A recent report in Fertility & Sterility has indicated that among women between the ages of 18 and 40, there is a significant amount of misconception regarding fertility and becoming pregnant. Dr. Illuzzi, an OB/GYN at Yale University School of Medicine, led a study in which 1,000 women of various ages and backgrounds completed a survey about their knowledge of reproductive health. The results showed a lack of knowledge across the board, with higher educated women knowing only slightly more than less educated women.

Over one-third of the women surveyed believed that specific positions during intercourse, such as elevating the pelvis, increase the odds of conception, although there is no scientific evidence to back this up. Additionally, only 10 percent of women know when the best time of the month to conceive is. The majority of women thought that sex must take place after ovulation to become pregnant, while in reality, pregnancy is most optimal when intercourse occurs 1 to 2 days prior to ovulation.

Other notable findings in the study include women’s thoughts on what can decrease fertility and prevent conception. Around 25% of surveyed women were unaware that factors such as obesity, smoking, and a history of sexually transmitted disease can cause infertility. In fact, the number one factor women cited as causing infertility was stress. Stress can have many negative side-effects, but according to Dr. Illuzzi, research does not currently support that it leads to infertility. While most of the women surveyed were aware that conception becomes more difficult with age, many did not know that later pregnancies are also more likely to result in miscarriage and chromosomal defects.

If you are concerned about fertility, or have questions about becoming pregnant, it is best to talk to your doctor, but you can get more information on websites such as the American College of Obstetricians and Gynecologists.

Source: Doucleff, Michaeleen. “You’d Think We’d Have Baby-Making All Figured Out, But No.” NPR. 27 January 2014.

Policy changes are necessary to decrease the death rate of pregnant women in developing countries.  Research, according to Dr. Stacie E. Geller, does not end once scientists publish.  The true battle is implementing that research to affect global change.  Dr. Stacie E. Geller, Director of the Center for Research on Women and Gender at the University of Illinois at Chicago College of Medicine, puts research into practice by providing safe, affordable medication to pregnant women in developing countries.  Dr. Geller spoke last week at a forum held at Northwestern University's Feinberg School of Medicine and presented her research on Postpartum Hemorrhaging (PPH) and its dangers to women in developing countries.

In 2008, there were an estimated 358,000 maternal deaths occurring during childbirth, 99% of these deaths occurring in developing countries. Such global disparities are reflected in the limited access to skilled birth attendants, restricted access to medications, rudimentary delivery facilities, and complications surrounding reliable transportation and communication in developing countries.  Postpartum Hemorrhaging (PPH) is the leading cause of maternal mortality worldwide, accounting for 30-50% of all maternal deaths in Africa and Asia alone.  While the drug Oxytocin is used to prevent PPH in developed countries, developing countries do not have the resources to preserve and administer this drug.  Dr. Geller began studying the drug Misoprostol as an alternative to Oxytocin to be used in developing countries due to its low-maintenance storage and cost-effectiveness.

Dr. Geller, along with a team of researchers traveled to communities in India and Ghana to study Misoprostol for prevention of PPH in home-birth settings.  Their research proved that Misoprostol provides a safe and efficacious alternative to Oxytocin in these communities, but Dr. Geller didn’t stop there.  She worked with the Indian Ministry of Health to approve the use of Misoprostol for PPH prevention by Auxillary Nurse Midwives (ANMs). In Ghana, Dr. Geller engaged with health stakeholders at all levels, conducted community sensitization and trainings, monitored the safe use of Misoprostol, and empowered women to take control of their health.  Furthermore Dr. Gellar’s success strengthened the networks of health providers, decreased maternal mortality and morbidity (due to PPH), and established a model for all of Ghana and other developing countries.  Dr. Geller was a primary advocate credited for Misoprostol’s addition to the WHO’s list of essential medications for the prevention of PPH in 2011, an accreditation which has a lasting global impact.

Dr. Geller stresses the importance of political will in enacting policy changes from scientific research.  Government engagement is critical in reducing maternal deaths, and a scientist’s work is not over once research is published.  Advocating for women’s sexual and reproductive rights, their access to equal treatment, and their right to effective medicine should inspire all researchers to utilize their knowledge to facilitate global change.

To read more about Dr. Stacie Geller and her ongoing research, please click here.

Yesterday morning we awoke to a political landscape that seems jarred by the process of democracy, but ready to move forward as a nation.  Three issues defined the outcome:  the percent of women who chose democratic principles; the resounding losses by candidates who are antiquated in their thinking about pregnancy, in particular; and, the need to hold all of us accountable as citizens in the care of each other starting at the research bench to the bedside.   I’m a reproductive scientist and direct the Women’s Health Research Institute at Northwestern University, so these issues are my issues and it is now time to look forward and identify actionable steps that moves our field forward.

