A promising new therapy for protecting the fertility of women with cancer and auto-immune diseases such as lupus was revealed at the 23rd annual conference of the European Society of Human Reproduction and Embryology. Dr. Kate Stern, Research Director of the Royal Women's Hospital, Melbourne, Australia, told the conference that her pilot study had shown gonadotropin-releasing hormone (GnRH) antagonists were likely to be able to protect the ovary in women receiving potentially toxic doses of chemotherapy. "We are now hoping to carry out a randomised controlled trial to assess the long term protective effect of this treatment", she said
GnRH analogues are commonly used in the management of women's disorders that are dependent on oestrogen production, and in IVF therapies. Dr. Stern and her team studied women between the ages of 18 and 35 years who were due to receive high doses of cyclophosphamide, a chemotherapy drug. They knew that GnHR analogues were already used for the temporary suppression of ovulation in infertility treatment, so reasoned that it would be possible to use it to shut down the ovaries temporarily during the time that chemotherapy was administered, and hence protect them from the effect of the drugs.
The women were given the GnRH antagonist cetrorelix by 3 subcutaneous injections, each of them four days apart, concurrently with their chemotherapy. The scientists observed that there was evidence that ovarian function was suppressed, but that this returned to normal after chemotherapy stopped. Follicle stimulating hormone levels were up in 73% of the patients, but these also subsequently returned to normal. 94% of the patients resumed spontaneous ovulation and menses within 12 months.
"We believe that using GnRH antagonists in this way could reduce the side effects of chemotherapy over a long period", said Dr. Stern. "Other studies have tried to analyse whether similar treatments work, but the medications used have been long-acting and therefore cause shutdown for the whole time the patient is in chemo. This means that patients get unpleasant side effects related to having low oestrogen levels, such as hot flushes, and can also lead to loss of bone mass."
The side effects associated with the cyclical use of GnRH antagonists were minimal, she said. "19% of patients did not experience any at all, and only 6% reported persistent side effects, none of which were dangerous or serious."
Dr. Stern and her team are currently completing a five year follow up of the pilot study. "We are optimistic that this will prove to be an effective way of protecting fertility for women without the problems that have been associated with GnRH agonists in the past", she said. "The medical community needs to acknowledge the importance of future fertility for young people having cancer treatment. Not all patients who are having cancer treatment have the opportunity to talk with a fertility specialist before beginning treatment, and yet there are already several options for protecting the ovaries and even preserving eggs, embryos, or ovarian tissue. In addition to raising awareness among the medical profession, more support is needed for research in this important area."
Source: Mary Rice
European Society for Human Reproduction and Embryology
суббота, 25 февраля 2012 г.
суббота, 18 февраля 2012 г.
New Emergency Contraceptive 'Ella' Expected To Reach Market By End Of Year
A recently approved emergency contraceptive that is effective for up to five days after sex is likely to be on the market by the end of the year, according to the drug's manufacturer, Watson Pharmaceuticals, USA Today reports. The drug, to be marketed under the name ella, contains a compound called ulipristal. Existing EC products -- including Teva Pharmaceutical's Plan B One-Step and the generic EC, Next Choice -- contain levonorgestrol.
View drug information on ella.
According to USA Today, there are two main differences between ella and other EC products. Ella, which FDA approved in August, will be available by prescription only, whereas the levonorgestrol products are available without a prescription for women ages 17 and older. The other major difference is that the existing dedicated EC products only are effective at preventing pregnancy for up to 72 hours after sex.
It remains to be seen whether more EC choices will help reduce the roughly 50% of pregnancies that are unintended in the U.S., USA Today reports. However, in a letter to FDA in June, a coalition of 20 women's health groups -- including the American College of Obstetricians and Gynecologists -- wrote, "We do not believe technology holds all the answers, but having two types of safe and effective [EC] will increase the likelihood that a woman can access a product that works for her situation."
James Trussell, head of Princeton University's Office of Population Research, said that women's health advocates "can't depend on doctors to spread the word about" EC, adding, "My suspicion is it's fallen off the radar for many because they know that women are going directly to the pharmacist for it."
According to Watson spokesperson Charlie Mayr, "one of the problems is that a lot of women don't know that emergency contraceptives exist" (Rubin, USA Today, 9/28).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families.
© 2010 National Partnership for Women & Families. All rights reserved.
View drug information on ella.
суббота, 11 февраля 2012 г.
In Pediatric Cardiology Parents Are The Unsung Heroes
It's a parents worst nightmare, a newborn baby going under the knife to repair a heart defect. If the baby survives, that's when the real work begins for parents. University of Alberta nursing professor Gwen Rempel has seen hundreds of babies on the brink as a former pediatric cardiology nurse; she wanted to find out just what parents go through.
"I'm not 100 per cent convinced that health-care professionals get what these parents are doing," said Rempel. "I think [pediatric cardiology nurses] really pleased to offer what we offer and we're proud of ourselves that these kids are now surviving."
