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Synthetic Hormones During Pregnancy and Gendered Brain Development

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I found a pair of slides illustrating an important scientific discovery made in 1959, which became known as the Organizational-Activational hypothesis. A team of scientists experimenting on guinea pigs, discovered that hormones early in life play a crucial role in determining the sex of the brain, and whether an animal will have male or female behavior in adult life. Similar results have since been found in numerous other animal species, and there is little doubt that the same applies to human beings too. Actually there is no doubt at all, going by my own experiences.

Basically the brain has a sex, which arises during a critical period in prenatal development (or in rats, which are born at an earlier stage of development than humans, during days 1-10 of postnatal life). If there are high levels of androgenic hormones present during this critical time, the brain becomes masculinized, and the adult behavior will be that of a male. If there aren’t androgenic hormones present, the brain develops following the default female pathway instead, and the adult behavior will be that of a female.

Rats are a particularly convenient animal for demonstrating this because their critical period occurs after birth. This makes it relatively straightforward to produce a male rat with a female brain through surgical castration at birth. With most other animals you’d have to do the surgery in utero, which is a much trickier task. It is also relatively straightforward to determine whether a particular rat has a male or female brain, because those with male brains when injected with testosterone will attempt to mate with any females present, whereas those with female brains will not. In addition, rats with female brains will adopt a posture called the lordosis posture when injected with estradiol, whereas those with male brains will not.

Organizational and Activational Effects of Hormones during Pregnancy

organizational and activational effects - males

organizational and activational effects

In the first graphic shown above, we see what happens to the adult behavior of males put through three different treatments:

  1. castrated as an adult
  2. castrated at birth with no supplemental testosterone
  3. castrated at birth, but with supplemental testosterone administered.

As is illustrated, treatments 1 and 3 result in adults that behave as males, whereas treatment 2 results in adults with female behavior. What this shows is that there is a crucial period early in the postnatal life of a rat during which either the presence of functioning testicles or externally administered testosterone causes male brain development to occur. In the absence of either, the rat ends up with a female brain, and female adult behavior despite being physically and genetically male. The period of development is roughly equivalent to gestational week 20 through birth during human pregnancy.

The second graphic illustrates what happens to females similarly treated. In this case through spaying, or removal of the ovaries, rather than castration. Here, only treatment 3 (spaying at birth + administering supplemental testosterone) results in an adult with male behavior. This is because, ovaries don’t produce much testosterone. So even the females spayed as adults do not have much testosterone present during the critical period for the sex of their brain. Once again, this emphasizes that it is the presence of testosterone during a critical period in brain development that produces a male brain, and the absence of that hormone during the critical period in which the brain ends up female instead. It appears that genetics and the sex of the body have nothing to do with sex based brain development. Instead, the sex of the brain is entirely dependent on whether or not androgenic hormones were present during a critical period in its development.

There are a couple of other things we can take away from this. Firstly, the effects of hormones during that critical period are permanent, and thus, are present for the remainder of the animal’s life. Secondly, anything that results in males being castrated, or females being exposed to testosterone-like hormones, during that critical period is a really bad thing, and likely to result in a male with a female brain or female with a male brain.

DES and Other Hormones Administered During Pregnancy

The miscarriage prevention drug DES given to women from the 1940s through the 1970s is a powerful chemical castration agent, so it is no small wonder that so many of the male-assigned people from DES pregnancies show signs of female brain development. The first generation progestins ethisterone and norethisterone, widely used in the 1950s and 1960s for miscarriage prevention, are both testosterone derivatives that have been shown to masculinize female fetuses (Wilkins 1960). This is why I think there’s likely to be a significant population of female assigned people from that era with male brains, as a result of their use.

DES isn’t the only drug that acts as a chemical castration agent to have been used during pregnancy. Progestins can also act as chemical castration agents, and unlike DES, they were never withdrawn, but remain in use even now. The archetypal progestin, medroxyprogesterone acetate (MPA), is one of the most popular drugs for chemical castration of sex offenders. It is in my 1972 Monthly Index of Medical Specialties (MIMS) and 1981 British National Formulary for treatment of habitual abortion (i.e. miscarriage prevention), so has definitely been used in human pregnancies in the past.

More to the point, hydroxyprogesterone caproate, which seems to be the most popular currently used miscarriage preventative, has similar pharmacological properties to MPA. The primary difference is that it is a pure progestin that doesn’t cross-react with non-target receptor types, whereas MPA, to a small extent, does. Other than that, they are quite similar drugs with similar effects. Therefore, I think there is a big risk of male assigned children from pregnancies in which hydroxyprogesterone caproate is used, being born with female brains. It is certainly something that bears looking at, by people independent of the pharmaceutical industry and the medical establishment.

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This article was published originally in July 2019.