I’ll start with the women.  I believe the 55% to 43% differential in the women’s vote for Obama was not just a vote for a person, but for a platform.  It is a vote that recognizes that sexuality is not something that can be regulated by the state.  It is a vote that states emphatically that the fact of rape is never legitimate. It says that the consequences of forced intercourse are never ‘god’s will’.  Women ‘got’ the vote in 1920 and today their votes say that the politicians must begin to understand that women’s concerns are important and legitimate.

How we move forward to ensure that women’s bodies and their health are not political footballs or pincushions (depending on your gender-identified metaphor) is critical.  Here are some suggestions:

• We can no longer allow basic research and new drug development be done solely in male models (cell, animal or human) —this practice loses the ‘bang for our buck’ when we discover sex differences further down the research pipeline.
• We must report sex differences (or no difference) in study findings and include them in our scientific publications.
• We must redistribute more federal dollars to fund important reproductive health studies that include the ovary, uterus, testis, egg, and sperm that impact the next generation of Americans.  (The Reproductive Science Branch of the National Institute of Child Health allocates only .022% of $30 billion to address reproductive health issues)
• And we must invest in tomorrow’s generation of innovators who might now be high school students or graduate students by funding innovative education programs and traditional training grants today that include a respect for sex and gender differences in all aspects of health and well-being.

I’ve gone from the very broadest issue of our day – the election and women’s issues and women’s votes – to the very granular issues of funding the next generation of research.  Bill O’Reilly, speaking on Fox News election night said that 50% of the population voted for Obama because they want ‘stuff’.  I think the ‘stuff’ we want is the right to speak our mind and be heard on issues that concern our health and the health of our families. We want  our bodies to be respected by politicians, scientists, and everyone in between.  The ‘stuff’ we want is assurances that the biomedical community is including male and female animals and patients in all of the scientific studies that we, women, fund through our taxes.  The ‘stuff’ we want is to make sure that there is a way forward for research in an area that without question, touches each and every one of us.  Our vote suggests that that ‘stuff’ is important and on this ‘morning after’ we are looking forward to the next four years.

Author:  Teresa K. Woodruff, PhD, Thomas J. Watkins Professor of Obstetrics and Gynecology

Our success as researchers is measured by our ability to translate our findings, according to the often-used phrase, from bench to bedside.  In other words, if we can apply our basic science findings to clinical care, we have the ability to impact countless lives.  This pipeline is a national priority, and in fact, many Academic Medical Centers have established programs to facilitate rapid clinical translation.  However, equally as important, and perhaps less appreciated is the need to translate basic science findings into relevant policies that protect and influence the general public.

Reproductive science and medicine are greatly impacted by the environment. Trends in reproductive health demonstrate that reproductive function has declined since the mid-20^th century in certain populations and locations [1].  Coincident with this decline in reproductive function is the large and ever-increasing number of natural and synthetic chemicals to which humans are exposed [2, 3].  Basic, clinical, and epidemiological research has demonstrated that exposure to certain compounds and contaminants, such as Endocrine Disrupting Chemicals (EDC), can have negative impacts on reproductive health. These compounds interfere with the production, transport, activity, and metabolism of natural hormones in the body. As we, as basic scientists and clinical researchers, understand the mechanisms by which these environmental exposures to such compounds affect developmental, reproductive, and neuroendocrine functions, we must also be able to inform and educate the implications of these specific reproductive health findings to the decision makers in Washington, DC.  The question is: How?

In  2010, the Program on Reproductive Health and the Environment at the University of California, San Francisco developed the Reach the Decision Makers Fellowship with the exact intent of providing interested individuals and teams with the resources to advance science-based policy solutions.  Specifically the Reach Program serves to provide individuals with a distinct interest in reproductive health and the environment, with mechanisms to interact with the United States Environmental Protection Agency (US-EPA).  Over the past two years, the Reach program directed by Tracey Woodruff, PhD, MPH, an esteemed leader in the field, has trained over 75 individuals nationwide based on the principles of participatory democracy, social justice, and taking action to prevent harm (for more recent news about the Reach Program, check out the following blog written for the Physicians for Social Responsibility).

Table 1. Our interdisciplinary team

To take advantage of this unique program, we assembled an interdisciplinary team of six individuals committed to reproductive health and the environment (Table 1).  Our team is comprised of professionals from academia, health care, government, and the community, and collectively we have experience in research, policy, advocacy, teaching, and communication (Table 2).   Prior to joining the Reach Program, our team has worked together at Northwestern University and Northwestern Memorial Hospital in various settings including the Women’s Health Research Institute, the laboratory of Teresa K. Woodruff, PhD, the Oncofertility Consortium, the National Physicians Cooperative, the Oncofertility Saturday Academy, and the proposed Northwestern University Superfund Research Center in Reproductive Health Hazards. We joined the Reach Program with the goal of ensuring that the manner in which the US-EPA evaluates reproductive health and toxicity is in line with the current state of scientific knowledge.

