American Society for Reproductive Medicine October 17-21 2009
The 65th Annual Meeting of the American Society for Reproductive Medicine took place October 17 to 21 in Atlanta. The theme of this year's meeting was "Envisioning the Reproductive Medicine of Tomorrow." Several educational opportunities were available, including postgraduate courses, lectures, symposia, abstracts, and roundtables; each of these forums were designed to meet the educational needs of both practitioners and scientists specializing in reproductive medicine and biology. Additionally, the latest research was presented, including topics such as stem cell research, robotic advancements in reproductive surgery, ramifications of obesity, menopause, contraception, ovarian stimulation, and oocyte and sperm cryopreservation.
Alice Domar, Ph.D., the executive director of the Domar Center for Mind/Body Health in Waltham, Mass., presented research suggesting that pregnancy rates were improved with mind/body programs. In a randomized, controlled trial, patients undergoing in vitro fertilization treatment were divided into two groups -- one group was directed to undergo 10 sessions of a mind/body program, while the second group did not.
For the first in vitro fertilization cycle, the research showed no difference in the success rate between the treatment and control groups. However, a sizable difference in success rate was observed with the second in vitro fertilization cycle, and more patients in the mind/body treatment group compared with the control group became pregnant (52 versus 20 percent). Importantly, rates of participation in the mind/body program were also higher among patients undergoing a second cycle of in vitro fertilization treatment. While only 9 percent of patients randomized to the mind/body program attended between six to 10 sessions prior to the first attempt of in vitro treatment, this proportion rose to 76 percent prior to the second attempt.
According to a statement from R. Dale McClure, M.D., the president of the American Society for Reproductive Medicine, "it's clear based on this carefully designed study, that a holistic approach to infertility care leads to better outcomes for patients."
Several abstracts focused on the topic of fertility preservation in cancer patients. Andrea E. Reh, M.D., of the New York University School of Medicine in New York City, used a quantitative methodology to assess the intentions, goals, and quality of life of female cancer patients who were seeking fertility preservation treatment. A total of 16 patients were enrolled from the university cancer registry, 11 of whom sought fertility preservation treatment. A total of 10 patients reported that having a child was the most important thing in their lives, and 11 patients had concerns regarding the impact of their cancer treatment on their fertility.
In a separate study, Gwendolyn P. Quinn, Ph.D., of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla., found that half (50.5 percent) of physicians asked reported not having a view about posthumous parenting, while only 13 percent supported it. Less than one-quarter (22.8 percent) of physicians surveyed agreed with the statement "patients with poor prognosis should not pursue fertility preservation."
Together, these and other research presentations focused on how both patients and medical professionals navigate issues regarding fertility preservation in cancer patients. "As fertility preservation options for cancer patients continue to improve, the demands for quality information sharing between patients and their doctors and nurses must continue to improve, as well," McClure said in a statement.
Kutluk Oktay, M.D., of the New York Medical College in Valhalla, N.Y., reported research which investigated associations between mutations in the BRCA1 gene and a diminished ovarian reserve. A total of 125 female breast cancer patients received fertility drugs to stimulate their ovaries prior to undergoing chemotherapy. Some of these women then went on to participate in a study in which they were assessed for BRCA1 gene mutations; of these, 30 percent had a BRCA1 gene mutation, while the remaining patients did not. Poor ovarian response was significantly higher among patients with a BRCA1 mutation, causing the investigators to conclude that BRCA1 gene mutations were associated with an early depletion in oocyte reserve.
Oktay and fellow researchers suggested these findings may provide an explanation for an association between infertility and reproductive cancers.
In another study involving the BRCA1 gene, 60 percent of males surveyed who were either carriers for or had a family member or partner with a mutated BRCA1 gene reported pre-implantation genetic diagnosis was an acceptable option to avoid transmitting the mutated BRCA1 gene. "It is essential that we pay attention to both the science and social aspects of cancer genetics. Studies like these play a vital role in advancing our knowledge on both fronts." McClure noted in a statement
Two studies presented research involving novel non-hormonal forms of emergency contraception. Alison Edelman, M.D., of the Oregon Health & Science University in Portland, conducted a three-month prospective study which randomized 11 women into two groups. All participants had regular ovulation cycles and did not use hormonal contraception. Both groups were observed with no intervention during the first month. During the second month, the first group of women was administered celecoxib, an inhibitor of prostaglandin synthesis; the second group was administered a placebo. Treatments were switched between the two groups for the third month. Edelman reported that 9 of the 11 study participants experienced a delayed rise in their luteal phase progesterone level during the cycle in which they received celecoxib, which indicated a delay in ovulation timing.
Diane M. Duffy, Ph.D., of the Eastern Virginia Medical School in Norfolk, performed a study evaluating the effects of the cyclooxygenase inhibitor meloxicam in monkeys. Over the course of four menstrual cycles, meloxicam was shown to reduce the ovulation rate in these monkeys without altering either their levels of reproductive hormones or their length of menstrual cycle.
"Emergency contraception is extremely useful when barrier methods fail or the pill has been forgotten. However, many women are uncomfortable with the large doses of hormones in emergency contraception. A non-hormonal means of delaying ovulation, if effective, would be a welcome addition to the world of contraceptive options." Bruce Carr, M.D., president of the Society for Reproductive Endocrinology and Infertility, said in a statement.
Financial matters were also presented and discussed at the meeting. According to results of one study, more than half of couples diagnosed as infertile who opted not to pursue treatment cited cost as the primary reason.
"It's financially challenging for some patients to pursue fertility treatments," said Andrew La Barbera, Ph.D., scientific director of the American Society for Reproductive Medicine. "In most states insurance coverage for assisted reproductive technology [ART] is not mandated. Most patients have to pay for ART procedures themselves and it's not easy."