Science Friday: Steroids can prevent miscarriage?

New hope for women suffering from recurrent miscarriage

A team of researchers, led by the University of Warwick, have published new data that could prove vital for advances in care for women who suffer from recurrent miscarriage.

The recurrent loss of pregnancy through miscarriage causes significant distress to couples, often exacerbated by there being so few treatments available to clinicians.

The search for an effective treatment has been the cause of significant controversy in the field of medical research, centering on the role of natural killer cells (or NK cells) and the ability of steroids to prevent miscarriage.

Scientists have been uncertain about how these NK cells could contribute to a miscarriage and this has raised doubt over their importance in causing pregnancy loss.

Led by Professor Jan Brosens of Warwick Medical School, the team found that elevated uterine NK cells in the lining of the womb indicate deficient production of steroids. Deficient steroid production in turn leads to reduced formation of fats and vitamins that are essential for pregnancy nutrition.

This study, published in The Journal of Clinical Endocrinology & Metabolism, is the first of its kind to provide an explanation for why high levels of NK cells can cause miscarriage.

Siobhan Quenby, Professor of Obstetrics at Warwick Medical School, explained, “This work is really exciting because after years of controversy and doubt we have a crucial breakthrough. This means, quite simply, that we have excellent scientific justification for steroid based treatment to prevent miscarriage.”


Story Source:

The above story is based on materials provided by University of Warwick. Note: Materials may be edited for content and length.


Journal Reference:

  1. Keiji Kuroda, Radha Venkatakrishnan, Sean James, Sandra Šućurović, Biserka Mulac-Jericevic, Emma S. Lucas, Satoru Takeda, Anatoly Shmygol, Jan J. Brosens, and Siobhan Quenby. Elevated Periimplantation Uterine Natural Killer Cell Density in Human Endometrium Is Associated With Impaired Corticosteroid Signaling in Decidualizing Stromal Cells. The Journal of Clinical Endocrinology & Metabolism, September 2013
  2. University of Warwick. (2013, September 11). New hope for women suffering from recurrent miscarriage. ScienceDaily. Retrieved February 27, 2015 from http://www.sciencedaily.com/releases/2013/09/130911132042.htm

Sympathy

I’ve actually never had a miscarriage. But I can imagine. Two out of three of my beautiful children had moments along the way where I really didn’t think I’d get to see them take their first breath. And it was scary. Really scary.

My first pregnancy my husband accompanied me to EVERY appointment, every blood draw, and every ultrasound. We were so excited. At about 6 months we went in for the routine check-up. We’d heard the heartbeat so many times before that I wasn’t even really paying attention when the doctor suddenly said “There’s no heartbeat, you just won yourself an ultrasound.” Then she walked out.

We were stunned. Out of nowhere I was pretty sure I heard that my baby was dead. I’m not sure if this is true, but I seem to remember that not a single person talked for the next hour. Not the nurse, not the doctor, not the ultra sound tech, not the people in the waiting room… no one. I had been having problems gaining weight during the whole pregnancy and I was convinced this was my fault. Finally we saw our perfectly healthy baby boy on the screen and everyone started talking again! I would like to say I’ve never been so relieved in my life, but that’s not true.

Four years later I was pregnant with my third child and while it was completely unplanned and unexpected, we were happy. At 13 weeks I experienced some major bleeding and was on bed rest for about a week. Things cleared up and it seemed like everything was fine. Baby came two weeks early and boy was it exciting! We had chosen to not find out the gender of this child so I was pumped to find out.

None of my children were born screaming so I wasn’t overly concerned when there wasn’t any noise. But then I saw him. Blue. Completely blue. Not just fingers and toes, but whole body blue. Once again, no one talked for 10 minutes while they tried to get him to breathe. I thought I was going to have a nervous breakdown.
Finally someone said “he’s breathing” And everyone started talking again! “Do you have any names?” “What will his brother’s think?” I think only my husband recognized that I was deeply traumatized by seeing our child essentially dead. Yes, in the end the result was a perfectly healthy little boy. No, I have not had a miscarriage. But I can imagine and I ache for every mother who has had to go through one.

My heart is with you.

–JK

Science Friday: Infertile women want more support

Many women coping with infertility count on relatives or close friends for encouragement and assistance. But according to research at the University of Iowa, when it comes to support, women may not be receiving enough — or even the right kind.

“Infertility is a more prevalent issue than people realize. It affects one in six couples, and in almost all cases, women want more support than they are getting,” says Keli Steuber, assistant professor in communication studies at the UI and co-author of the paper, published this week in the print edition of the journal Communication Monographs.

