Future Consequences of Egg Donation

A recent report in the journal Nature investigated the ethics and economics of donating eggs for stem-cell research. Helen Pearson In 1989, a healthy 32-year-old woman offered her infertile younger sister some of her healthy eggs, and with them the chance to have a baby. Doctors at the Cromwell IVF and Fertility Centre in London gave the donor hormones that made a batch of eggs in her ovary mature, and collected six eggs for fertilization. Three embryos were transferred to the younger sister and two were frozen. One baby girl was born. Five years later, the doctors contacted the egg donor to ask whether to discard her frozen embryos. They discovered that she had been diagnosed with late-stage colon cancer that spread to her skull. She died just before her thirty-ninth birthday. Doctors don't know if the fertility drugs caused or accelerated the woman's cancer. But the possibility prompted Cromwell infertility specialist Kamal Ahuja to report the case as a reminder of how little is known about the risks of donating eggs (K. E. Ahuja and E. G. Simons, Hum. Reprod. 1998;13, 227-231; 1998). "It shook us all up," he says. Specialists in reproductive medicine say there is insufficient information about the long-term risks of drugs used to stimulate ovulation, a practice that has become more common in the past 25 years, with the proliferation of in vitrofertilization (IVF) and assisted reproduction. But some studies have suggested the drugs may be linked to the development of certain cancers.The question is receiving renewed scrutiny now that scientists are asking healthy women to donate their eggs forstem-cell research and exposing them to the potential risks of ovulation stimulation without the end result of a baby . The uncertainty makes it even more difficult to reach a consensus on whether women who donate eggs should be compensated, and if so by how much. "This discussion should emphasize long-term risk assessment rather than money," Ahuja says.During ovulation stimulation for IVF or egg donation, women are given drugs that encourage the ovary to ripen several eggs simultaneously, rather than the one egg normally ovulated each month. Doctors know that this can have side effects ranging from moodiness to infection. The most serious is ovarian hyperstimulation syndrome, which seriously affects about 6% of women receiving the drugs. Thirty or more eggs start to develop at once and fluid leaks out of blood vessels and collects in the abdomen, causing nausea, bloating and very occasionally kidney failure or even death.There is little information on how frequently ovarian stimulation has tragic side effects, says obstetrics and gynaecology professor Didi Braat of Radboud University Medical Centre in Nijmegen, the Netherlands, because doctors are often reluctant to report such cases and rarely have to. But deaths are thought exceptional: in a study reported at this year's meeting of the European Society for Human Reproduction and Embryology, Braat and her colleagues found only six deaths clearly linked to IVF from the medical records of some 100,000 women who underwent the procedure between 1984 and 2006.So some specialists are more worried about the long-term risks of fertility drugs. In the 1990s, for example, studies pointed to a link between fertility drugs and breast or ovarian cancer, although it's not clear how cancer would be promoted. One study suggested that women who took an ovulation-stimulating drug called clomiphene citrate for more than a year had 11 times the risk of developing ovarian tumours compared with the general population (M. A. Rossing et al. N. Engl. J. Med. 1994;331, 771-776).But these studies are controversial. It might be infertility, not fertility drugs, that predisposes women to disease. Other aspects of women's reproductive lives influence ovarian and breast cancer whilst pregnancy is thought to protect against tumours, for example. And ovarian cancer is so rare that it's hard to get a large enough sample to spot any connection.Louise Brinton at the US National Cancer Institute in Bethesda, Maryland, and her colleagues tried to control for these factors in one of the most comprehensive studies so far. They collected the medical records of more than 12,000 women who received ovulation-stimulating drugs between 1965 and 1988. The team did not find statistically significant increases in breast and ovarian cancer, but did find that the women were around 1.8 times more likely to develop uterine cancer (M. D. Althuis et al. Am. J. Epidemiol. 2005;161, 607-615).Such studies have reassured many specialists that the risks of ovulation stimulation are insignificant. But Brinton and others studying the issue say the picture is still incomplete. Brinton's study involved mainly women who took clomiphene citrate, rather than the gonadotropin hormones introduced for IVF in the 1980s. Researchers have only had a decade or so to study significant numbers of women taking the newer drugs, but extra cancers may not appear until the women reach 50 or 60. Researchers also don't know whether studies on infertile women can be generalized to egg donors, who are typically younger and healthier. Epidemiologist Mary Croughan at the University of California, San Francisco, has unpublished data suggesting donors are at lower risk of cancer. But "it's important to follow these women into the future", she says.She and other experts want more extensive studies to follow up women who have had IVF treatment or donated eggs. There is at least one large study of the long-term effects of ovarian stimulation under way in the Netherlands. But it's unclear who will drive the effort, particularly when private fertility clinics may have little interest in finding out the potential risks of the drugs they use. Ahuja suggests that an authority such as Britain's HFEA could coordinate such an investigation.Some argue that the researchers asking women for eggs should help pin down the health risks. Kevin Eggan of the Harvard Stem Cell Institute, for example, says that his group tells egg donors of the risks, and that they cancel the procedure if women show signs of ovarian hyperstimulation syndrome.If the risks aren't made clear upfront, one well-publicized tragedy could kill efforts to find donors, adds John Buster, professor of obstetrics and gynaecology at Baylor College of Medicine in Houston, Texas. "If a woman has a cardiac arrest while giving eggs for stem-cell research, it won't go down too well.