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Surviving Inborn Errors of Metabolism with Diet: Multiple Acyl CoA Dehydrogenase Deficiency

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For DES Daughters, Conception and Pregnancy Are Difficult

My first pregnancy, now 30 years back, was difficult. I am a DES daughter and after years of trying to conceive naturally, we tried in-vitro fertilization (IVF), which was pretty new at the time. The first IVF attempt led to a miscarriage. The second IVF attempt was successful and I gave birth to triplets. The pregnancy was difficult. I was on bed rest throughout the pregnancy and in hospital from week 26 through 30 when the babies were born prematurely. Although they were preemies and had to stay in the NICU for five weeks before coming home, they had few problems once they were home. They were all good nursers after they developed the sucking reflex at about thirty two weeks of age – two weeks after delivery. I nursed all three of them for the first six months and when they went onto solids they were great eaters.

A Miracle Baby but Something Was Wrong

Fast forward eight years, I became pregnant naturally. Something I NEVER in the world expected. This baby was such a miracle. To my surprise, the pregnancy was normal. I delivered what appeared to be a healthy baby boy via c-section. Early on, however, it became obvious that something was wrong.

My son, Austen had no interest in breast feeding and although the nurses said it was not an uncommon thing for a baby not to eat for the first few days. I remember being very concerned about his crying. Since, I had c-section, I stayed on at the hospital to get back on my feet. Austen wailed like only a hungry baby could. When he was taken from my room so I could get some rest, I could hear his cries in the little nursery down the hall, louder than all the others. The second day was like the first. Now I was worried. The staff seemed indifferent. He still wouldn’t eat and he was clearly unhappy.

That evening lying next to my bed in his little bassinet, his wailing forced me to get out of my bed to pick him up. The nurses were all busy and because it was a Friday there were a lot of visitors, noise, and rejoicing the birth of all the new babies.

Once I got Austen settled in my arms and I was comfortable, I tried once again to nurse him. Nothing. His crying turned to a sound that a little kitten would make. The light was low and I held him and tried to soothe my sweet little man. I don’t know if I fell asleep or we both became one again and my breaths were his and finally he was at peace. Suddenly my dream turned into a nightmare. I stroked his head and it was cold. I called his name and he didn’t move. I screamed at the top of my lungs for help and my baby didn’t flinch. I recall screaming forever until the room was full of people and lights and the hallway was silent. Austen was a strange blue color. They took him away and I knew he was dead and I still kept screaming.

My writer’s block is kicking in. This is where I always stop the scene running in my head. I can’t keep writing because I feel sick and clammy and the tears make it hard to see. I need to finish this story because maybe it could have a happy ending.

Austen was eventually revived. The nurses said he was without oxygen for twenty minutes. I think it was longer because no one came to my room to tell me anything and I was very hoarse from wailing. He was transported by ambulance to New England Medical Center, (also known at the time as The Floating Hospital for historical Boston reasons), where he was stabilized from the seizures and put under oxygen. Once again I had a baby hooked up to wires and tubes, but there was no excitement this time. He had suffered serious brain damage and on the third day of his stay in the NICU. I was asked to sit down with the doctors who had been following him.

The Diagnosis: Multiple Acyl CoA Dehydrogenase Deficiency (MADD)

Dr. A, the metabolic doctor who had been spending a lot of time with him, told me that he had a serious genetic defect. She called it Glutaric Acidemia type II or otherwise known as Multiple Acyl CoA Dehydrogenase Deficiency (MADD). She told me that it was a fatal disease and explained that he could not metabolize fats or proteins. She said that no other child born with this disease had lived for longer than six to eight months. She was patient with me when I cried. She said that she wanted to send a muscle fibroblast to a doctor in Iowa who would confirm the disease. She said that he could be brought home once he was taken off the tube feeding him through his nose and suck on his own. He should be given the best life possible in the next few months. It was “best not to resuscitate” should he stop breathing again, because of all the damage that he had already sustained. He was not to drink breast milk, too much fat and protein, so he needed a special formula.

The Power of a Mom Fighting for Her Child

Up to this point, I was in shock and depressed and felt very alone and defeated. But as I spent days with him watching as he came out of his long sleep and when he finally looked up at me and took formula from a bottle, something changed in my attitude. On the day we were told we could go home I became an angry, assertive woman, a person I had never been in my whole life. I demanded an apnea monitor to have at home in case he stopped breathing. I insisted that I would breastfeed him and I didn’t want the formula. After all if he was to be given the best life in six quick months, shouldn’t he be allowed to breastfeed?

He went home and I pumped and he learned how to nurse. I got in touch with the FOO (Fatty Oxidation Disorder) Family Support Group and the Organic Acidemia Support group and got a home computer. Austen grew. He gained weight and I became more determined not to let the diagnosis defeat us. We got the confirmation from the fibroblast that he had “2% of controls… as low as enzymes get.” It was a mitochondrial disease and there was no cure except to continue with the carnitine and B2 supplements that were supposed to sustain him.

