Wednesday, September 28
RMA of NY
Have established working relationship with RMA of New York and have been seeing some of their patients. Wonderful doctors all. I highly recoomend Drs. Mukherjee, Copperman, Sandler and Grunfeld. All top-notch, leading-edge reproductive endocrinologists - that care!
Supplement could be key to pregnancy for older women
Co-enzyme Q10 results in healthier eggs, delays onset of menopause during experiments on mice
By Sharon Kirkey, Postmedia News September 22, 2011 Canadian scientists are working on a way to make older human eggs young again - and maybe even slow menopause - experiments that could make it easier for women in their 40s and perhaps beyond to have babies.
The answer may lie in a single vitamin.
Toronto fertility doctors say their experiments in mice show that co-enzyme Q10 makes older mice produce more and healthier eggs. The doctors are now preparing to test the supplement on women aged 35 and older undergoing fertility treatments.
The work comes as women are pushing back motherhood ever later in life.
Across Canada, pregnancies in women over 35 are increasing, and fertility clinics are seeing more women over 40.
"Our mean age for patients first coming to see us is now 37," said Dr. Robert Casper, medical director of the Toronto Centre for Advanced Reproductive Technology.
Five years ago, it was 33.
Not only do older women find it more difficult to get pregnant, they run an elevated risk of miscarrying or of conceiving embryos with chromosomal abnormalities that cause conditions such as Down syndrome.
A woman is born with all the eggs she will ever have, and by the time she reaches her late 30s, the quality of those eggs begins an irreversible slide. They have less chance of leading to a normal live birth.
Eggs have 46 chromosomes to begin with, but they undergo a change when a woman ovulates. Each egg discards 23 of its own chromosomes and, if it's fertilized, takes in 23 from the sperm cell to replace them. But this takes a lot of energy.
The energy in eggs, and essentially in all human cells, is produced by mitochondria, little power packs inside all our cells. But these weaken with age so that they don't produce as much energy, resulting in a steady decline in tissue and organ function.
"Somebody who is 20 will have eggs with 20-year-old mitochondria in them, and somebody who's 40 will have 40-year-old mitochondria that will produce less energy," said Casper, professor in the division of reproductive sciences at the University of Toronto and a senior scientist at the Samuel Lunenfeld Research Institute at Toronto's Mount Sinai Hospital.
If there isn't enough energy to separate the chromosomes properly, some get left behind.
"They don't get pulled out," Casper explains.
Extra chromosomes can lead to aneuploidy, an abnormal number of chromosomes, the stringlike structures that carry our genetic material.
"That's why Down syndrome increases with age - it's all an energy issue," Casper said.
"It's not that there is anything wrong with the eggs, it's just that the batteries have run down."
Casper's team has been studying mitochondria for years, trying to understand whether it's possible to boost energy production in human eggs.
Together with Dr. Andrea Jurisicova, an associate professor in the department of obstetrics and gynecology at the University of Toronto, the researchers originally tried injecting young mitochondria into old mouse eggs, using a preparation made from cordblood stem cells, which are fetal cells, so that the old eggs would have young, healthy mitochondria.
The technique worked - it improved the quality of the eggs and the embryos. The problem was, the embryos had two different mitochondrial DNA - essentially, two different mothers. When Canada's Assisted Human Reproduction Act outlawed mitochondrial gene replacement in 2004, Casper's team abandoned that avenue of research.
Now they're taking a different tack, using co-enzyme Q10.
Mitochondria need co-enzyme Q10 to make energy.
The vitamin is also a powerful anti-oxidant that may prevent mitochondrial DNA damage, Casper said. Co-enzyme Q10's production by the body also decreases as we get older, starting around age 25.
"One of the theories about why we get old and die in the first place is that our cells just run out of energy - the mitochondria stop working properly and there's just not enough energy for cellular function so organs start to fail," Casper said. "A simple explanation could be that there's not enough fuel from the co-Q10 around."
In a pilot study using 52-week-old mice - mid-life for a mouse, and the equivalent of 40 to 50 for a human - Casper's team gave half the group co-enzyme Q10, and the other half a placebo. Next they compared eggs retrieved from both groups of mice with eggs from 10-week-old mice.
