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Tuesday 30 September 2008
Source: Proceedings of the National Academy of Sciences
Scientists have made another significant breakthrough which has the potential to offer treatment for hundreds of thousands of couples who suffer from so-called unexplained infertility.
A team from Oxford University have for the first time been able to explain and film why some embryos don't implant in the womb.
The researchers discovered two distinct proteins which play a key role in the embryo's latching to the womb. What they found is that once the embryo comes into contact with the womb, chemical signals are sent which allow the embryo's cells to invade the womb and then make connection with the mother's blood supply to form the placenta.
Professor Helen J. Mardon who led the study says that with "many women, attachment and implantation doesn't happen and this is a major cause of infertility. The embryo and womb lining talk to each other, molecularly speaking, which allows them to interact. When the embryo lands on the surface of the uterus wall, it triggers a cascade of signals in both the embryo and uterus. The resulting changes allow the embryo to invade the lining."
The two proteins involved in the crucial latching process belong to the family of Rho GTPases proteins and are called Rac1 and RhoA. Professor Mardon described how they both work: "The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo."
Professor Mardon concluded that if the balance between these two proteins is altered, the cells of the womb lining won't move aside to allow for implantation.
Now that the process behind implantation and its potential failure have been discovered, it could lead to the development of drugs that help embryos implant properly.
It's basically a guide to overcoming infertility naturally, containing useful, well researched, practical and genuine tips to improve the chances of improving implantation and achieving a natural pregnancy. It also includes the equally good eBook Preventing Miscarriage » For more on these eBooks click here » . . . . . . . . 
In the meantine, if you are looking for some immediate answers and solutions to suspected implantation failure, I highly recommend you have a look at The Fertility Plan »
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Monday 22 September 2008
Source: Royal College of Obstetrics and Gynaecology, Montreal
Obese women could be at greater risk of suffering multiple miscarriages.
New research has found that women who have already miscarried are more likely to miscarry again if they are over weight.
A team from St Mary's Hospital in London surveyed close to 700 women who had suffered a so-called unexplained miscarriage and found that the risk of a recurrent miscarriage increased by 73% among those who were obese.
Lead author and clinical nurse specialist Winnie Lo says the study is "the first to look directly at the link between BMI and recurrent miscarriage. It shows that obese women who experience recurrent miscarriage are at greater risk of subsequent pregnancy loss."
She added that "all women with recurrent miscarriage should be weighed at their first consultation. Those who are found to be obese should be advised regarding the benefits of weight loss in increasing their chances of a successful pregnancy and programs should be in place to help with the weight loss process."
However, one leading endocrinologist has warned obese pregnant women against undertaking crash diets during pregnancy as this has been shown to cause serious problems to the unborn baby.
Sarah Williams, IVFG Reporter
What are the myths and what are the truths surrounding pregnancy loss?
Miscarriage Myths:
1. It is the woman's fault. New research suggests that it is not just the egg but the sperm that can be defective. For instance, older fathers means older sperm (although nobody told Rupert Murdoch or Rod Stewart) and it can contribute to defective zygotes, a common cause of miscarriage. Similarly men who smoke, take drugs or drink heavily can contribute to miscarriage although this is perhaps compensated for by also having sex a lot and therefore still producing quantities of children equal to or higher than the general population.
2. Long car trips cause miscarriage. This was vehemently told to me by my mother-in-law who was pregnant in the early sixties and this was information being sternly imparted by doctors at the time whilst they were writing thalidomide scripts. If there was any truth to it back then, it may have been to do with the way they made cars then but roads and suspension have come a long way.
3. Lying down can stop miscarriage. I have been vertical, horizontal and on the incline throughout my three miscarriages, but mostly horizontal and I can vouch for the fact that it makes no difference. Once a miscarriage has started there is little you can do but wait and see, as difficult as this is. Obviously if there is just some slight bleeding it is advisable not to persist with concreting the pool or chopping firewood but remaining flat and still achieves nothing but boredom at the least and mental disturbance at the worst.
