A Breast Cancer Drug May Help Women Become Pregnant

The drug may be a new option for women dealing with infertility

For women with polycystic ovary syndrome (PCOS), getting pregnant is tough. The disorder effects 5-10% of women, and interferes with their sex hormones and menstrual cycles, sometimes preventing women from ovulating altogether. Some women also develop ovarian cysts and have trouble getting pregnant.

The drug clomiphine citrate has been the go-to treatment because it spurs ovulation, but it’s not perfect: it’s just 22% successful with up to six cycles of treatment; it has a high rate of multiple pregnancies; and it can cause side effects like mood swings and hot flashes. Clearly, women need another option.

In a new study published in the New England Journal of Medicine, the researchers looked at 750 infertile women with PCOS and randomly assigned them to either take clomiphene or a newer drug called letrozole—which is also used to treat breast cancer in a different dose—for up to five cycles. The results show that the women taking letrozole had a significantly higher rate of births at 27.5% compared to 19.1% for the women on clomiphene. The women receiving letrozole also had higher ovulation rates and fewer twin pregnancies. Birth defects for women on both medications were rare.

The findings are encouraging for women looking for better options to increase fertility, but more research is needed.

MONEY health

WATCH: The Cost of Trying for a Baby

Meet Carrie and Dan Zampich, who have spent $55,000 on fertility treatments over the past five years.

TIME fertility

Guys, Your Smartphone Is Hurting Your Sperm

It may be time to take the phone out of your pants pocket, gents. A new study found that the low-level electromagnetic radiation (EMR) that mobile devices emit lowered sperm motility by 8%, and viability by 9%

Even while the debate over whether cell phones cause cancer rages on, researchers are starting to explore other potentially harmful effects that the ubiquitous devices may have on our health. Because they emit low-level electromagnetic radiation (EMR), it’s possible that they can disturb normal cell functions and even sleep.

And with male infertility on the rise, Fiona Mathews at the University of Exeter, in England, and her colleagues decided to investigate what role cell phones might play in that trend. In their new research, they analyzed 10 previous studies, seven of which involved the study of sperm motility, concentration and viability in the lab, and three that included male patients at fertility clinics. Overall, among the 1,492 samples, exposure-to-cell-phone EMR lowered sperm motility by 8%, and viability by 9%.

(MORE: Frozen Assets)

Previous studies suggested several ways that the magnetic fields might be wreaking havoc on sperm — they could be generating DNA damage by promoting more unstable oxygen compounds, or because most men carry their phones in their pants pockets, the fields, which can cause up to a 2.3°C temperature increase on the skin, could be raising the temperature of the testes enough to suppress and interfere with normal sperm production.

(MORE: Why the Latest Study on Cell Phones and Brain Cancer Won’t Be the Last Word)

Exactly how much the cell phones are contributing to lower-quality sperm isn’t clear yet — the researchers note that how long the phones are kept in pockets, as well as how much EMR the phones emit (most are legally required to stay below 2.0 W/kg) are also important things to consider when figuring out an individual’s risk. But the lab-dish studies do show that sperm are affected by the exposure, and that provides enough reason to investigate the possibility that cell phones may be contributing to lower-quality sperm and potentially some cases of infertility. More good reason to keep cell phones away from your body when you’re not using them — easier in theory than in practice, however.

TIME Cancer

Drug Found to Preserve Fertility Among Young Women on Chemo

Goserelin protected ovaries from chemotherapy damage in a recent trial

A common drug may be a more cost-effective way for young breast cancer patients to preserve their fertility during chemotherapy than freezing their ovaries.

The drug goserelin is often used as a hormonal therapy for breast and prostate cancer. It has also been used to control the timing of ovulation. Now, researchers have discovered that the drug may actually protect the ovaries from chemotherapy damage. In a recent clinical trial women who received monthly doses of goserelin were more likely to give birth compared to women who did not receive the drug during treatment.

For young, premenopausal woman, the possibility that cancer treatment could leave them infertile is devastating. But researchers showed that only 8% of the women on goserelin had ovarian failure compared to the 22% of women who did not receive the drug. Exactly how the drug protects the ovaries is unknown.

Currently, young women who want to ensure their ability to have kids after cancer may opt for egg freezing for the future in vitro fertilization (IVF) treatments. However, the cost for egg freezing and IVF are in the thousands of dollars, and women must sometimes start their chemotherapy immediately, before egg freezing can be done.

The researchers, who presented their findings at the annual meeting of the American Society of Clinical Oncology, recommend women beginning chemotherapy consider goserelin as an option. Further research is still needed to confirm their findings.