"What we found was that just treating the mice with co-Q10 we got more eggs than when we gave them fertility drugs," Casper said. The nuclear spindles that pull the chromosomes apart were more like those in young eggs. The litter size was bigger, and the eggs from the vitamin-treated mice had improved mitochondrial function.
Even more surprising, when the researchers examined the mouse ovaries, there were significantly more egg follicles in the old mice treated with the co-Q10 - suggesting, Casper said, "that we actually were able to delay the onset of the equivalent of menopause in the mice."
The glitch is that the mice were pre-treated for 18 weeks - the equivalent of 10 years or so relative to a human lifespan.
"We might be able to delay menopause, but it might take a decade of pre-treatment," Casper said. The more immediate application might be in improving an older woman's fertility by improving her egg quality. When word got out about his early research on the Internet, women undergoing fertility treatments began taking co-enzyme Q10.
Casper is now trying to recruit women over 35 for a study testing whether taking 600 mg daily of the supplement can lead to a higher number of chromosomally normal eggs.
The rub is that, as soon as the researchers explain the mouse results, none of the women want to be randomized to the placebo group, "especially if they're 40."
The Toronto researchers need 50 women for their study; they're up to 25 so far, after a year-and-a-half of trying.
If the mice experiments hold up in the clinical trials, the implications would be significant, Casper said. "Women could get pregnant easier when they're older."
It also could buoy calls for more single-embryo transfers. For years, fertility clinics have been putting three, four or more embryos back into women over 40 in the hope that at least one would implant and a baby would result.
"If we could improve the percentage of normal eggs, you wouldn't have to put back so many embryos."
The other hope is that, "if we can increase the energy for chromosome separation, then we could eliminate Down syndrome and other chromosomal abnormalities," said Casper.
© Copyright (c) The Vancouver Sun
Read more: http://www.vancouversun.com/health/Supplement+could+pregnancy+older+women/5440917/story.html#ixzz1ZFGGXaek
By Sharon Kirkey, Postmedia News September 22, 2011 Canadian scientists are working on a way to make older human eggs young again - and maybe even slow menopause - experiments that could make it easier for women in their 40s and perhaps beyond to have babies.
The answer may lie in a single vitamin.
Toronto fertility doctors say their experiments in mice show that co-enzyme Q10 makes older mice produce more and healthier eggs. The doctors are now preparing to test the supplement on women aged 35 and older undergoing fertility treatments.
The work comes as women are pushing back motherhood ever later in life.
Across Canada, pregnancies in women over 35 are increasing, and fertility clinics are seeing more women over 40.
"Our mean age for patients first coming to see us is now 37," said Dr. Robert Casper, medical director of the Toronto Centre for Advanced Reproductive Technology.
Five years ago, it was 33.
Not only do older women find it more difficult to get pregnant, they run an elevated risk of miscarrying or of conceiving embryos with chromosomal abnormalities that cause conditions such as Down syndrome.
A woman is born with all the eggs she will ever have, and by the time she reaches her late 30s, the quality of those eggs begins an irreversible slide. They have less chance of leading to a normal live birth.
Eggs have 46 chromosomes to begin with, but they undergo a change when a woman ovulates. Each egg discards 23 of its own chromosomes and, if it's fertilized, takes in 23 from the sperm cell to replace them. But this takes a lot of energy.
The energy in eggs, and essentially in all human cells, is produced by mitochondria, little power packs inside all our cells. But these weaken with age so that they don't produce as much energy, resulting in a steady decline in tissue and organ function.
"Somebody who is 20 will have eggs with 20-year-old mitochondria in them, and somebody who's 40 will have 40-year-old mitochondria that will produce less energy," said Casper, professor in the division of reproductive sciences at the University of Toronto and a senior scientist at the Samuel Lunenfeld Research Institute at Toronto's Mount Sinai Hospital.
If there isn't enough energy to separate the chromosomes properly, some get left behind.
"They don't get pulled out," Casper explains.