If Christmas was run by Commonwealth Public Servants

Life After 40

The Indian Transfer Student to an American School

It was the first day of school and a new student named Chandrashekhar Subrahmanyam entered the fourth grade.

The teacher said, "Let's begin by reviewing some American History. Who said "Give me Liberty , or give me Death"? She saw a sea of blank faces, except for Chandrashekhar, who had his hand up: "Patrick Henry, 1775" he said. "Very good! Said the teacher.

Who said "Government of the People, by the People, for the People, shall not perish from the Earth?" Again there was no response except from Chandrashekhar. "Abraham Lincoln, 1863" said Chandrashekhar.

The teacher snapped at the class, "Class, you should be ashamed. Chandrashekhar, who is new to our country, knows more! About its history than you do."

She heard a loud whisper: "F**k the Indians". "Who said that?" she demanded. Chandrashekhar put his hand up. "General Custer, 1862." At that point, a student in the back said, "I'm gonna puke" The teacher glares around and asks "All right! Now, who said that?" Again, Chandrashekhar says, "George Bush Sr to the Japanese Prime Minister in 1991"

Now furious, another student yells, "Oh yeah? S*ck this!" Chandrashekhar jumps out of his chair waving his hand and shouts to the teacher, "Bill Clinton, to Monica Lewinsky, 1997!" Now with almost mob hysteria someone said "You little shit, if you say anything else, I'll kill you." Chandrashekhar frantically yells at the top of his voice, "Gary Condit to Chandra Levy, 2001."

The teacher Fainted, and as the class gathered around the teacher on the floor, someone said, "Oh shit, we're f**ked!" And, Chandrashekhar said quietly, "George Bush, Iraq , 2005."

Indian Herbal Remedy- Cancer Hope

An Indian herbal remedy could one day be used to help fight pancreatic cancer, scientists hope. A team at the University of Pittsburgh Cancer Institute found extracts of triphala slowed the growth of human pancreatic tumours grafted onto mice.
The findings, presented recently at the annual meeting of the American Association for Cancer Research, offer hope that one day a treatment might be developed. But experts have warned the research is still at a very early stage.Triphala is a herbal preparation used in the traditional Indian medicine system Ayurveda. It contains the dried and powdered fruits of three plants, and it is said to ease intestinal-related disorders, promoting good digestion.Triphala triggered the cancerous cells to die off and significantly reduced the size of the tumors. Previous studies have shown triphala to have an anti-cancer activity in cell cultures, and the new research found this effect also worked in mice fed the herb preparation, without damaging normal pancreatic cells. The team fed mice grafted with human pancreatic tumours a triphala solution five days per week. After four weeks they compared the tumour size and protein contents of the tumours with those of a control group of mice that had not received the triphala. They found that the tumours in triphala-treated mice were half the size of those in the untreated mice.
The also found the treated mice tumour cells had higher levels of proteins associated with apoptosis - the process by the which the body normally disposes of damaged, old of unneeded cells. In cancer cells this process is often faulty, allowing the tumours to divide rapidly without any cells dying.
More research will investigate if the findings in mice can be extended. Further testing revealed that triphala had also activated tumour-suppressor genes, but did not negatively affect normal pancreatic cells. Their results demonstrated that triphala has strong anti-cancer properties given its ability to induce apoptosis in pancreatic cancer cells without damaging normal pancreatic cells.
Pancreatic cancer is the sixth most common cause of cancer death. It is difficult to treat and survival rates are very low - the latest figures show that the length of time between diagnosis and death is usually less than six months. Much more work needs to be done to see if triphala will work in humans. Experts said researching new treatments for pancreatic cancer was important, but warned the current research is still at an early stage.

