Some sunscreen ingredients may disrupt sperm cell function

Many ultraviolet (UV)-filtering chemicals commonly used in sunscreens interfere with the function of human sperm cells, and some mimic the effect of the female hormone progesterone, a new study finds. Results of the Danish study will be presented Friday at the Endocrine Society's 98th annual meeting in Boston.

"These results are of concern and might explain in part why unexplained infertility is so prevalent," said the study's senior investigator, Niels Skakkebaek, M

D, DMSc, a professor at the University of Copenhagen and a researcher at the Copenhagen University Hospital, Rigshospitalet.

Although the purpose of the chemical UV filters is to reduce the amount of the sun's UV rays getting through the skin by absorbing UV, some UV filters are rapidly absorbed through the skin, Skakkebaek said. UV filter chemicals reportedly have been found in human blood samples and in 95 percent of urine samples in the U.S., Denmark and other countries.

Skakkebaek and his colleagues tested 29 of the 31 UV filters allowed in sunscreens in the U.S. or the European Union (EU) on live, healthy human sperm cells, from fresh semen samples obtained from several healthy donors. The sperm cells underwent testing in a buffer solution that resembled the conditions in female fallopian tubes.

Specifically, the investigators evaluated calcium signaling, which is signaling inside the cell brought on by changes in the concentration of calcium ions. Movement of calcium ions within sperm cells, through calcium ion channels, plays a major role on sperm cell function, according to Skakkebaek. CatSper is a sperm-specific calcium ion channel that he said is essential for male fertility. This channel is the main sperm receptor for progesterone, a potent hormone attractant for human sperm cells. Binding of progesterone to CatSper causes a temporary influx, or surge, of calcium ions into the sperm cell, controlling several sperm functions necessary for fertilization.

The researchers found that 13, or 45 percent, of the 29 UV filters tested induced calcium ion influxes in the sperm cells, thus interfering with normal sperm cell function. "This effect began at very low doses of the chemicals, below the levels of some UV filters found in people after whole-body application of sunscreens," Skakkebaek said.

Furthermore, nine of the 13 UV filters seem to induce this calcium ion influx by directly activating the CatSper channel, thereby mimicking the effect of progesterone. This finding suggests that these UV filters are endocrine disruptors, Skakkebaek said. In addition, several of the UV filters affected important sperm functions normally controlled via CatSper, such as sperm motility.

Skakkebaek called for clinical studies to investigate whether chemical UV filters affect human fertility. He added, "Our study suggests that regulatory agencies should have a closer look at the effects of UV filters on fertility before approval."

Eight of the 13 UV filters that disrupted sperm cell function are approved for use in the U.S. They are avobenzone, homosalate, meradimate, octisalate (also known as octyl salicylate), octinoxate (or octyl methoxycinnamate), octocrylene, oxybenzone (also called benzophenone-3 or BP-3) and padimate O. These chemicals are common active ingredients in sunscreens as well as sunscreen-containing personal care products, such as makeup, moisturizers and lip balms.

PhD student and coauthor Anders Rehfeld, MD, will present the study findings.

Portugal vetoes the Surrogacy law

Portugal’s president has just vetoed a law authorizing surrogacy on June 7, 2016.

The law modifying the conditions for recourse to medically assisted procreation (MAP) was passed in parliament last May 13th by a slim majority. The new law extends MAP to single women and to lesbian couples, without any stipulations for medical indications. It also allows recourse to surrogate mothers for couples faced with medical infertility due to uterine dysfunction.

Portuguese president, Marcelo Rebelo de Sousa, decreed the law on Tuesday June 7th, but vetoed surrogacy practices, invoking the recommendations set out by the National Council of Ethics for the Life Sciences.

According to Caroline Roux, Director of VITA International:

“The vote by the Portuguese Parliament was in contradiction with the current international momentum against the practice of surrogacy. Last December, the European Parliament condemned all forms of recourse to surrogacy by a large majority. The Portuguese president’s veto has a far-reaching political impact. Several countries such as India, Nepal, Thailand and Mexico are in the process of changing their legislation to be more restrictive on surrogacy. There is no “ethical” Surrogacy even without paying the surrogate mother. It is the very principle of having recourse to surrogate mothers which is contrary to women and children’s rights. However it is disturbing to see MAP be legalized without any medical stipulations, thereby deliberately depriving a child from having a father. This constitutes a serious injustice for the children thus conceived.”

