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We have been utilising a test for anti-Mullerian hormone clinically for a while now to help assess ovarian reserve – it is a marker of egg quantity, not quality! Assessment of ovarian reserve may provide insight into the remaining number of fertile years a woman has or may predict ovarian reserve prior to IVF treatment.Ovarian reserve, constituted by the size of the ovarian follicle pool and the quality of the oocytes therein, declines with increasing age, resulting in the decrease of a woman’s reproductive function. AMH is a hormone marker for quantitative prediction of ovarian reserve, ovarian aging, ovarian dysfunction and ovarian responsiveness.AMH levels correlate with the number of antral follicles. It has been documented that women with lower AMH and antral follicular counts produce a significantly lower number of oocytes compared with women with higher levels. Women with low AMH levels have fewer oocytes, have lower fertilisation rates, generate fewer embryos, and have a higher incidence of miscarriage during fresh transfers, ultimately culminating in a halving of the pregnancy rate per IVF cycle compared with women with high AMH levels.  When compared to using FSH and age, AMH acts as a superior predictor of live birth and anticipated oocyte yield.I find this easy test extremely useful in clinic as it helps women to make informed decisions regarding their fertility – whether that is to bring their pregnancy plans forward or pursue IVF sooner rather than later.Comparing anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) as predictors of ovarian function.Barad DH, Weghofer A, Gleicher N.Center for Human Reproduction, New York, New York 10021, USA. dbarad@thechr.comWe compared predictive values of anti-Müllerian hormone (AMH) and baseline FSH with respect to IVF cycle outcomes based on oocyte numbers […]

If you need some hard evidence that the various tablets that you are taking every morning are beneficial to you and your baby then read on. There are more and more studies being published that conclude prenatal and pregnancy nutrient status has a significant effect on pregnancy outcome.Miscarriage is a common and poorly understood adverse pregnancy outcome. It is especially problematic for women with PCOS, endometriosis and autoimmune conditions, who have significantly higher rates of miscarriage compared to other women. The University of North Carolina recently released a study of 4,752 pregnant women. Results indicate that vitamin supplementation during early pregnancy was associated with a reduced risk of miscarriage. After analysing the data, the researchers concluded that any use of vitamins during early pregnancy was associated with a 57% reduced risk of miscarriage, compared with no use of vitamins. Thus, the results of this study suggest that use of vitamins during early pregnancy may reduce the risk of miscarriage. Hasan R et al, Self-reported Vitamin Supplementation in Early Pregnancy and Risk of Miscarriage, Am J Epidemiol. 2009 Apr 16.

A bacteria present in the fluid near the ovaries may reduce a woman’s chances of becoming pregnant via in vitro fertilisation (IVF), according to an Aussie researcher. Dr. Christine Knox, a microbiologist at Queensland University of Technology, says that this finding contrasts the traditional view that fluid surrounding the ovum, known as follicular fluid, is sterile.In her opinion, the study can help increase the success rates of assisted reproductive technologies (ART). She also believes that the bacteria could be responsible for infertility cases that have no apparent cause. For the study, Knox, along with researchers at the Wesley Monash IVF clinic, tested the fluid surrounding individual eggs taken from the ovaries of 31 women undergoing ART. The researchers found that 21 of the samples had bacteria in the follicular fluid.Knox said that the findings were startling because “traditionally it was assumed the fluid surrounding the ovum was sterile.” The researchers even revealed that the finding was later replicated in a larger study, wherein they analysed the follicular fluid of 148 women and found bacteria in the fluid of all but one woman.Further tests showed that, in some cases, the bacteria had been transferred from the lower genital tract to the follicular fluid during the medical procedure used to collect eggs known as transvaginal oocyte retrieval (TVOR). But in 52 of the women, the follicular fluid contained bacteria that were not found in the lower tract.According to Knox, the unique, colonising bacteria appear to play a role in reducing pregnancy outcomes. She said that only 25 percent of women with follicular fluid colonised by this bacteria, had achieved a successful pregnancy.”We also found that eggs from women with colonised follicular fluid had a lower rate […]

Eating more fish during pregnancy can improve brain function of children according to a new study. Women who ate more than two servings of fatty fish per week had children who, at age three, performed better on cognitive and motor skills test. However, women who had higher mercury levels in pregnancy had children with lower test scores. The problem is that women who had high mercury levels also consumed more fish. This conundrum is what prevents many women from getting enough omega 3 fatty acids in their diet while pregnant. In fact, the US FDA recommends pregnant women not eat any shark, king mackarel or swordfish because of increased levels of mercury in these fish. It may be more feasible that women take a pure fish oil supplements in pregnancy rather than eat potentially contaminated fish. The website of the Australian Marine Conservation Society has a fantastic resource to help you determine which fish you should be eating. It is called the Sustainable Seafood Guide and you can order a copy from their website – http://www.amcs.org.au/ . Oken E et al. Maternal Fish Intake during Pregnancy, Blood Mercury Levels, and Child Cognition at Age 3 Years in a US Cohort. Am J Epidemiol. 2008 Mar 28

Three years ago Dr. Michael Odent, a world renowned leader in the field of obstetrics, stated that “human health is shaped to a great extent during intrauterine life and prenatal pollution is a threat for the health of future generations”. Such an accumulation of research demonstrates that there are enormous implications in terms of public health – nothing is more important today than the health and wellbeing of pregnant women. We need to address the importance of nutrition before the conception of the baby, as a way to prepare the intrauterine environment.
One important factor that Dr. Odent considers is the effect of fat soluble synthetic chemicals on health. Over the years we have accumulated hundreds of chemicals in our adipose tissue that would not have been there 60 years ago as such chemicals didn’t exist. Many of these chemicals have a long half life and we do not have the enzymes required to break them down for excretion. During the time an embryo is nourished in the uterus, molecules used by cells to “talk” to each other affect the way that genes are expressed. This ability of the environment to “turn on” or “turn off” a gene is studied in the fascinating science called Epigenetics. This is a field that I am particularly interested in and there are many emerging studies that are shedding light on this.
Going back to fat soluble chemicals, many of them are biologically active at very small amounts, usually too small to be detected in standard testing procedures. Just because a substance is not detected on a test does not mean that it is harmless! We now have strong conclusive evidence that the increasing rates of male genital tract disorders […]