Women in labor may be allowed to quench their thirst with more than just the standard allowance of ice chips, according to a new Committee Opinion released today from The American College of Obstetricians and Gynecologists (ACOG) and published in the September issue of Obstetrics & Gynecology. Although the guidelines on prohibiting solid food while in labor or before scheduled cesarean surgery remain the same, ACOG says that women with uncomplicated labor, as well as uncomplicated patients undergoing a planned cesarean, may drink modest amounts of clear liquids during labor if they wish.

Standard hospital policy for many decades has been to allow only ice chips for pregnant women in labor if they were thirsty. Women are not allowed to eat any solid food during labor. “The reason for restrictions on food and water (or other liquids) during labor is to avoid aspiration in the event that a woman needs to be anesthetized for a cesarean delivery,” said William H. Barth, Jr, MD, of Massachusetts General Hospital in Boston and chair of ACOGs Committee on Obstetric Practice. Aspiration, which is potentially fatal, can occur when the contents of the stomach are drawn into the lungs while under anesthesia. Over the past 60 years, however, the incidence of maternal death due to aspiration while under anesthesia has declined dramatically, mainly due to the prohibition on solid foods as well as improvements in obstetric anesthesia.

According to ACOG, women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Fluids with solid particles, such as soup, should be avoided, however. Women who have uncomplicated pregnancies and are scheduled for a cesarean delivery may also drink these clear liquids up to two hours before anesthesia is administered.

“Allowing laboring women more than a plastic cup of ice is going to be welcome news for many,” Dr. Barth said. “As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common.”

According to ACOG, expert consensus supports the recommendation that women undergoing a planned cesarean delivery or elective postpartum tubal ligation after vaginal birth should have no solid food from six to eight hours prior to surgery. Pregnant women who have additional risk factors for aspiration, such as morbid obesity or diabetes, and those at high risk for operative delivery (ie, forceps, vacuum), may need to be restricted from fluid intake on a casebycase basis.

Committee Opinion #441, “Oral Intake during Labor,” is published in the September 2009 issue of Obstetrics & Gynecology.

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At a town hall meeting in Abuja, Nigeria, on Wednesday, the fifth stop of her sevennation African tour, Secretary of State Hillary Clinton urged Nigeria to fix its “flawed electoral system,” and “pledg[ed] U.S. assistance in efforts to bring peace to the volatile and oilrich Delta region,” the Wall Street Journal reports. Clinton said Nigeria has the potential to become a member of the G20, “but a big but the corruption reputation … it is a problem,” according to the newspaper. She announced plans for the U.S. and Nigeria to enter into a binational commission, which would aim to address some of Nigerias domestic problems, including electoral reforms (Connors, 8/13).

Clinton said the commission will work at federal and state levels to further develop “what she says is an already strong relationship,” according to VOA News. The U.S. “views Nigeria as a friend, an ally, and a partner on so many important issues, as well as an important country in Africa and increasingly globally,” Clinton said (Stearns, 8/12).

On Thursday, Clinton is going to Liberia “in a show of support for Africas only female leader, who has faced calls to step down over actions during brutal civil wars,” the Agence FrancePresse reports. Johnnie Carson, the assistant secretary of state for African affairs, said Clinton “wants to reaffirm U.S. support” for President Ellen Johnson Sirleaf (Tandon, 8/13).

Clinton Must Continue To Highlight Rape Problem In Congo, Editorial Says

During her trip to Africa, “Clinton used her formidable voice to protest sexual violence during a visit to eastern Congo, where an estimated 200,000 people have been abused in war in the last decade,” the Los Angeles Times writes in an editorial about rape worldwide. Clintons $17 million pledge for victims of sexual violence in Congo is “welcome aid for a horrific problem,” according to the editorial. Though she offered U.S. military resources “to advise on stopping further sexual assaults … far more is needed on this front,” the newspaper writes. The Los Angeles Times concludes “The Congolese military must hold officers accountable for overseeing or turning a blind eye to rape. And Clinton must continue to highlight the issue until reality begins to catch up with international law” (8/13).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

Optimistic women have a lower risk of developing heart disease or dying from any cause compared to pessimistic women, according to research reported in Circulation Journal of the American Heart Association.

