One in Four Women Show Ambivalence Toward Pregnancy

For years, a widely held assumption was that women of childbearing age fell neatly into two camps: those trying to have children, and those not trying to have children.

A new nationwide study suggests, however, that nearly a fourth of women consider themselves “OK either way” about getting pregnant — a wide swath of ambivalence that surprised researchers, and that could reshape how doctors approach many aspects of women’s healthcare.

In a study of nearly 4,000 women ages 25 to 45 who are sexually active, about 71 percent said they were not trying to get pregnant, while 6 percent said they were. But nearly one in four, 23 percent, told researchers they were “OK either way” — they were neither trying to conceive, nor trying to prevent a pregnancy.

Among women who had no children, 60 percent said they were trying to not get pregnant, 14 percent were trying to get pregnant and 26 percent responded that they were “OK either way.”

“This finding dramatically challenges the idea that women are always trying, one way or another, to either get pregnant or not get pregnant,” said Julia McQuillan, professor of sociology at the University of Nebraska-Lincoln and the study’s lead author. “It also shows that women who are OK either way should be assessed separately from women who are intentional about pregnancy.”

The study also gave more accurate measures of women’s pregnancy intentions, which are important for estimating unmet need for contraception, building more effective family planning programs, promoting infant health and helping maternal and infant well-being.

“If healthcare providers only ask women if they are currently trying to get pregnant and women say no, then the assumption is that they are trying not to get pregnant,” McQuillan said. “Clearly, many women are less intentional about pregnancy. Yet this group should be treated as if they will likely conceive and should therefore get recommendations such as ensuring adequate folic acid intake and limiting alcohol intake.”
In addition, the study examined the attitudes and social pressures regarding pregnancy of the respondents, as well as their socioeconomic status.

Among the findings:
*Women who said they were OK either way reported the highest number when asked what the ideal number of children would be — 3.17 on average. They also tended to be slightly more religious than women who were either trying to get pregnant or not trying to get pregnant.
*Seventy-three percent of women who said they were OK either way said they would like a baby, compared with 34 percent of women who were not trying to get pregnant, and 95 percent of women who said they were trying to get pregnant.
*Those who were trying to get pregnant were more likely to report that having a child — or another child — was very important to their partner compared with women in the other two groups. Among women who had not yet had children and who said they were trying, 40 percent said it was important to their partner.
*Half of all women in the survey said their career was very important to them, while 45 percent said the same about having an adequate amount of leisure time. All three groups — women who were trying, women who weren’t trying, and women who were OK either way — reported similar attitudes about work and leisure.

The study, which is forthcoming in Maternal and Child Health Journal, was authored by UNL’s McQuillan along with Arthur L. Greil of Alfred University and Karina Shreffler of Oklahoma State University.

For more information, visit: www.unl.edu/.

Chinese-American, Korean-American Women At Highest Risk For Diabetes In Pregnancy

More than 10 percent of women of Chinese and Korean heritage may be at risk for developing diabetes during pregnancy, according to a Kaiser Permanente study of 16,000 women in Hawaii. The study also found that Korean-American and Chinese-American women’s gestational diabetes risk is one-third higher than average — and more than double that of Caucasian and African-American women.

Funded by the American Diabetes Association, the study found that Pacific Islanders, Filipinos, Puerto Ricans, and Samoans are also at higher-than-average risk — while Caucasian, Native-American, and African-American women have a lower-than-average risk.

Untreated gestational diabetes mellitus (GDM) can lead to serious pregnancy and birthing complications, including early delivery and C-sections. It can also increase the child’s risk of developing obesity later in life, researchers said.

While previous studies have shown that GDM is more prevalent among Asian women and Pacific Islanders, this study separates those ethnic groups into sub-categories to find out who is at higher risk. Researchers chose Hawaii for the study because it has one of the most ethnically diverse populations in the world.

Researchers divided Asians into five ethnic sub-groups and found some striking differences: Korean and Chinese women have the greatest risk of developing GDM. Filipinos are next, but Japanese and Vietnamese women have the same risk as the rest of the population. Among three groups of Pacific Islanders, Samoans and other Pacific Islanders (including women from Fiji and Tahiti) have a higher-than-average risk, while women classified as Native Hawaiians are at average risk. Caucasian, Native-American, and African-American women have the lowest risk for developing GDM.

