NEW YORK (Reuters Health) – Despite studies suggesting that birth control pills might not work as well in obese women, a new study suggests that they prevent pregnancy the same no matter what a woman weighs.

As long as a woman-heavy or thin–took the pill consistently, Dr. Carolyn L. Westhoff of Columbia University Medical Center in New York City and her colleagues found, it prevented her ovaries from producing eggs. Westhoff and her team report their findings in the August issue of Obstetrics & Gynecology.

Studies have found that obese women are 30 to 40 percent more likely to get pregnant while taking the pill than were normal-weight women taking it, perhaps because excess weight might blunt its effectiveness. Overall contraception failure rates are estimated between 2 and 8 percent per year.

In their study, Westhoff and her colleagues enrolled 226 normal-weight or obese women, randomly assigning them to take a lower or higher dose version of the pill. After three or four cycles of oral contraceptives, the researchers then had the women undergo multiple ultrasounds and blood tests to determine if their ovaries were making eggs.

The researchers tested women’s blood levels several times to determine if they were using the pill consistently; about 90 percent of the normal-weight women had hormone levels indicating consistent use, compared to 72 percent of the obese women.

Ninety-seven percent of the 150 consistent pill users did not ovulate, the researchers found, meaning they would not have gotten pregnant during that cycle. Whether or not a woman was obese didn’t affect her likelihood of ovulation; among the consistent pill users, three of the 96 normal-weight women ovulated, and one of the 54 obese women did.

Two ovulations occurred in women taking the higher-dose pill, and two occurred in women on the lower dose.

But more than a third of the 13 women who were inconsistent pill users ovulated, and two-thirds of the 18 non-users produced eggs.

The new findings, along with more recent clinical trials, should put to rest concerns that obese women are more likely to get pregnant while on the pill, Westhoff says. The issue has confounded doctors, she notes, because some companies have pushed physicians to prescribe higher dose formulations to their obese patients based on the idea that lower doses aren’t effective.

The problem with this approach, she explains, is that obese women are at increased risk of developing life-threatening blood clots in their veins. Taking the pill-especially at higher doses-further increases the risk these clots will occur.

But according to her findings, Westhoff says, obese women who take lower-dose pill formulations can be reassured that they will be effective in preventing pregnancy.

Westhoff has consulted for drug firms that make oral contraceptives, including Duramed, Schering-Plough, and Bayer.

The problem with previous studies, Westhoff told Reuters Health, was that women were asked to recall unintended pregnancies that had occurred in the past; the women also reported their own weights, rather than being weighed by the research team.

Dr. Victoria Holt of the University of Washington in Seattle, who led the studies finding different failure rates among obese and normal-weight research, said she still believes obese women are more at risk of becoming pregnant while on the pill.

She argues that Westhoff’s research suggests obese women are less likely to achieve adequate hormone levels while taking the pill, because just 72 percent had levels indicating consistent oral contraceptive use, compared to 90 percent of the normal-weight women.

“If indeed there is lower effectiveness among obese women, then this does not appear to be the mechanism through which it works,” Dr. James Trussell, the director of the Office of Population Research at Princeton University in New Jersey, told Reuters Health. Trussell studies contraceptive failure, but wasn’t involved in Westhoff’s research. “But nobody has any idea what the other mechanism would be.”

This November, the National Institutes of Health will convene a group of experts to investigate whether further research should be done on obesity and oral contraceptives, he noted, while the Food and Drug Administration is also planning a hearing to address evidence that a new emergency contraceptive pill is more likely to fail in obese women.

“It’s a particular concern in the United States because obesity is increasing so rapidly,” Trussell said. “I would say that the pill is still not going to be the front line, the top tier contraception for obese women.”

Methods with a lower risk of failure due to human error, like the IUD, hormonal implants, or vasectomy for the male partner, would likely be a better choice, he said.

“If a woman really doesn’t want to become pregnant I would suggest combining oral contraceptives with a barrier method,” Holt advised, such as condoms or a diaphragm.

While going through our infertility journey we learned never to take anything for granted, to never give up hope and to always lean on each other for support.  We leaned on each other because there wasn’t much support for infertility when we were going through our journey.  We wished that we had someone to talk to who knew exactly what we were going through.

My husband and I would like to extend our prayers for those who are trying to become parents.  If you or someone you know are on a fertility journey, please feel free to contact us for support.

