Category Archives: Fertility

An ancient imaging system proves to be an amazing cure for infertility!

Towards the end of the work week, Medical News Today revealed a story that looks like a miracle and something out of science fiction simultaneously. Infertility is a huge problem, with expensive, whose treatments are temperamental to say the least, fraught with emotional travails for families and other complicating issues.

And now, a single study appears to upend the problems and probably offer a simple, cost effective solution that will beat infertility right out of the cliched ball park! It is probably imprudent to get so excited, but it is hardly resistible.

Old techniques have gotten a second look in the past. Some of these techniques were trial and error prone, and many times the underlying science has not been understood. Renal Denervation is one such technique. With a surprising and incredible purchase of Ardian by Medtronic, it caused a frenzy, only to be let down by a poorly designed clinical trials. I have seen similar comebacks on old studies that controlled the Over Active Bladder condition. Therefore, one should look at any revivals of old techniques with ample caution.

Interesting Coincidences

Dr. Ben Mol, a Professor at Australia who spearheaded the study into an age old imaging technique as a possible treatment, appears to have been conceived as a result of this imaging treatment and has a younger brother! It seems remarkable that he started research intot his technique even before being made aware of his own history and relationship with the technique. Please refer to the MNT link below for more on this.

The Technique – Hysterosalpingography (HSG)

The technique, whose name is a mouthful, simply refers to imaging of the hystero, the uterus and salpingo, the fallopian tube. It was first carried out exactly 100 years ago, in 2017, just a few years after X-rays came into existence.

The procedure itself is a dye test, performed under X-ray. Water or oil are used to flush the Fallopian tubes. It is the flushing that appears to have aided fertility. In view of this notion, Dr. Ben Mol and others led a study with 1119 women, that produced interesting results.

The Study

The study, titled H2Oil was held in Netherlands, and as mentioned before, recruiting 1119 women, approximately half received HSG with oil, and as MNT put it, Lipidoil Ultra-Fluid, an iodized solution of fatty acids derived from poppy seeds.

The other half received HSG with water.

The Results

Nearly 40% of the women in the oil group, and 29% in the water group all conceived within 6 months. This is an amazing result. It shows immense promise.

Of course, more needs to be known, as I mentioned before. An underlying understanding of science, safety of flushing fallopian tubes and other important, fundamental considerations remain. However, for women and families struggling with infertility, this study shows great promise.

References: 

  1. The MNT Article: http://www.medicalnewstoday.com/articles/317532.php
  2. The NEJM Publication: http://www.nejm.org/doi/10.1056/NEJMoa1612337
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/close-up-of-hands-holding-baby-feet-325690/

Early Menopause and lack of child birth increase risks for Heart Failure

Heart Health in Women has many risk factors associated with it. A new study, another retrospective one, examined 28,516 women, who were enrolled as part of the Women’s Health Initiative (link below), a great effort that is now providing invaluable statistics that can be used to identify root causes and create awareness.

Eliminating all other known factors, such as BMI, smoking etc., two new factors popped up:

  1. Early Menopause
  2. Lack of pregnancy

They also identified that for every year’s worth of delay in menopause initiation, a woman’s heart failure rate drops by 1%. The other risk is caused by nulliparity, or lack of pregnancy. I am quoting directly here:

The latest study also found that women who had never given birth were 2.75 times more likely to have diastolic heart failure than women who had children.

The study authors did not establish a direct causal link, but they were able to identify a statistical link. The lead author did mention that polycystic ovary syndrome (a blog post for another day) has been known to increase cardiovascular risk. Diastolic Heart Failure happens when the heart is not able to pump enough blood to the body.

Study Limitations

Retrospective studies, especially ones based on efforts such as the Women’s Health Initiative, where large amount of data can be a treasure trove of information, just as this study has been. However, there are limitations. The current study only shows an association, not a causation, and no clues on the actual causation.

Such limitations however can be overcome by future studies, that focus on trying to identify causes.

Mitigating Circumstances

The more causes that are identified for the risk of heart failure, the better. Instead of considering these things in a negative light, women and doctors can better prepare ahead, taking precautionary measures ensuring a long and fruitful lifespan. It is also true that women in this century, prefer to make their life choices and therefore, knowing that avoiding pregnancy means a need to plan and prepare ahead for optimal health is always very good!

References:

  1. The study (sits behind a paywall): http://www.sciencedirect.com/science/article/pii/S0735109717367694
  2. The Guardian Article summarizing the study: https://www.theguardian.com/science/2017/may/15/earlier-menopause-puts-women-at-greater-risk-of-heart-failure-study-shows
  3. The Women’s Health Initiative: https://www.nhlbi.nih.gov/whi/
  4. Nulliparity: http://medical-dictionary.thefreedictionary.com/nulliparity
  5. A simple review of early menopausehttp://www.webmd.com/menopause/guide/premature-menopause-symptoms#1
  6. Diastolic Heart Failure: http://www.webmd.com/heart-disease/heart-failure/tc/diastolic-heart-failure-topic-overview#1
  7. Image Courtesy, Pexelshttps://www.pexels.com/photo/sunset-hands-love-woman-5390/

Obesity is a risk factor for IUD Expulsions

This is National Women’s Health Week. I am trying to highlight key health-related news all week. This night’s post also comes from the latest ACOG 2017 meeting from last week.