I read Dr. Andrew Weil’s book, “Spontaneous Healing” and was particularly affected by the chapter that addressed malfunctions in DNA. He says that it can be reversed through diet especially by ingesting natural enzymes. I changed my diet radically after going to see a naturopathic doctor who put me on a meat-free, dairy-free diet which included mostly raw fruits and vegetables and whole grains, (both Austen and myself still follow this diet). I didn’t stop there, I sought out a Native American shaman, a Catholic priest who was a faith healer, a chiropractor… and a second opinion from another metabolic doctor.

A New Doctor and New Hope

From the first time I met Dr.K , I knew that we would be in good hands. He believed in treating Austen the individual, not the disease. His approach was much more hopeful and that is what I needed to keep going, especially since I was a single parent at this point. He marveled at his weight gain and cognitive abilities. He was delayed but he seemed to be progressing. The one concern was that his head circumference had come to a halt. Dr. K prescribed CoQ10 and in the next few months after starting it, his little head started growing again. Although he is still considered to be microcephalic.

When we started with solid foods each meal was traumatic, because he would throw it up from reflux. I had to clean up the mess and start all over again. I knew if he didn’t eat we would end up in the ER. He came to recognize that he had no choice in this food business, he had to keep it down!

I weaned him very gradually off of the barbiturates that he had to take for seizures and he has never had another one since. Ear1y on I recognized that Austen had a severe visual impairment and hooking up with Perkins School for the Blind got us involved with the infant toddler program, preschool, the ‘Lower School’ and last June he graduated to the ‘Secondary Program’. Social skills, PT, OT, sensory integration, mobility, music therapy, gym, arts, swimming and of course academics are only part of the total program. We had a skilled health care clinic on the grounds and were very lucky to live so close to the school and be part of this wonderful community.

Surviving Genetic Errors of Metabolism Through Diet

Today, at almost 22 years old, he is of normal height and weight, a handsome devil who is devoted to his older siblings, Nathan, Sasha and Taylor, and his loving stepfather, Joe. It has not been an easy road. We have had many bumps and starts. He stopped sleeping, (night and day) at about age three. Several trips to the ER after a vomiting bouts, severe sinusitis and airborne allergies, incontinence still to this day, but we persisted.

He has many food allergies which have been hard to decipher since he can’t really tell us ‘where it hurts’ and displays his discomfort through tantrums or negative behavior. Although once we got the nuts, legumes and lentils, etc., out of his diet, we have seen much less confusion and better spirits. The change in diet and recognizing that his behavior was on the autistic spectrum, (and getting the diagnosis of Asperger’s syndrome), has afforded me with much more knowledge of how to help my son deal with this world that he doesn’t really understand, and help others to understand his world. He is about to graduate from the Guild School for Human Behaviors where he has learned so much about how to express himself and keep his meltdowns to a minimum.

I feel strongly that the choices I have made for my son have been the right ones, but I could not have done it without the help of all the wonderful people I have met along the way, who now share a part of Austen’s world. Without them, I might not have made some of the connections that have made such a big difference in the quality of my son’s life. I cannot stress enough how important diet has been. The physicians in the NICU suggested that he would not live beyond 6 months and that we should not resuscitate should he stop breathing. I ignored them and with diet and persistence, he has lived and we have loved him for 22 years.

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From DES to the Pill: Are We Doomed to Repeat History?

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“The doctor wouldn’t have given it to me if he thought it was dangerous, right?”

My wife asked this salient question as we discussed the pros and cons of The Pill. It sent us both into deep reflection. Everything we read said The Pill was dangerous, but the doctor had acted like they should come in a Pez dispenser. To this day, I’m not sure where the cognitive began and the dissonance ended.

The DES Debacle: Origins of Obstinance

Doctors are generally dogmatic, but their nearly universal laissez-faire attitude toward The Pill seems particularly paradoxical when you study the scope and seriousness of its side effects. How can doctors believe that The Pill is safe, when tomes of studies suggest otherwise? Research links The Pill to everything from breast cancer and strokes, to Crohn’s Disease and lupus. To understand where we are and how we got here, it’s important to study the journey that brought us here.

By 1970, the current dogma that ‘The Pill is safe’ was well rooted in the medical community. However, enough doctors expressed concerns that Senator Gaylord Nelson decided to hold Congressional Hearings on the matter. The big three networks covered the hearings extensively, which caused great anxiety among women taking The Pill — and even greater anxiety among pill proponents, who subsequently demanded more ‘pro-pill’ doctors be included.

Senator Nelson took umbrage with their complaints, noting that all but one of the previous doctors had actually been ‘pro-pill’ to some extent, but all had reservations about its complications. Nonetheless, many of the doctors in the second round of hearings seemed more decidedly ‘pro-pill,’ including Dr. Kenneth Ryan, who stated,

I know of no information that indicates that biological properties of the estrogens used in the contraceptive pill are any different than stilbesterol for which we have at least 30 years of clinical experience…(Competitive Problems in the Drug Industry, Ninety-First Congress, Second Session, Page 6541)

Very reassuring… Unless you were actually familiar with the 30-year history of stilbesterol, also known as diethylstilbestrol (DES). Sir Charles Dodds discovered DES in 1938, and rushed it to market in the public domain. The English doctor bypassed the patent process hoping it would discourage the Nazis from further tests on women prisoners in their development of ethinyl estradiol (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 36).

