Dr. Mann is asked, and answers

In case you missed it, our Jessica Salas Mann, M.D., was featured in the popular magazine Monmouth County Ask the Doctor last month.

Asked, “Should I freeze my eggs?” Dr. Mann gave a detailed and thoughtful description of the pros and cons of this procedure. “The decision to freeze your eggs is not an easy choice,” she said. “It can represent a financial and emotional burden. However, it may be the only real way to ‘turn back the clock.’” As the doctor explained, a woman could have a child at 38 with eggs harvested when she was 30.

If you would like to read the entire article, you can download it from the Monmouth County Ask the Doctor website.

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Pregnant women actually get sicker from the flu

Expectant mothers have an unusually strong immune response to influenza, new research from the Stanford University School of Medicine and Lucile Packard Children’s Hospital Stanford has found. The unexpected finding may explain why pregnant women get sicker from the flu than other healthy adults.

The results were surprising because immune responses were thought to be weakened by pregnancy to prevent the woman’s body from rejecting her fetus.

The study, published online in the Proceedings of the National Academy of Sciences, is the first to examine the reactions of immune cells taken from pregnant women to influenza viruses, including the H1N1 strain that caused the 2009 flu pandemic.

“We were surprised by the overall finding,” said Catherine Blish, MD, PhD, assistant professor of infectious diseases at Stanford and the study’s senior author. “We now understand that severe influenza in pregnancy is a hyperinflammatory disease rather than a state of immunodeficiency. This means that treatment of flu in pregnancy might have more to do with modulating the immune response than worrying about viral replication.”

“If our finding ends up bearing out in future studies, it opens the possibility that we can develop new immune-modulating treatment approaches in the setting of severe influenza, especially in pregnant women,” said Alexander Kay, MD, instructor in pediatric infectious diseases and the study’s lead author.

The investigators hope their research will remind women who are pregnant or planning a pregnancy to get their flu shots. “Flu vaccination is very important to avoid this inflammatory response we’re seeing,” Kay said. “But only 50 percent of pregnant women are currently vaccinated for influenza.”

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A call to avoid artificial sweeteners

Turning to artificial sweeteners to soothe a sweet tooth may not be the most healthful move, a new Israeli study suggests. Artificial sweeteners can potentially make blood sugar levels rise despite containing no calories, researchers found in human and mouse studies.

Saccharine and its counterparts appear to alter the bacteria residing in the intestines in ways that can impair some people’s ability to process glucose, the researchers report in the Sept. 17 issue of Nature. That means that rather than helping to curb the current epidemics of obesity and type 2 diabetes in the United States, artificial sweeteners could potentially be contributing to the problem, according to the study.

The researchers found that mice fed artificial sweeteners developed higher blood-sugar levels compared with mice drinking plain water or even water laced with sugar. Also, the investigators could induce higher blood-sugar levels in healthy mice never exposed to artificial sweeteners by transplanting gut bacteria from mice that had been fed saccharine.

In a group of nearly 400 people, the researchers found that long-term users of artificial sweeteners were more likely to have higher fasting blood-sugar levels. They were also more likely to have signs of impaired glucose processing, compared with people who don’t normally use such sweeteners.

“We must stress that by no means are we saying sugary drinks are healthy and should be brought back as a healthy part of our nutrition,” said lead author Eran Elinav, M.D., Ph.D., of the Weizmann Institute’s Immunology Department.

If you seek a healthy thirst quencher, drink water.

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The wide-ranging effects of endometriosis

Endometriosis, a chronic, recurring disease that affects approximately 10 per cent of women worldwide, causes such common physical symptoms as painful menstruation, heavy menstrual bleeding, pain during intercourse and infertility. But it also affects women in other profound ways.

Research published in the Journal of Family Planning and Reproductive Health Care found that endometriosis takes a long time to be diagnosed and affects all areas of women’s lives, including their work and sex lives, personal relationships and emotional well-being.

The study found that women were more likely to be diagnosed sooner when they approached their doctor describing symptoms as fertility-related rather than as a menstrual issue. Some women initially delayed seeking help for their symptoms because they believed all women had painful periods, the researchers said. The study also found that women often felt frustrated and angry about unsatisfactory experiences with healthcare providers and had concerns about the effectiveness and side effects of treatments.

Do you suffer from endometriosis? Tell us about your experience.

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Is surrogacy right for you?

In September, the New York Times ran an interesting article on surrogacy—also known as gestational carriers—and the confusing laws and regulations surrounding it. In “Surrogates and Couples Face a Maze of Laws, State by State,” reporter Tamar Lewin writes:

“While surrogacy is far more accepted in the United States than in most countries, and increasing rapidly (more than 2,000 babies will be born through it here this year), it remains, like abortion, a polarizing and charged issue. There is nothing resembling a national consensus on how to handle it and no federal law, leaving the states free to do as they wish.”

“Seventeen states,” she reports, “have laws permitting surrogacy, but they vary greatly in both breadth and restrictions. In 21 states, there is neither a law nor a published case regarding surrogacy, according to Diane Hinson, a Washington, D.C., lawyer who specializes in assisted reproduction. In five states, surrogacy contracts are void and unenforceable, and in Washington, D.C., where new legislation has been proposed, surrogacy carries criminal penalties. Seven states have at least one court opinion upholding some form of surrogacy.”