Researchers also reported that women with a high degree of cynical hostility harboring hostile thoughts toward others or having a general mistrust of people were at higher risk of dying; however, their risk of developing heart disease was not altered.

“As a physician, Id like to see people try to reduce their negativity in general,” said Hilary A. Tindle, M.D., M.P.H., lead author of the study and assistant professor of medicine at the University of Pittsburgh. “The majority of evidence suggests that sustained, high degrees of negativity are hazardous to health.”

In the largest study to date to prospectively study the health effects of optimism and cynical hostility in postmenopausal women, researchers found that white and black American womens attitudes are associated with health outcomes.

Optimistic women, compared to pessimistic women, had a 9 percent lower risk of developing heart disease and a 14 percent lower risk of dying from any cause after more than eight years of followup. Furthermore, women with a high degree of cynical hostility, compared to those with a low degree, were 16 percent more likely to die during eight years of followup.

“Prior to our work, the strongest evidence linking optimism and allcause mortality was from a Dutch cohort, showing a more pronounced association in men,” Tindle said.

Tindles team studied 97,253 postmenopausal women (89,259 white, 7,994 black) ages 50 to 79 from the Womens Health Initiative. The women were free of cancer and cardiovascular disease (CVD) at the start of the study.

Using the Life Orientation Test Revised Questionnaire to measure optimism and cynical hostility, researchers categorized scores into quartiles high scores of 26 or more were considered optimists; scores of 2425 were considered midhigh; scores of 2223 were considered midlow; and scores below 22 were considered pessimists.

Optimism was defined as answering “yes” to questions like, “In unclear times, I usually expect the best.” Pessimism was defined as answering “yes” to questions like, “If something can go wrong for me, it will.”

Race also appears to modify the relationship between optimism and death, with a stronger association seen in AfricanAmerican women as compared to white women. Among AfricanAmerican women, optimists (vs. pessimists) had a 33 percent lower risk of death across eight years of followup. Among white women, optimists (vs. pessimists) had a 13 percent lower risk of death. Researchers also found that optimists (as compared to pessimists) were more likely to be younger (especially in blacks); live in the Western United States; report higher education and income; be employed and have health insurance; and attend religious services at least once a week.

Optimists were less likely to have diabetes, high blood pressure, high cholesterol or depressive symptoms, smoke, be sedentary or have a high body mass index. However, the relationship between optimism and heart disease and death persisted even after considering all of these factors.

“This study is a very reasonable stepping stone to future research in this area both on potential mechanisms of how attitudes may affect health, and for randomized controlled trials to examine if attitudes can be changed to improve health,” Tindle said.

Coauthors are YueFang Chang, Ph.D.; Lewis H. Kuller, M.D., Dr.PH.; JoAnn E. Manson, M.D., Dr.PH.; Jennifer G. Robinson, M.D., M.P.H.; Milagros Rosal, Ph.D.; Greg J. Siegle, Ph.D. and Karen A. Matthews, Ph.D. Author disclosures are on the manuscript. The National Heart, Lung, and Blood Institute and the National Center for Research Resources funded the study.

Source
Maggie Francis

Before blogs, FaceBook and YouTube, two women Mimi Dow and Lucie DiMaggio recognized the power of their stories. Mimi Dow was diagnosed with early stage breast cancer in 1992 and everything went smoothly until she had a recurrence in the same breast in 1996. At that time a young physician, Lucie DiMaggio, was recovering from mastectomy and implant reconstruction. Their lives converged.

Recognizing the lack of helpful information for women diagnosed with breast cancer, Dow and DiMaggio launched WomenStories an opportunity for women to share their personal journeys through breast cancer.

Today these videos cover topics from Initial Discovery and Diagnosis of Breast Cancer, Family Support, Intimacy, Surgical Choices, Young Women and Breast Cancer, Chemotherapy, Radiation, Hormone Treatment, Recurrence and Metastasis, through Life After Breast Cancer. The videos have been edited into a series of TV programs to be aired for 16 Monday evenings on ThinkBright, a division of WNED, the Buffalo, New York, PBS station. The series will reach 120,000 households in NY State and Southern Ontario, Canada.