From DES to the Pill

Despite his noble intentions, Dodds soon regretted the decision. Without a patent, drug companies around the globe were free to produce DES. He never expected that synthetic hormones would be given to healthy women, and was horrified that doctors were prescribing it as hormone therapy for natural menopause.

You Can’t Put the Hormones Back in the Tube

Even worse, Dodds soon learned that an American doctor named Karnaky had begun blazing a new trail – doling out DES to ‘prevent miscarriages’. Alarmed by the news, Dodds sent him a study he had personally performed, which showed that the drug actually caused miscarriages in animal subjects. It didn’t deter Dr. Karnaky or the many doctors who followed his lead. (Robert Meyers, D.E.S. The Bitter Pill; pp. 56-73)

Dodds began to feel like he was fighting a monster that he himself had unleashed. He was most concerned about how his discovery could affect certain cancers. He sent DES samples to the newly formed National Cancer Institute in the United States, and urged them to conduct tests and notify doctors.

Dodds wasn’t alone. The Council on Pharmacy and Chemistry warned,

…because the product is so potent and because the possibility of harm must be recognized, the Council is of the opinion that it should not be recognized for general use at the present time…and that its use by the general medical profession should not be undertaken until further studies have led to a better understanding of the functions of the drug. (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 44)

The concerns sent murmurs through the medical community, and many doctors began experimenting with lower doses of DES. By 1940, the editors of the Journal of the American Medical Association (JAMA) felt compelled to add theirs to the litany of warnings:

“It would be unwise to consider that there is safety in using small doses of estrogens, since it is quite possible that the same harm may be obtained through the use of small doses of estrogen if they are maintained over a long period.” (JAMA, April 20, 1940)

In 1959, the FDA determined the link to side effects (including male breast growth) was sufficient to ban poultry farmers from using DES as a growth hormone. However, the widespread use of DES in humans continued. In fact, it had become standard medical practice by the time Dr. Ryan assured Congress that The Pill was just as safe as DES – showing how medical dogma often trumps scientific evidence.

The greater irony of Dr. Ryan’s statement materialized one year after his testimony, when researchers first linked a rare vaginal cancer to the daughters of women who received DES during pregnancy. The FDA reacted strongly, listing pregnancy as a contraindication for DES use.

Consumer Groups Take the Lead

You would expect this to be the beginning of the end for DES. Shockingly, the medical community responded with indifference, continuing to prescribe DES for a variety of ‘off label’ uses, including as a morning-after pill, to catalyze the onset of puberty, and the old faithful, hormone replacement therapy. (Robert Meyers, D.E.S. The Bitter Pill; page 185)

It took nearly a decade of passionate effort from consumer movements like DES Action to convince doctors to (mostly) abandon DES. Dozens of lawsuits were filed; some were settled; and some are still pending. There is evidence that the harmful consequences could now be affecting a third generation of DES victims.

The current Director of Epidemiology and Biostatistics at the National Cancer Institute, Robert Hoover, M.D. oversees the DES Follow-Up Study to track the ongoing repercussions. With identifiable problems now affecting the grandchildren of women who took DES, the disaster hasn’t yet moved into the past tense of our nation’s history. Despite that, Dr. Hoover says:

There’s essentially a whole generation of medical students who don’t know the story. The story has such powerful lessons that I think that’s a tragedy…For about 20 years now, when I standardly ask in my general epidemiology lecture… how many of you have heard of DES, nobody raises their hand.

Sidney Wolfe, M.D., who headed up Ralph Nader’s Health Research Group offered this perspective,

DES is an excellent example of how drug companies behave, how they take advantage of the ways doctors act, and how they make millions of dollars by ignoring evidence of a drug’s harmfulness, by failing to get evidence that it is effective, and then by marketing a product that plays on fears and misconception. (Robert Meyers, D.E.S. The Bitter Pill; page 208).

In just 20 years, the American Medical Association moved from “It would be unwise to consider that there is safety in using small doses of estrogens…” to embracing the release of insufficiently tested hormones as birth control for millions of women. I’m leery of trusting a dogma founded on such an erratically moving target. In their defense, the dogma really hasn’t moved much in the decades since.

Today, the medical community assures us The Pill is the most researched drug ever. Sorry doc, that reassurance just doesn’t ring true. At this point, it feels more like a phrase learned by rote than a statement based on any kind of empirical evidence. Unfortunately, it’s not the only hollow mantra that should raise a red flag when it comes to hormonal contraceptives. I will discuss how the medical community responds to scientific studies in my next post, The Spin Doctor’s Prescription for Birth Control.

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This article was published originally on Hormones Matter on August 31, 2016. 