Goserelin is sold by AstraZeneca as Zoladex, and global sales of the drug were around $1 billion in 2013, the New York Times reports. Goserelin has been shown to cause side effects like temporary menopausal symptoms including hot flashes.

TIME Japan

Japan Is Desperate to Rescue Its Economy from an Early Grave

General Images of Economy Ahead Of Nationwide Quarterly Land Price Data Release
Pedestrians cross an intersection in the Shibuya district of Tokyo, Japan, on Friday, Nov. 22, 2013. Kiyoshi Ota—Bloomberg/Getty Images

Any less than 100 million people would spell doom for the nation's economy, officials warned, while neglecting one glaringly easy fix

Japan’s battle against gray hairs took an unusual turn this week when the Ministry of Commerce set the very lowest acceptable bound for its aging population: 100 million people. Beyond this point, there lays a “crisis.”

Or so warned Akio Mimura, head of Japan’s Chamber of Commerce and Industry. Mimura urged the government to make 100 million the official population target, backed by policies that would promote childrearing. “If we don’t do anything, an extremely difficult future will be waiting for us,” Mimura said.

His concerns are well founded. Japan has one of the lowest fertility rates in the world, with each woman bearing an average of 1.4 children. At that rate, demographers project a plunge from 127 million people today to 87 million by 2060, sapping the workforce of its vital young workers and putting an enormous strain on state finances.

The shrinkage has already begun. In 2013, Japan’s population declined by a record-breaking 244,000 people.

All of which has led to some rather creative policy proposals from the Chamber of Commerce, such as retaining 70-year-old’s in the workforce, doubling government expenditures on childcare and encouraging men to ask working women out on a date.

But once again, policymakers dodged the quickest fix, namely to import workers from abroad. The island nation has an outstandingly small number of immigrants. They form less than 2% of the population, compared with a wealthy country average of 11%. Japan could triple the number of foreigners and still not approach the norm among wealthy nations.

Source: UN Population Division of the Department of Economic and Social Affairs

Of course there’s a reason for policymakers’ skittishness around the issue. Immigration reform consistently takes a beating at the polls. One recent survey by Asahi Shimbun newspaper asked respondents if they would accept more immigrants to preserve “economic vitality.” Even with the positive spin, 65% opposed.

Japan Immigration Bureau’s motto is, “internationalization in compliance with the rules.” A simple rule rewrite could alleviate Japan’s demographic fix. It certainly would be easier than prodding the nation’s families to have another 13 million babies. But judging from this week’s presentation from the Chamber of Commerce, it remains politically stillborn.



Over 40 and Infertile? Go Straight To IVF, Study Says

The latest study on IVF suggests that older women can benefit from a telescoped IVF experience. But is that really good news for couples struggling to get pregnant?

For couples struggling to conceive, the suggestion that fewer cycles of in vitro fertilization (IVF) can lead to pregnancy is certainly welcome news. From the daily hormone injections to the invasive and expensive process of removing eggs to try to fertilize them, IVF brings not just hope but also stress—and many women go through several cycles before they become pregnant, not to mention give birth to a baby.

So the latest study, called the Forty and Over Treatment Trial (FORT-T), published in the journal Fertility and Sterility looks, on the surface of things, to offer a roadmap for infertile couples in their quest to have children. The scientists report on how older couples can optimize their chances of conceiving, while also saving money by avoiding a trial-and-error approach to a successful pregnancy. A closer look at the results could cast a shadow on what appear to be sunny findings, though.

MORE: The Best and Worst States for Infertility

Lead researcher Marlene Goldman, at the Geisel School of Medicine at Dartmouth-Hitchcock Medical Center, concluded that the series of treatments that doctors have followed for years may not give older women the best chances of getting pregnant. Traditionally, doctors start with the least invasive strategy, ovulation-stimulating pills, followed by artificial insemination, and if that doesn’t work, they move on to the more invasive injections of a hormone that activates egg development followed by artificial insemination. If neither of those therapies helps the woman conceive, she then becomes a candidate for IVF. Each treatment is generally tried for at least two menstrual cycles, so it may take some women up to six months before they try IVF.

Goldman and her team wanted to test some encouraging evidence that skipping the first rounds of treatments and moving directly to IVF might help some women, especially older ones. They randomly assigned 154 couples to one of the three treatments: ovulation-stimulating pills followed by artificial insemination; injections of a hormone that activates egg development followed by artificial insemination; or immediate IVF. Those in the first two groups eventually went on to IVF if they failed to get pregnant. Goldman and her colleagues found, however, that the couples who started with IVF were able to achieve pregnancy and a live birth with fewer tries than those who tried the other methods first.