Until next time,

Jack and Leisha

Nature has optimized the main function of sperm cells in a similar way to race cars. These cells consist of sub-cellular organelles that contain, for example, mitochondria. Mitochondria are the power stations supplying energy for sperm motion and mobility — one of the crucial factors in fertility. The research team has shown that cellular damage on a molecular level in mitochondria can be present although changes in form and morphology are not visible. This stresses that besides morphology, which is a strict criterion by the WHO Manual for Andrology Laboratories to classify human sperm fertility, it is now possible and necessary to improve the test criteria by incorporating chemical signatures.

The RUB researchers obtained detailed 3D chemical maps which do not require the introduction of additional labels or markers. The Raman micro-spectroscopy used in this study detects sub-cellular components using the spectral fingerprints of molecules based on their characteristic vibrations. Different organelles within human sperm are visualized by their chemically unique Raman spectra. In addition to optical and morphological images, it is now possible to directly image the chemical constituents of individual human sperm cells.

This discovery may contribute to the development of new standards for the classification of healthy fertile and damaged infertile human sperm cells. Since the sperm count of human males around the world has dropped an alarming 50 per cent of what it was more than 50 years ago, there is an urgency to investigate human fertility organelles.

The development of innovative spectroscopic and microscopic methods for high resolution imaging of living cells is one of the research areas at the Chair of Physical Chemistry II (Prof. Dr. Martina Havenith-Newen). The work of Konrad Meister, Diedrich A. Schmidt and Erik Bründermann uses confocal Raman microscopy for detailed 3D imaging and identification of organelles of human sperm cells to reveal the origin of infertility on the molecular level. The funding for the Raman microscope used in this study was supported by the Federal Ministry of Education and Research (BMBF 05KS7PC2).

The findings are published in the journal The Analyst, and are also featured in Highlights in Chemical Biology and in the news section of Chemistry World of the Royal Society of Chemistry in May.

Home fertility tests aren’t just for women anymore.

A new device that looks a lot like home ovulation and home pregnancy tests but checks sperm count will soon be available in Europe, and is undergoing Food and Drug Administration review for marketing in the United States.

The test targets couples who have been trying to get pregnant for a few months, but aren’t ready to seek professional help, according to Dr. John Herr of the University of Virginia in Charlottesville, who helped develop the new test.

He said the test helps couples find out if the male is a factor in the infertility “and to do that in privacy with some cost savings.”

“The product will retail for about $25. That’s a lot cheaper than going in and having a full semen analysis,” Herr said.

He said depending on where people live in the United States, it would cost anything from $65 to $250 for a semen analysis, which may or may not be covered by insurance.

In the journal Human Reproduction, Herr and his team report on a study comparing the accuracy of their SpermCheck Fertility test with standard laboratory sperm count methods, using 225 semen samples.

The tests were accurate 96 per cent of the time, the researchers found.

Sperm counts of 20 million per millilitre of semen and above are considered normal and a test will tell if a man’s sperm count meets this level and if he has a severely low sperm count of below five million sperm per millilitre.

“It basically tells the man how deep the infertility is,” Herr said. “If both strips are negative it’s important that they then seek medical treatment for the infertility.”

The test works by detecting an antigen found on the surface of the head of a sperm cell known as SP-10, which Herr and his colleagues discovered. The work of discovering SP-10 and developing the test, much of which was funded by the National Institutes of Health, took about 10 years.

The world is rife with suggestions about how to get pregnant:  some are sound and based in true science, such as charting your Basal body temperature, while others are less scientific in nature, like placing a quartz crystal under your pillow.  You may choose to follow whichever piece(s) of advice you like, but in this special report are some of the most effective methods to getting pregnant.

Sign up for a SPECIAL REPORT:  Top Ten Tips For Trying To Conceive.

This weekend I was reminded of how scary a pregnancy can be. The waiting for the blood test to find out if your HCG level increased. The worry of “what if”. Going to the bathroom and checking to make sure that you are not spotting. Worrying that if you are spotting could this mean a miscarriage. I would like to share some of our scary pregnancy experiences with you and I hope that they might put your mind at ease on some of your scary experiences.