 

 

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DES was Given to My Mom as a Vitamin

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I was exposed to DES before I was born. My mother was given the medicine while she lived in a Catholic maternity home in NYC in 1967. They told her it was a necessary vitamin, even though she did not have any issues with her pregnancy. Nobody told her what DES would do to me, her unborn baby. At the time of my birth, and towards the latter part of her pregnancy, she thought it was odd that her breasts didn’t swell and that did she produce milk. Nobody gave her an explanation. After suffering from postpartum depression, she was told they found adoptive parents for me. She was shattered and became even more depressed for years to come.

A DES Daughter

At 18, I noticed I didn’t have a menstrual cycle. I was brought to a gynecologist. She tried to complete an examination on my organs. I had to fight her off, since it was too painful. I was sent to a specialist in NYC who determined my birth defect. He completed an MRI, which at time (1987), showed an underdeveloped uterus. My fallopian tubes and ovaries appeared normal, but my vagina was smaller. I was told at age 19, if I chose to have children, it would have to be done through a gestational surrogate. This was shattering and I became depressed for many years. I had such a difficult time fitting in with peers. I felt so different like nobody could relate to me. I must be some kind of freak.

Believe it or not, I actually married. The man I married accepted me. He knew for many years of my DES exposure. He loved me unconditionally. Unlike many married couples who experience infertility after marriage, my husband already knew what he was getting into. One gift to come out of this horror for me, I found true love.

The Consequences of DES

The years progressed and medical science improved. In 2003, I underwent a laparoscopy which gave a more definitive diagnosis. It was the same as above, except they used term “floating uterus” and it was determined that I do not have a cervix. Again, I revisited that part of myself that felt like a freak, but I learned to accept my diagnosis.

It was medically determined that I was exposed to DES before I was born. I learned what made me feel like a freak was called a DES injury. I also learned that other women and even men were exposed to DES before they were born too. When I met my mother, we pieced together this tragedy, and it has been very painful for both of us. The DES injury will never come between my love for my mother. It was never an issue that drew us apart. Maybe this pain drew us closer. I prayed my whole life, I prayed, “Lord, if you can’t give me my own child, could you please give me the gift of meeting my mother.” The Lord granted me this gift.

In terms of my health, it has been good. The only medical issue I have is hypothyroidism. I never had my eggs frozen, but I still live with the fantasy that I will one day give birth. I will never part with that fantasy, and if someone out there thinks I am a freak for never giving up on that dream, it doesn’t hurt me anymore, because nobody is a freak for dreaming.

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This article was published originally on Hormones Matter in September 2013.

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DES – The Drug to Prevent Miscarriage Ruins Lives of Millions

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Let’s rewind time. We’re in 1970. My mum, like millions of other women, puts all her trust and last hopes of carrying a successful pregnancy in the hands of health professionals. She accepts to take a drug recommended and prescribed in good faith by her doctor without knowing that years later it would have devastating consequences not only on her health but the health of her daughter and possibly her grand-children. She takes Diethylstilbestrol (or DES in short), the first synthetic man made female sex hormone (oestrogen) widely prescribed for public use in the mistaken belief that it would prevent miscarriage and loss.

Now let’s fast forward. We’re in 2001 three decades after my mum took DES. I’m in a hospital ward anxiously waiting for the results of a scan. I’m pregnant. “We’re so sorry, but you know 1 out of 5 pregnancies end in miscarriage. You should try again” I’m told. My head is spinning. What did my Mum said again? DES, yes DES, I remember now. She mentioned when I was just a teenage girl that research had confirmed that the drug taken throughout her pregnancy to prevent miscarriage was responsible for all sorts of dreadful health issues including a rare form of vaginal cancer, infertility and high risks pregnancies. What if this was responsible for the loss of my baby, I ask. “DES? What is DES? Never heard of it!” replies the consultant on duty that day. ”If you keep miscarrying, we’ll investigate further” he adds.

I don’t listen and seek help and advice from an organization founded by a mother who had been prescribed this drug and advocates for the many families affected by DES. A Professor, expert in fertility treatment, confirms a congenital uterine malformation typical of DES exposure and confirms that I’m a DES daughter, one amongst millions of other women whose mothers took Diethylstilbestrol during pregnancy.

If you were born or pregnant in the US between 1938 and 1971, and until the mid-’80s in some European countries, you may have been exposed to DES too and you may suffer from the consequences of this drug without even knowing it. Diethylstilbestrol has put the mothers prescribed the drug, their daughters and sons exposed in utero, and potentially their grandchildren due to the trans-generational effects of this synthetic hormone, at risk for serious health problems including but not limited to: structural damages in reproductive organs, high risk pregnancies and miscarriage, cancer, infertility and possible immune system impairment. Many other suspected effects are still awaiting further research but funding is critically missing.

Often referred to as the “Silent Thalidomide” by the media, diethylstilbestrol is considered as the world’s first drug scandal. Despite evidence of its ineffectiveness and danger, it continued to be prescribed to pregnant women beyond 1971 when the first link between DES and a rare form of vaginal cancer (clear cell adenocarcinoma) was formally established in Boston, Massachusetts.

