Science Friday: Good news everyone!

Stress and tension do not stop fertility treatment from working, study finds

Women undergoing IVF or other assisted reproduction therapy can be reassured that emotional distress caused by their infertility or other life events will not prevent the treatment from working, according to new research.

Infertility affects up to 15% of the childbearing population and over half of these individuals will seek medical advice in the hope of becoming a parent.

Many infertile women believe that emotional distress (for example stress and tension) is a factor in not getting pregnant naturally or lack of success with fertility treatment. This view is largely based on anecdotal evidence and fertility myths such as ‘don’t think about it and you’ll get pregnant’.

However, doctors are skeptical that stress affects fertility due to the lack of evidence on this issue.

The authors, led by Professor Jacky Boivin from the Cardiff Fertility Studies Research Group, investigated links between the success of fertility treatment and stress by undertaking a large scale review (meta-analysis) of related research.

Fourteen studies with 3,583 infertile women undergoing a cycle of fertility treatment were included in the review. The women were assessed before fertility treatment for anxiety and stress. The authors then compared data for women who achieved pregnancy and those who did not.

The results show that emotional distress was not associated with whether or not a woman became pregnant.

Professor Boivin therefore argues that “these findings should reassure women that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise their chance of becoming pregnant.”

Editor’s note: Just to clarify, the Science Friday article from two weeks ago outlined how stress can adversely affect a person’s “natural” fertility. This article outlines how that stress does not lessen the effectiveness of IVF or other assisted reproduction therapy. So yes! Good news!

Good news everyone!
Journal Reference:
  1. J. Boivin, E. Griffiths, C. A. Venetis. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ, 2011; 342 (feb23 1): d223 DOI: 10.1136/bmj.d223
  2. BMJ-British Medical Journal. (2011, February 28). Stress and tension do not stop fertility treatment from working, study finds. ScienceDaily. Retrieved January 29, 2015 from http://www.sciencedaily.com/releases/2011/02/110224201901.htm
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Choice part two

My personal history with miscarriage needs a little background info. I started on birth control pills very early in my life because of a drug called Accutane. I took these pills because I had horrible acne and was very hard on myself because of it. I just wanted to look normal. On the back of every blister pack were dozens of pregnant silhouettes with big no symbols on them. No pregnancy while taking these drugs! Your baby will be born with more defects than you can count! I was about 15 when I took these pills. I wasn’t even having sex yet, and didn’t until much later in my life, but I stayed on birth control pills until I was in my 30s.

However, that doesn’t mean that I was always on top of taking my birth control. After so long, I had become a complacent. In my early 20s I got pregnant. I was in the middle of a divorce and had just started dating my boyfriend. We’ve been together about 7 years now, but at that point I knew the timing was wrong. I wasn’t ready to be a mom. He was going to college and was the only one in his family to move away from his small southern town. He came from a world of teen pregnancies and ruined life plans. I knew he would be a good father and work to support his child, but it wasn’t what he wanted at that point and I didn’t want to ruin his plans with an unplanned pregnancy. Of course I told him about it, and he said it was my choice how to proceed. I had an abortion at about 7 weeks.

Fast forward about six years, he has graduated, he has a great job, I’ve been in a stable job for years, and we’re both ready to start trying for babies. Two months later I get the positive test! We were both so excited, but naturally cautious. Although it’s not often discussed, I knew enough women who had miscarried that I decided to hold the news close. Only a couple of close friends knew we were expecting. A few weeks later, it was all over. I miscarried as my best friend was giving birth to her second child. I was devastated. I felt totally alone in my grief.

Now don’t get me wrong, my boyfriend is incredibly supportive, but he’s very logical and he knew the miscarriage stats. He understood my grief but he knew that we could try again soon and that it miscarriages are normal. He wasn’t attached and admitted he couldn’t understand my attachment, but he tried and was supportive of my sadness. What I didn’t share with him was my fear and self blaming.