The study comes on the heels of National Infertility Awareness Week, a movement started in 1989 by the National Infertility Association to raise awareness about infertility and to encourage the public to better understand their reproductive health.

Steuber and Andrew High, assistant professor in communication studies at the UI and the paper’s co-author, surveyed more than 300 women across the nation who were coping with infertility.

They found that infertile women want more support of all kinds — ranging from practical aid such as help with household chores, to advice and emotional reassurance like hearing a spouse say, “I love you.”

Without this support, women wrestling with infertility may become depressed or be less able to cope with stress, according to the researchers.

The good news is there are easy ways a spouse, relative, or friend can be more supportive, say Steuber and High. Though family and friends have the best of intentions, the study found they tend to dole out too much advice.

The researchers say it’s best to keep the advice to a minimum and instead focus on other ways to be supportive. That could be as simple as cooking a meal or connecting your loved one to other women with whom she can share her feelings.

“People are overwhelmed by unsolicited advice from family and friends,” says Steuber, who cites mom, female relatives, and other women with children as key perpetrators when it comes to doling out excessive information.

“Parents perceive themselves to be experts in having children, but they may not be well-informed. That puts women in an awkward position,” she explains.

As for spouses? High and Steuber found that while women cited their husbands as the strongest source of emotional support, many felt their spouses could provide more.

That’s not surprising, say High and Steuber, who note previous research has suggested that men feel uncomfortable talking about infertility issues. That can leave women feeling like some of their emotional needs are not being addressed.

“It’s a very real strain on the marriage,” says High.

The researchers suggest that husbands become a more active participant in their wives’ infertility treatments by attending appointments, advocating for their spouse, and helping them explore alternatives to pregnancy or other treatment options.

“Becoming more involved gives you the opportunity to be more emotionally invested,” says High.

And Steuber adds that couples who stick together through the infertility experience often have a stronger marital foundation moving forward. “If you can find effective, supportive ways to communicate with each other, you’re better equipped to handle stressors down the road,” she explains.

In addition to close friends and family, the researchers also looked at the support provided by doctors and nurses. “We found those in healthcare often see themselves as sources of information rather than someone who can provide emotional support or suggest a valuable network of contacts,” says High.

Though the researchers acknowledge there is no simple solution, they suggest doctors and nurses could help women feel better supported by spending additional face time with their patients, phrasing questions in an empathetic manner, and handing out resources tailored to individual needs.

The UI Office of the Vice President for Research and Economic Development funded the study.

Journal Reference:

Andrew C. High, Keli Ryan Steuber. An Examination of Support (In)Adequacy: Types, Sources, and Consequences of Social Support among Infertile Women. Communication Monographs, 2014; 81 (2): 157 DOI: 10.1080/03637751.2013.878868

University of Iowa. (2014, April 30). Infertile women want more support. ScienceDaily. Retrieved February 19, 2015 from http://www.sciencedaily.com/releases/2014/04/140430192529.htm

Scary, Dark, Tunnel of the Unknown

As soon as we started trying, I began to tell everyone. I knew it was risky, but I just couldn’t contain myself. I was so excited for this new journey and I never was one to hide my emotions. I have always worn my heart on my sleeve.

Months and months went by…I did everything right. I gave my body time to regulate after being on birth control (for basically all of my reproductive life); I tracked my ovulation using a kit. We even started using “fertility friendly” lube. But after just one month of trying and nothing…I had a bad feeling that something was not exactly right.

You see, I always did everything right when it came to my reproductive health; it’s in my blood. My mother is a nurse midwife and she knew about the minute I started having sex. She prescribed me my first birth control, how ever unethical that may have been. I took it on time, every single day since I was 16 years old. I got my yearly pap smears, I used protection and I got tested regularly. Because I liked sex and I wasn’t ashamed of it, but I was always acutely aware of the consequences it could bear. So, I was smart about it. It’s so funny; you spend your whole fucking life protecting yourself against it, then, when you decide the time is right, you expect it to be easy. But it doesn’t always work out that way.

I am now on month 6 of trying, which may not seem like all that much to some people. But, like I said, after the first month, I knew something wasn’t right. “At my age” (like my mother so delicately put it), “after 6 months of trying, you should go get checked out.” So like the reproductively responsible woman I am, at exactly 6 months, I went in the see MY midwife (not my mother, just in case you were worried). She did an exam…everything normal. She did blood tests…everything normal. She did a pelvic ultrasound…uh oh! “The endometrial echo complex demonstrates multiple tiny cystic structures, the largest one measures 6 x 3 x 3 mm, of uncertain etiology”. What the fuck does that mean?