Even though this drug was given to pregnant women decades ago, it affects and continues to affect millions of families today and possibly for many years to come. Yet, diethylstilbestrol has been and still is a well-kept secret, a taboo subject not only in families but within the medical community too.

No drug manufacturers, health authorities, nor governments have ever taken responsibility for the long term health side effects of this drug.

Don’t Pharmaceutical companies have a responsibility to their consumers to provide a product that is safe?

Four sisters recently filed a lawsuit against drug manufacturer Eli Lilly. They feel that their breast cancer was a direct result of Eli Lilly’s negligence. Eli Lilly has never accepted responsibility nor apologized for the DES tragedy, even though the company has paid millions in out-of-court settlements and verdicts to DES Daughters and Sons who suffered injuries from their exposure. The Melnick sisters reached a settlement with the drug company a few weeks ago, but Eli Lilly has not accepted any responsibility. Outraged by Eli Lilly’s failure to fess up on DES, Patricia Royall, a plaintiff in one of the 72 pending DES breast cancer lawsuits in Boston federal court and the District of Columbia, is now calling on the general public to sign a petition urging the drug manufacturer to apologize for the DES tragedy. From all corners of the globe, Australia to France, the UK to the Netherlands, Ireland to the USA, DES victims are crying out for justice.

Diethylstilbestrol is a world drug disaster yet very few people know about its tragic health consequences or have even heard about it. Public health awareness campaigns are vital to reaching out to the millions of people who have been exposed to this harmful drug. People who are not aware of their exposure to DES are not receiving proper medical treatment, or making truly informed decisions about their healthcare, as a result. It is equally important to educate the next generations of health professionals who have never heard of DES so they can provide adequate care to DES victims for years to come.

DES DaughterDES is not something of the past. People who have been exposed to this drug years ago are battling with health issues and fighting for their lives as I’m writing this blog post. Who knows what health problems the grandchildren of the mothers who were prescribed this drug will have to deal with as they grow up. I want my daughters to receive adequate medical care and monitoring if they ever have to suffer the consequences of this drug. This is why together with my husband we support the great work done by the very few International DES Action Groups who are providing valuable information and are advocating for the DES victims.

If you’re concerned that you may have been exposed to DES, please don’t let doctors dismiss your concerns. Contact your local DES Action Group for professional advice and guidance.  Connect with me and other DES daughters via my blog: DES Daughter Network and my website: Journal of a DES Daughter. You have the right to know.

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This article was published previously on Hormones Matter in February 2013. 

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Assisted Reproductive Technologies, Birth Defects and Epigenetics

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Assisted reproductive technologies (ART) have grown in popularity and success over the recent decade. According to the CDC, in 2011 there were 61,610 babies born via ART, representing 1% of the US newborn population, nearly doubling ART use in just one decade. ART can be a blessing for the nearly 6% of US couples struggling with fertility issues. In the 30 years since ART began, there have been over 3.5 million children conceived using ART, many of whom are now adults of reproductive age. One wonders, what long-term, transgenerational effects might exist from ART; will those conceived via an assisted reproductive technology, also require reproductive assistance? Are the rates of cancer, especially reproductive cancers and hormone dependent cancers known to be epigenetic in nature, increased? Each of these questions remains to be addressed fully, but here is what is known so far.

The Basics – What is ART?

Assisted reproductive technologies refer to the techniques used to bring sperm and egg together in order to achieve pregnancy. The methods of assisted reproductive technologies include: in vitro fertilization – embryo transfer (IVF-ET), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), and frozen embryo transfer (FET). By far the most common is IVF- ET with fully 99% of couples using this method of assisted reproductive technology. IVF begins with intense hormone treatment to stimulate maternal oocyte production. Those eggs are removed and fertilized with the donor or partner’s sperm.  In most cases, eggs and sperm are placed in a petri dish and allowed to mix freely. In some cases, additional manipulation is required and the sperm is injected into the egg. This is called intracytoplasmic sperm injection or ICSI. IVF plus ICSI appears to account for a large subset of the birth defects associated with IVF.

Early Indicators of Birth Defects with Assisted Reproductive Technologies

A 2007 study of California couples found that children conceived using ART, especially those conceived with ICSI, had a 35% increase in risk for birth defects compared to those conceived naturally. Most common among them were eye abnormalities, heart defects and malformations of the genitourinary tract. Other studies have linked ART to an increased risk major structural malformations of the heart, cleft lip and palate, esophogeal atresia (the esophogus dead-ends in a pouch rather than into the stomach where it should be) and anorecto atresia – (a malformed anal opening).

Among the few studies addressing birth defects and developmental anomalies post infancy, a Chinese study found an increase in observed birth defects in ART males as time progressed, compared to females and compared to those observed at birth. In fact the rate of observed birth defects doubled over the course of the 3 years. Similarly, a study looking at one year olds conceived via ART found a doubling of the rate of multiple major birth defects including chromosomal and musculoskeletal defects.

