Lymphoma treatment may lower men’s fertility

Both Hodgkin lymphoma and non-Hodgkin lymphoma, which are cancers of the body’s white blood cells, often affect young people who are still in their reproductive years. For men, treatment for these cancers can harm or halt sperm production. Although most men regain their fertility within two years of treatment, the journal Fertility and Sterility cautioned that men should be counseled about the possibility of this significant side effect before treatment begins.

In conducting the study, the researchers monitored the sperm of lymphoma patients undergoing various treatments to determine how each therapy affected the men’s fertility. Depending on their diagnosis, the men received combination chemotherapy, with or without radiation. Following treatment, their sperm density, total count, motility and vitality dropped. The lowest levels occurred three and six months after treatment. 

A treatment called alkylating chemotherapy was more often associated with a total halt in sperm production or a longer period of time for sperm production to resume. Alkylating chemotherapy damages DNA as it attacks cancer cells, to prevent the cells from reproducing. 

For all the men who received non-alkylating chemotherapy, with or without radiation, sperm production recovered 12 to 24 months after treatment ended. Two years after treatment ended, sperm production had not recovered for 7 percent of the men in the study.

“While many men can look forward to their fertility returning after treatment is over, not all will be so fortunate,” said Rebecca Sokol, M.D., president of the American Society for Reproductive Medicine. “It is imperative that prior to the initiation of therapy, counseling and sperm preservation be made available to all lymphoma patients and their partners who may want to have children in the future.”

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Can low sperm count lead to birth defects?

No, according to new research presented at the American Urological Association annual meeting in May 2014. 

Men are partially or fully responsible for the inability of a couple to conceive about 40 percent of the time. Assisted reproductive technologies such as in vitro fertilization can help couples have children, and researchers examined a Baylor College of Medicine database to determine if there were any connections between birth defects and low sperm count. They didn’t find any links.

“For couples considering assisted reproductive technology, the results of this study show they should not be concerned about decreased semen quality and birth defects,” said Tobias Kohler, M.D., residency program director at Southern Illinois University School of Medicine. “More than 5 million happy and healthy babies have been conceived using these techniques.”

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Important info for the LGBT community

Lesbian, gay, bisexual and transgender individuals who want to conceive a child face the same fertility problems as their heterosexual peers, but they face additional physiological and legal challenges to become parents.

“In the past, many people in the LGBT community did not regard reproduction as a realistic option; however, social and scientific progress has changed that,” says William Byne, M.D., Ph.D., Icahn School of Medicine at Mount Sinai, New York.

The journal LGBT Health, of which Dr. Byne is editor in chief, recently published an article entitled, “LGBT Assisted Reproduction: Current Practice and Future Possibilities.” In it, medical professionals discuss the many options available to the LGBT community, including gestational surrogacy, in vitro fertilization, donor egg banks and techniques to preserve future reproductive capability for transgender individuals whose transition plan entails procedures that will, or are likely to, compromise their fertility. The article also explores important economic and legal implications of assisted reproduction.

Contributors to the article were: A. Evan Eyler, M.D., M.P.H., University of Vermont College of Medicine, Burlington; Samuel C. Pang, M.D., Reproductive Science Center of New England, Lexington, Mass.; and Anderson Clark, Ph.D., a reproductive biologist from Boston.

“Clinicians who work with LGBT-identified people, particularly transgender youths and their families, should familiarize themselves with the material covered in this interview,” says Dr. Byne. “Future options may become available even for transgender youths who undergo pubertal suppression prior to the production of viable gametes.”

The article is available free on the LGBT Health website.

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Welcome Dr. Martinez

We are pleased to announce that Dr. Alan Martinez has joined RSCNJ as our newest specialist in Reproductive Endocrinology and Infertility.

Fluent in Spanish, Dr. Martinez is committed to caring for a diverse patient population and is a passionate, committed physician who provides comprehensive medical treatment in a caring, individualized fashion. Dr. Martinez boasts stellar credentials. He completed his fellowship training at the University of Cincinnati Medical Center and is board-eligible in Obstetrics and Gynecology as well as Reproductive Endocrinology. Dr. Martinez has expertise in hysteroscopic and advanced laparoscopic surgery.

After graduating with distinction with a B.S in Biology and B.A. in Psychology from San Diego State University, Dr. Martinez received his medical degree from the David Geffen School of Medicine at the University of California, Los Angeles. He completed his Obstetrics and Gynecology residency training at Saint Barnabas Medical Center, a teaching institution affiliated with Rutgers New Jersey Medical School.

Dr. Martinez is actively involved in the American Society of Reproductive Medicine and the Endocrine Society. He has presented his research at numerous national conferences, and his work has appeared in several internationally recognized journals. His clinical interests include infertility, PCOS, in vitro fertilization, oocyte and embryo freezing, and third-party reproduction.

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A better fertility treatment for women with PCOS?

A fertility drug that has been used for more than 40 years may soon be replaced with another drug that is 30 percent more effective in helping women with polycystic ovary syndrome (PCOS) become pregnant, with fewer side effects, according to a study published in The New England Journal of Medicine.

Researchers at seven different academic centers recruited 750 couples to compare the long-used fertility drug clomiphene (commonly called Clomid) to letrozole, a drug initially developed to prevent the recurrence of breast cancer in women.

Of the 376 women who were given Clomid, 72 became pregnant and gave birth. Of the 374 women who took letrozole, 103 gave birth.