At this point, we aren’t quite sure, but to me it feels like a death sentence (I am also not a melodramatic at all, just ask my husband). When I called to talk to my midwife about the results and what the next steps are, I had to leave a message. The midwife’s nursing assistant called back the next day and said “the midwife would really like you to come in and talk with her directly about your results”. Fuck me!

I have an appointment in a week. I am scared. Now, I don’t want to talk about it with anyone. It’s no longer an exciting new journey of trying to conceive our first child. It’s a scary, dark, tunnel of the unknown and I am not sure I want to see what is on the other side.

–Kate B.

Science Friday: Fracking correlated with reproductive harm?

Chemicals released during natural gas extraction may harm reproduction, development

Unconventional oil and gas (UOG) operations combine directional drilling and hydraulic fracturing, or “fracking,” to release natural gas from underground rock. Recent discussions have centered on potential air and water pollution from chemicals used in these processes and how it affects the more than 15 million Americans living within one mile of UOG operations. Now, Susan C. Nagel, a researcher with the University of Missouri, and national colleagues have conducted the largest review to date of research centered on fracking byproducts and their effects on human reproductive and developmental health. They determined that exposure to chemicals released in fracturing may be harmful to human health in men, women and children and recommend further scientific study.

“We examined more than 150 peer-reviewed studies reporting on the effects of chemicals used in UOG operations and found evidence to suggest there is cause for concern for human health,” said Nagel. “Further, we found that previous studies suggest that adult and early life exposure to chemicals associated with UOG operations can result in adverse reproductive health and developmental defects in humans.”

The “weight of evidence” review of scientific literature and peer-reviewed publications, where studies are examined thoroughly for patterns and links, included international studies that focused on UOG chemicals. Reviewers say these chemicals have been measured in air and water near UOG operations, and have been associated with harmful effects in both animals and humans.

The reviewers concluded that exposure to air and water pollution caused by UOG operations may be linked to health concerns including infertility, miscarriage, impaired fetal growth, birth defects and reduced semen quality.

“There are far fewer human studies than animal studies; however, taken together, the studies did show that humans can be harmed by these chemicals released from fracking,” Nagel said. “There is strong evidence of decreased semen quality in men, higher miscarriages in women and increased risk of birth defects in children. There is a striking need for continued research on UOG processes and chemicals and the health outcomes in people.”

Nagel, an associate professor of obstetrics, gynecology and women’s health in the School of Medicine, and adjunct associate professor of biological sciences in the College of Arts and Science at MU, conducted the review with colleagues from the University of Missouri as well as researchers at the Institute for Health and the Environment and the Center for Environmental Health.


Story Source:

The above story is based on materials provided by University of Missouri-Columbia. Note: Materials may be edited for content and length.


Journal Reference:

  1. Ellen Webb, Sheila Bushkin-Bedient, Amanda Cheng, Christopher D. Kassotis, Victoria Balise, Susan C. Nagel. Developmental and reproductive effects of chemicals associated with unconventional oil and natural gas operations. Reviews on Environmental Health, 2014; 29 (4) DOI: 10.1515/reveh-2014-0057

Two in heaven, three on Earth

I have two babies in heaven. Three on Earth. My second son was not quite 3 when my husband and I decided, “just one more.”

Getting pregnant was always easy for me. My mother-in-law joked that we would just think about it and bam! Baby.

After two easy successful pregnancies, I really had no reason to worry. But worry I did. I couldn’t explain it, but the moment I saw the positive test I felt a sense of gloom surrounding me.

Two weeks later I began spotting. I never bled once with my older kids so immediately I knew something was wrong. I went in for blood work and an ultrasound the next day. My HCG levels were low and the ultrasound tech couldn’t find an egg sac.

Just like that, my fears were confirmed. My body had already started the process. So I chose to let it go on its own. I was devastated. Every wipe of blood was a reminder my body had failed me.

Ten days later, I got a call from my OB. She had been taking my HCG levels to make sure my body was dispelling the pregnancy. They suddenly spiked after steadily declining. She feared it was ectopic and so after nearly two weeks, I had to endure a D&C.

It was like the nightmare wouldn’t end. In the midst of it all, a friend told me she was pregnant and due literally the day after my due date. I could barely speak. She didn’t know I’d miscarried yet.

Fast forward seven months. I had decided to work on my health. I lost 40lbs,was taking lots of vitamins, doing everything I could to make sure when we tried again I wouldn’t lose this baby. The first month in trying I was pregnant. I felt so good! I knew this time would be different. It was not.