Long Term Consequences of ART

Studies looking at longer-term difficulties, whether health or developmentally related are few and have had mixed results, always ending with the caveat that it is unclear whether the assisted reproductive technology or the original infertility itself was to blame for the defect. There does seem to be a near doubling of the risk of some rare cancers children conceived via ART, but again the data sets are small and the risk of theses cancers in general is low.

A more recent study compared cardiac function between children and young adults conceived naturally versus those conceived with ART. What they found was striking. The apparently healthy individuals with no visible malformations who were conceived by ART had significant decreases in cardiac and pulmonary functioning by a number of parameters. There was marked vascular dysfunction of the systemic and pulmonary circulation, to which the authors of the study suggest may lead to premature cardiac morbidity at a rate similar to rates seen in type 1 diabetes.

ART and Imprinting Errors

A number of ART epigenetic studies published have assessed the risk or rate of what are called imprinting errors. Imprinting errors occur when genes are incorrectly silenced. A individual normally gets one active imprinted gene, either from mom or dad. When errors occur, they may get two active or two inactive copies. Children born from assisted reproductive technologies have an increased risk of imprinting errors compared to the rest of the population. The common conditions that arise include:

As with the some of the other birth defects observed with ART, those using ICSI – the forcible injection of the sperm into the egg, seem to proffer higher risks and seem to affect males more than females (or perhaps, as is the case with most research, it is the male offspring that are studied more frequently). Of note, the combination of ICSI and environmental endocrine disrupting chemical exposures is linked to trends in demasculization and potential sterility.

Epigenetics and Assisted Reproductive Technologies

Thus far the notion of epigenetic changes in children conceived via assisted reproductive technologies has been limited to research on the aforementioned imprinting errors, also called epimutations. Research on the broader consequences ART, particularly in general health and reproductive health is lacking. The exposure to hyper hormonal states common in many assisted reproductive technologies has the possibility of disrupting critical hormone pathways across the lifespan of the offspring and may impact his/her reproductive health in subtle, and not so subtle, ways. Some effects may not appear until much later in life and certainly there is the possibility of transgenerational changes as those observed with DES, dexamethasone and other hormone exposures during embryonic and fetal development. Additionally, as evidenced by the study on cardiac-pulmonary function, it is conceivable that many of the epigenetic effects will be functional in nature versus more obvious structural malformations. However, because ART bypasses the natural buffers in human reproduction that might have otherwise selected out for specific traits, it is difficult to disentangle native ‘deficits’ – those of the mom and dad – versus those directly linked to the procedure itself. Only time will tell what the effects of ART are on the health and functioning of subsequent generations.

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Dexamethasone During Pregnancy Increases Ovarian Germ Cell Death

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Dexamethasone or DEX, the synthetic corticosteroid that mimics the anti-inflammatory and immunosuppressant effects of endogenous cortisol, has been given to pregnant women who are at risk of delivering a child with congenital adrenal hyperplasia (CAH) for almost 30 years, despite the fact there are no data indicating either its safety or efficacy, and one study from Sweden suggesting such a high risk of adverse events and long term consequences, that the study was halted and the use of the drug was banned.

Similarly without evidence, physicians who specialize in vitro fertilization (IVF) are using DEX to prevent miscarriage. There is only one small and recent study suggesting that DEX may augment ovarian response and increase follicle production for egg retrieval. There are no studies showing improvement in fertilization, implantation or pregnancy rates, or even data showing it prevents miscarriage, its supposed purpose. Indeed, IVF physicians have embraced the myth of this miracle hormone, on perhaps no more than medical hunch.

Dexamethasone and Ovarian Germ Cells

A recently published study looked at the impact of in vitro – organ culture – exposure of fetal ovaries (obtained from recent abortions), and ovary germ cell development. What they found was Dexamethasone Induces Germ Cell Apoptosis in the Human Fetal Ovary. Remember germ cells are those that are handed down at birth from our parents that contain the genetic materials needed to form ovarian follicles (eggs) for women, sperm cells for men. We know that dexamethasone impairs genital development in males, but this is the first study to look at DEX and females – and they went right to the source, germ cell development.

Typically germs cells divide in a logical sequence that eventually results in oocytes or eggs for women or sperm cells for men. In some women and men, the cell division progresses unconventionally, as a result of epigenetic factors including the health and environmental exposures of our parents, even our grandparents. In utero exposures to medications, such as DEX, vaccines and other toxins can cause errors in germ cells. Germ cell division is very highly environmentally influenced and as such, it is not a big leap to think that fetal exposure to synthetic hormones such as DEX during germ cell division – weeks 6-20 of pregnancy, would have an impact on ovarian health. Indeed, it does.