It’s certainly complicated, and at Reproductive Science Center of New Jersey, we will coordinate the care of the biological parents and gestational carrier and continue the care of the gestational carrier for the first seven to eight weeks of pregnancy. The entire process will be explained to you at your initial consultation.

For more information, visit our Gestational Carrier web page. We hope you will read it, and the Times article, and share your thoughts below.

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Antidepressants not linked to autism—but depression is

There’s been controversy for years over whether the use of common antidepressants by women during their pregnancies might raise the odds of mental health issues in their children. Now, a study involving more than 13,000 children finds no rise in the risk of autism in children whose mothers used an antidepressant while pregnant.

The findings challenge prior research pointing to a link between exposure to antidepressants in the womb and a greater risk of autism. Instead, severe maternal depression may be the risk factor boosting a child’s odds for autism, and not any antidepressant a woman took during her pregnancy, the new study’s authors said.

“We know that untreated depression can pose serious health risks to both a mother and child, so it’s important that women being treated with antidepressants who become pregnant, or who are thinking about becoming pregnant, know that these medications will not increase their child’s risk of autism,” said study senior author Dr. Roy Perlis of the department of psychiatry at Massachusetts General Hospital in Boston.

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Are chemicals in cleaning products reducing fertility?

Yes—at least in mice. A new study finds that two active ingredients commonly found in household detergents caused reproductive decline in mice.

Environmental chemicals are increasingly being linked to many health problems, including infertility. Earlier this year, bisphenol A (BPA), a chemical used to make plastics and other resins, was associated with infertility in women.

The new study, published in the journal Reproductive Technology, revealed that mice exposed to the two chemicals, alkyl dimethyl benzyl ammonium chloride (ADBAC) and didecyl dimethyl ammonium chloride (DDAC), took much longer to become pregnant. And when they did conceive, they gave birth to fewer babies. In addition, 40 percent of female mice exposed to these chemicals died in late pregnancy or during delivery.

These chemicals are found in many everyday products, including household cleaners, disinfectants, hand sanitizers, fabric softeners and even preservatives in cosmetics. Although they appear to be toxic to mice, it is still not known if they have the same effect in humans. But since these compounds are so common, the researchers believe that further investigation into their potential implications for human reproduction is warranted.

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Stem cells may restore male fertility

Infertility, which affects as many as 4.7 million men in the United States, is a key complication of cancer treatments such as chemotherapy and radiation therapy. New research out of the University of Texas Southwestern Medical Center has found rare stem cells in testis that produce a biomarker protein called PAX7, which helps give rise to new sperm cells—and may hold a key to restoring fertility.

Researchers studying infertility in mice found that, unlike similar types of cells that develop into sperm, the stem cells that express PAX7 can survive treatment with toxic drugs and radiation. If the findings hold true in humans, they eventually could lead to new strategies to restore or protect fertility in men undergoing cancer treatment.

The findings, presented in the Journal of Clinical Investigation, provide insight into the process of sperm development. Known as spermatogenesis, sperm development is driven by immature stem cells called progenitors. These cells gradually mature into fully differentiated sperm cells. Even after exposure to toxic chemotherapy or radiation treatments, the PAX7-expressing cells continued to divide and therefore could contribute to restoring sperm development.

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Open for patients in Lawrenceville

Good news! On Monday, Oct. 6, our Lawrenceville office is reopening and our newest physician, Dr. Alan Martinez, will be taking new patients at this office.

Dr. Martinez, a specialist in reproductive endocrinology and infertility, is also fluent in Spanish and dedicated to caring for a diverse patient population. He is a passionate and committed physician who provides comprehensive medical treatment in a caring, individualized fashion.

Dr. Martinez has impeccable credentials: he received his medical degree from the David Geffen School of Medicine at UCLA and completed his Ob/Gyn residency training at Saint Barnabas Medical Center, an affiliate of Rutgers New Jersey Medical School. He received fellowship training at the University of Cincinnati Medical Center, and has expertise in hysteroscopic and advanced laparoscopic surgery. His clinical interests include infertility, polycystic ovary syndrome (PCOS), in vitro fertilization, oocyte and embryo freezing, and third-party reproduction.

We are also now offering free second opinions. To learn more or to make an appointment, please call the office nearest you:

• Eatontown: 732-918-2500
• Toms River: 732-240-3000
• Lawrenceville: 609-895-1114

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Help raise awareness of breast cancer in October

Breast cancer is the second most common kind of cancer in women. About 1 in 8 women born today in the United States will get breast cancer at some point.

The good news is that many women can survive breast cancer if it’s found and treated early. And National Breast Cancer Awareness Month—October—is a chance to raise awareness about the importance of early detection of breast cancer.

Mammography is still the gold standard for early detection. If you’re not sure when you need to be screened, talk to your doctor. The American Cancer Society’s mammogram recommendations for all women can be found on their website.

You can help make a difference in spreading the word about mammograms and encouraging communities, organizations, families and individuals to get involved. The National Institutes of Health offer a few ways to get involved with their online toolkit, at www.Healthfinder.gov.

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