“This study has important implications for diagnosis and treatment of gestational diabetes,” said study lead author Kathryn Pedula, MS, a researcher at the Kaiser Permanente Center for Health Research. “All pregnant women and their caregivers need to be educated about gestational diabetes, but it is especially important for women in these ethnic groups at higher risk.”

“Many previous studies have lumped all Asians and Pacific Islanders together—we now know that the risk for developing GDM varies greatly depending on your specific ethnic background,” said study co-author Teresa Hillier, MD, MS, an endocrinologist and senior investigator at the Kaiser Permanente Center for Health Research. “Future studies should also look at whether women in these higher risk groups also have more complications.”

This study involved 16,757 women aged 13-39, who gave birth in the Kaiser Permanente Health Plan in Hawaii between 1995 and 2003. Some women had more than one child during that time, bringing the total number of pregnancies to 22,110. Researchers obtained ethnic classification from the mothers’ birth certificates on file with the Hawaii Department of Health.

All women in the Kaiser Permanente system are screened for gestational diabetes between 24-28 weeks of pregnancy. If they have GDM, they are treated as part of routine care. More than 20 percent of women in the study had elevated glucose levels, and 6.7 percent of women met the Carpenter and Coustan threshold for gestational diabetes.

“This study underscores Kaiser Permanente’s commitment to identify differences in risk and clinical outcomes for different ethnic and racial groups,” said Winston F. Wong, MD, MS, medical director of Kaiser Permanente’s Community Benefit Disparities Improvement and Quality Initiatives. “While we cannot eliminate the increased risk of prenatal diabetes among our Korean and Chinese patients, we use this kind of research to alert and empower our health care professionals and physicians to reduce disparities and achieve the best possible outcomes for our patients and their children.”

Study authors include Kathryn L. Pedula, MS, and Teresa A. Hillier, MD, MS, from the Kaiser Permanente Center for Health Research in Portland, Ore.; Mark M. Schmidt, BA, Kaiser Permanente Center for Health Research, Honolulu; Judith A. Mullen, APRN, BC,CDE, Kaiser Permanente, Honolulu, Hawaii; Marie-Aline Charles, MD, MPH, INSERM, Paris, France; and David J. Pettitt, MD, Sansum Diabetes Research Institute, Santa Barbara, CA.

The study was published in the Dec. issue of the Ethnicity and Disease journal. For more information, visit: www.dor.kaiser.org.

Economy Affects Fertility Treatment Treatments, RMACT Offers Payment Plans

The current turbulent economy has influenced all aspects of consumers’ spending habits, even family planning.

According to the National Center for Health Statistics, there was a nearly 2 percent drop in the nationwide birth rate in 2008. This trend seems to extend to infertility treatment, which many are opting to delay, especially when they are without insurance or worry about a potential job loss.

To help patients who face tough decisions between their dreams for a family and financial realities, Reproductive Medicine Associates of Connecticut (RMACT) fertility clinic has created RMACT Opportunity Plans. The service and payment plans allow infertility patients to choose a flat rate for fertility care. In the first 8 weeks, 20 patients have signed up.

RMACT Opportunity Plan patients receive the same quality of care as the practice’s other patients because infertility treatment plans are based on their individual needs. The goal is to help patients grow their families and fulfill their family plans by taking fertility treatment financial worries out of the equation. Along with the fertility treatment plan, RMACT doctors encourage patients to be mindful of their overall wellness, including healthy eating, exercise and stress reduction.

“Over the past year, we’ve seen a decline in the number of patients going through with fertility treatment because of finances,” said Dr. Mark Leondires, medical director at RMACT.

“Our patients talk to us about how they want children, but have financial concerns that cause them to delay starting a family. We want our patients to have all the necessary tools for fulfilling their dreams for a family – including financial solutions. This is why we created RMACT Opportunity Plans, which give patients without fertility benefits access to customized medical fertility treatment plans at an affordable cost,” he said.

RMACT Opportunity Plans cover two of the most common treatment options – intrauterine insemination (IUI) and in vitro fertilization (IVF).

IUI places a concentrated semen sample into the uterine cavity. This treatment involves cycle monitoring, sperm washes, intrauterine insemination and injections for ovulation. RMACT IUI Opportunity Plan covers IUI cost for up to three cycles of ovulation induction and intrauterine insemination with oral medications.

The second option is RMACT IVF Opportunity Plan, which covers costs of IVF for one cycle. IVF starts by treating a woman with medications to stimulate the development of multiple ovarian follicles to produce eggs. These eggs are retrieved from the woman and are combined with sperm in a laboratory. One or more embryos are then transferred into the woman’s uterus. The IVF Opportunity Plan includes all cycle monitoring (blood work and ultrasounds), egg retrieval, anesthesia, embryo transfer, assisted hatching and cycle medications.