Extra chromosomes can lead to aneuploidy, an abnormal number of chromosomes, the stringlike structures that carry our genetic material.
"That's why Down syndrome increases with age - it's all an energy issue," Casper said.
"It's not that there is anything wrong with the eggs, it's just that the batteries have run down."
Casper's team has been studying mitochondria for years, trying to understand whether it's possible to boost energy production in human eggs.
Together with Dr. Andrea Jurisicova, an associate professor in the department of obstetrics and gynecology at the University of Toronto, the researchers originally tried injecting young mitochondria into old mouse eggs, using a preparation made from cordblood stem cells, which are fetal cells, so that the old eggs would have young, healthy mitochondria.
The technique worked - it improved the quality of the eggs and the embryos. The problem was, the embryos had two different mitochondrial DNA - essentially, two different mothers. When Canada's Assisted Human Reproduction Act outlawed mitochondrial gene replacement in 2004, Casper's team abandoned that avenue of research.
Now they're taking a different tack, using co-enzyme Q10.
Mitochondria need co-enzyme Q10 to make energy.
The vitamin is also a powerful anti-oxidant that may prevent mitochondrial DNA damage, Casper said. Co-enzyme Q10's production by the body also decreases as we get older, starting around age 25.
"One of the theories about why we get old and die in the first place is that our cells just run out of energy - the mitochondria stop working properly and there's just not enough energy for cellular function so organs start to fail," Casper said. "A simple explanation could be that there's not enough fuel from the co-Q10 around."
In a pilot study using 52-week-old mice - mid-life for a mouse, and the equivalent of 40 to 50 for a human - Casper's team gave half the group co-enzyme Q10, and the other half a placebo. Next they compared eggs retrieved from both groups of mice with eggs from 10-week-old mice.
"What we found was that just treating the mice with co-Q10 we got more eggs than when we gave them fertility drugs," Casper said. The nuclear spindles that pull the chromosomes apart were more like those in young eggs. The litter size was bigger, and the eggs from the vitamin-treated mice had improved mitochondrial function.
Even more surprising, when the researchers examined the mouse ovaries, there were significantly more egg follicles in the old mice treated with the co-Q10 - suggesting, Casper said, "that we actually were able to delay the onset of the equivalent of menopause in the mice."
The glitch is that the mice were pre-treated for 18 weeks - the equivalent of 10 years or so relative to a human lifespan.
"We might be able to delay menopause, but it might take a decade of pre-treatment," Casper said. The more immediate application might be in improving an older woman's fertility by improving her egg quality. When word got out about his early research on the Internet, women undergoing fertility treatments began taking co-enzyme Q10.
Casper is now trying to recruit women over 35 for a study testing whether taking 600 mg daily of the supplement can lead to a higher number of chromosomally normal eggs.
The rub is that, as soon as the researchers explain the mouse results, none of the women want to be randomized to the placebo group, "especially if they're 40."
The Toronto researchers need 50 women for their study; they're up to 25 so far, after a year-and-a-half of trying.
If the mice experiments hold up in the clinical trials, the implications would be significant, Casper said. "Women could get pregnant easier when they're older."
It also could buoy calls for more single-embryo transfers. For years, fertility clinics have been putting three, four or more embryos back into women over 40 in the hope that at least one would implant and a baby would result.
"If we could improve the percentage of normal eggs, you wouldn't have to put back so many embryos."
The other hope is that, "if we can increase the energy for chromosome separation, then we could eliminate Down syndrome and other chromosomal abnormalities," said Casper.
© Copyright (c) The Vancouver Sun
Read more: http://www.vancouversun.com/health/Supplement+could+pregnancy+older+women/5440917/story.html#ixzz1ZFGGXaek
Monday, June 20
We are all headed towards a state of ignorance which comes from the pursuit of knowledge.
For a long time now I have been privy to brilliant and articulate writings and research on the efficacy or lack thereof of traditional Chinese medicine. You can find all the research you want on the Internet. Some research shows efficacy in treating certain pathomechanisms of infertility and some research denies efficacy.