But that doesn’t mean that all infertile couples should do the same.

To start, the study involved a relatively small number of women who had very specific characteristics when it came to their reproductive potential. All had tried unsuccessfully for six months to get pregnant via intercourse, none had tried any infertility treatments, and they all had to have one functioning ovary, a fallopian tube, a certain level of ovarian reserve and no history of a tubal pregnancy.

MORE: How Healthy Are IVF Babies?

There’s also the possibility, says Dr. Tommaso Falcone, chairman of the Obstetrics, Gynecology and Women’s Health Institute at the Cleveland Clinic, that the comparison among the three groups of women isn’t quite fair. If women who start off with the pills or shots get pregnant using those strategies, then those who remain—the women who end up needing IVF—represent a more challenging group to treat. On the other hand, those who started out with IVF will include a mix of those who might more easily get pregnant as well as those who require more intensive treatment. So of course the group that went immediately to IVF would have a higher pregnancy and live birth rate. “These are different populations,” Falcone says.

Previous research done by Goldman shows that conception rates were similar (about 23%) in each group, however, which supports Goldman’s results, and strongly suggests that older women may benefit from moving directly to IVF and skipping the traditional first line infertility therapies.

MORE: IVF Babies Hit Record High

Goldman admits that understanding fertility data remains a challenge, especially considering the fact that the success rates of fertility clinics are self-reported and since certification by the Centers for Disease Control is voluntary. For the clinics that do report, there’s an obvious incentive to keep their success rates (defined as number of live births per IVF cycle) high. Some turn away older couples or those who have already tried unsuccessfully to get pregnant using reproductive technologies. And in states where infertility treatments are not covered by insurance, the numbers may look worse, as couples who try all other, less expensive means first to get pregnant, only turn to IVF when they have saved enough to pay for it. “There is definitely a selection bias, and definitely access issues,” says Goldman. “So just looking at the stats aren’t helpful unless you understand the patient population for that clinic.”

MORE: The Problem With America’s Twin Epidemic

That puts the burden of figuring out what the numbers mean on couples, who are already juggling difficult emotional, financial and physical challenges that comes with trying to get pregnant. For older women, Goldman’s study may provide some hope—as long as they fit the rather strict criteria of the couples included in the study. As crass as it may seem, fertility services are a product being sold to couples, and as with every purchase, experts warn that the principle of caveat emptor should apply.


The Best and Worst States for Infertility

Fertility report card scores states on insurance coverage for IVF, fertility specialists, and support groups.

If you’re struggling to get pregnant, the best states to live in are Connecticut, Illinois, Maryland, Massachusetts, and New Jersey.

That’s according to a “fertility report card” from RESOLVE: The National Infertility Association, which assessed each state based on whether they offer insurance coverage for in vitro fertilization (IVF), the number of fertility specialists in each state, and the prevalence of infertility support groups.

So what are the worst states for couples struggling to get pregnant? RESOLVE says it’s Alaska, New Hampshire, and Wyoming, which all were graded an “F.”

“For the second year in a row, we are working to highlight state-by-state disparities between access to support resources and fertility treatment, in an effort to motivate people to take action to improve their state’s fertility friendliness,” said Barbara Collura, President/CEO of RESOLVE. Insurance coverage is one of the biggest hurdles for IVF, with some states not providing insurance due to IVF not being a life or death issue, and for ethical reasons.

See a snapshot below, or view the full interactive here:

map of 2014 Fertility Scorecard  copy

TIME Education

Put the Sex Back in Sex Ed

Grant Cornett for TIME

When public schools refuse to acknowledge gender differences, we betray boys and girls alike

Fertility is the missing chapter in sex education. Sobering facts about women’s declining fertility after their 20s are being withheld from ambitious young women, who are propelled along a career track devised for men.

The refusal by public schools’ sex-education programs to acknowledge gender differences is betraying both boys and girls. The genders should be separated for sex counseling. It is absurd to avoid the harsh reality that boys have less to lose from casual serial sex than do girls, who risk pregnancy and whose future fertility can be compromised by disease. Boys need lessons in basic ethics and moral reasoning about sex (for example, not taking advantage of intoxicated dates), while girls must learn to distinguish sexual compliance from popularity.

Above all, girls need life-planning advice. Too often, sex education defines pregnancy as a pathology, for which the cure is abortion. Adolescent girls must think deeply about their ultimate aims and desires. If they want both children and a career, they should decide whether to have children early or late. There are pros, cons and trade-offs for each choice.

