The American Society of Reproductive Medicine 64th Annual Meeting took place Nov. 8-12 in San Francisco under the banner: "Bridge to the Future of Reproductive Medicine."
At a Monday Symposium Breakfast, Sandra A. Carson, M.D., of the Warren Alpert Medical School of Brown University, moderated a session titled “Luteal Support in Reproduction: Why, What and How?” which cited conflicting data on the necessity or benefits of progesterone supplementation, and provided clinicians with current perspectives on the use of progestogens in assisted reproductive technologies, the treatment of secondary amenorrhea, postmenopausal hormone therapy, and recurrent pregnancy loss.
During Monday's President's Guest Speaker/EMD and Serono, Inc., Endowed Lecture, Alan O. Trounson, Ph.D., of the California Institute of Regenerative Medicine, discussed stem cell advances, the increasing clinical use of adult stem cells, and how pluripotential stem cell science is ready for clinical testing.
During a Tuesday Commercial Supported Session, John E. Buster, M.D., of Brown University, and Nanette Santoro, M.D., of the Albert Einstein College of Medicine, discussed advances in hormonal therapy for postmenopausal women.
“Seven years ago, the Women's Health Initiative study resulted in doctors being careful about placing women on estrogen,” Buster said. “The call we heard after this study was to give the lowest possible doses. Since then, there's been a tremendous amount of research on estrogen patches, creams gels, and sprays that deliver low doses of hormones directly into the micro-circulation of the skin that don't go through the liver. What's new is that these methods are not associated with an increased risk of deep-vein thrombosis. They don't affect clotting factors, lipids, or inflammatory factors. It's a very exciting time in hormone therapy. Although the hue and cry over the Women's Health Initiative is important, it shouldn't prevent physicians from prescribing estrogen to patients now.”
Another Tuesday presentation – “Lions, Tigers, and Pandas, Oh My! The Importance of Genetic Management and ART in Species Preservation” – featured David E. Wildt, Ph.D., of the National Zoo and Smithsonian Institution. Wildt's presentation emphasized how assisted reproductive technologies that benefit humans also help endangered species such as the black-footed ferret of the American West and the giant pandas of Asia.
A Wednesday session, “Conscientious Refusal in Reproductive Medicine,” addressed controversial moral and legal issues that often confront specialists in reproductive medicine, and discussed how claims of conscience should be weighed or limited when considering which services should be provided to particular patients.
Robert G. Bryski, M.D., of the University of Texas Health Sciences Center in San Antonio, and chair of the ASRM Ethics Committee, discussed a recent American College of Obstetrics and Gynecology statement addressing the issue of conscientious refusal in abortion and other topics. "In reproductive medicine, there are other issues, including assisting same-sex couples in conception, and collaborative reproduction where multiple donors and surrogates are involved," Bryski said. "We conducted an overview of the tension between providers' individual values and moral beliefs, and the need to serve patients."
The session also featured Judith F. Daar, J.D., of the Whittier Law School, and Leslie P. Francis, J.D., of the University of Utah. "Legal requirements vary from state to state," Bryski said. "In some states, pharmacists who don't believe in contraception don't have to fill prescriptions for birth control pills. In other states, they are required to fill such prescriptions. Although the society hasn't come out with an over-arching statement, we have made statements similar to ACOG's position on the provision of reproductive services to gay and lesbian couples, and our conclusion is that there's no ethical justification to deny services to these individuals."
Two studies presented at the conference addressed the possible link between bisphenol A (BPA) – a common contaminant found in many food and beverage containers – and reproductive health.
In one study, researchers from the University of California in San Francisco measured serum levels of BPA in 44 women who underwent in vitro fertilization cycles. They found that mean BPA levels were higher in women who did not achieve pregnancy than in those who did (4.17 versus 3.4 ng/mL). "Although this did not reach statistical significance, enrollment is ongoing to clarify the relationships between BPA and in vitro fertilization outcomes," the authors conclude.
In a second study, researchers from the Harvard School of Public Health assessed BPA levels in 71 men, but their preliminary analysis showed that there were no significant associations between urinary BPA concentrations and semen quality parameters. "The lack of an association of urinary BPA concentrations with semen parameters should be interpreted cautiously due to the small sample size," the authors conclude. "Future statistical analyses will include additional men."
Another study presented at the conference by researchers from the Robert Wood Johnson Medical School in Camden, N.J., compared the effects of conventional circumcision in five adult men with nerve sparing circumcision with minimal foreskin mucosa in seven adult men. "Our findings suggest that nerve sparing circumcision with minimal foreskin mucosa offers maximum HIV/AIDS protection and sensory nerve preservation," the authors conclude. "The nerve count in the removed skin was significantly less, they required fewer post-operative pills, and they returned to intercourse earlier than mean with conventional circumcisions."