The dangers of being an older dad

Women with older partners may be at higher risk of suffering miscarriages irrespective of their own age, according to a study that has linked the increased chance of a failed pregnancy with men over the age of 40.

Until now it was widely assumed that miscarriage rates largely increased with female age only, but a study into women undergoing artificial insemination with their partner's sperm has found that it can also be linked with older men. Scientists also found that pregnancy rates fell as the male partner gets older. This may reflect a decline in sperm quality in men over 40 that affects both the chances of conception and the increased risk of a miscarriage, they said. It is the first time scientists have discovered such a strong paternal effect on rates of pregnancy and miscarriage, and they suggest that, in future, fertility clinics should look more closely at the age of men as well as the age of women when advising on treatment.

Stephanie Belloc, of the Eylau Centre for Assisted Reproduction in Paris, said: "Until now … the message was to get pregnant before the age of 35 or 38 because afterwards it would be difficult. But now the gynaecologists must also focus on paternal age and give this information to the couple.

'Fertility clinics should look more closely at the age of men' "We suggest that there is a link between paternal age and DNA decay in the spermatozoa because we previously demonstrated that age is associated with increased sperm DNA fragmentation. So maybe there is a link between paternal age and DNA decay that are implied in the miscarriages.

"I think it's important to consider not only the woman, but both members of the couple in natural conception, but also in assisted reproductive technology [such as artificial insemination and IVF]."

The scientists analysed data gathered at a fertility clinic that performs artificial inseminations directly into a woman's uterus, a technique which improves the conception rate.

They followed up 21,239 cases of these intrauterine inseminations to see whether the age of the man or the woman had any significant effect on the chances of conception and miscarriage.

As expected, they found maternal age was a strong factor in pregnancy rates, with just 8.9 percent of women over the age of 35 getting pregnant, compared with 14.5 percent in younger women.

'We also found that the age of the father was important in pregnancy rates' "But we also found that the age of the father was important in pregnancy rates - men over 35 had a negative effect," said Belloc.

"And, perhaps more surprisingly, miscarriage rates increased where the father was over 35."

The study - the results of which were to be released at the European Society for Human Reproduction and Embryology in Barcelona - found the miscarriage rate among women with partners aged between 35 and 39 was 18.1 percent, but 33 percent for the partners of men aged between 40 and 44.

Couples undergoing assisted reproductive technology where the man is older than 35 or 40 should consider using the technique of intracytoplasmic sperm injection (ICSI), for directly injecting single sperm into an egg, because then the best sperm could be chosen for fertilisation, Belloc said.

"It's the conclusion of my study that ICSI should be the [technology] of choice when paternal age is increasing because we can choose the best spermatozoa.

"We can choose spermatozoa without DNA fragmentation, and DNA fragmentation is increasing with paternal age. So it is a way to be free of paternal age."

Older dads

TV presenter Des O'Connor's wife, the Australian singer-songwriter Jodie Brooke Wilson (35), gave birth to their son Adam in September 2004. O'Connor, then 72, claimed: "It felt like the right time."

US presidential hopeful John McCain was 48 when he and his wife Cindy had their first child together, the now-award-winning blogger Meghan McCain. They have since had two more.

There were a few sleepless nights at the Playboy mansion in the early 1990s when a sexagenarian Hugh Heffner fathered sons Marston and Cooper by his fiancee Kimberley Conrad.

When Leo Blair was born in 2000, 47-year-old Tony became the first serving prime minister to have a baby in more than 150 years.

Actor David Jason became a dad for the first time aged 61 when his daughter, Sophie Mae, was born.

A 56-year-old Michael Douglas welcomed Dylan Michel into the world in 2000, then married the mother, Catherine Zeta-Jones, soon afterwards. The couple had a daughter three years later.

Parenting Today & Aircraft Routes

Weekend Humor

Happy Valentine's Day

In spite of what you have been told by everyone, the truth is that Valentine's Day originated hundreds of years ago, in India, and to top it all, in the state of Gujarat !!!

It is a well known fact that Gujarati men, specially the Patels, continually mistreat and disrespect their wives (Patelianis). One fine day, it happened to be the 14th day of February, one brave Patelani, having had enough "torture" by her husband, finally chose to rebel by beating him up with a Velan (rolling pin to make chapattis). Yes....the same Velan which she used daily, to make chapattis for him.... only this time, instead of the dough, it was the husband who was flattened.

This was a momentous occasion for all Gujarati women and a revolt soon spread, like wild fire, with thousands of housewives beating up their husbands with the Velan. There was an outburst of moaning "chapatti-ed" husbands all over Anand and Amdavad.

The Patel men-folk quickly learnt their lesson and started to behave more respectfully with their Patelanis.
Thereafter, on 14th February every year, the womenfolk of Gujarat would beat up their husbands, to commemorate that eventful day - the wives having the satisfaction of beating up their husbands with the Velan and the men having the supreme joy of submitting to the will of the women they loved.

Soon The Gujju men realised that in order to avoid this ordeal they need to present gifts to their wives....they brought flowers and sweets. This is how the tradition - Velan time - began.

As Gujarat fell under the influence of Western culture, the ritual soon spread to Britain and many other Western countries, specifically, the catch words 'Velan time' !!! In course of time, their foreign tongues, this got anglisized to 'Velantime' and then to 'Valentine'.

And thereafter, 14th of February, came to be known as Valentine's Day and now you know the true story of Valentine's day.