Servier Laboratories Limited has been granted permission by the Court of Appeal to challenge a High Court decision made at a Judicial Review in February this year, in which Servier was previously successful in its claim that the National Institute for Health and Clinical Excellence (NICE) had unlawfully failed to provide the economic model underlying its Guidance for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. 1,2

The Court of Appeal will hear Serviers appeal against Februarys ruling on one legal point misinterpretation of Serviers clinical data on the reduction of risk of hip fracture by its osteoporosis treatment, Protelos® (strontium ranelate).

Michael Sumpter, CEO of Servier Laboratories Ltd, commented; “We are delighted with todays decision granting Servier the right to appeal on the basis of the irrational consideration by NICE of data submitted by Servier during the appraisal process.”

NICE refused to accept a post hoc analysis of a randomised controlled trial titled “The TReatment Of Peripheral OSteoporosis” (”TROPOS”), which was specifically requested by European Medicines Agencys (the “EMEA”) scientific committee and clearly showed the efficacy of Protelos in teducing the risk of hip fracture. It was accepted as the basis for granting a licence for reduction of risk of hip fracture in post menopausal osteoporotic women by the European Commission on the recommendation of the EMEA.

Servier challenged NICE at Judicial Review because it believes the osteoporosis guidance unfairly and unnecessarily restricts access to Protelos for many patients who could benefit from it. Servier remains satisfied with the ruling by Mr Justice Holman on 19 February 2009 that NICE acted with procedural unfairness and, therefore, unlawfully by not releasing the economic model on which it based its decisions in the osteoporosis guidance. As a result of the February ruling, NICE has shared a copy of the economic model with the stakeholders who submitted evidence for the current NICE guidance. In addition, the current guidance is now being reevaluated.

Professor Tim Spector, Consultant Rheumatologist at St Thomas Hospital said; “Many of my patients are unable to tolerate the treatment recommended by NICE under the current guidance, but I have to wait for their disease to deteriorate before I can give them an alternative treatment. This leaves them unprotected from the risk of fracture for many years. While the previous court ruling means that the original NICE guidance is already under review, todays decision means there is a greater chance of the appropriate data being considered. This will hopefully result in new guidance that is simpler and more flexible, giving clinicians a real choice in prescribing for women with osteoporosis, who all have individual needs.”

Osteoporosis is a severe disease that affects one in two women over the age of 50 and one in five men. Up to 20% of women who suffer a hip fracture die within the first year of a fracture.3 Half of those suffering an osteoporotic hip fracture can no longer live independently as a result of the injury. Following a hip fracture, 64% need a walking aid and half can no longer move about outside on their own.4The appeal will be heard by the Court of Appeal in due course. The date will be confirmed by the Court.

About the Judicial Review

In January 2009, Servier challenged NICE on three grounds

1. Lack of transparency around the economic model used to evaluate cost effectiveness
2. Misinterpretation of Serviers clinical data around hip fracture data
3. Unlawful discrimination on the basis of disability

On 19 February 2009, the High Court found in Serviers favour on ground one Lack of transparency around the economic model used. The Judge ruled that the procedure by which the NICE guidance on treatments for primary and secondary prevention of osteoporosis was produced (Final Appraisal Determination dated 30 June 2008) was unlawful and the guidance must therefore be reevaluated. The Judge ruled that the current guidance will not be quashed pending reevaluation.

In light of Februarys decision NICE has been ordered to grant access to the economic model to stakeholders who will be given the opportunity to comment on the assumptions NICE made when developing the guidance. NICE will then be required under their legal duty of transparency to reevaluate the guidance in light of the comments it receives.

The High Court did not find in Serviers favour on grounds two and three.

About the NICE guidance

The Final Appraisal Determinations (FADs) on the treatment of osteoporosis were published on 26 June 2007. An appeal hearing involving the National Osteoporosis Society, the Alliance for Better Bone Health and Servier Laboratories took place in October 2007. A decision upholding the appeal was published in December 2007 and the revised FADs were published by NICE in July 2008. Serviers second appeal took place in September 2008. Subsequently, technology appraisal guidance for both the primary and secondary prevention of osteoporotic fragility fractures in postmenopausal women was published in October 2008. The Judicial Review took place 2022 January 2009. The decision by Mr Justice Holman was announced on 19 February 2009.