Obesity

Obesity is already a risk factor for various health conditions, such as diabetes, cardiovascular diseases and so on. For long term, reversible contraception, it is recommended that obese women opt for IUD over oral pills or patches, as the chances of venous thromboembolism is higher in obese and overweight women, than in women of normal weight. Please see referenced link below. It is an earlier paper by the same lead author/group as the current one, coming from Hawaii.

Weight classification, takes women and men from underweight to normal weight, overweight and obese. Within obesity, depending on waist size, the classification goes from Class I to Class III, representing extreme obesity. I have attached an NIH reference for your convenience.

It appears that in women with Class III obesity, IUDs can shift inside the uterus, also commonly termed IUD expulsion, at a higher rate than in women of other weight classes. This was the focus of the presentation at ACOG last week.

The current study

A retrospective cohort study, in Hawaii, with access to a diverse population including approximately a third each of Asian women and Native Pacific Islanders, has shown that obese women with Class III obesity have a risk, that is 3.06 times other women. Read other details in the paper summary and the article linked below.

Theories

The study itself was only performed, retrospectively to titrate risks. Some theories have been presented by the authors.

Placement itself might pose difficulties because of obesity.

Another risk of obesity is heavy menstrual bleeding, and therefore, IUD expulsions might be encouraged.

The authors however continue to encourage the use of IUDs in all women, regardless of body weight, as the benefits outweigh risks.

Conclusion

While on one end, further studies are needed, and will likelihood indicate why IUD expulsions occur at a higher rate in obese women, women should not stop opting for IUDs.

Additional studies that describe the causes for IUD expulsion might indicate that it is solely not a function of obesity, and it has already been shown that obesity is but one risk factor for expulsion.

Knowing why IUDs dislodge or move would make for better IUD design! 

Until the reasons are known and designs could be potentially improved, for the long term, women should focus on efforts that help them lose weight, in a healthy and practical manner.

References:

  1. ACOG Presentation Summary: http://mobile.journals.lww.com/greenjournal/Abstract/2017/05001/Levonorgestrel_Intrauterine_Device_Complications.235.aspx
  2. A previous article by the same group: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642497/
  3. The mdedge article http://www.mdedge.com/clinicalendocrinologynews/article/137744/gynecology/beware-hormonal-iud-expulsion-obese-women?channel=261&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  4. NIH Weight Classification: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm
  5. Some information on IUD Expulsion and what to do: http://www.healthline.com/health/birth-control/iud-fell-out#5
  6. Retrospective Cohort Studies: https://en.wikipedia.org/wiki/Retrospective_cohort_study
  7. Image Courtesy, Pexels: https://www.pexels.com/photo/backlit-beach-dawn-dusk-227674/

Some secrets of the relationship between Vitamin D and Calcium Intake to Early Menopause revealed

A Cholla Dusk

Early Menopause

Early Menopause is generally detrimental to a woman’s health and mental well being. Thus it is important that factors that delay early menopause are exposed and women are prescribed appropriate remedies.

Limitations in the reported study

This particular study (link below) tried to differentiate Vitamin D and Calcium intake through food and through supplements. The article that talks about this study reveals some key limitations of the study, with respect to the number of people who take large quantities of supplements, enrolled as well as the fact that the subjects are predominantly Caucasian. Because the diet data was self-reported, that offers a problem as well. It is a little saddening to see an NIH funded study take on such a form.

They did account for factors such as smoking, alcohol, BMI etc.

For many of the explanations though, there are only theories and hypotheses offered. This, I am sure, is because it will take thorough, large scale studies before they can be proven.

Interesting Results

Despite the fact that at least the article tries to conclude that food-based intake of Calcium and Vitamin D is the primary driver of the push-back on early menopause, as opposed to supplemental intake, I am not sure the study lays this out for us to subscribe to, with enough confidence.

In general, it appears that taking in recommended levels of Calcium and Vitamin D, either through food, supplements, or in the case of Vitamin D, safe exposure to sun (a problem for Caucasians with their high risk to skin cancer, and perhaps a factor in the recruitment for the study, which if true, is perhaps explained better in the paper, which unfortunately sits behind a paid wall), reduces the risk of early menopause.

Conclusion

As stated, early menopause comes with significant health and financial burden to the women and health systems in the general. Therefore, not only should the results of such studies be used, they should be expanded to solidify evidence, and diversify it based on race and other factors.

Reference:

  1. A summary of the study: http://www.medpagetoday.com/endocrinology/menopause/65189