Thursday, September 13, 2012

Fertility & Exercise
Volume 14, Number 18
March 16, 2012
Study Shows Moderate Exercise May Help Normal Weight Women Get Pregnant Faster, While Vigorous Exercise Delays Pregnancy for All But the Overweight or Obese
Danish and US researchers found evidence for a relationship between increasing levels of vigorous exercise and longer times to conception in healthy, normal weight women who are planning to become pregnant. In overweight and obese women planning pregnancy, however, vigorous physical activity did not result in delays.
Moderate levels of physical activity were observed to result in small decreases in time to pregnancy regardless of women’s BMI.
The observational prospective cohort study used the internet to recruit and administer questionnaires to 3628 women, age 18 to 40. Participants accepted into the study were required to be in stable relationships with male partners, planning to become pregnant, and not receiving any fertility treatments.
The women were given baseline questionnaires to gather information on their demographics, height, weight, reproductive and medical history, lifestyle, and behavior. Follow-up questionnaires were emailed to participants every two months for 12 months or until the participant became pregnant. Eighty-three percent, or 3,027, completed the study.
One of the things the women were asked at baseline was the average number of hours per week they exercised. In addition, they were asked to report different types of moderate and vigorous activity separately. Activities such as running, fast cycling, aerobics, gymnastics, and swimming were characterized as vigorous. Brisk walking, leisurely cycling, golfing and gardening were considered moderate. Assigning values- total metabolic equivalents (METs)- to the activities, the researchers quantified the amount of moderate and vigorous physical activity each participant engaged in.
The participants were categorized by their exercise exposure and the results were further stratified by BMI to see whether the effect of physical activity on time to pregnancy differs according to body weight.
The researchers found that there was an inverse association between vigorous physical activity and how long it took to become pregnant for normal weight women (BMI under 25). In overweight or obese women (BMI of 25 or above) there was no association between vigorous exercise and a longer time to pregnancy.
Moderate physical activity was associated with improved time to pregnancy across the range of BMI. Women who engaged in 20-39 MET hours per week of physical activity had the shortest times to pregnancy.
ASRM President-Elect, Linda Giudice, MD, PhD, noted, “This study is particularly interesting because its participants were recruited from the general population, not from infertility patients. It points out the benefits of moderate exercise to all women who are planning a pregnancy and suggests that women might reduce their time to pregnancy by modulating their exercise programs.”
Wise et al, A prospective cohort study of physical activity and time-to-pregnancy, Fertility and Sterility in press.

Tuesday, May 29, 2012

IVF Treatment Not Associated with Overall Increased Rate of Breast Cancer

Volume 14, Number 30   
MAY 29, 2012 

Highlights from Fertility and Sterility:  IVF Treatment not Associated with Overall Increased Rate of Breast Cancer; Some Increased Risk Found in Younger Patients.

In a large population-based study out of Western Australia, researchers have found that IVF is not associated with an overall increased risk of breast cancer. However, the analysis of 20 years' worth of linked hospital and registry records demonstrates an underlying, age-related connection between IVF treatment and breast cancer.

The effect of IVF on breast cancer rates differed depending on the age of the women at the time treatment was commenced.  In younger, but not older, patients there was an association between having IVF and an increased risk of breast cancer.   Women who first underwent IVF treatment at age 24 were about one-and-a-half times more likely to develop breast cancer than women of the same age who received a non-IVF infertility treatment.  Women who commenced IVF at 40 had no increased risk. 

The cohort study was designed to compare rates of breast cancer between women whose infertility treatment included IVF and women who received other infertility treatments and utilized data from 21,025 women undergoing investigation or treatment in hospital for infertility in Western Australia from 1983 to 2002.  Of the total, 7,381 women had IVF and 13,644 did not.  Patients were between the ages of 24 and 44 at their first admission. Women with prior breast cancer diagnoses and those who developed breast cancer within six months of their first infertility admission were excluded from the study.

The data were adjusted to account for potential confounders on record, such as age at first delivery, delivery of twins or higher-order multiples, age at entry to the cohort, and socioeconomic status.  While age at first delivery was associated with an increased breast cancer rate, the delivery of twins or higher-order multiples suggested a reduced rate of cancer.     Linda Giudice, MD, PhD, President-elect of ASRM, noted, "The development of breast cancer is linked to estrogen exposure and the longer one is exposed, the greater the risk.  In an IVF cycle, there is a short, but significant elevation in circulating estrogen, and whether this is linked to the observations found in this study is not clear at this time. Women should be reassured that, overall, IVF was not associated with an increased risk for development of breast cancer.  However, as noted in the study, women in their thirties and forties still need to be aware of the increased risk of breast cancer associated with delivering one's first child at this stage of reproductive life.  For younger women, there is the possibility that IVF is associated with increased risk, but more research is needed to confirm this." Stewart et al., In vitro fertilization and breast cancer: is there cause for concern?

Tuesday, April 24, 2012

Costs of Infertility Treatments over 18 Months

In the March 30, 2011 Bulletin of the American Society for Reproductive Medicine, Fertility and Sterility, researchers at UCSF published a study of 398 women who chose reproductive endocrinology as an approach to getting pregnant. None had undergone IVF prior to the study.

The average per-person costs were $1,182 for medication-only to $24,373 for IVF and $38,015 for IVF-DE (with donor eggs). Treatment costs for successful outcomes were higher: $5,894, $61,377 and $72,642 respectively.

Compare these costs to the vastly less expensive approach using reproductive acupuncture!