About Servier Laboratories Limited

Servier Laboratories Limited is the UK subsidiary of The Servier Research Group, a researchbased pharmaceutical company specialising in innovative pharmaceuticals. Servier UK offers a range of products in a number of medical areas cardiovascular disease, especially hypertension and cardiac disease, diabetes, osteoporosis and diseases of the central nervous system. Servier develops truly innovative drugs and invests in therapeutic areas where there is an unmet patient need.

About osteoporosis

The World Health Organisation defines osteoporosis as a progressive skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue with a consequential increase in bone fragility and susceptibility to fracture. There is increased risk of fracture particularly of spine, hip, pelvis and forearm. It is predominantly a disease of postmenopausal women and risk of fracture increases with age. Fractures caused by osteoporosis affect one in two women and one in five men over the age of 50.

About Protelos

Protelos is a true innovation which was developed to improve quality of life for osteoporosis patients.5,6,7 Protelos is unlike other treatments and works by building bone to promote bone strength and reducing hip and spinal fractures.8,9,10 Unlike more traditional osteoporosis treatments the most common side effects of Protelos are mild and transient.11

References

1. Case number CO/2469/2008 between The Queen on the application of Servier Laboratories Ltd and the National Institute for Health and Clinical Excellence

2. National Institute for Health and Clinical Excellence (NICE). Alendronate, etidronate, risedronate and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women and Alendronate, etidronate, risedronate, strontium ranelate and teriparatide for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. Available from snice.org.uk (last accessed February 09)

3. Cooper C, et al. Am J Epidemiol 1993;13710011005

4. Osnes EK, Lofthus CM, Meyer HE, et al. Osteoporos Int 2004;15567 574

5. Jiang Y, Zhao JJ, Genant HK. Osteoporos Int 2006;17(suppl2)late breaking news

6. Arlot ME, et al. J Bone Miner Res 2008;23(2)215222

7. Ammann P, et al. J Bone Miner Res 2004;19(12)20122020

8. Protelos SPC

9. Meunier PJ, et al. N Engl J Med 2004;350459468

10. Reginster JY, et al. Arthritis Rheum 2008;58(6)6871695

11. Reginster JY, et al. J Clin Endocrinol Metab 2005;90(5)28162822

Source

Abortion opponent Rep. Tim Ryan (DOhio) and abortionrights supporter Rep. Rosa DeLauro (DConn.) held a press conference on Thursday to announce a bill that aims to reduce the need for abortion by preventing unintended pregnancies, among other proposals, the New York Times “The Caucus” reports. The bill crafted in part by the centrist group Third Way would increase access to contraceptive services, sex education, health care coverage for pregnant women and children, and adoption. It also would expand access to comprehensive sex education and adoption programs.

The bill has the support of abortionrights groups like the Planned Parenthood Federation of America and NARAL ProChoice America, both of which had representatives at the press conference. The bill also has the support of antiabortionrights religious leaders like Joel Hunter of Northland, Fla., and Derrick Harkins of Washington, D.C.

The bill, which has been introduced in each of the past three congressional sessions, could “broker a detente” and help “turn down the volume on the culture war,” DeLauro said at the press conference. Ryan called the bill an “idea whose time has come,” noting that it has gained support from advocates on both sides of the abortionrights debate.

During the press conference, Hunter said advocates of the bill, regardless of their side in the abortionrights debate, are “taking heat” from other members of their side. He added that the bill is important because it “links together traditional adversaries in a way that advances each of our goals without compromising any of our values” (Becker, “The Caucus,” New York Times, 7/23). Harkins said that he is “more optimistic now than I ever have been,” adding that women “need real support that divisive debates cannot provide” (Stephenson, CQ HealthBeat, 7/23).

Despite support from some antiabortionrights advocates, the bill has not been welcomed by all groups opposed to abortion rights, including conservative groups Family Research Council, National Right to Life and Democrats for Life of America. Kristen Day, executive director of Democrats for Life, said her group does not support the bill because preventing unintended pregnancies already is a goal of other programs. She noted that her group instead supports the Pregnant Women Support Act (HB 2035, SB 270), which focuses on services for women who carry their pregnancies to term but does not include prevention (CQ HealthBeat, 7/23). In a statement, Family Research Council President Tony Perkins said the bill is “fraught with funding for abortion providers and provisions that further encourage promiscuous sex and discourage parental involvement.”