For more information, visit: www.RMACT.com.

Hormone Offers Promise As Fertility Treatment

New research suggests the hormone kisspeptin shows promise as a potential new treatment for infertility.

Scientists led by Dr. Waljit Dhillo from Imperial College London, have shown that giving kisspeptin to women with infertility can activate the release of sex hormones which control the menstrual cycle. This research could lead to a new fertility therapy for women with low sex hormone levels.

Kisspeptin is a product of the KISS-1 gene and is a key regulator of reproductive function. Animals and humans lacking kisspeptin function do not go through puberty and remain sexually immature. In a previous study, Dhillo and colleagues showed that kisspeptin treatment leads to the production of sex hormones in fertile women; they have now extended their research to look at the effects of kisspeptin in women whose periods have stopped due to a hormone imbalance.

In this study, funded by the Medical Research Council, The Wellcome Trust and National Institute for Health Research, a group of ten women who were not menstruating and infertile, were injected with either kisspeptin (n=5) or saline (control, n=5). Blood samples were then taken to measure their levels of luteinising hormone (LH) and follicle stimulating hormone (FSH), two sex hormones essential for ovulation and fertility. Kisspeptin led to a 48-fold increase in LH and 16-fold increase in FSH, when compared to the control treatment.

This is the first study to show that kisspeptin can stimulate sex hormones in women with infertility and presents kisspeptin as a potential new therapy for human infertility.

Dhillo from the Department of Investigative Medicine at Imperial College London said, “Infertility is a devastating condition that affects millions of couples worldwide. This research shows that kisspeptin offers huge promise as a treatment for infertility. From our previous results, we know that kisspeptin can stimulate release of reproductive hormones in healthy women.”

“We have now extended this research to show that kisspeptin treatment has the same effect in women with infertility. In fact, our current data show that kisspeptin causes a greater increase in luteinising hormone production in non-menstruating women, than that in fertile women in the previous study. This is a very exciting result and suggests that kisspeptin treatment could restore reproductive function in women with low sex hormone levels. Our future research will focus on determining the best protocol for repeated kisspeptin administration with the hope of developing a new therapy for infertility,” he said.

The research is being presented at the annual Society for Endocrinology BES meeting in Harrogate. For more information, please visit: www.endocrinology.org.

Fertility Drugs Do Not Increase Risk Of Ovarian Cancer, Study Shows

The use of fertility drugs does not increase a woman’s risk of developing ovarian cancer, finds a large study from Danish researchers.

During the past three decades there has been considerable debate as to whether use of fertility drugs increases a woman’s risk of developing ovarian cancer. Previous studies have given conflicting results and concerns remain, particularly for women who undergo several cycles of treatment or who never succeed in becoming pregnant.

Allan Jensen and colleagues at the Danish Cancer Society examined the effects of fertility drugs on ovarian cancer risk by using data from the largest cohort of infertile women to date. The study involved 54,362 women with infertility problems referred to all Danish fertility clinics between 1963 and 1998. 156 of these women had ovarian cancer.

After adjusting for several risk factors, the researchers assessed the effects of four groups of fertility drugs over an average period of 16 years. They found no overall increased risk for ovarian cancer after use of any fertility drug. They also found no increased risk among women who had undergone 10 or more cycles of treatment or among those who did not become pregnant.

Although the authors did observe a statistically significant increase in risk of the most common serious type of ovarian cancer among women who had used the drug clomiphene, they stress that this was probably a chance association.

The authors said their results show no convincing association between the overall risk for ovarian cancer and use of fertility drugs, and are generally reassuring.

However, they do point out that, as many of the study participants have not yet reached the peak age for ovarian cancer, they will continue to monitor the risk. In a society where there is more and more female infertility and later age at birth of the first child, the unfavourable effects of fertility drugs should be balanced against the physical and psychological benefits of a pregnancy made possible only by the use of these drugs, they conclude.

These data are reassuring and provide further evidence that use of fertility drugs does not increase a woman’s risk of ovarian cancer to any great extent; although, small increases in risk cannot be ruled out, warned Penelope Webb of the Queensland Institute of Medical Research, in an accompanying editorial.

Some women who take fertility drugs will inevitably develop ovarian cancer by chance alone, she wrote, but the current evidence suggests that women who use these drugs are not increasing their risk of developing this highly fatal cancer.