The Italian Confession

Study Demonstrates Superiority of ICSI over IVF Procedure in Extremely Low Ooocyte Retrieval Cycles

Intracytoplasmic sperm injection (ICSI), in contrast to the conventional IVF procedures, may help attain a higher rate of normal fertilization in extremely low oocyte retrieval cycles. The results of the study have been published in the recent issue of the journal Fertility and Sterility. Yu-Che Ou from the Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taiwan, and colleagues, conducted a case-control study on infertile subjects with one to three oocytes per retrieval, and were divided into two groups undergoing either ICSI or IVF treatment. During the study, the cycle cancellation, fertilization, implantation and clinical pregnancy rates per transfer were observed. The study results are shown in the Table:

Although the rates of clinical pregnancy, implantation, and live births per transfer were higher in the ICSI group, the difference was not statistically significant between the two groups. Also, the cycle cancellation and complete fertilization failure rates were found to be similar in both the groups.Earlier, Requena, et al. (Journal of Assisted Reproduction and Genetics, 2000) conducted a prospective case-control study to evaluate maturation in vitro of human oocytes (MIVHO) as an alternate to IVF treatment, in low ovarian responders. Oocyte retrieval, maturation in vitro, fertilization, and blastocyst development rates were observed in spontaneously ovulatory women at the Instituto Valenciano de Infertilidad. The study results showed that the oocyte retrieval rate was considerably higher in cases where the pickup was carried out before follicular selection. The results of MIVHO in normal responders as well as low responders with an ovarian content of early antral follicles >5, were comparable. The study results demonstrated that MIVHO in low responders with an adequate number of early antral follicles could be successful and oocyte retrieval before follicular selection would aid in attaining more oocytes.

Although low ovarian response is not well defined, usually a patient with <34 oocytes, serum peak levels of <500mg/ml after aggressive stimulation, and with a background of at least two unsuccessful attempts of ovarian stimulation, is considered to be a low responder. Low ovarian reserve could be a result of high body mass index, pelvic adhesions, prior ovarian surgery, or progressive age. As the IVF outcome is directly dependent on the number of embryos available, low embryo count could result in decreased pregnancy rates.Though ICSI is associated with damage to a low percentage of injected oocytes, this micro-assisted fertilization technique is preferable in cases of oligospermia and azoospermia. Demonstrating the better performance of ICSI compared to IVF in very low oocyte retrieval cycles, the current study suggests ICSI as a superior choice for treating this condition.

References
1. Ou YC, Lan KC, Huang FJ, Kung FT, Lan TH, Chang SY. Comparison of in vitro fertilization versus intracytoplasmic sperm injection in extremely low oocyte retrieval cycles. Fertil Steril. 2008 Dec 22. [Epub ahead of print].
2. Requena A, Neuspiller F, Cobo AC, et al. The potential use of maturation in vitro of human oocytes in low responder patients. J Assist Reprod Genet. 2000 May;17(5):239-44

New Research Questions Use Of Common Fertility Treatments

A new study published on bmj.com has found that fertility is not improved in infertile couples who have been treated with long-established medical interventions. The team of researchers led by the University of Aberdeen has called for UK and national guidelines to be reviewed with this new evidence that challenges current practices.

In the UK, one in seven couples experience infertility. Of these, about 25% of the infertility is unexplained, and the standard treatment includes a body of common interventions that have been used for years and have been issued by the National Institute for Health and Clinical Excellence (NICE).

The research team set out to compare two specific interventions with expectant management (i.e., no treatment). From four teaching hospitals and a district general hospital in Scotland, they recruited a sample of 580 women who have had unexplained infertility for over two years. The women were randomly assigned such that one group had no medical intervention and tried naturally to become pregnant, a second group took oral clomifene citrate (CC) to correct subtle ovulatory dysfunction, and a third group received unstimulated intra-uterine insemination (IUI) of sperm.

During the course of the study, 101 women became pregnant and had a live birth. The birth rate for women with no intervention was 17%, and the rates for the oral CC group and the IUI group were 14% and 23%, respectively. According to the researchers, the 6% difference between the IUI and the non-intervention group is no large enough for the results to suggest a meaningful and significant improvement in the live birth rate.

Many women suffered from side effects that included: pain, bloating, hot flushes, nausea and headaches. These affected about 10 to 20% of women, most of whom were taking oral CC. Also, it is worth noting that satisfaction was higher in the groups of women being actively treated - as they were reassured by the treatment process - compared to women who received no intervention.

"These interventions, which have been in use for many years, are unlikely to be more effective than no treatment. These results challenge current practice, as endorsed by a national guideline in the UK," conclude the authors.

Tarek El-Toukhy and Yacoub Khalaf (Assisted Conception Unit at Guy's and St Thomas' NHS Foundation Trust) write in an accompanying editorial that: "As a direct result of the lack of evidence, many couples with unexplained infertility endure (and even request) expensive, potentially hazardous, and often unnecessary treatments." There is a need for high quality clinical trials as well as better information for patients to determine the best treatments in light of effectiveness and adverse effects. El-Toukhy and Khalaf also call for the current NICE guidelines to be reviewed with this research in mind.

Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial
S Bhattacharya, K Harrild, J Mollison, S Wordsworth, C Tay, A Harrold, D McQueen, H Lyall, L Johnston, J Burrage, S Grossett, H Walton, J Lynch, A Johnstone, S Kini, A Raja, A Templeton
BMJ (2008). 337: a716.
doi:10.1136/bmj.a716