Although the White House has not voiced a position on the bill, there are “reasons to believe” that the Obama administration will support some of the legislations proposals, “The Caucus” reports (”The Caucus,” New York Times, 7/23). DeLauro said that she and Ryan plan to seek Republican cosponsors for the bill, although they do not yet have any. She added that she thinks President Obama will support the bill because it includes language similar to his rhetoric on reducing the need for abortion. In addition, Obamas chief of staff, Rahm Emanuel, was a cosponsor of the bill when he served in the House (CQ HealthBeat, 7/23). Ryan said that the bill, which does not yet have an estimated cost, is “now open for support from all quarters.”

According to “The Caucus,” the bill is being introduced at a time when abortion is a growing topic in health care reform legislation. Policymakers on both sides of the abortionrights debate are expressing concern about how private insurance coverage of abortion is treated in health care reform. Ryan and DeLauro both support a policy that would neither require nor forbid insurance companies from covering the procedure (”The Caucus,” New York Times, 7/23). During the press conference, DeLauro said that the new bill would not force insurance providers to cover abortion services. She said, “What we dont want to do is go backward. We should neither prohibit nor require insurance companies to offer these kinds of services” (CQ HealthBeat, 7/23).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Senate Minority Leader Mitch McConnell (RKy.) on Friday announced that he will oppose Supreme Court nominee Sonia Sotomayor, even as increased Republican support seemed to ensure that she would be confirmed, the New York Times reports. McConnell said that he would not support Sotomayors nomination because her “record of written statements suggests an alarming lack of respect for the notion of equal justice, and, therefore, in my view, an insufficient willingness to abide by the judicial oath.” McConnell intends to deliver the remarks to the Senate on Monday.

Meanwhile, Republican Sens. Richard Lugar (Ind.), Mel Martinez (Fla.) and Olympia Snowe (Maine) said that they would support Sotomayor. The Times reports that the senators backing of Sotomayor combined with her “solid Democratic support” shows that she should receive “strong confirmation approval” (Hulse, New York Times, 7/18).

Senate Judiciary Committee Chair Patrick Leahy (DVt.) and ranking member Jeff Sessions (RAla.) would not predict how many Republicans could vote for her confirmation. Sessions said that Republicans are seeking a committee vote on Sotomayor on July 28, one week later than the date sought by committee Democrats. During that week, Republicans hope to review her record, her answers from her confirmation hearings and other responses to questions (AP/Boston Globe, 7/20).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

All Department of Veterans Affairs outpatient clinics and hospitals are failing to fully comply with federal privacy standards for women, according to a Government Accountability Office report, the AP/Boston Globe reports. The report comes as thousands of female veterans are entering the VA health system after returning from Iraq and Afghanistan.

GAO auditors said that many VA facilities had gynecological tables that faced the door. In one instance, a gynecological table faced a door opening to a waiting room. The investigation also found cases where women had to walk through waiting rooms to use the restroom a violation of VA policy requiring adjoining restrooms. Four VA hospitals did not guarantee women access to private bathing facilities. In two of those cases, the facilities did not have locks.

Nearly 20% of female veterans have been diagnosed with posttraumatic stress disorder, and many of them have experienced sexual trauma while serving, according to the report. The report also said that most female veterans at VA facilities are ages 20 to 29. On average, female veterans using VA facilities are much younger than male VA patients, it noted.

Randall Williamson, director of health care issues at GAO, said that although top VA officials are committed to improving care for female veterans, facilities are not always taking simple steps, such as repositioning exam tables. Patricia Hayes, chief consultant for VAs veterans strategic health care group, said that the agency recognizes issues and is making changes to address disparities in care. She noted that VA is creating a longterm plan for construction improvements to address space and building layout challenges (AP/Boston Globe, 7/15).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

Changing Humanitarian Messaging Could Save More People

In a New York Times opinion piece, columnist Nicholas Kristof says G8 leaders are “collectively so far behind in meeting humanitarian aid pledges,” and asks why it is easier “to try to assist a stranger before us” than “to donate to try to save strangers from malaria half a world away.” Kristof writes, “Theres growing evidence that jumping up and down about millions of lives at stake can even be counterproductive. A number of studies have found that we are much more willing to donate to one needy person than to several.” Humanitarians are “abjectly ineffective at selling their causes,” he writes, arguing that “toothpaste is peddled with far more sophistication than the lifesaving work of aid groups.” Although there are “no easy answers here,” Kristof writes, pointing out that if a toothpaste company had the same “miserable results in its messaging” as aid groups do, “it would go back to the drawing board.” He concludes, “Thats what bleeding hearts need to do as well” (7/8).