4. You should just go ‘it was for the best' and get over it. No, everyone has a different response to the loss of a pregnancy. Go with what feels right - if you want to stay in bed for a week, do. It's the only way to heal.
5. If you have one miscarriage you'll have more. The vast majority of women have one miscarriage and then have normal pregnancy/s. I wasn't one of them but you need to keep the faith and keep trying, it's part of the healing process.
Miscarriage Truths:
1. Despite being experienced by hundreds of millions of women worldwide it is one of the least talked about issues, which is why I've discussed it openly in my book In Vitro Fertility Goddess »
2. You cannot stop a miscarriage from happening, nor can any medical practitioner.
3. You are more likely to suffer a miscarriage over the age of 35. The rates are - Over 35 - 25%, Over 40 - 33%, over 45 - at least 50% of pregnancies ending in miscarriage.
4. If you have 3 in a row it is termed ‘Recurrent Miscarriage' and doctors will order tests to see if there is an underlying medical reason as I had.
When you are focussing on trying to conceive a baby, the last thing that usually occurs to you is the possibility that you might lose it, unless of course you have previously suffered pregnancy loss.
This is especially true when experiencing the type of euphoria that overwhelms you when you find you've been successful after a long time, it can be virtually impossible to allow such an awful possibility to gain access to your head.
If, like me, you haven't devoured an entire library of pregnancy books, spines and all, before becoming pregnant you can be blissfully ignorant of the things that can go wrong with pregnancy.
And even if you do like to be prepared for all eventualities, in the effort to remain positive and uplifting, to convey the joy of pregnancy, most of the pregnancy books devote little coverage to topics such as what to expect during miscarriage or what a miscarriage looks like.
For that you need to go straight to the books entitled ‘Miscarriage' and who, when newly pregnant, is doing that, no matter what paranoid tendencies they may possess? Even when I was finally pregnant again after my first miscarriage I was not tempted. Well, not much, only a bit. I confess that I may have picked one up and peeped inside before realizing I was on the verge of taking leave of my senses and put it hurriedly back on the shelf.
So, how do you know if you've had a miscarriage and not realized it? Especially if you hadn't heard or read anything about it beforehand, it is entirely possible to have missed it altogether.
Miscarriage statistics are based on ‘known pregnancies' and do not take into account women who miscarry when they didn't know they were pregnant. Generally it is passed off as a particularly heavy or nasty period, with heavier than usual bleeding accompanied by some clotting. A pregnancy test when taken up to several days after a miscarriage will still show a positive result. My state of denial after my second miscarriage was so strong that I frantically took two further tests, despite an ultrasound having shown nothing but an empty sac and the fact that I'd bled the equivalent of small dam, and both of them showed the strong double line. I called my doctor, who told me that the pregnancy hormones could remain in my system for up to a week.
Miscarriage emotions, on the other hand can last a lot longer and can vary widely: from hysteria involving wailing uncontrollably and flinging oneself at objects like a Greek widow at a funeral, to the depths of despair causing curling up in foetal position for days at a time, to a kind of blank dissociative state where you go through the motions of living without feeling anything.
Is it harder to conceive after a miscarriage? Personally I found it hard to conceive before and after my miscarriages but this was due to a whole host of reasons, which may or may not have been linked to the miscarriages themselves. My doctors, after each miscarriage, advised me to ideally wait three months before trying again, to ‘allow the system to get back into order' or words to that effect. Yet I've met many women who didn't even wait to have another period, they resumed trying again right away and fell pregnant first go.
Even after loss of infant due to miscarriage, when the miscarriage is later in the pregnancy and not far from a still birth, women conceive relatively quickly and successfully. I had a work colleague who lost a baby at twenty weeks and just over a year later she gave birth to a healthy child.