I had another suspected ectopic (honestly my OB couldn’t explain what happened fully) and I endured another D&C. It was Halloween.

My faith was tested then. How could God let me suffer twice? What was I doing wrong? But questioning God got me nowhere. I realized, sometimes bad things just happen. We live in a world where bad things happen. My faith, family, and friends helped pull me through.

After some testing, my doc put me on Metformin and progesterone pills. I successfully conceived our third little boy, Liam. I now know why I had to wait. I was waiting for this child. This joyful, happy, funny, amazing little boy, who would not have been if circumstances were different.

I’ve helped several friends since my losses, to deal with their own, and for that I am grateful. It’s a sad club to be a member of. But I’m so thankful for all of my sisters in this journey.

There is so much more I could say. So many feelings I felt, so many awful things people said to me after my losses (at least they were early, maybe it was a boy and you need a girl, everything happens for a reason, blah blah, blah). But I don’t choose to focus on those things. Instead I choose to remember the good parts, the amazing love and support of God and my loved ones, and especially on my three amazing boys who keep me going every day. I am truly blessed!

–Amy Demler

Editor’s note: On a personal note, I’d like to thank Amy for chatting with me as I sat in my OB’s office minutes after finding no heartbeat at 9w3d and having no idea what to do or how to cope. Love to you Amy, I’m not sure what I would have done without your support ❤ ❤

Science Friday: Fertility problems and multiple miscarriages connected to thyroid disease?

Effect of thyroid disorders on reproductive health

Thyroid disease can have significant effects on a woman’s reproductive health and screening for women presenting with fertility problems and recurrent early pregnancy loss should be considered, suggests a new review published today (23 January) in The Obstetrician & Gynaecologist (TOG).

The review examines the effect of thyroid disorders on reproductive health and reviews the current evidence on how to optimise thyroid function to improve reproductive outcomes.

Thyroid hormones control the metabolism via the production of two hormones triiodothyronine and thyroxine. These hormones also have key roles in growth and development, particularly brain development. Changes in thyroid function can impact greatly on reproductive function before, during and after conception.

Thyroid disease is divided into hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid), and the causes of the diseases are numerous.

The review highlights that hyperthyroidism is found in approximately 2.3% of women presenting with fertility problems, compared with 1.5% of women in the general population. The condition is linked with menstrual irregularity. Hypothyroidism affects around 0.5% of women of reproductive age. Hypothyroidism in childhood and adolescence is associated with a delay in reaching sexual maturity, and in adulthood is associated with menstrual problems and in some cases a lack of ovulation, state the authors.

The authors note that thyroid disease has long been associated with fertility problems, however, national guidance does not currently recommend routine measurement of thyroid function in asymptomatic women presenting with problems conceiving.

Additionally, the authors of the review note that miscarriage is common, affecting approximately one in five pregnancies and recurrent miscarriage, defined as three consecutive miscarriages, affects 1% of couples. Given that thyroid hormone plays an important part in embryonic development, thyroid disease has long been associated with an increased risk of miscarriage.

Thyroid disease, in particular hyperthyroidism, can also have a significant effect on pregnancy, the authors of the review state. Adverse outcomes can include preterm delivery, pre-eclampsia, growth restriction, heart failure and stillbirth.

The authors conclude that screening for thyroid disease should be considered in women presenting with fertility problems and recurrent pregnancy loss. Additionally, the authors highlight that there is evidence to suggest that routine screening of the general population for thyroid dysfunction at the start of pregnancy may be beneficial.

Furthermore, women diagnosed with thyroid disease should continue on anti-thyroid medication throughout pregnancy and receive close monitoring, emphasise the authors.

Amanda Jefferys, from the Bristol Centre for Reproductive Medicine, Southmead Hospital, Bristol, and co-author of the study said:

“Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes.

“However, with appropriate screening and prompt management, these risks can be significantly reduced.”

Jason Waugh, TOG Editor-in-chief, added:

“Thyroid disease is common in the reproductive medicine setting, in fact, it is the most common endocrine condition affecting women of reproductive age.

“This paper highlights how thyroid disorders can affect fertility and pregnancy and makes a case for universal screening.”

  1. A Jefferys, M Vanderpump, E Yasmin. Thyroid dysfunction and reproductive health. The Obstetrician & Gynaecologist, January 2015 DOI: 10.1111/tog.12161
  2. Wiley. (2015, January 23). Effect of thyroid disorders on reproductive health. ScienceDaily. Retrieved February 4, 2015 from http://www.sciencedaily.com/releases/2015/01/150123081929.htm