Wasn’t all of this my fault? I mean, I had been on birth control for so long, of course I had ruined my womb for carrying babies or something. Maybe it was the Accutane, it had caused some sort of issue? Or maybe it was the abortion? Did something happen in the procedure that had damaged me physically? Was that baby my only chance to have a child? Even though I’m not religious I found myself wondering if I was being punished. Each period that passed felt like a reminder of my failure. Each time my family asked when I was going have kids like my brother, I wanted to scream.

I thought I was being stupid. I wasn’t sure who to talk to about my feelings. My doctor and friends who did know about the miscarriage were encouraging me to look on the bright side. “At least you know you’re both fertile!” I was told. It wasn’t until a few months later, after I talked to a friend of a friend who had recently miscarried, that I started to feel better. We had a lot of the same fears and anger. We both secretly resented family members who we felt had it easier than they should have when it came to conception. After we talked I knew that I wasn’t being stupid, just dealing with the loss in my own way. My feelings weren’t right or wrong, they were mine and they were helpful. My body is my own and if the choices I made were going to keep me from being able to conceive I could still be proud that I had made my own choices.

Four months later, I got that positive test again. I was really happy that it happened so soon, but terrified. I didn’t tell anyone (other than the boyfriend) until after I passed the previous miscarriage date. Then I told a couple of people, then more, then finally my family. I also told them about the miscarriage and I can’t tell you how liberating that was. If I could do it again, I would have told more people earlier because the more I think about it, the more it would have been helpful to have that support if something went wrong again.

Currently, I’m in my third trimester. It hasn’t been an easy pregnancy. I have gestational diabetes, my back and side hurt so bad, I often have to give up on most daily activities and lay down, and I’m completely terrified of what my life will become after baby is born. I’m also determined, excited and so ready to be a mom. I find support in my boyfriend, friends, and family as well as online forums like reddit (r/babybumps has some of the most supportive and honest users).

So here is what I’ve learned: pregnancy isn’t easy. It’s a journey that is complicated and influenced by your sexual history and other life experiences. Miscarriage is complicated and your feelings will help you cope. Find support, someone out there has been through the same thing you have.

Most importantly, I’ve learned this is something that is normal. We need to talk more openly and honestly about miscarriage so women know it’s not their fault. Take the time to share your story and thanks for reading mine.

–Anonymous

Science Friday: The Right to Miscarry

Science Friday is a fun thing for me to do for this blog. Let’s face it, the material for Miscarriage Memoirs is not light, typically isn’t funny, and mostly serves as an outlet for me to get my frustration out by doing something positive in sharing stories and reminding us that we are not alone. This article is serious. It is long. But I ask you to read it anyway because the women I write about below are important.

I felt moved to write about the stories of the women of El Salvador who miscarry. El Salvador’s anti-abortion laws are so stringent that women who miscarry or suffer a stillbirth are highly suspect, and in some cases have been jailed. For murder. Chile, Dominican Republic, Honduras, and Nicaragua have similar laws. No exceptions. No abortions: not for rape, not if the mother’s health is at risk, not if the fetus has genetic issues not compatible with life.

Carmen Guadalupe Vasquez was pardoned from her 30 year sentence for aggravated murder on Wednesday. Guadalupe already served seven years of her sentence–which came down on her after suffering complications during her pregnancy resulting in her child’s death very soon after birth.

Another woman, Glenda Xiomara Cruz, went to a hospital with abdominal pain on October 30, 2012, not knowing she was pregnant. She was informed that she lost her baby, and four days later was charged with the aggravated murder of her fetus. In September 2013 she was sentenced to 10 years in prison.

To make things even more terrible, it was her abusive partner who provided testimony that she had intentionally killed the fetus. Reliable witness indeed.

In 2012, Maria Teresa Rivera had a miscarriage. She was sentenced to 40 years for aggravated murder. A witness claimed Rivera thought she might be pregnant–but that was 11 months before her miscarriage.

In early 2013, a woman named Beatriz, who had lupus and a fetus with deformations incompatible with life, endured deteriorating health during a court fight for an abortion. She gave birth via Caesarian section at 27 weeks and the baby died within hours. Beatriz is alive today, but arguably would have died had her doomed pregnancy continued to term.