Baby Boy or Baby Girl?

A slightly greater number of males than females are born worldwide every year. In recent decades, although there are still more baby boys born than girls, there has been an apparent decline in the ratio of male to female newborns in several industrialized countries, including Canada, Denmark, England, Germany, Japan and the United States. That has led researchers to ask: Are there any factors that can influence the probability of giving birth to a baby boy or girl? A new study from the Harvard School of Public Health (HSPH) and Karolinska Institutet in Stockholm, Sweden, found that mothers who experienced an increase in weight from the beginning of the first pregnancy to the beginning of the second pregnancy may be slightly more likely to give birth to a baby boy during their second pregnancy. The study appears online September 24, 2007 in the journal Fertility & Sterility.

"The results are provocative because few biological factors are known in humans to influence the chances of either conceiving or carrying to term a baby boy or girl. Our study suggests that maternal nutritional factors might play a role," said Eduardo Villamor, assistant professor of international nutrition at HSPH and lead author of the study. Some prior studies had looked at what factors might influence the sex ratio, but evidence of causality has been weak. Parental smoking, for example, has been associated with both lower and higher sex ratios. Maternal nutritional status had been studied, but there was little evidence to support a causal relationship with the sex ratio. One of the hypotheses that the authors of this study wanted to test was whether the increase in maternal obesity in several industrialized countries could play a role in the declining sex ratio. Their study found the opposite--maternal weight gain seemed to favor the birth of boys.

The study population, drawn from the Swedish Birth Registry, included 220,889 women who had successive pregnancies between 1992 and 2004 (live births and stillbirths were included). The researchers analyzed the change in women's body mass index (BMI) between the first and second pregnancies. (BMI is weight in kilograms divided by the square of height in meters.) The male to female sex ratio of the second pregnancy increased linearly with the amount of weight change from the first to second pregnancy, from 1.024 in women who lost more than 1 unit BMI to 1.080 in women who gained 3 or more units (a male to female sex ratio of 1.000 would indicate an equal number of boys and girls being born). The trend was independent of obstetric complications, maternal smoking, parental age, length of the interpregnancy interval and the sex or survival status of the first-born child. The data suggest that interpregnancy weight gain appears related to a slight increase in the probability of giving birth to a baby boy during a second pregnancy. The obesity epidemic does not appear to explain the observed decline in the sex ratio in some industrialized countries, which indicates that there are factors still unknown influencing the probability of giving birth to boys or girls.

The authors are careful to note that women should not gain weight to try to influence the sex of their baby. "Weight gain before pregnancy carries significant risks to the mother and the baby, and should not be practiced to influence the odds of having a boy," said Villamor. "Other factors of which weight gain is only an indicator could be at play here."

You cannot beat age

A report published by the US Centers for Disease Control and Prevention (CDC) shows that the younger a woman is when she uses assisted reproductive technology (ART), the more likely she is to become pregnant and have a live birth using her own eggs. The report defines ART as procedures in which both egg and sperm are handled in a laboratory, and says the majority of ART treatments its data include refers to IVF. The CDC's annual report,used data for the year 2002 collected from 391 of the 428 fertility clinics in the US. The report, called '2002 Assisted Reproductive Technology Success Rates', showed that, in 2002, 45,751 live births were achieved from 115,392 ART procedures performed in the US. This was an increase from the previous year's figures, when there were 40,687 live births from 107,758 treatments. Overall, the per-cycle ART success rate in 2002 was 35 per cent, compared to 28 per cent in 1996.The 2002 data show that 37 per cent of women who undergo ART using their own, fresh eggs when they are below the age of 35, had a live birth. This is compared with 31 per cent of women aged between 35 and 37; 21 per cent of women aged between 38 and 40; 11 per cent of women aged between 41 and 42 and just four per cent for women older than 42. However, the report also showed that the age of the woman undergoing ART had 'little effect' on success rates if donated eggs were used. In 2002, the live birth rate for all ART procedures where donated eggs were used was 50 per cent, with the success rate varying only slightly between age groups.
Victoria Wright, one of the authors of the CDC report, said that the data show that 'women in their 20s and early 30s who used ART had the most success with pregnancies, and single live births'. But, she added, 'success rates declined steadily once a woman reached her mid-30s'. She said the figures should act as 'a reminder that age remains a primary factor with respect to pregnancy success, and younger women have greater success than older women, even with technology'