The study was published on on the British Medical Journal website. More information can be found by visiting: www.bma.org.

NPT May Be the Superior Alternative To IVF

Researchers from the International Institute of Restorative Reproductive Medicine (IIRRM) have responded to concerns expressed by infertility specialists that patients might choose NaProTechnology (NPT), over in vitro fertilization (IVF) treatment for infertility, finding the alternative surpassing IVF .

NPT is a new medical approach focused on restoring natural reproductive function rather than bypassing the problem through artificial means. In their response, NPT researchers emphasized that cumulative live birth rates are similar to those from IVF, but with much healthier outcomes for the babies, with no increased risk of multiple births.

The original study looked at 1100 couples who sought medical help to conceive using natural procreative technology, called NPT.

Overall, 52.8 percent of patients completing treatment could expect to have a successful live birth, most often a single healthy baby. For patients who hadn’t previously tried IVF before initiating NPT, the live birth rate rose to 61.5 percent. There were only a small number of twins, as would be expected naturally and no triplets or higher order births, the researchers found.

Almost all the babies were born at a normal healthy weight and gestational age, avoiding the complications of prematurity and low-birth weight common in IVF. A third of the patients trying NPT had already failed IVF, and had on average already tried more than five years to have a baby, researchers said.

The patients’ ages ranged from 25 to 48, with the average being over 35 years. Consistent with previous research, this study found that younger women were more likely to have a successful pregnancy; however, NPT was still successful for older women, as long as they were not in established menopause, the researchers noted.

The success rate over age 35 approached 50 percent. Despite this high rate of effectiveness, IVF doctors were concerned these patients would choose NPT instead of artificial treatments, which, they note, patients may find “too invasive, too expensive or inconsistent with their personal beliefs.”

NPT can often resolve infertility or miscarriages by detecting and correcting problems overlooked by standard approaches, they began to explain.

“Nearly half the patients we see have been told they have unexplained infertility,” said Dr. Phil Boyle, one of the study authors and director of the Galway NaProTechnology Medical Centre. “After NPT investigations, 2/3 of the patients had a hormone abnormality and more than 1/4 were diagnosed with cervical mucus dysfunction, a critical factor for sperm survival and transport. Once these and other problems were identified and treated, NPT enabled the couples to conceive using a natural act of intercourse.” With NPT, hormones are assessed throughout pregnancy so women can receive support to lessen their chance of miscarriage or premature delivery.

The medical care in the study was provided by specially trained family physicians, heralding a breakthrough in improving access to effective infertility treatment. Many artificial infertility treatments are only available in specialist clinics. Specialized NPT surgical care was not available at this location during the study period. Integrated NPT surgical care is part of ongoing studies and is likely to result in even further improvements in the live birth rates.

Professor Joseph Stanford, the paper’s lead author stated, “This study represents a landmark publication that demonstrates that NPT is a safe and highly effective alternative to existing treatment options, even for patients who have unsuccessfully tried other reproductive treatments. GPs and Obstetricians who were previously not aware of NPT will now be able to inform patients that they have other viable and effective choices to help them have a baby without all the risks associated with IVF and other artificial reproductive approaches.”

The paper was published in the Journal of the American Board of Family Medicine, and is available at www.jabfm.com. For more information, please visit: www.reproductiveinstitute.com.

Miscarriage And Infertility Treatment Increase Pre-eclampsia Risk

Repeated miscarriages and hormone treatment for infertility give an increased risk of pre-eclampsia among pregnant women, according to a new study from the Norwegian Institute of Public Health.

More than 20,000 first-time mothers from the Norwegian Mother and Child Cohort Study (MoBa) were included in the study. First-time mothers who had not miscarried or had problems becoming pregnant had a 5.2 percent risk of pre-eclampsia.

Women who had three or more miscarriages had a 50 percent increased risk of pre-eclampsia compared with women who had not miscarried. Women who had one or two miscarriages are not thought to be at higher risk. Among women who had both miscarriages and treatment for infertility, the risk for pre-eclampsia was 13 percent, researchers found.

The study also shows that women who had infertility treatment had a 25 percent higher risk of pre-eclampsia. Women who became pregnant after hormone treatment to stimulate ovulation had a doubled risk of pre-eclampsia compared to women without treatment. Assisted conception treatment was not linked to an increased risk, even though hormone stimulation is part of the procedure.