Cristina Quintanilla unexpectedly gave birth to her premature baby on October 24, 2004 in her bathroom. She woke up in the hospital, and was then interrogated, handcuffed to her hospital bed, charged with manslaughter, and taken to a police cell.

Initially Quintanilla’s case was dismissed, but on appeal, the prosecution upped the ante. Now the charges were aggravated murder. She was found guilty and sentenced to 30 years in jail. Quintanilla’s sentence, luckily, was reduced the three years with the help of human rights lawyer Dennis Munoz Estanley.

El Salvador’s problems are arguably larger than the abortion issue: Munoz says that El Salvador’s courts use a presumption of guilt rather than innocence like the US. The prosecutions rely on flimsy character witnesses and dubious medical evidence.

Now El Salvador’s largely poor, uneducated population is scared to go to the hospital when faced with obstetric complications. They do not trust the doctors and nurses.

Tragically, these circumstances have contributed to suicide rising to the most common cause of death among women aged 10 to 19 in 2011. Half of of these women were pregnant. Suicide is now the third most common cause of maternal mortality in El Salvador.

From 2000-2012, more than 200 women were reported for suspected abortion. Of these women, 136 were prosecuted, 56 were convicted, most for murder, the rest for abortion. Sentences for murder convictions ranged between 12 and 35 years. These women are forced into prisons like Ilopango women’s prison. Built to house 220 women, Ilopango now holds more than 2000 prisoners. There are not enough beds for all of the prisoners.

Munoz is currently leading an effort to free 17 women from this undeserved hell–the El Salvadorian Supreme Court is considering his motion to free these women. Since 2007, Munoz has helped to free eight women jailed for “crimes” similar to those described above.

El Salvadorian politicians worry that rolling back these extreme abortion laws would cost them their jobs. They fear losing the voters and the support of the Catholic Church. Sound familiar?

These stringent anti-abortion laws are not even effective: highly restrictive abortion laws are not associated with lower abortion rates. “In Uganda, where abortion is illegal and sex education programs focus only on abstinence, the estimated abortion rate was 54 per 1,000 women in 2003, more than twice the rate in the United States, 21 per 1,000 in that year. The lowest rate, 12 per 1,000, was in Western Europe, with legal abortion and widely available contraception.” (Study. Article. Article.) But they are connected to higher maternal mortality rates, and that study does not even include the suicides mentioned above.

Women in the United States should care about what happens to these women in El Salvador because they are humans being treated unfairly. But there are reasons that hit closer to home as well.

Access to contraception in the US is not as easy as one might think. Large proportions of women who seek out contraceptives are young, women of color, low-income or uninsured and typically go to publicly funded clinics, mostly safety-net health centers. These are the same clinics that are being shuttered in across the US through TRAP (targeted regulation of abortion providers) laws.

Closure of these health centers will limit women’s access to safe abortion and contraceptives–both of which are connected to higher abortion rates.

Many people think this problem will not affect them personally. That women in the United States would never have their right to health care taken away. An article by the NY Times and a study by Paltrow and Flavin are eye-opening, and terrifying. Excerpts are below.

Christine Taylor, a pregnant Iowa woman fell down the stairs. She was arrested for attempted fetal homicide, reportedly because she told a nurse she had previously considered abortion/adoption or because she told the nurse that she intentionally fell down the stairs and wanted to end her pregnancy, it depends what source you read. Taylor was allegedly in the first week of her second trimester but it was noted in her chart that she was in the first week of her third trimester. I’m assuming that a very large majority of nurses don’t lie. But some do.

A Utah woman was arrested and charged with fetal homicide when one of her twins was stillborn. She was trying to avoid a Caesarean section. After a long fight, she ended up avoiding jail time.

Michelle Marie Greenup (p. 308) had a miscarriage and did not report it. After seeking out medical treatment for bleeding and stomach pain. she was locked up for over a year and charged with second-degree murder. Her medical history revealed spontaneous miscarriage at 11 to 15 weeks of pregnancy due to an injection of Depo-Provera.