I can remember how excited my husband and I were to find out that we were pregnant. After ten long years, our dream of having a family was finally coming true. We were both excited and scared to go for our 6 week ultrasound. This would show us if there was a heartbeat or not. It brought back unhappy memories of the prior year when we were pregnant. The year prior when we had our ultrasound our IVF doctor told us that we had a blighted ovum (an empty sack). Today’s ultrasound we were hoping to see a heartbeat. We were thrilled this time when our IVF doctor told us that there was a heartbeat, in fact there were three heartbeats. Of course with expecting triplets our doctor had to warn us of the dangers that can occur with carrying multiples. My husband and I were a happy couple one minute and in a blink of an eye we were faced with having to make a huge decision. We were so scared and worried that if we continued with the pregnancy what would happen, would the babies be ok, would I be ok?. We did our research and decided to go on with the triplet pregnancy.

My first ultrasound with my “high risk” OB/GYN doctor happened at 9 weeks. At this ultrasound we were able to bring in a blank video and have our ultrasound taped. My husband and I were crying with joy when we saw all three babies each in their own sac. This was really happening, this was reality, we had three babies in my belly! After, we went to eat lunch and talk about the babies.

The first scary moment was during lunch, I had felt this gush and I excused myself to go to the bathroom. While in the bathroom I started to bleed very heavily, so much that it went right through my pants. I came out of the bathroom and yelled across the restaurant to my husband that I think I am having a miscarriage and to get the car. On the way to the hospital, I called my doctor (her practice was in the hospital) and she advised me to come see her right away. She did another ultrasound to reassure that the babies were still ok and yes they were. While doing the 2nd ultrasound she showed me some little sacs that were most likely filled with blood. She explained that these were probably left over from my last period and sometimes can pop, hence the bleeding. Just to be on the safe side, she put me on 3 weeks bed rest just the same.

Our second scary moment came one Sunday evening, we were watching the health channel. They were showing women giving birth. My husband turned to me and asked me if I knew what a contraction felt like. I of course had no idea. That night I was having what felt like my belly getting really hard and then really soft. At first I didn’t think anything of it, but it kept going on all night. I got up and started timing when my belly would get really hard and then get really soft again, it turned out to be about every minute to every 2 minutes. Not knowing any better I fell asleep. The next morning I awoke and advised my husband of what I was experiencing the prior evening and he suggested I call my doctor. I went to work and called my doctor, she told me to come in A.S.A.P. I was probably having contractions. When I arrived she immediately sent me to the hospital to get admitted. I didn’t know what kind of a long haul I was in for that day. While my husband and I waited to get admitted to the hospital a doctor came up to us and asked what we were there for, my husband told them I was having contractions. The doctor asked how far long I was in my pregnancy and we told him 1 day shy of 24 weeks. He stated that we need to hold on to these babies at least through the night because if they would be born at 23 weeks, there was nothing legally that they could do to save them. This comment not only worried us, but also scared the living crap out of us!!!

The third scariest moment was when my husband was called in the middle of the night to come to the hospital right away. My bed was wet and the nurse thought that I was leaking embryonic fluid. I was almost rushed into surgery for an emergency c-section. After that scare I had several more spotting moments. I was told to try to stay in bed and not get up as the babies could “fall out” because they were so little. Just the thought of having them fall out kept me in bed for the next two months.

I think that the scariest moment for us was when I was ready to give birth. The nurses were prepping me for my c-section, my husband was not allowed in the room when I was getting my epidural. When the man was done administering the epidural shot the babies heartbeats dramatically dropped, they dropped so low so fast that the nurses called the doctor in right away and the doctor told me to lay on my left side and see if this helped and we waited a few minutes. I remember crying and the doctor telling me that I need to calm down. I told her that my husband was in the hallway and I needed him to be in here with me. Imagine how scared he was, seeing all these nurses and doctor rushing into my room and not being able to come in and not knowing what was going on!

I told our story because we want those of you to know that we have been were you have and we felt what you are feeling. My husband and I are real people who experienced Infertility, we went through IVF, we became pregnant, we had miscarriages, and we were amazingly blessed with triplets.

We have to say that our pregnancy was probably the most scariest thing we have ever dealt with in our lives an we wanted to share this with you to offer support while you are going through some of your scary moments and experiences. YOU ARE NOT ALONE!!

My husband and I were married in March and were trying to get pregnant by July. Long before we wed, we discussed how we wanted to start a family immediately. We knew we may not get pregnant right away, but were ill prepared for the path our conception efforts would take.