Unfortunately, sex education in the U.S. is a crazy quilt of haphazard programs. A national conversation is urgently needed for curricular standardization and public transparency. The present system is too vulnerable to political pressures from both the left and the right–and students are trapped in the middle.

Currently, 22 states and the District of Columbia mandate sex education but leave instructional decisions to school districts. Sex-ed teachers range from certified health educators to volunteers and teenage “peer educators” with minimal training. That some instructors may import their own sexually permissive biases is evident from the sporadic scandals about inappropriate use of pornographic materials or websites.

The modern campaign for sex education began in 1912 with a proposal by the National Education Association for classes in “sexual hygiene” to control sexually transmitted diseases like syphilis. During the AIDS crisis of the 1980s, Surgeon General C. Everett Koop called for sex education starting in third grade. In the 1990s, sex educators turned their focus to teenage pregnancy in inner-city communities.

Sex education has triggered recurrent controversy, partly because it is seen by religious conservatives as an instrument of secular cultural imperialism, undermining moral values. It’s time for liberals to admit that there is some truth to this and that public schools should not promulgate any ideology. The liberal response to conservatives’ demand for abstinence-only sex education has been to condemn the imposition of “fear and shame” on young people. But perhaps a bit more self-preserving fear and shame might be helpful in today’s hedonistic, media-saturated environment.

My generation of baby-boom girls boldly rebelled against the cult of virginity of the Doris Day 1950s, but we left chaos in our wake. Young people are now bombarded prematurely with sexual images and messages. Adolescent girls, routinely dressing in seductive ways, are ill-prepared to negotiate the sexual attention they attract. Sex education has become incoherent because of its own sprawling agenda. It should be broken into component parts, whose professionalism could be better ensured.

First, anatomy and reproductive biology belong in general biology courses taught in middle school by qualified science teachers. Every aspect of physiology, from puberty to menopause, should be covered. Students deserve a cool, clear, objective voice about the body, rather than the smarmy, feel-good chatter that now infests sex-ed workbooks.

Second, certified health educators, who advise children about washing their hands to avoid colds, should discuss sexually transmitted diseases at the middle-school or early-high-school level. But while information about condoms must be provided, it is not the place of public schools to distribute condoms, as is currently done in the Boston, New York and Los Angeles school districts. Condom distribution should be left to hospitals, clinics and social-service agencies.

Similarly, public schools have no business listing the varieties of sexual gratification, from masturbation to oral and anal sex, although health educators should nonjudgmentally answer student questions about the health implications of such practices. The issue of homosexuality is a charged one. In my view, antibullying campaigns, however laudable, should not stray into political endorsement of homosexuality or gay rights causes. While students must be free to create gay-identified groups, the schools themselves should remain neutral and allow society to evolve on its own.

Paglia is the author of Glittering Images: A Journey Through Art From Egypt to Star Wars

TIME Pregnancy

What Women Still Don’t Know About Getting Pregnant

Getty Images

As surprising as it seems, about half of women of reproductive age have not talked to their health care provider about their reproductive health, according to a new study.

As a result, the researchers, from the Yale School of Medicine, found that women between ages 18 and 40 weren’t aware of some the important factors that influence fertility and their ability to get pregnant, as well as about basic prenatal practices once they were expecting.

(MORE: The Frontiers of Fertility)

Among the most notable findings, which were published in the journal, Fertility & Sterility :

  • 30% of the women reported that they only visited a reproductive health provider less than once a year or not at all.
  • 50% of the women did not know that taking multivitamins and folic acid are recommended to avoid birth defects.
  • A little over 25% of women did not know that things like STDs, smoking and obesity impact fertility.
  • 20% did not know that aging can impact fertility and increase rates of miscarriage
  • 50% of the women thought that having sex multiple times in a day increased their likelihood of getting pregnant
  • Over 33% of women thought that different sex positions can increase their odds of getting pregnant
  • 10% did not know that they should have sex before ovulation to increase the chances of getting pregnant instead of after ovulation

The significant gaps in the women’s knowledge about their fertility may also explain why 40% reported that they had concerns and questions about their ability to get pregnant. The researchers believe that as women put off starting families — the latest CDC report showed women between 25 to 29 years old have the highest pregnancy rates, compared to women aged 20 to 24 in earlier years — doctors, particularly reproductive health specialists, should have more opportunity for improving women’s education about fertility and pregnancy so they know what to expect when they are finally ready to have a child.

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