Regina McKnight (p. 306) was arrested for homicide by child abuse after suffering a stillbirth due to infection. She was arrested because it was assumed her cocaine use caused the stillbirth–it did not. “Cocaine has been shown to be no more harmful to a fetus than nicotine use, poor nutrition, lack of prenatal care, or other conditions commonly associated with the urban poor.” (p. 306) McKnight served eight years in jail.

Floridian Laura Pemberton was attempting a VBAC (vaginal birth after Caesarian). Doctors thought this put the baby’s life at risk, so they got a court order resulting in Pemberton’s arrest. They strapped her legs together for transport to the hospital where she was prepped for surgery as an emergency hearing proceeded to determine her fate. Pemberton was not allowed counsel; her fetus was. The Caesarian went on.

Afterwards Pemberton sued for violation of her civil rights, and lost. The court said the life of her fetus was more important than her First, Fourth, and Fourteenth Amendment rights. Pemberton had three more children vaginally afterwards.

Women who suffer from drug addiction, are pregnant, and seek out help with their addiction, like Rachael Lowe, are also subject to arrest (p. 307), rapid detox (which is more dangerous to the fetus than continued drug use (p. 307 end of page)), prescribed Xanax (a category D drug, “positive evidence of risk”), and held in a psychiatric ward–all without counsel. Lowe consequently lost her job, and her husband was forced to take a leave of absence from his.

There are dozens of other terrifying stories in the paper. And let’s not forget about the tragic story of Savita Halappanavar, who died in Ireland after being refused an abortion as she miscarried. After the fetus’s death, doctors refused to perform a life-saving “abortion” and she succumbed to septicemia after complete organ failure.

Just like in El Salvador, evidence shows that cases involving arrest, detention, and forced interventions with pregnant women disproportionally affect women of color, poor women, and homeless women. One in ten of the cases studied involved domestic violence against the pregnant woman. Scarily enough, these cases tend to come out of specific states and specific counties and hospitals within these states. For a list of which to avoid, see pages 309-311.

Not all of the people reading my blog will agree on abortion rights. But I like to believe that, just like Obama said in the SOTU on Tuesday, “Surely we can agree…that every woman should have access to the health care she needs.”

I also like to think that every woman should have the ability to choose her own way to give birth–with a doctor, midwife, doula, in a hospital, at home, in a birthing center, Caesarean, VBAC, with an epidural, without, what have you. All women should also have access to free or very low cost contraceptives as a part of a comprehensive insurance plan or access to a low cost clinic.

But most of all–the right to have a miscarriage or stillbirth and not be arrested, charged, or convicted of ANYTHING. As it has been pointed out time and time again, this is a tragedy for 99.9% of the women, and families, affected by miscarriage and stillbirth.

Sources: International Women’s Health Coalition, Thomson Reuters Foundation, The Guardian, BBC, Al Jazeera

How can I help? Donate: International Women’s Health Coalition article, Amnesty International Article

SPREAD THE WORD! Share my article and/or any of the articles above, and here is a video from El Salvadorian activists (in Spanish)

Choice

I found out I was pregnant in my boyfriend’s bathroom, his roommates on the other side of the wall playing halo, blissfully unaware that a new life had begun in the room next to them.

I was barely 21, in college, and not ready for a baby. I was considering all options, one more heavily than the rest.

The A word. I’m fiercely pro-choice. I believe that all women in all circumstances should have the right to an abortion, it seemed like the right choice for me. After all, the being inside of me was just a collection of cells.

I spoke with my boyfriend, he agreed, and in the next few days, we went to the clinic.

I don’t know what snapped inside of me, but I couldn’t do it. In that waiting room, I knew I was pro-choice, and I knew what my choice was. I had to carry the baby to term. In tears, I lead my boyfriend out of the waiting room back to our car. I explained to him that my choice was to keep the baby. He was shocked and scared, but supportive.

Over the next couple of weeks, we got excited. We had lists of names, bought baby books galore, and had told the family closest to us. We found a midwife and went to our first appointment.