Alliance VITA is an active partner in the international collective initiative No Maternity Traffic promoting the universal abolition of surrogacy. This European petition was recognized admissible last May 26 by the Council of Europe, and thus transmitted to the Committee on Social Affairs charged with evaluating surrogacy in order for European citizens to have their voices heard and be taken into consideration.

World report on fertility treatments reveals high use of intracytoplasmic sperm injection

The editor-in-chief of one of the world's leading reproductive medicine journals has attacked the rising use of intracytoplasmic sperm injection (ICSI) for the treatment of infertility, following publication of the latest world report on assisted reproductive technologies (ART) [1] today (Saturday).

The report in Human Reproduction shows that while ICSI use has levelled off in some regions, its use is approaching 100% of assisted reproduction cycles in the Middle East and a few countries in other regions, despite the fact that ICSI was developed for the treatment of male infertility, which is a factor in around 40% of couples seeking fertility treatment [2]. The world report covers the years 2008, 2009 and 2010 -- the years for which the most recent data are available.

In an editorial entitled "Santa Claus in the fertility clinic" [3], to accompany the world report by the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), Professor Hans Evers highlights the fact that in 2010 there were 220,000 in vitro fertilisation (IVF) treatments, but there were more than 455,000 ICSI treatments in the world. There was 1.4 times as much ICSI than IVF in Asia, twice as much in sub-Saharan Africa, just over twice as much in Europe, 2.7 times as much in North America, more than six times as much in Latin America and more than 60 times as much in the Middle East.

He writes that doctors are guilty of over-estimating the effect of ICSI. "The majority of the patients who will get pregnant with intracytoplasmic sperm injection (ICSI) will also do so with IVF." Studies have shown that ICSI results in fewer live births than IVF when used for couples where male infertility is not the problem. "Intending to improve their patients' pregnancy probability by preventing fertilization failure, well-meaning doctors actually decrease their chances. This has to stop. We have pledged to do no harm," he writes.

Prof Evers says doctors will serve their patients best by making decisions based on the evidence, "not by playing Santa Claus and doling out nicely wrapped presents of unnecessary, ineffective and costly care."

The authors of the ICMART report say that the reasons behind the high use of ICSI are not fully understood and are beyond the scope of their report. They write: "Investigating why ICSI is a preferred fertilization technique in a number of countries, particularly in Latin America and the Middle East, is warranted."

The report includes data from nearly 2,500 ART clinics from between 58 and 61 countries in the years 2008, 2009 and 2010, and it is the first time the report has included all regions of the world, with the first submissions of data from some sub-Saharan African countries.

During the three years, more than 4,461,300 ART cycles were carried out, resulting in an estimated 1,144,858 babies born around the world. This represents a 9.5% increase in the number of cycles over the three years and a 9.1 increase in babies born.

The report shows wide variation in the use of ART between countries. Globally, ART use remained fairly constant, with 436 cycles per million of the population in 2008 and 474 cycles per million in 2010. However, ART use ranged from 4,775 cycles per million in Israel (which had consistently the highest levels of access over the three years) to just eight cycles per million in the Dominican Republic in 2010. In the same year there were almost 2,500 cycles per million in Australia and New Zealand, more than 900 per million in Europe, 570 cycles per million in North America, 150 cycles per million in Latin America and nearly 90 cycles per million in sub-Saharan Africa. The authors of the report write that the global figure for the use of ART "conservatively represents less than 20% of the demand for ART treatment being met."

The safety of ART improved, with an increase in the number of single embryos transferred per cycle. This increased from 25.7% in 2008 to 30% in 2010, while the average number of embryos transferred fell from 2.1 to 1.9 and the rates of twin and triplet births also fell. However, there were wide regional variations: in Australia and New Zealand 8.2% of ART births were twins, but 30% were twins in the Middle East. The practice of freezing embryos and then thawing them and transferring them to women's wombs (known as frozen embryo transfer or FET) also increased by 27.6% between 2008 and 2010; FET cycles had approximately half the multiple birth rate when compared with fresh embryo transfers, namely 13% (2008), 11.9% (2009) and 12% (2010), with just 0.6% triplet births in all three years.

