

Imerman Angels also assists the caregivers of cancer patients, including parents, children, and friends. Imerman developed the organization so, “Parents with a child in treatment can talk to families that were in the same place 5 years ago.” As with cancer patients, this provides emotional support to caregivers.

In 2009, alone, Immerman Angels made connections for more than 1,400 cancer fighters.  Further growth of the organization, such as increasing the number of survivors in the program, will allow Imerman Angels to support more cancer patients and their caregivers.

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Jonny Imerman also spoke about his experiences with fertility preservation on the myoncofertility.org website.

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