In Western medical approaches to the treatment of infertility there is much research that points to the efficacy of PGD and much research that denies its value. Many doctors promulgate intercourse the night before IVF, many don’t. Many doctors give patients antibiotics before a transfer, many don’t. Many doctors believe in IVIG or intralipid therapy, many don’t. There is lots of research on the deleterious effect of autoimmune mitigators of infertility including natural killer cells but there are many doctors who think this is all hogwash.
Many doctors believe in going straight to IVF after two failed IUI’s, though many believe that one should do four to five IUI’s before engaging in the first IVF.
Many IVF doctors believe in this protocol and many believe in that protocol. Many doctors believe that obesity interferes with fertility outcomes (there is research attesting to this!) and many doctors will do an IVF on a three hundred pound woman.
There was a time when I was very interested in research, which would prove the value of acupuncture in the treatment of the infertile patient.
There is a parable that tells the story of a Zen master talking to his student and pointing at the moon. The student looked at the master’s finger and was summarily dismissed by the master. Have we, as practitioners become too focused on the finger?
It is my contention that we are all headed towards a state of ignorance which comes from the pursuit of knowledge; an incorrect type of knowledge. Knowledge or lack thereof of regarding why something works does not confer or negate efficacy. I remember when I was a student at Pacific College of Oriental Medicine in Dr. Yan Wu’s class when a student asked Dr. Wu a question as to why, when a needle was inserted at a particular point, did it have the intended effect. Dr. Wu’s reply was “who cares – it just does”. Dr. Wu is a master physician with more than 30 years of clinical TCM experience under his belt. It is in the West that we care about cause and effect, but in TCM the effect is what counts.
I am now less inclined to be interested in research regarding TCM and it’s efficacy. I am interested more in learning TCM and its theories and applications. Those of you who are spending years and years doing research on how TCM mitigates a pro-inflammatory state may be fooled into thinking that you are learning something of value. This is debatable. True value is measured by our success rates. The way to higher success rates is attained through learning the medicine that we practice. Most of you, and certainly I, know very little about TCM just as reproductive endocrinologists know very little about why women conceive and why they do not.
If you want to help patients to conceive then learn your medicine.
Want facts? Here’s one: I can look any patient or doctor in the eyes and state that acupuncture and herbal medicine have been used continuously for the past three thousand years to treat infertility; sometimes successfully. It was used in China before the advent of Western medicine and is now used in China in conjunction with Western medicine to treat infertility.
I think that many of us (including me when I was a mere tadpole) felt that we needed the nod from Western medical practitioners and researchers to validate TCM. Now that I am a frog, I realize that my own legs are strong enough to propel me forward.
Study Chinese medicine and study Western medicine and then integrate the two in a way that works for you.
Be able to defend your ideas and treatment protocols; be sure that your ideas have integrity.
Treat as many patients as you can so you may positively impact many lives.
I am through with sitting on the edge of my seat waiting for an REI to say, “Acupuncture seems to offer some value to those trying to conceive” and jump up and down shouting yea! I don’t mean to seem trite or competitive, I assure you, this is not my intention, but here goes: we were successfully treating any and every pathology which existed long before Hippocrates was a twinkle in his momma’s eye.
I believe in the value of IVF – but not for all its research. Indeed with all its research it still has far more failed cases than successful ones. But it does have some successful cases, and that demands respect – as do acupuncture and herbs. So don’t show me research – show me take home babies.
Knowledge is doing. You can study martial arts for years and analyze the dynamics of kicks, punches, thrusts and parries, and take - downs, and joints locks – but that does not mean that you can fight. If you can’t fight, then you do not know martial arts – you research them only. Outcomes are all that matter.
I have not renewed my memberships with AFA and Resolve. When they honor an acupuncturist for his or her work in the field of reproductive medicine I’ll re-join. In the mean time, they will, one again, undoubtedly honor Zev Rosenwaks. Dr. Rosenwaks, what is your success rate for the thirty-nine year-old women with ovarian resistance? Is it any better than mine? I don’t think so.
I’m going to study herbs now.
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