Rempel interviewed parents from across Western Canada, talking to both mothers and fathers about their day-to-day life with a child growing up with a congenital heart defect.
"These parents are extraordinary in what they're doing. Not just what they're doing for their child, but what they're doing to take care of themselves," said Rempel.
In these families, it's all about teamwork. Common public perception is that mothers do most of the work with newborns, but in these families fathers know just as much about their baby. The study found that some of the things both the mothers and the fathers were doing included calculating how much formula the baby needed, feeding the baby and monitoring both the baby's weight and oxygen levels.
"I was very struck by how these couples work together," said Rempel. "I'm continually struck by that. It's stressful because one parent might be in the hospital all the time, and one's at home trying to keep things spinning," she said. "They really do have to make an effort to keep on the same page."
The study also found that the parents in the study have a great support network. "These parents were never alone and it's family that's with them. It's amazing the amount of time grandparents will spend at hospitals, as well as aunts and uncles."
That's exactly what these parents need, says Rempel. For these kids to survive, the parents need to look after themselves.
"The parents are the ones safeguarding the child's survival. So if the parents are doing okay, there's a better chance the child's going to be okay."
But the parents' ability to succeed starts with asking for help. Rempel says a lot of these parents are just happy their child survived and don't want to ask for anything more. She suggests that health-care professionals need to be stepping up for these families.
"Can we teach them to ask for help? They're already doing what they do really well," she said. "We need to be more pro-active so that they can do even better."
Source: Quinn Phillips
University of Alberta
"I'm not 100 per cent convinced that health-care professionals get what these parents are doing," said Rempel. "I think [pediatric cardiology nurses] really pleased to offer what we offer and we're proud of ourselves that these kids are now surviving."
Rempel interviewed parents from across Western Canada, talking to both mothers and fathers about their day-to-day life with a child growing up with a congenital heart defect.
"These parents are extraordinary in what they're doing. Not just what they're doing for their child, but what they're doing to take care of themselves," said Rempel.
In these families, it's all about teamwork. Common public perception is that mothers do most of the work with newborns, but in these families fathers know just as much about their baby. The study found that some of the things both the mothers and the fathers were doing included calculating how much formula the baby needed, feeding the baby and monitoring both the baby's weight and oxygen levels.
"I was very struck by how these couples work together," said Rempel. "I'm continually struck by that. It's stressful because one parent might be in the hospital all the time, and one's at home trying to keep things spinning," she said. "They really do have to make an effort to keep on the same page."
The study also found that the parents in the study have a great support network. "These parents were never alone and it's family that's with them. It's amazing the amount of time grandparents will spend at hospitals, as well as aunts and uncles."
That's exactly what these parents need, says Rempel. For these kids to survive, the parents need to look after themselves.
"The parents are the ones safeguarding the child's survival. So if the parents are doing okay, there's a better chance the child's going to be okay."
But the parents' ability to succeed starts with asking for help. Rempel says a lot of these parents are just happy their child survived and don't want to ask for anything more. She suggests that health-care professionals need to be stepping up for these families.
"Can we teach them to ask for help? They're already doing what they do really well," she said. "We need to be more pro-active so that they can do even better."
Source: Quinn Phillips
University of Alberta
суббота, 4 февраля 2012 г.
First Babies Born Following Genetic Screening Study
Two women taking part in the world's first controlled study of a comprehensive genetic screening test before IVF have given birth to healthy babies. The babies, twin girls born in Germany in June and a singleton boy born in Italy in September, are the first deliveries in a pilot study of comparative genomic hybridisation (CGH) by microarray, a new method of screening oocytes for IVF for a full range of chromosomal disorders.
Dr Cristina Magli, embryologist at the SISMER Centre in Bologna, one of the two centres taking part in the trial, said: " All the babies and their mothers are doing very well in terms of weight and overall developmental performance."
The births, as well as several ongoing pregnancies in the study group, are the final stage in the "proof of principle" that the screening of oocytes and embryos before transfer in IVF can increase birth rates; both these pregnancies were derived from oocytes whose complete chromosomal status had been assessed by microarray CGH.
The study, which was conducted in Bologna, Italy, and Bonn, Germany, was designed and organised by a task force of ESHRE to determine the clinical value of CGH as a non-subjective means of genetic screening before embryo transfer.
"We have learnt from more than 30 years of IVF that many of the embryos we transfer have chromosome abnormalities," explains ESHRE's chairman Luca Gianaroli. "Indeed, it's still the case that two out of every three embryos we transfer fail to implant as a pregnancy, many of them because of these abnormalities.
"The whole world of IVF has been trying to find an effective way of screening for these abnormalities for more than a decade, but results so far have been disappointing with the technology available. Now we have a new technology in array CGH and our hopes are that this will finally provide a reliable means of assessing the chromosomal status of the embryos we transfer."