What at first was fear and doubt, turned into excitement and happiness. We were thrilled to welcome our baby into the world.

Then, one night, I started bleeding.

We went to the ER, they told us that my levels were normal and everything was fine. But I knew it wasn’t. I don’t know how I knew, but I did.

My boyfriend was more optimistic, and I tried to be. I continued looking at names and baby clothes and those funny little wives tales telling us if our baby would be a boy or a girl.

To us, that clump of cells was our child.

Later that night, I had horrendous cramps. I went into our shower and out came my worst nightmare: the sack and the cells.

I was devastated. My whole world fell apart. Over a clump of cells. My clump of cells. My baby.

I lived through the due date, but ‘living’ is a generous word. I slept. I cried. I mourned. I didn’t live – I still find it hard to live. There was nothing in this world that I wanted more than that baby on that day.

I didn’t care about the stigma, about how hard it would be to raise a baby and finish my degree, I cared about having him or her in my arms.

I will never get to hold him or her in my arms.

The baby only lasted two months in my body, but its presence will haunt my thoughts and dreams for the rest of my life.

Rest in peace, little one. Rest in peace.

–Anonymous

Science Friday: Eliminating Stress-induced Infertility

Blocking hormone could eliminate stress-induced infertility

University of California, Berkeley, scientists have discovered that chronic stress activates a hormone that reduces fertility long after the stress has ended, and that blocking this hormone returns female reproductive behavior to normal.

While the experiments were conducted in rats, the researchers are optimistic that blocking the gene for the hormone — called gonadotropin inhibitory hormone (GnIH) — could help women overcome the negative reproductive consequences of stress.

Stress is thought to be a major contributor to today’s high levels of infertility: Approximately three-quarters of healthy couples under 30 have trouble conceiving within three months of first trying, while 15 percent are unable to conceive after a year.

“What’s absolutely amazing is that one single gene controls this complex reproductive system, and that you can elegantly knock this gene down and change the reproductive outcome completely,” said Daniela Kaufer, an associate professor of integrative biology.

GnIH was discovered only 15 years ago, in quail, and found to be a powerful suppressor of fertility. Its mammalian equivalent, RFRP (RFamide-related peptide), was isolated in humans in 2009 by Kaufer’s UC Berkeley colleague George Bentley, an associate professor of integrative biology.

Bentley and Kaufer later found that exposing male rats to stress increased the brain’s production of RFRP. The new study found similar negative effects on fertility in female rats, though the increased levels of RFRP caused by chronic stress last much longer in females than in males. Three UC Berkeley labs — those of Kaufer, Bentley and Lance Kriegsfeld, an associate professor of psychology — collaborated on the study, which was led by graduate student Anna Geraghty and undergraduate Sandra Muroy.

“GnIH seems to be the main player, because it is elevated in the brain’s hypothalamus for a full estrus cycle after the stress ends,” Kaufer said. “When we knocked down levels of GnIH, we restored all reproductive behavior back to normal.”

“We know that human GnIH is present in the human brain and gonads, and that it inhibits the production of steroids in human ovaries, so certainly the potential is there for it to be manipulated to address human infertility,” Bentley said.

The researchers will publish their findings in the Jan. 13 issue of the journal eLife.

Relieving stress to allow captive breeding

Bentley is also excited about the potential to knock down GnIH to improve breeding success in captive animals, in particular those threatened with extinction in the wild.

“A lot of wild birds and vertebrates won’t breed in captivity in part, we think, because of chronic low-level stress,” Bentley said. “Just a chronic slight elevation in glucocorticoid stress hormones might influence the GnIH system and inhibit reproduction sufficiently to stop females from ovulating properly.”

Blocking the GnIH gene via gene therapy might alleviate this chronic stressor, he said. “The biology is there; I think we can do it.”

He and Kaufer are also involved in attempts, funded by a Michelson grant from the Found Animals Foundation, to boost RFRP hormone in mammals to induce permanent infertility in feral animals without the need to capture and neuter them.