The first author of the ICMART report, Professor Silke Dyer, a senior specialist in reproductive medicine in the Department of Obstetrics and Gynaecology, at Groote Schuur Hospital and the University of Cape Town, South Africa, said: "The move towards single embryo transfer (SET) and thus towards greater safety and better outcome for ART is a significant finding. Very importantly, however, SET is not a stand-alone practice or finding, but closely related to the cost patients pay for treatment, and to utilisation rates and the use of FET. Supportive funding of ART, either through public or third party funding [4], increases utilisation through the provision of more affordable ART treatment, and at the same time encourages SET, which in turn allows for the freezing of excess embryos. This means patients and doctors are under less pressure to maximise the immediate chance of pregnancy by transferring more than one embryo, which comes with the risk of multiple pregnancy.

"We must acknowledge that this approach carries additional cost. However, given that the optimal outcome of fertility treatment is a healthy single live birth, supportive funding meets the dual goals of equitable access to treatment and safer outcomes for ART-conceived children and mothers. The global multiple birth rate of 21.5% in 2010 is still too high, and policy and practice should seek

to reduce the multiple birth rates.

"Through this three-year report, as well as our previous reports, we contribute to a global understanding of the role of scientific data, and how these data can and should inform sound policy-making."

[1] "International Committee for Monitoring Assisted Reproductive Technologies -- world report on assisted reproductive technologies: 2008-2009-2010"

[2] ICSI is a technique in which a single sperm is injected into the centre of a woman's egg. It is designed to be used in situations where there are very few good quality sperm available for conventional in vitro fertilisation (IVF) techniques.

[3] "Santa Claus in the fertility clinic," by J.L.H. (Hans) Evers. Human Reproduction journal. doi:10.1093/humrep/dew092.

[4] Third party funding covers funding by neither the supplier (hospital or unit through their internal funds) nor the patient; the third party could be a medical aid or insurance scheme, or a government fund or other funding models.

US surrogate takes custody case to appeal

A woman in the USA who acted as a surrogate for a single man, and gave birth to triplets, has taken her claim for custody of at least one of the children to an appeals court.

Melissa Cook agreed to act as a surrogate for the man, known as CM, in 2015 using his sperm and donor eggs. The pair drew up a contract under which it was agreed she would be paid US$33,000 for the pregnancy plus $6000 for each additional child.

However, when CM discovered that Cook was pregnant with triplets, his lawyer allegedly asked her to abort one of the fetuses, claiming that CM was not in a financial position to support three children – a fact that was later disputed by CM.

Cook also claims that CM threatened to withhold payments due to her under the agreement, including money for hospital care, if she did not comply – the contract allegedly contained a clause allowing CM the option of abortion. He also reportedly told Cook that he would rather give up the third child for adoption than to allow her to have custody.

Cook sought to challenge the validity of the contract by asking a court to rule that Californian surrogacy law, under which commercial surrogacy arrangements are permitted, was unconstitutional.

Cook, who has four previous children, also sought custody of the child that CM allegedly said he could not afford to raise, but has said she would have all three if it was shown he could not care for them adequately.

A Californian state court ruled against her, but Cook is now appealing that decision and the case was heard at a federal district court last week, and the decision is currently pending.

Her lawyer, Michael Caspino, said it was a 'landmark case'. 'Surrogacy needs to be fixed because right now the women who carry the babies and the children have zero rights. No right whatsoever. And there needs to be balance here,' he told the Daily Mail.

'The only people with rights under the California statute are the people who write the cheques to get the babies. Nobody else matters. That is wrong. That needs to be fixed.'

Cook is also being represented by one of the lawyers involved in the 'Baby M' case in the 1980s, in which a surrogate sought custody of a child, who was later allowed to remain with the intended parents with the surrogate being granted visitation rights. The contract in this case was declared invalid.

CM's lawyer, Robert Walmsley, said that while CM could have requested that Cook terminate a fetus, he could not have forced her to do so. 'Most importantly, the children are still his,' he added.

Walmsley also disputed many of the claims made by Cook. 'There are so many erroneous facts in the court complaints filed by Melissa Cook and her lawyers,' he said. 'Their goal is to litigate this in the media and file in any court available to drain him financially.'