Different causes of infertility (polycystic ovary syndrome, blocked Fallopian tubes etc.) can probably explain the difference in risk for pre-eclampsia. It is likely that factors that cause infertility in mothers may also give an increased risk of pre-eclampsia, said the researchers.

It is less likely that the treatment itself explains the increased risk, even if this cannot be excluded. The study has been recently published in the British Journal of Obstetrics and Gynaecology.

The causes of pre-eclampsia are unknown, but involve the placenta. The placenta is important for normal development of the pregnancy. Failure in the development and function of the placenta seems to be an important mechanism in the development of pre-eclampsia but no-one knows why, the researchers explained.

The results from this study show that the protective effect seen after earlier normal pregnancies (births or terminations) is not present among women with repeated miscarriages. The study indicates that common causal factors linked to the placenta’s development and function may be present in infertility, repeated miscarriages and pre-eclampsia.

Facts about pre-eclampsia

• Affects 3-5 percent of all pregnant women.
• Greatest risk among first-time mothers.
• Appears in second half of pregnancy
• Recognized by high blood pressure and protein in mother’s urine.

In mild cases the mother can be unaffected by the condition, but in serious cases, pre-eclampsia can be life-threatening for mother and baby, with organ failure and danger of seizures among mothers. The child risks poor growth and development due to insufficient placenta function. The only treatment is delivery of baby and placenta. Pre-eclampsia is therefore an important cause of premature birth, said the researchers.

Among women who have given birth earlier, the risk is approximately halved. The same applies to women who have had earlier terminations. It is unknown why earlier normal pregnancies protect against pre-eclampsia in later pregnancies.

For more information, please visit: www.fhi.no/english.

Secondhand Smoke Raises Odds Of Fertility Problems In Women

Scientists at the University of Rochester Medical Center have found that women exposed to second hand smoke, either as adults or children, were significantly more likely to face fertility problems and suffer miscarriages.

An epidemiologic analysis of more than 4,800 non-smoking women showed those who were exposed to second hand smoke six or more hours per day as children and adults faced a 68 percent greater chance of having difficulty getting pregnant and suffering one or more miscarriages.

“These statistics are breathtaking and certainly points to yet another danger of second hand smoke exposure,” said Dr. Luke J. Peppone, research assistant professor at Rochester’s James P. Wilmot Cancer Center.

In the study, 4 out of 5 women reported exposure to second hand smoke during their lifetime. Half of the women grew up in a home with smoking parents and nearly two-thirds of them were exposed to some second hand smoking at the time of the survey.

More than 40 percent of these women had difficulty getting pregnant (infertility lasting more than a year) or suffered miscarriages, some repeatedly, said researchers.

“We all know that cigarettes and second hand smoke are dangerous. Breathing the smoke has lasting effects, especially for women when they’re ready for children,” said Peppone, who analyzed information in the Patient Epidemiology Data System, a well-studied cohort that has yielded information on a variety of cancers.

Peppone analyzed surveys collected from 4,804 women who visited Roswell Park Cancer Institute for health screenings or cancer care from 1982-1998. The 16-page survey focused on lifestyle, habits, family and personal health history, and occupational and environmental exposures. Each participant in this study reported that they had never smoked, and had been pregnant at least once or tried to become pregnant.

Participants reported whether one or both of their parents smoked and if they lived with or worked with smokers as adults. They also estimated the amount of time they were exposed to second hand smoke.

Peppone acknowledges that the data is based upon self-reporting and that is not perfect. However, he said “Women, especially mothers, have extremely accurate recall. Mothers can easily recall details like how long they breastfed, what vitamins they took during prenatal care, and childhood activities.”

Many of the women in the study grew up in the 1940s and 1950s, long before the surgeon general issued the first warning about the dangers of cigarette smoking in 1964. Since then, millions of dollars were spent to study the dangers of cigarette smoking. Tobacco use contributes to more than nearly 90 percent of all deadly lung cancers and 30 percent of all cancer deaths in the U.S., and a host of other health problems, said researchers.

Since the mid-1960s, smoking bans and government-funded, anti-smoking campaigns have encouraged smokers to quit and discouraged others from starting using a number of passive and aggressive techniques. Smoking rates have declined, however people continue to use tobacco and suffer the health risks.

The study was funded by a National Cancer Institute grant and was previously presented at the Society for Behavioral Medicine and Society of Research of Nicotine and Tobacco conferences; it is published online in Tobacco Control.

For more information, please visit: www.urmc.rochester.edu.