So, achieving pregnancy after a miscarriage is more likely to be difficult if you had difficulties before the miscarriage, like myself. Some women, after the initial ‘hiccup' will sail through and never have another problem whereas there are those of us who will experience a spectrum of problems in our endeavours to have a child. Something to remember is that, if one in four (including the unknown) pregnancies end in miscarriage, the more pregnancies you achieve there is some chance that you may lose one of them.
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Wednesday 10 September 2008
Source: Human Reproduction
A new scientific breakthrough has the potential to prevent millions of unexplained miscarriages worldwide after the discovery that up to a third of them are caused by an excess of immune cells in a woman's uterus.
Researchers in Britain will soon start trials involving a steroid drug which will be administered to women who have suffered recurrent miscarriages.
Professor Siobhan Quenby from the school of reproductive and developmental medicine at Liverpool University who led the study says the treatment should be able to prevent up to 3000 miscarriages a year in the UK alone once it's available to patients in 5 to 10 years time.
Professor Quenby also hopes to develop a screening test to determine if certain women are at risk of miscarriage before they fall pregnant.
30 out of 40 of her patients who were suffering from multiple miscarriages have already given birth to healthy babies after receiving the steroid drug called prednisolone.
The research focused on the discovery of a link between excess blood supply and the failure of a foetus to implant in the womb which is thought to be caused by a type of immune system cell in the womb that promotes the growth of blood vessels.
This in turn creates an over supply of blood and oxygen undermining the foetus' ability to become implanted into the wall of the womb, leading to miscarriage.
But leading fertility expert Professor Lord Robert Winston warned that it was difficult to know how affective the treatment is until a full clinical trial had been completed.
He said: "It is a very important area, but a difficult one. There is always the chance of this being caused by the placebo effect."
Sarah Williams, IVFG Reporter
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Is it possible to believe you have miscarried and still be pregnant? Well, yes, especially if you are twenty-five year old Leanne Wright of Greater Manchester, UK.
She claims she presented at the Royal Bolton Hospital at six weeks pregnant with symptoms of miscarriage and was sent home and told to take ‘labour-inducing pills'.
Two weeks later she was devastated to find she hadn't miscarried and was still pregnant, with the baby due in February.
Now there is a part of this story that I can't relate to in any shape or form and that is the bit where she is devastated to find out she's still pregnant. When I had my three miscarriages I think I'd have personally handed over the keys to my home and my car if it meant I could have heard the words, ‘Sorry but you're still pregnant.'
How may of us have the reverse happen, the thinking you're pregnant, having all the symptoms then having a scan which reveals you haven't technically been pregnant for several weeks and all that's there is a sac containing either a dead under formed foetus or nothing at all?
And how many of us would have killed to be in Leanne's shoes at that point? Excuse me while I hastily obtain a dangerous weapon.
Regardless of what Leanne may or may not have been feeling, the question begging to be asked is, how did this happen? How on earth could a hospital get it wrong, resulting in a woman being convinced she was miscarrying when she wasn't?
The hospital has simply said that ‘all pregnancies are not straightforward' and I got taste of this when I was miscarrying for the second time and blubbering in my doctor's surgery. I'd used up all of my doctor's tissues and was halfway up my second sleeve when she interrupted me to say that, despite the fact that I was bleeding substantially enough to be using maternity pads and had cramps I may in fact not lose the baby.
Slowly I ceased snivelling as she went on to say that when she was pregnant with her second child she thought she was having her worst period ever - bleeding, crippling pain and clots - and she was not only pregnant but went on to have a healthy child.
Yet as a precaution she sent me for a scan, which rapidly killed my new false hope when it showed that I had indeed miscarried. I have to wonder if the Bolton Hospital had actually done a scan or, busy with Friday night drunks, had simply sent her away without properly examining her. We don't know.
There is no doubt that many women bleed both regularly and even substantially during pregnancy but don't miscarry however they are not the majority. Whilst it is important to try and stay positive unfortunately you have to be realistic.