Because we wanted to get pregnant quickly, I started charting my Basal body temperature from the beginning. It was only three months before we knew something was wrong. I had a flat temperature for three months straight and I had also ceased having a regular monthly cycle. I had recently had a string of urinary tract infections and thought they could be related, so I went to see my OB. She ran some tests and found that I had no trace of infection left, then suggested my lack of menses was due to the stress of getting married and trying to start a family. She said I should relax, practice breathing exercises, and keep a journal. After a few more months and still no regular cycle, I went to a new OB. She also told me that I was causing my own problems through stress and if I just relaxed, I would be fine. A third OB said the same but agreed to do a fertility workup after we’d been trying for a year.

One year after trying to conceive, we started the fertility workups with our new OB. She could find no reason I was not ovulating, so started me on Clomid. The first month of Clomid I ovulated and experienced a chemical pregnancy. That would be the last cycle I would ovulate while on Clomid. My OB tried a series of dosages and varied the days of my cycle the Clomid was taken, but invariably I would end each month with a dosage of progesterone to bring on a cycle so that I could start again. Several months later, I was finally able to get an appointment with an RE.

My RE did a complete fertility workup on both my husband and myself. Everything from PCOS to endometriosis to male factor infertility was ruled out, and we were given the unfortunate diagnosis of “unexplained infertility.” I reminded my new doctor about the repeat UTIs that happened just before our problems started, but he said that infections had already been ruled out and they did not affect our current problems. My RE kept me on Clomid, monitoring me through ultrasound. He said that I was producing follicles, but they were not dropping for some reason. We added an injection of Novarel to my monthly drug cocktail, which was meant to force the follicle to drop, which was followed shortly by IUI. The Novarel did not work; I still did not ovulate.

My husband and I reached the conclusion that we were spending far too much time and money on fertility treatments when we could be devoting our efforts toward adoption. At the end of two years, we agreed on one final month of trying to conceive, then we would start adoption proceedings. I went to my RE with the news and told him that I wanted to try something else. I’d done some research and thought that a stronger drug would be the practical choice for our last ditch effort. My RE agreed to a cocktail of Clomid combined with Repronex, followed by Novarel. At first, it seemed as though the Repronex was not working, so my RE increased the dosage. At that point, my ovaries kicked into overdrive. I produced 20 follicles. Through some fancy dosaging, my RE thought he could get the largest of the follicles to increase in size enough to release while the others stayed behind, hopefully dissolving on their own. In the end, eight of the 20 follicles released and though our RE advised against it (fearing multiples), we continued with the IUI. We became pregnant with a singleton, our son.

After giving birth to our son, we wanted to get pregnant again, but my husband and I agreed that we would not pursue fertility treatments. It was too emotionally and physically draining, and with the money that we might spend on fertility treatments, we could put our son through college! We thought that it would have to happen the old fashioned way or not at all. Our doctors assured us that it would not happen at all as I simply was not ovulating. We still didn’t know why. The latest doctor I had seen had suggested I had andometriosis, a disorder that is undiagnosable without a hysterectomy.

About three more years passed when I decided to dig out a book I had bought just before we got pregnant with our son. It is called “The Infertility Diet” and suggests natural ways to cause one’s body to cooperate. I was still holding onto my idea that the recurrent UTIs from years earlier had contributed in some way to my problems. I learned that andometriosis, like endometriosis, can be caused by the same toxins that contribute to yeast infections and UTIs. Through the infertility diet, I stopped eating any foods that could contribute to the growth of yeast – this included yeasted breads, sugar, and all dairy. At the same time I was training for my first marathon. Toward the end of my marathon training I was finding myself exhausted all the time and after a couple of months on the diet, I had not yet experienced a cycle. I thought that marathon training in conjunction with the dietary change was causing my body too much stress so I decided to start the diet again once the marathon was over.

A few days after the marathon, I found myself very ill. I felt fine except for extreme nausea, which is not uncommon for me after a race. What was uncommon was the amount of time it lasted – after nearly a week of constant illness, my husband picked up a pregnancy test. We were shocked when it was immediately positive – the test line showed before the control lines! A visit with the doctor confirmed the pregnancy. We are now in our 2nd month and are still working on overcoming the shock of getting pregnant without medical intervention!