SpainFertility

Being born premature can bring several implications during the whole lifetime of a person´s health, according to a long-term study carried out by Duke University and Norwegian researchers. These researchers studied more than a million men and women and found out important consequences of premature births.

Preterm birth, meaning birth before 37 weeks of gestation, contributes to several long-term quality of health issues, including lower educational achievement, lower rates of reproduction, and an increase in the likelihood that future offspring will be born preterm and with complications, according to researchers at the Duke Medical Center.

It is also the leading cause of infant mortality. Research has documented the short-term complications as well as the long-term disabilities survivors must cope with.

“When a baby is born preterm, we tend to focus on the short-term risk of complications,” said Geeta Swamy, MD, a maternal-fetal medicine specialist at Duke, and lead author of the study. “While it is true that the risk of complications is highest in the immediate time period including hospitalization and the first year of life, that risk continues into adolescence. And the earlier you’re born, the higher the risk. Those who are born extremely prematurely are more likely to have complications throughout their lives.”

Working with colleagues at the Norwegian Institute of Public Health, Swamy and fellow researchers at Duke used a national population-based registry containing birth and death data to analyze how preterm birth affects long term survival, subsequent reproduction and next-generation preterm birth. The population studied spanned 20 years, from 1967 through 1988. Births occurred on or after 22 weeks and through 37 weeks gestation.

The study found, in the first place, that boys born between 22 and 27 weeks had the highest rate of early childhood death. Secondly, that reproduction rates were considerably lower for men and women born preterm when compared to those born at term. Reproduction increased in direct proportion to higher gestational age. Also, women born preterm were more likely to experience recurrent preterm birth and an increased risk of adverse outcomes in their offspring. A similar pattern was reported for fetal stillbirth and infant mortality among women born preterm.

The lower the gestational age, the greater the risk of having less education, since gestational age plays a very large role in overall health, Swamy said. Low birth weight has been the traditional indicator of how well a baby will do. However, Swamy now believes gestational age may be an even stronger predictor.

In addition, she says the research raises an important question concerning the long-term effects of advances in prenatal and neonatal care. “Preterm survival is improving now because of interventions we have in pregnancy and neonatal care. However, it may be that we’re improving survival while adversely affecting the overall health and quality of life in the long run.”

            Researchers from a Tel Aviv University have made trying for a baby easier. In a surprising finding, they have discovered that the same pill used to prevent pregnancy can actually help a woman conceive.

            Dr. Haim Pinkas MD, a senior physician at the Rabin Medical Center and an academic staff member of Tel Aviv University’s Sackler School of Medicine, and his colleagues at the infertility center where he practices, have found that a two-week intervention treatment using a standard low-dose birth control pill can help time egg harvesting, making the IVF process more convenient for both doctor and patient.

            The study was done on 1,800 women at the Infertility and IVF Unit, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva and appeared in the Journal of Assisted Reproduction & Genetics in January of this year.

            There are currently two types of therapy - natural methods and assisted reproductive techniques such as IVF. In many cases, IVF offers the last hope to conceive a child.

            Convenience is a factor that contributes to a woman’s general peace of mind and health. But from a clinician’s point of view, the ability to time the IVF process is also crucial.

            Dr. Pinkas explains that “One of the main drawbacks in treating infertility is timing a woman’s body with the clinic’s schedule, so we can get as many mature eggs as possible. IVF clinics can be extremely busy. With a proven and safe method for timing when a woman can undergo therapy, there is a lot less stress placed on the physicians’ shoulders too.”

            Normally doctors start the IVF treatment from the moment a woman gets her period. But the use of birth control pills, for 10-14 days after a period, allows the treatment to be adjusted without compromising the “ovarian response to stimulation,” says Dr. Pinkas. This way, egg-harvesting can fall on a date mutually convenient to both the clinician and patient.

            This study is not the first to investigate the use of the pill in IVF, but it is the largest one performed so far. It is also unique in that it placed an emphasis on the impact of a patient’s age, her ovarian response, the characteristics of her cycle, and the final outcome - a birth.

            The important thing is that the treatment gives a woman comfort without compromising her chances to conceive. Dr. Pinkas says, “The IVF process can be very stressful. Adding to that stress is the timing issue. Women need to be able to get on with their lives. This treatment makes it possible.”

Spain´s government has adopted a pro-natal policy, encouraging couples to have babies by giving each newborn a check for € 2,500. If the baby is born to a family with three or more children, that amount is raised to € 3,500.

President Jose Luis Rodriguez Zapatero announced the policy and then transmitted to the Parliament that “In order to continue progressing Spain needs more families with more children. And families need more aid to have more babies and more resources for their upbringing.”

In only 30 years, Spanish average family has dropped from 3.8 members to 2.9. Today, two and a half million Spanish people live alone. There are now only about 1.7 million large Spanish families –with three or more children- and the number is steadily decreasing.

There are, however, some problems with the new policy. In the first place, given that it costs over € 100,000 to raise a child to adulthood in Spain, the 2,500 payment may not be sufficient to encourage more childbearing. The head of the Consumers Association of Spain, Juan Moreno, has said that the amount offered by the government is “insignificant”.

Also, Spain spends less on family and childhood programs than any other country in the EU: they only account for 0.7 % of Spain´s GNP, while in Europe as a whole the average is 2.1 %. Moreover, the abortion rates in Spain are significantly high. Abortion is legal in Spain only for cases of rape, “fetal defect” and danger to the mother´s physical and psychological health. At present, one in every six pregnancies ends in abortion. Every day, 252 abortions are done in Spain, for an average of 11 each hour.

These issues will probably need address from the government. The idea and the project is, however, ambitious and serious. Spain is the one of the European countries that contributes the most to fertility studies, and it is the country with the most couples wanting to be assisted in having family with the newest available methods.

A group of scientists in Edinburgh have found that common genital disorders, low sperm count an testicular cancer, the usual male fertility problems, are linked to low hormone levels or androgens in the gestation period, precisely from weeks eight to 12.
Studying rodents, the researchers also found that the androgen hormon level at this time of pregnancy was related to the distance between the base of the penis and the anus.
This could be an early warning system of future reproductive problems in baby boys, as reported in the latest edition of the Journal of Clinical Investigation.
The study’s lead author, Michelle Welsh, said: “We know from other studies that androgens work during foetal development to programme the reproductive tract. But our assumption was that it would be much later in pregnancy”.
“We would suggest that this measurement, even at this later stage in life, could offer an indication of hormone exposure. For example, the shorter the distance, the less confident we can be that hormones have acted correctly and at the right time,“ he added.
Leading experts in this field have welcomed the research but have raised doubts too.