New Promise To Ensure Maternal Health Worldwide Needed

Although the decision for President Obama and the first lady “to visit Ghana on the heels of the G8 summit in Italy this week” demonstrates the administrations commitment to “develop a healthy and prosperous Africa,” a new promise “must be made to provide highly costeffective solutions to ensure that women are healthy before, during and after pregnancy,” Rep. Gwen Moore (DWis.) writes in an opinion piece in the Hill. According to Moore, it is “unacceptable” that “[m]ore than 500,000 women worldwide die from pregnancy each year, and millions more endure lifethreatening complications.”

“The president has said, We will not be successful in our efforts to end deaths from AIDS, malaria and tuberculosis unless we do more to improve health systems around the world, focus our efforts on child and maternal health, and ensure that best practices drive the funding of these programs,” writes Moore, who adds that she is looking “forward to hearing from the president and first lady on this very issue following their trip to Ghana.” She writes, “Improving impoverished womens chances of survival before, during and after pregnancy is an issue of rights and social justice. It is also a sound economic and social investment, given the importance of women to the wellbeing of their children, families and societies” (7/7).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

A new technique for transplanting the ovaries of women who have lost their fertility as a result of cancer treatment was outlined to the 25th annual conference of the European Society of Human Reproduction and Embryology. Dr. Pascal Piver, manager of the IVF Centre at Limoges University Hospital, Limoges, France, described a new, twostep method of ovarian transplant that has produced excellent results in women whose ovaries have been frozen because of cancer treatment. He said that his teams technique worked to restore ovarian function quickly and already one patient from his clinic had had a baby and another had become pregnant.

“On June 22, a baby girl was born to a mother who had been menopausal for two years as a result of treatment for sickle cell anaemia. After transplanting her own ovarian tissue she started ovulating in four months and became pregnant naturally six months after transplantation. Both mother and baby are doing well”, he said.

Dr. Piver and colleagues set out to tackle one of the biggest problems of ovarian transplantation the low response to stimulation caused by insufficient vascularisation of the transplanted tissue.

“In order for a woman to become pregnant, the ovaries need to be responsive to the action of hormones that cause them to release eggs each month,” he explained. “If the blood supply to the ovaries is insufficient, this will not happen, even though the transplant may look as though it has been successful.”

To overcome this problem they carried out a twostage procedure, first grafting small pieces of the frozen ovarian tissue in the ovarian and peritoneal areas three days before the real transplant. The first graft encourages the growth of blood vessels and paves the way for the ovary to become fully functioning in a shorter time scale than would be possible if all the tissue were to be transplanted at the same time.

The researchers have so far utilised this technique with two patients who had been treated for cancer and had their ovaries frozen. In addition to the first patient, treated for sickle cell anaemia, the second patient had been treated for periarteritis nodosa, an inflammation of mediumsized arteries, which become swollen and damaged from attack by rogue immune cells.

“She suffered menopause for eight and a half years before transplantation,” said Dr. Piver. “But after transplanting half of the frozen ovary, she recovered spontaneous ovulation in four months. Her right fallopian tube had been destroyed by the ovarian retrieval, and the function of the ovary and hence the chances of pregnancy are limited in time. Hence we decided to collect the highest number of eggs we could, and carry out an IVF procedure on this patient.

“Six months after the operation, we transferred two blastocysts. A total of 22 oocytes were retrieved and produced 16 embryos, which in turn produced seven blastocysts. Unfortunately the first time round this patient developed an ectopic pregnancy, but she is now pregnant again.”

The technique was developed by Dr. Piver and his team, he told the conference. “This is the first time that a pregnancy has been obtained after a ten year gap between ovarian cryopreservation and grafting. We believe that it represents a considerable advance on the methods of ovarian transplantation used until now, not least because we are able to obtain large numbers of oocytes. We hope that it will enable more young patients who have been cured of cancer to regain their reproductive health and become pregnant with their own children,” he said.

Source
Mary Rice
European Society for Human Reproduction and Embryology