“If the role of GnIH plays out to be a fundamental mechanism for integrating stress into the reproductive axis, we think we can turn it around the other way and overexpress RFRP in the brain and gonads and cause infertility in pest species or feral cats and dogs,” he said.

Stress and fertility

The effect of stress on reproduction is thought to be adaptive, preventing new births during times of scarcity or social disruption. Chronic stress can decrease the sex drive in both men and women, but also affect women’s ability to get pregnant and carry a fetus to term. Even the stress of trying to conceive can lower women’s chances. Tales abound of couples who adopt because they can’t conceive and suddenly become new biological parents.

To test the effects of chronic stress on female rats, Geraghty confined female rats for three hours a day for 18 days, then let the rats relax for four days — the rat’s typical estrus period, akin to women’s 28-day menstrual period. By the end of that stress-free hiatus, cortisol levels had returned to normal, though levels of the inhibitory hormone, called RFRP3 in rats, were still elevated.

“Even after the chronic stress was gone and levels of the stress hormone cortisol had returned to normal, we still saw a decrease in reproductive behavior: from an 80 percent pregnancy rate in normal rats to 20 percent in those who should have recovered from stress,” Kriegsfeld said. The 20 percent that actually got pregnant also experienced an increased incidence of embryo resorption of the fetus — the equivalent of a miscarriage.

Geraghty then used a virus developed in Kriegsfeld’s laboratory to insert into the brain an RNA blocker of the RFRP3 gene, which knocked down levels of the peptide hormone by about 75 percent during the period of chronic stress. She turned the gene back on after the stress ended in case it also plays a role during pregnancy.

“The knock-down RNA delivered during the period of chronic stress restored all subsequent reproductive behavior to normal: Mating behavior, pregnancy rate and the amount of embryo resorption were all back to normal,” Geraghty said.

“This study shows that even when chronic stress is not that extreme to where you stop your cycle, as when women under caloric restriction get amenorrhea, reproductive function is still hampered.”

 Story Source:

The above story is based on materials provided by University of California – Berkeley. The original article was written by Robert Sanders. Note: Materials may be edited for content and length.


Journal Reference:

  1. Anna C Geraghty, Sandra E Muroy, Sheng Zhao, George E Bentley, Lance J Kriegsfeld, Daniela Kaufer. Knockdown of hypothalamic RFRP3 prevents chronic stress-induced infertility and embryo resorption. eLife, 2015; 4 DOI: 10.7554/eLife.04316

The worrier

I’m a worrier. I worry when I have nothing to worry about. So when I found out I conceived only two weeks after going off the pill in April 2013, I was both elated and worried- it seemed “too good to be true.” I also unfortunately knew several women who miscarried before me, and even a few who had either a stillbirth or had a death shortly after birth. I did not take my blessing for granted.

The day we were scheduled for our first ultrasound was a day of both excitement and trepidation. The ultrasound tech took several minutes of looking, in which I started to wonder, but had no background knowledge to know this was unusual. Once she said, “I’m going to take one more minute before I say anything,” I burst into tears, knowing what that meant.

The miscarriage is known as a blighted ovum, in which the fetus terminates almost immediately, but the placenta continues to grow, with hormones still intact. It feels especially cursed you have no reason to suspect anything is wrong- the body feels and essentially tells you are pregnant. The next week was a whirlwind of grief, telling those we had announced to that it wasn’t to be, and the D&C, the hardest part of all. I both desperately needed and dreaded the closure.

99% of the time our worst fears never come to realization. I experienced the 1% when it does. And I lived. There were days I couldn’t get out of bed. There were days nothing and no one could help me. There were days I was so bitter, resentful, and jealous of those who had a child. But there were many more days where I was humbled and amazed by those who supported and loved me.

My son, Ace, is four months old now. The moment I saw his little heart flicker on the ultrasound at seven weeks was the greatest moment of my life. It does get better, if you allow it to, one day at a time.

–Kelly Johnson

Science Friday: Faulty “switch” causes infertility or miscarriage?