Clomid is often prescribed to women with PCOS as a first step in their treatment. It works by partially blocking estrogen receptors in the brain. This triggers the brain to send a signal to the ovaries to produce more estrogen, which causes ovulation.

Letrozole is prescribed to prevent the recurrence of breast cancer in women by shutting off an enzyme that converts circulating testosterone to estrogen, causing estrogen levels in a woman’s bloodstream to fall. The brain then tells the ovaries to make more estrogen, which triggers ovulation.

The study also found that letrozole results in fewer twins. Approximately 10 percent of women who are treated with clomid give birth to twins. That rate drops to 3–4 percent in women who take letrozole.

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Mom’s voice triggers learning in utero

You don’t need to play Mozart or read Shakespeare to stimulate your baby as it develops in utero. According to researchers at the University of Florida, all a baby really needs is the music of mom’s voice to begin learning.

Research published in the journal Infant Behavior and Development shows that babies in utero begin to respond to the rhythm of a nursery rhyme, showing evidence of learning, by 34 weeks of pregnancy and are capable of remembering a set rhyme until just prior to birth.

The researchers recruited 32 pregnant women between 18 and 39 years of age during their 28th week of pregnancy. From 28 to 34 weeks of pregnancy, all mothers in the study recited a passage or nursery rhyme out loud twice a day and then came in for testing at 28, 32, 33 and 34 weeks’ gestation for an evaluation on the emergence of learning. Testing involved studying the fetal heart rate—researchers interpret a small heart rate deceleration as an indicator of learning or familiarity with a stimulus.

During testing, the fetuses in the experimental group were played a recording of the same rhyme their mother had been reciting at home, but spoken by a female stranger. Those in the control group heard a different rhyme, also spoken by a stranger. This distinction was made to help determine if the fetus was responding simply to its mother’s voice or to a familiar pattern of speech, which is a more difficult task.

The researchers found that the fetal heart rate began to respond to the familiar rhyme recited by a stranger’s voice by 34 weeks of gestational age. At 38 weeks, there was a statistically significant difference between the two groups. The experimental group that heard the original rhyme responded with a deeper and more sustained cardiac deceleration, whereas the control group that heard a new rhyme responded with a cardiac acceleration.

“The mother’s voice is the predominant source of sensory stimulation in the developing fetus,” said Charlene Krueger, Ph.D., R.N., an associate professor in the University of Florida College of Nursing. “This research highlights just how sophisticated the third-trimester fetus really is and suggests that a mother’s voice is involved in the development of early learning and memory capabilities. This could potentially affect how we approach the care and stimulation of the preterm infant.”

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Final comments

We’d like to share two more comments we’ve received recently. Thanks to all of our patients who said such nice things about us.

“Excellent experience. We really felt like the doctors were trustworthy and were interested in getting us pregnant!”

“Everyone was so nice and caring. It’s hard enough knowing you have infertility issues, but the staff was very caring, which helped tremendously. The doctor was awesome, very attentive to my needs and questions, and explained things on my terms.”

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Does ‘The Pill’ lower ovarian reserve?

Yes, according to a recent Danish study. Looking at preconception lifestyle and biological factors as predictors of fertility, the researchers found a significant effect of the contraceptive pill on markers used to assess ovarian reserve, which can predict future reproductive lifespan.

The Pill has little effect on short-term fertility. Typically, stopping the Pill returns cycles to normal, and pregnancy is likely within six months or so.

But the long-term effect is less well known. The new study finds that the Pill suppresses two markers of ovarian reserve, which reliably predict ovarian aging and the onset of menopause. The study, which included 833 women (aged 19 to 46 years), found that measurements of the two markers were 19 percent and 16 percent lower in Pill users than in non-users. Ovarian volume—the size of the ovaries themselves—also was significantly smaller, by between 29 and 52 percent, with the greatest reductions seen in the group aged 19 to 29.9 years.

These effects don’t necessarily reflect future fertility, according to the researchers, but the relationship between the Pill and ovarian reserve is important to know.

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A clearer picture of IVF success

Using computer-automated, time‐lapse photography of embryos in the laboratory during in vitro fertilization (IVF) may improve embryo selection, potentially increasing the chances of pregnancy among women undergoing the procedure, according to new research from the Perelman School of Medicine at the University of Pennsylvania and five other fertility centers.

The researchers used the Early Embryo Viability Assessment imaging device (Eeva), which records images of developing embryos during the first three days of laboratory culture, to evaluate embryos transferred into 177 patients. The images were then fed into a software program that uses several measures to assess the embryo’s developmental potential, rating them high, medium or low for their capacity to reach the blastocyst stage by the fifth or sixth day of culture.

Embryos normally implant at the blastocyst stage, when they have divided into about 100–200 cells, and blastocysts have a much greater chance of implanting successfully and resulting in an ongoing, viable pregnancy.

Researchers found that patients with at least one “high”-rated embryo transferred had a 54 percent viable pregnancy rate compared to a 34 percent rate for those with only a “low”-rated embryo transferred.

“Our findings provide promising news for couples using or considering in vitro fertilization because it shows that this technology offers the prospect of selecting embryos that have a greater likelihood of resulting in a pregnancy,” said lead author Matthew VerMilyea, Ph.D.

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Any comments?

“Everyone was great!!” says one of our patients. “I was very nervous, and everyone was so pleasant and seemed to really care. I appreciate everything. Thank you!!”

Any suggestions:

“Nothing—everything was great.” (smiley face)

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