Your mum, not IVF, determines age of menopause

A group of researchers at the Bourn Hall Clinic, Queensland University of Technology and the Weill Medical College of Cornell University, New York, have concluded that IVF treatment does not hasten the onset of the menopause or the severity of symptoms, having investigated the first generation of IVF patients.
Senior research scientist Dr Kay Elder and her team examined women who were treated at Bourn Hall Clinic in the UK between 1981 and 1994. When IVF treatment was first used there were worries that the hormones used to stimulate the ovaries to generate the eggs required might trigger an early menopause, by 'using up' a woman's eggs too quickly.
However, through theory and biological observations on 700 women, the age of onset of menopause was found to be more linked to maternal history than IVF treatment, and there was no increase in perimenopausal symptoms. Dr Elder said of the concerns that 'it was unknown territory in those days. Although all the studies showed that the treatment was safe, it was ground-breaking and we couldn't predict the potential long-term impacts'.
'This is a question patients often ask - and it's very useful to finally have a scientific study to point to which offers them reassurance that IVF will not affect timing or severity of the menopause,' she said.
Meanwhile, a group of researchers publishing in JCEM, a publication of The Endocrine Society, claims to have discovered a way to predict a woman's age at menopause more accurately. The study shows that anti-Mullerian hormone (AMH) levels in the blood can reflect how many follicles are present in a woman's ovaries. The stock of follicles ensures monthly ovulations, and depletion of the stock leads to menopause. Dr Jeroen van Disseldorp and Dr Frank Broekmans of the University Medical Centre Utrecht in the Netherlands said that 'knowing when menopause may occur could greatly impact childbearing decisions and our findings show that such knowledge may now be available from AMH levels'.

Fatal Attraction

The Tax Department's Pencil Sharpner

Is China Ready For the Olympics?

The New York Times on India

Lab Grown Eggs

A major breakthrough by British scientists could bring new hope for women facing the heartbreak of infertility. For the first time a team has managed to grow hundreds of eggs in the laboratory using a new technique which could help cancer patients whose treatment can leave them infertile. It would also allow thousands more women to wait until middle age to have children.
The scientists from Edinburgh University have shown that immature eggs can be frozen, grown and matured in the lab. The process could lead to women having pieces of ovary containing the immature eggs removed and stored. Much later on, they could be thawed, fertilised and finally implanted into the womb. Some say it is morally wrong for a woman to do so and have them fertilised years later in order to delay having children while she pursues a career. However, scientists hope the new process will revolutionise fertility preservation for women because it will allow them to store many more eggs than they can under traditional IVF techniques. And, because immature eggs survive the freezing process much better than the mature ones used in IVF, it is much more likely that older women will be able to conceive using them. It brings forward the prospect that thousands of women will use the technique to side-step the menopause, delaying motherhood for the sake of their careers.
The process, which could be available in five years, also provides hope for cancer sufferers who at the moment are often left infertile following chemotherapy and radiotherapy. Powerful anti-cancer drugs can destroy follicles in the ovaries, wiping out any possibility of women having children. At the moment, these women have a piece of ovary removed, frozen and then re-transplanted after their cancer treatment. But there is always the danger that the cancer could be reintroduced by the implant.
The new technique means women's immature eggs contained in the patch of ovary could be grown in the lab and then screened for cancer before being used in IVF treatment.

There are also hopes it will provide a rich source of eggs for scientists to study for clues on ways to treat a range of diseases.
There is a shortage of human eggs for medical research, and if the technique works it would bypass the controversy over the use of animal-human 'hybrid' embryos. The research, carried out by an Edinburgh University team led by Dr Evelyn Telfer,has been published in the journal Human Reproduction. "This is a significant step in developing immature eggs to maturity outside the body," said Dr Telfer. "Women who face infertility as a result of chemotherapy, or who want to put their biological clock on hold, could benefit from this system. "However, there is a lot more research to be carried out before this technique could be safely applied within a clinical setting."

Last year, Canadian scientists announced the first birth of a child created from a human egg matured in the laboratory. However, they did not use the same "primordial follicles" studied by the researchers from Edinburgh. These are the tiny egg-bearing pockets within the ovaries that are present in their millions at birth, but gradually die off over the course of a woman's life. They represent a woman's fertility "battery" which once depleted cannot be recharged. Many remain dormant, but some go on to mature and eventually release their eggs in preparation for fertilisation. For the first time, the team led by Dr Telfer has succeeded in growing primordial follicles to a late stage of maturation in the lab. They took pieces of ovary containing the follicles from six volunteer women who were giving birth by caesarean section. These were then exposed to a chemical that promotes growth, similar to the one that functions in the ovaries. Around a third of them survived and went on to reach the advanced 'antral' stage of development. At this stage, the follicles are filled with fluid and contain eggs almost ready to be fertilised. It means that it could soon be possible to grow hundreds of eggs in the laboratory.