For every Leanne, angry about being pregnant when she thought she wasn't, there are thirty women like me, sobbing because they aren't pregnant when they thought they were.
If there is one constant, it is that neither pregnancies or miscarriages are straightforward, of that you can be certain.
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I never thought I'd see ‘miscarriage' and ‘good news' in the one sentence, or even for that matter on the same page, but even the most unlikely couplings can occur. And what, in this instance, brings these strange bedfellows together?
Firstly miscarriages, treated by much of the medical profession and most of the well-meaning-no-idea-relative-and-friend-society as being due to some unfathomable deep dark force that you can't argue with, are actually due in most cases to something both identifiable and treatable.
Obviously a first miscarriage is unforeseeable and therefore in theory unavoidable yet it can be the cue to get checked out before another occurs.
The medical profession, however, have other ideas. They like you to experience three consecutively before springing or at times limping into action. Then they officially label it as ‘recurrent miscarriage' which opens the door to all sorts of tests although often you need to ask for the key.
Unfortunately at this point you're so stressed and stricken with grief you aren't feeling very assertive so unless you have a pro-active doctor you still may not have any answers.
See, there are many factors which have been identified as causing or contributing to miscarriage and these include diabetes, high blood pressure, polycystic ovary syndrome, fibroids and thyroid abnormalities. As well there are chromosomal abnormalities, blood-clotting disorder and weak cervix.
And here's the thing, the good news as it were - except for the chromosomal abnormalities they all are easily treatable. Even the non-treatable chromosomal abnormalities have their jaunty side. As the cause of 50% of miscarriages they are usually random and therefore one-off unlike miscarriages that have an underlying medical cause.
So the idea is, get thoroughly checked out for all possible causes after a miscarriage although some doctors, like Mary Stephenson, MD, a professor of obstetrics and gynaecology and director of recurrent-pregnancy-loss program at University of Chicago Medical Centre says when planning to get pregnant you should get checked out. Sensible woman, I say.
Having talked my doctor into getting every test in the solar system done after my second miscarriage, which showed up my thyroid condition, I wish I'd had those tests done first. Then again it's probably not practical to have every woman of fertile age lined up at pathology clinics and letting enough blood to keep Count Dracula comfortable in retirement.
So how, short of pleading with your GP, can you be tested for miscarriage-causing conditions? According to Stephenson a specialized recurrent-pregnancy-loss clinic will be able to identify and test for underlying problems which can manifest themselves in someone who is outwardly healthy.
Once picked up, it is a matter of treating them, usually with a course of medication. Hence for women who have experienced the devastation of recurrent miscarriage there is plenty of hope that they can conquer it and win. In the gloom and doom surrounding pregnancy loss this can only be good news.
I confess that, despite being the owner of many a blighted ovum, I have been highly neglectful of them. By neglectful I mean that I've failed to acknowledge their very existence.
It wasn't until I was thirty-nine that I gained an awareness of the blighted ovum as they are incredibly insidious and it's only when you start poking around trying to make sense of your fertility problems that you generally learn about them.
So imagine my surprise when I learnt that not only was my first failed pregnancy likely due to a blighted ovum but that I may have had more that I hadn't a clue about.
It was explained to me that the definition of one is a pregnancy that starts to develop at the embryonic stage as a sac without the future content, the baby. So it's like having an unfurnished untenanted house inside you. Often it will self-abort before you've had time to realize it's there although some can linger, in which case you may experience a bleeding after blighted ovum is discovered. An ultrasound of blighted ovum is the chief way to confirm its existence before the bleeding commences.
Apparently they are fairly widespread and, the older you get, the more common, but nobody knows the true cause of blighted ovum. So yet again we find one of nature's many obstacles to reproduction and wish we hadn't. And another case of ignorant bliss being replaced by dashed hopes (this time in the form of cracked eggs).