The microarray CGH technique as evaluated in the ESHRE study has several advantages over other methods:
CGH tests all 23 pairs of chromosomes in a cell, and not just a limited number (as in former methods)
The cell tested (known as the polar body) is taken from an oocyte at fertilisation, and so does not require biopsy of a cell from a developing embryo for its analysis
Earlier chromosome tests were on cells biopsied from growing embryos and did not necessarily reflect the total status of the embryo (because of chromosome "mosaicism"); polar body analysis removes this potential problem
Other CGH tests on biopsies from five-day-old embryos require several days to deliver complete results - and thus require the freeze-storage of the embryo before it can be transferred; polar body CGH can be done in real time and does not require freezing
At the everyday clinical level, polar body CGH is likely to have two more important consequences: first, because the analysis is performed on oocytes and not on embryos, countries like Germany which outlaw embryo analysis and freezing will now have at their disposal a reliable method of preimplantation genetic screening; and second, because the chromosomal status of the transferred embryo can be accurately predicted (with no more than a 10 per cent error rate as found in the ESHRE study), the reduction of multiple pregnancies in IVF by single embryo transfer will become more attractive.
In the short term, the IVF patients most likely to benefit from preimplantation screening by polar body CGH are those of an older maternal age (over 37 years), those with a record of unsuccessful IVF, and those with a history of miscarriage; all these conditions are associated with a higher than average rate of embryonic chromosomal abnormality.
"The study has already caused huge interest in the scientific and clinical community," says Dr Magli, "and we are very proud to announce these results. It is the first time that a scientific society like ESHRE has organised a study to determine the clinical value of a technique which could prove a revolution in IVF."
The next step for ESHRE will be to upgrade the pilot study into a large-scale international clinical trial, which is planned to start in 2011.
Source:
Hanna Hanssen
European Society of Human Reproduction and Embryology
Dr Cristina Magli, embryologist at the SISMER Centre in Bologna, one of the two centres taking part in the trial, said: " All the babies and their mothers are doing very well in terms of weight and overall developmental performance."
The births, as well as several ongoing pregnancies in the study group, are the final stage in the "proof of principle" that the screening of oocytes and embryos before transfer in IVF can increase birth rates; both these pregnancies were derived from oocytes whose complete chromosomal status had been assessed by microarray CGH.
The study, which was conducted in Bologna, Italy, and Bonn, Germany, was designed and organised by a task force of ESHRE to determine the clinical value of CGH as a non-subjective means of genetic screening before embryo transfer.
"We have learnt from more than 30 years of IVF that many of the embryos we transfer have chromosome abnormalities," explains ESHRE's chairman Luca Gianaroli. "Indeed, it's still the case that two out of every three embryos we transfer fail to implant as a pregnancy, many of them because of these abnormalities.
"The whole world of IVF has been trying to find an effective way of screening for these abnormalities for more than a decade, but results so far have been disappointing with the technology available. Now we have a new technology in array CGH and our hopes are that this will finally provide a reliable means of assessing the chromosomal status of the embryos we transfer."
The microarray CGH technique as evaluated in the ESHRE study has several advantages over other methods:
CGH tests all 23 pairs of chromosomes in a cell, and not just a limited number (as in former methods)
The cell tested (known as the polar body) is taken from an oocyte at fertilisation, and so does not require biopsy of a cell from a developing embryo for its analysis
Earlier chromosome tests were on cells biopsied from growing embryos and did not necessarily reflect the total status of the embryo (because of chromosome "mosaicism"); polar body analysis removes this potential problem
Other CGH tests on biopsies from five-day-old embryos require several days to deliver complete results - and thus require the freeze-storage of the embryo before it can be transferred; polar body CGH can be done in real time and does not require freezing
At the everyday clinical level, polar body CGH is likely to have two more important consequences: first, because the analysis is performed on oocytes and not on embryos, countries like Germany which outlaw embryo analysis and freezing will now have at their disposal a reliable method of preimplantation genetic screening; and second, because the chromosomal status of the transferred embryo can be accurately predicted (with no more than a 10 per cent error rate as found in the ESHRE study), the reduction of multiple pregnancies in IVF by single embryo transfer will become more attractive.
In the short term, the IVF patients most likely to benefit from preimplantation screening by polar body CGH are those of an older maternal age (over 37 years), those with a record of unsuccessful IVF, and those with a history of miscarriage; all these conditions are associated with a higher than average rate of embryonic chromosomal abnormality.
"The study has already caused huge interest in the scientific and clinical community," says Dr Magli, "and we are very proud to announce these results. It is the first time that a scientific society like ESHRE has organised a study to determine the clinical value of a technique which could prove a revolution in IVF."
The next step for ESHRE will be to upgrade the pilot study into a large-scale international clinical trial, which is planned to start in 2011.
Source:
Hanna Hanssen
European Society of Human Reproduction and Embryology
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