Faulty molecular switch can cause infertility or miscarriage

Scientists have discovered an enzyme that acts as a ‘fertility switch’, in a study published in Nature Medicine on October 16, 2011. High levels of the protein are associated with infertility, while low levels make a woman more likely to have a miscarriage, the research has shown.

The findings have implications for the treatment of infertility and recurrent miscarriage and could also lead to new contraceptives. Around one in six women have difficulty getting pregnant and one in 100 women trying to conceive have recurrent miscarriages, defined as the loss of three or more consecutive pregnancies.

Researchers from Imperial College London looked at tissue samples from the womb lining, donated by 106 women who were being treated at Imperial College Healthcare NHS Trust either for unexplained infertility or for recurrent pregnancy loss.

The women with unexplained infertility had been trying to get pregnant for two years or more and the most common reasons for infertility had been ruled out. The researchers discovered that the womb lining in these women had high levels of the enzyme SGK1. Conversely, the women suffering from recurrent pregnancy loss had low levels of SGK1.

The team found further evidence of SGK1’s importance in experiments using mouse models. Levels of SGK1 in the womb lining decline during the fertile window in mice. When the researchers implanted extra copies of the SGK1 gene into the womb lining, the mice were unable to get pregnant, suggesting that a fall in SGK1 levels is essential for making the uterus receptive to embryos.

The research at the Institute of Reproductive and Developmental Biology (IRDB) at Imperial College London was led by Professor Jan Brosens, who is now based at the University of Warwick. “Our experiments on mice suggest that a temporary loss of SGK1 during the fertile window is essential for pregnancy, but human tissue samples show that they remain high in some women who have trouble getting pregnant,” he said. “I can envisage that in the future, we might treat the womb lining by flushing it with drugs that block SGK1 before women undergo IVF. Another potential application is that increasing SGK1 levels might be used as a new method of contraception.”

Any infertility treatment that blocks SGK1 would have to have a short-lived effect, as low levels of the protein after conception seem to be linked to miscarriage. When the researchers blocked the gene that codes for SGK1 in mice, the mice had no problem getting pregnant. However, they had smaller litters and showed signs of bleeding in the uterus, suggesting that lack of SGK1 made miscarriage more likely.

After an embryo is implanted, the lining of the uterus develops into a specialised structure called the decidua, and this process can be made to occur when cells from the uterus are cultured in the lab. Cultured cells from women who had had three or more consecutive miscarriages had significantly lower levels of SGK1 compared to cells from controls.

Blocking the SGK1 gene, both in pregnant mice and in human cell cultures, impaired the cells’ ability to protect themselves against oxidative stress, a condition in which there is an excess of reactive chemicals inside cells.

“We found that low levels of SGK1 make the womb lining vulnerable to cellular stress, which might explain why low SGK1 was more common in women who have had recurrent miscarriage,” said Madhuri Salker, the study’s first author, Institute of Reproductive and Developmental Biology (IRDB) at Imperial College London. “In the future, we might take biopsies of the womb lining to identify abnormalities that might give them a higher risk of pregnancy complications, so that we can start treating them before they get pregnant.”

The research was funded by the Consortium for Industrial Collaboration in Contraceptive Research, the Genesis Research Trust, and the Imperial Comprehensive Biomedical Research Centre, established by a grant from the National Institute of Health Research.


Story Source:

The above story is based on materials provided by Imperial College London. Note: Materials may be edited for content and length.


Journal Reference:

  1. Madhuri S Salker, Mark Christian, Jennifer H Steel, Jaya Nautiyal, Stuart Lavery, Geoffrey Trew, Zoe Webster, Marwa Al-Sabbagh, Goverdhan Puchchakayala, Michael Föller, Christian Landles, Andrew M Sharkey, Siobhan Quenby, John D Aplin, Lesley Regan, Florian Lang, Jan J Brosens. Deregulation of the serum- and glucocorticoid-inducible kinase SGK1 in the endometrium causes reproductive failure. Nature Medicine, 2011; DOI: 10.1038/nm.2498