The Canadian team which managed to create a child from immature eggs was working with only around a dozen. Another advantage is that the follicles mature much more quickly in the lab than they do in the ovary. The scientists do not yet know whether eggs - or oocytes, to give them their technical name - matured in this way are completely normal and suitable for in-vitro fertilisation. But animal studies suggest they are. The next step is to use hormones and other substances to try to nudge the 'antral' eggs on to the next stage of maturation, and then test the technique on humans. "We believe there's good evidence that we can get normal oocytes, but of course you would never apply this technique clinically until you are sure," said Dr Telfer.
"We're seeking funding for further research to bridge that gap. It might take five to ten years from now before we get to the stage of a clinical trial." Dr Jane Stewart, consultant in reproductive medicine at the Newcastle Fertility Centre, said:
"This work increases our understanding of the maturation of human eggs in the lab and takes us a step nearer the goal of strong immature eggs for fertility preservation for women."

Acupuncture: just a placebo?

Last week, there was yet another piece of research trumpeting the benefits of acupuncture; in this case, needling was said to relieve hot flushes in breast cancer patients by up to 50 per cent. The new study, unveiled at a conference in Berlin, follows similar claims that the ancient treatment can benefit those with arthritis, back pain, migraine and infertility. But is acupuncture really the miracle treatment it seems?

It appears to have become a fashionable cure-all, with 3,000 practitioners now regulated by the British Acupuncture Council. Earlier this year the highly respected British Medical Journal (BMJ) reported that acupuncture could increase IVF success rates by 65 per cent, based on analysis of seven separate trials involving 1,366 women. According to Chinese philosophy, acupuncture works by interfering at particular points along channels in our bodies, known as meridians, thereby enhancing the flow of life energy, known as Ch'i. Although the concepts of Ch'i and meridians make no sense in terms of science, medical researchers have been interested in testing the claims of acupuncture ever since the 1970s.

But in order to test the impact of acupuncture, one must disentangle the placebo effect (which means that as long as a patient believes that a treatment will work, then they are likely to respond positively). The best clinical trials involve two groups of patients: one receiving the real treatment, the other taking something that feels real, but which is ineffective. Researchers can then see if the new intervention offers any benefit beyond what is seen with the sham one. But how do you create a form of sham acupuncture? In recent years, researchers have developed three procedures. The first involves needling the patient at the wrong points on the skin, thereby missing the "meridians". In the second, acupuncturists insert the needles to shallow depths, again avoiding the meridian. The third procedure uses retractable needles: like theatrical daggers, the skin drives the needles back into the handle of the instrument, but the patient is none the wiser.

So how accurate were the trials analysed in the BMJ? The problem is that four out of the seven trials did not include a "sham" acupuncture group, but merely compared the effect of acupuncture with no acupuncture at all; any benefit could be due to the placebo effect and therefore these trials should be ignored. When focusing on the remaining three trials which had included such a sham group, the results are less than impressive. Two out of three failed to show that real acupuncture offers any significant benefit (in terms of likelihood of pregnancy) beyond the fake treatment. The sensible conclusion is that acupuncture is still unproven in terms of increasing IVF success rates. So it is worth avoiding acupuncture in the context of IVF, since 10 per cent of patients complain of pain, bleeding or bruising, and some even experience fainting, dizziness, nausea or vomiting. These adverse effects are not serious, but the known risks outweigh the unproven benefits.

The needles helped me conceive, says Lydia Slater. As a doctor's daughter, I was brought up to despise alternative medicine. But then, about five years ago, I found myself struggling with a variety of conditions that my GP seemed unable to treat. I had developed irritable bowel syndrome; I had put on weight, was unable to sleep and full of unspecified rage at my unexplained failure to conceive. All that modern medicine seemed to offer was a course of soporific antidepressants. Then I met a friend who was being treated for polycystic ovary syndrome by a Harley Street acupuncturist, a practitioner who, incidentally, specialised in unexplained infertility. I booked myself in, without telling my parents. The weekly sessions weren't cheap - some £80 a time. Initially, I was scared of the needles, but the acupuncturist was so skilled I felt nothing. I soon had them sticking out of my ears and in my finger joints. As the needle went in, I sometimes felt a violent jolt of electricity in one limb, or flashing along my body's nerve networks. Often, I would be visited by a burst of exhilaration or was suffused with a feeling of calm. The experience was positively addictive. I increased the sessions, sometimes to twice a week, which I could ill afford. Instead, I gave up shopping and eating out. The effects were startling: first, the IBS cleared up; then I ceased to comfort-eat and lost weight. I booked sessions to coincide with difficult situations, such as prior to a work meeting at which I had to negotiate a new contract. The acupuncturist told me that he would arrange the needles so as to boost my oestrogen levels, reduce stress and thus improve my chances of conceiving. It sounded like mumbo jumbo, but although I'm normally diffident, I found myself storming into the office and insisting on precisely the deal I was after. It was about the same time that I discovered I was pregnant. I now have two daughters, Asya, nearly four, and Rosie, two. I can't believe that my return to health can be attributed to a placebo effect. So many people I know can attest to the benefits of acupuncture: it has helped friends with everything from healing torn muscles to boosting low self-esteem. These days when I'm ill, I still go to my GP. But if a problem is nebulous or intractable, I'll be straight back to the needles.

By Simon Singh (The Telegraph, London, UK)
'Trick or Treatment? Alternative Medicine on Trial' by Simon Singh and Edzard Ernst (Bantam) is available from Telegraph Books for £14.99 + £1.25 p&p. To order, call 0870 428 4112 or go to books.telegraph.co.uk