Depression and Heart Disease

Studies have associated depression with an increased risk of heart disease. Researchers have shown that depression is associated with an accumulation of visceral fat, which has been proven to increase the risk of cardiovascular disease and diabetes. Visceral fat is located between one's internal organs and collects around one's waistline, which is why apple-shaped individuals are more likely to suffer from heart disease than pear-shaped people. Depression's link to this type of fat was made by researchers at Rush University Medical Center.

Appetite and Postpartum Depression

Although changes in appetite may be one of the symptoms indicative of depression, loss of appetite was not associated with postpartum depression. Rather, the better discriminators were lack of concentration, and/or motor retardation or motor agitation.

depression and SSRIs During Pregnancy

Depressed pregnancy women who were using SSRIs or were untreated both were at risk for preterm birth, with rates exceeding 20%. Infants who were exposed to either SSRIs or depression in utero were more likely to be born preterm when compared with infants with no exposure or partial exposure to either. The use of SSRIs did not increase the risk for minor physical anomalies for infants, or reduced maternal weight gain. Infant birth weights were equivalent, and other neonatal outcomes were similar except for the 5 minute APGAR ratings.

Although we have no knowledge regarding caffeine withdrawal symptoms, apparently drinking up to three caffeinated beverages daily does not effect birthweight, prematurity, or fetal growth. Thus, a study by Jahanfar et al., showed no benefit to those women who avoid caffeine intake during early pregnancy.

Chronic Pain and Psychotherapy

Cognitive Behavior Therapy (CBT) and Behavior Therapy (BT) were used to help people who experience pain and/or disabilites change their behavior. CBT additionally worked to change some of the thoughts and feelings of people who experience chronic pain. Although both types of therapies worked to help with negative affect, i.e., anxiety and depression, it is still unknown exactly what is the best format of treatment or for how long the psychological therapy should continue. This could be useful for those simultaneously experiencing both pain and infertility.

Complementary and Alternative Medicine

Dr. Jackie Boivin, a member of the MHPG of the ASRM recently published an article in the April volume of Human Reproduction. Dr. Boivin found that concurrent use of complementary and alternative medicine (CAM) with assisted reproductive technologies (ART) was associated with a 30% lower pregnancy rate. The findings were not found to be related to poor prognosis, such as age related fertility decline, or life style factors, such as smoking or ingestion of alcohol. Unfortunately, no specific complementary or alternative choices were most associated with the lower pregnancy rates. However, this study places them back on the radar screen for future studies to examine. The results of this study do suggest that use of CAM(s) should be carefully monitored during ART treatments.

Unrealistic Beliefs about Fertility

Female college undergraduates were found to be aware that fertility declines with age. However, they inaccurately reported higher and unrealistically optimistic chances of pregnancy for older women. These same university students also believed that the chances of miscarriage were higher for women of all ages, but did not attribute a woman's age as a causal factor for pregnancy loss. Although there have been efforts to educate the public in the past, it is obvious that additional and more precise instruction would improve the public's comprehension, and might help reduce the rate of age related infertility, as well as pregnancy loss.

Cost of IVF Babies related to a Woman's Age

Reaearches in Europe found costs per live birth for women over age 40 were 2.5 times higher than for women age 35-39 y/o. The cost per ongoing pregnancy was a staggering three times higher for the older group. These costs included the IVF cycle, as well as early pregnancy care for the mother and care needed after giving birth.

Just Another Reason

I have been in favor of stem cell research from the start. However, if I wasn't before, the following would have convinced me. In the UK, scientists have created human inner ear cells from fetal stem cells. What this means is that there is potential to replace abnormal or damaged inner ear cells with stem cells obtained from frozen embryos. Hopefully, permanent hearing loss could be reversed and a variety of different cell types could be developed. Currently this does not yet signal a cure for deafness. If research is adequately funded and, as indicated by the new administration in the White House, given the green light, we can hope to see many and varied advances using fetal stem cells.

Fertility and Sexual Problems

As fertility treatment continues sexual problems frequently arise. Often people who are experiencing infertility have sexual intercourse at times when one or both members of the couple are clearly not in the mood. Sex on demand is unromantic and often mechanical. Sex becomes something one must do to achieve the end goal, which is pregnancy. Both men and women, therefore, may develop sexual problems.One such problem is dyspareunia, which is genital pain that is associated with sexual intercourse, usually occurring during, but also possibly occurring before or after intercourse. Symptoms range from discomfort to sharp pain, and cause distress and interpersonal difficulty.At least one episode of male erectile difficulty has been reported in approximately 90% of men who are in fertility treatment. Erectile problems can infrequently or regularly occur.Hypoactive sexual desire, also known as inhibited sexual desire, may occur early, late, and/or intermittently throughout fertility treatment. One or both partners may begin to look at their sex life as a total failure, because it never leads to conception. Situational depression and anxiety are common reactions to infertility and individuals do not feel particularly sexy or attractive when their emotional state is negatively affected.Both men and women misread their partner's lack of sexual interest, and begin to feel ambivalent toward sex. Each may feel unattractive to his or her partner or may feel sexually inadequate. If either had a poor body image prior to being diagnosed with infertility, the likelihood that this will become more pronounced is high. This, in turn, may lead to a rigid or routine approach to sex that may cause additional problems for the couple.Guilt is another emotional reaction to infertility. The person with the physical problem leading to infertility may feel guilty that he or she is unable to provide his or her partner with a child. Guilt may also occur when one no longer desires sexual activity, even though it is the rule rather than the exception. There are many ways to stop the downward spiral, but more often than not, physicians and nurses do not inquire whether sexual problems are occurring during fertility treatment. You may need to be proactive and take responsibility for having this discussion with your doctor. A good source for referrals to mental health professionals who deal with sexual problems is the AASECT website: www.aasect.org where you can find a certified sexual therapist.
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3/29/09
by Judith E. Horowitz, Ph.D.

In an attempt to make their product more affordable, Xytex International, a sperm bank located in the United States, has reduced the price of obtaining sperm that has been provided by some of their more frequent (read: copious) donors. The 30-35% savings may help those who otherwise might find the prices for donor sperm prohibitive. Additionally, Xytex has announced a reduction of fees charged for the sperm to be used for ICSI and IVF. It is possible for them to provide the recipients using those ART procedures with a smaller quantity of sperm vs the amount needed for a cycle of IUI. Cost cutting by the other sperm banks may ensue.
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