Table 2. Team backgrounds

As Reach Program fellows, we have participated in a rigorous training program to define a reasonable “ask” in relation to our goal, to perform research on the topic, and to learn how to identify the key decision makers within the US-EPA who will listen to our request and affect change.   Over the past six months, we have engaged in a first trip to Washington, DC where we attended presentations from policy experts regarding the US-EPA hazard evaluation procedures and how scientists can inform the agency on emerging research regarding the effects of environmental toxins on reproductive health. Meetings at the US-EPA gave the team a greater understanding of the overall institution and current initiatives of the agency. We have also participated in nine webinars covering topics spanning from the effects of environmental toxins on reproductive health to identifying policies and policy makers at the US-EPA.

We also developed our policy project by systematically gaining an understanding of the US-EPA as an agency and the documents and guidelines that inform its staff. Members of the US-EPA helped us identify a principle document in reproductive health and the environment, the Guidelines for Reproductive Toxicity Risk Assessment. This document was written in 1996 and has not been revised since that time so our group decided to focus on some of the significant opportunities to improve upon the guidelines. Since 1996, the state of reproductive research has advanced and we identified three specific areas of research that could be prioritized during the updating of the Guidelines for Reproductive Toxicity Risk Assessment, as follows:

• While the Guidelines acknowledged the importance of non-reproductive consequences of an impaired reproductive system, such as osteoporosis and increased risk of stroke, they did not include these outcomes as endpoint measures for further research study.
• Model organisms are necessary for advancing research in reproductive and environmental health. In the Guidelines, the authors state that effects seen in one organism may be assumed to occur in another. While this is meant to be protective for unstudied species, it is also true that certain species are ideal to investigate different aspects of science and health. Thus, we encourage the study of multiple model organisms in reproductive health and the environment.
• Research advances over the past decade have shown that significant sex differences are seen in the way males and females respond to different drugs and environmental toxins. This warrants the need to include both sexes in reproductive research, a consideration that could strengthen the updated Guidelines.

Our team developed these ideas into a position statement to inform US-EPA staff and interested parties of the need to advance reproductive health and the environment. This project culminates tomorrow, Thursday, October 18, 2012 when the team will fly to Washington, D.C. to meet with Nica Louie (Environmental Health Scientist at the National Center for Environmental Research), Brenda Foos (Director, Regulatory Support and Science Policy Division, Office of Children's Health Protection), and Daniel Axelrad (Environmental Scientist, Office of Policy) at the US-EPA. We hope to gain a greater understanding of the procedures of the agency at these meetings and advocate for the need to update Guidelines for Reproductive Toxicity Risk Assessment.

Virginia Neale, the Associate Director of Government Relations for Northwestern University, will also join the team and bring her expertise in bridging academia and the government to the project. Neale also facilitated a meeting between team members and legislative assistants to the House of Representatives congresswoman Jan Schakowsky (D-IL), who resides over Northwestern University’s Evanston campus. As congressional requests to the US-EPA are often needed to gather teams of experts and update guidelines, we will ask Schakowsky’s office to make such a request to gather the National Academy of Sciences and revise the Guidelines for Reproductive Toxicity Risk Assessment.

The work done this week, and over the past six months, by this interdisciplinary group, will build the foundation for the team to continue communicating evidence-based reproductive health findings to the policy makers in Washington D.C. who have the ability to affect change on a federal level. The relationships we develop this week will be fostered in the coming months and years to ensure that reproductive health is promoted at the highest level within the EPA and advocate that US-EPA guidelines are updated to include the most recent advances in reproductive research

This blog was Contributed by Francesca Elizabeth Duncan, PhD and Kate Waimey Timmerman, PhD    Read more about the team here in a Northwestern University press release.

1.         Woodruff, T.J., J. Schwartz, and L.C. Giudice, Research agenda for environmental reproductive health in the 21st century. Journal of epidemiology and community health, 2010. 64(4): p. 307-10.

2.         Sutton, P., L.C. Giudice, and T.J. Woodruff, Reproductive environmental health. Current opinion in obstetrics & gynecology, 2010. 22(6): p. 517-24.

3.         Woodruff, T.J., et al., Proceedings of the Summit on Environmental Challenges to Reproductive Health and Fertility: executive summary. Fertility and sterility, 2008. 89(2 Suppl): p. e1-e20.