Researchers found that when the fetal ovaries were exposed to dexamethasone in culture for only two weeks, the rate of germ cell death increased, the density or total number of germ cells decreased, as did the expression of one of the genes associated with germ cell survival. This was with only two weeks of exposure. In most cases, women at risk of having a baby with CAH are given dexamethasone continuously from nine weeks through the first trimester. Those pursuing IVF are given DEX preconception through the first 10 weeks of pregnancy, though at a reduced dose compared to CAH. In both cases, fetal exposure to dexamethasone is chronic, during the most critical period of reproductive organ development and germ cell division, a fact that seems to be missed with the purveyors of this drug.

What Happens When We Alter Germ Cell Development?

While there may be limited adverse effects in the moms given dexamethasone, their offspring and potentially even their grandchildren may have varying levels of altered reproductive and sexual development, including changes in the structure and function of the reproductive organs, but also, in the brain chemistry that supports gender identity. We don’t know, however, because there have been so few studies and so little recognition of the potential dangers associated with prenatal dexamethasone, or even with prenatal hormone exposures in general.

In male rodents, exposed to dexamethasone in utero, there are significant problems: reduced penis size, malformed genito-urinary tracts, undescended or malformed testicles and even testicular germ cell cancer. Until this publication, females, animal or human, had not been studied. The fact that they observed germ cell errors, leads one to speculate that later in life, perhaps similar to the DES daughters and granddaughters, these women too will experience the congenital uterine malformations and the complement of reproductive diseases, that include various cancers. At the very least, because of the increased rate of germ cell apoptosis – cell death – observed in the present study, the researchers speculate in utero exposure to dexamethasone will elicit a higher and earlier rate of premature ovarian failure in the offspring.

What becomes abundantly clear is that we ought to stop dosing pregnant women with drugs, especially those hormonal in nature, when we have no data supporting safety or efficacy. We ought to recognize that these substances cross the placental barrier and will affect fetal development. Given medical history over the last 70 years from DES, thalidomide and now, DEX, it is clear any changes in medical practice must be initiated by women themselves. There seems no impetus from medical science to investigate before medicating pregnant women.

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She Was Given DES and My Story Begins

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My story is not special other than it is my story. My mother, a Navy wife, got pregnant with her first child on her honeymoon. Nine months later a healthy baby girl was born. Over the next six years she suffered miscarriage after miscarriage in an attempt to expand her family. Finally, late in 1954 she learned that she was once again pregnant. The doctors told her that there was a wonderful medication available to help support the pregnancy. She was given diethylstilbestrol (DES) and my story begins.

The Early Realities of DES

My childhood and youth were not very eventful. As an adolescent, I had very painful periods, though still not outside the norm. When I was 19 years old in 1974 my mother read an article in a woman’s magazine about DES, and the daughters who were now having health concerns do to DES exposure. Recognizing that she had taken DES during her pregnancy with me, she told me that I should be evaluated by a physician. Up until then I had never had a PAP test or any pelvic exam. I was young, modest, and naive.  My innocence was gone in the sterile clinical exam room. Medical history taken, laying down on the hard table, feet in the stirrups I was poked, prodded, and then scraped for samples of cervical cells. Then the doctor asked for the colposcopy equipment to be brought in. Wheeled into the room, my insides were stained, and then magnified. Finally, when the abnormalities were found, the camera attached to the colposcopy machine documented the DES damage. I was now a DES Daughter.

These exams now became an every 6-month ritual as I was told “you will get cancer, it isn’t a matter of if, but when.”  They wanted to catch the cancer (Clear Cell Carcinoma) the moment it turned. After a few years though with no changes they had started relaxing their prognosis. I was allowed to go in for these exams once a year. Still cautious, but more optimistic, I starting living my life as a young woman. I dated, fell in love and got married.

Starting a Family as a DES Daughter

When my husband and I decided to start our family, I had been given no warnings about the potential issues with pregnancy combined with my DES exposure.  My fertility was good, I got pregnant right away. The pregnancy also went smoothly until the 22nd week of gestation. I was feeling nothing different, enjoying the growing baby I was carrying. Without warning my water broke. Quickly I called my Ob/Gyn who dismissed my experience. “Perhaps you just lost bladder control, not unusual.”  I knew it was not an issue of bladder control, so I went in to his offices. It was the lunch hour, the offices were quiet and the staffing short. I was taken back to an exam room and waited. I waited a long time, and finally, the dismissive doctor came in to examine me.  He tested my discharge and his affect changed at once. He called over to the hospital and had me admitted at once.

DES Exposure Claims its First Victim

I was observed for several days, with no changes. Finally contractions started, and at 22 weeks I delivered a nearly one pound baby boy. He died during the delivery. The DES exposure had taken its first victim.

DES Exposure Claims its Second Victim

A few months later, back in the sterile exam rooms for more testing, I was found to have a very incompetent cervix. I was told that I would be considered a high risk pregnancy from then on, though they felt there were options to help me carry a baby to term. With the blessing of the doctors I became pregnant again, and this time a cerclage was placed in my cervix to help support the pregnancy.  When the doctor came in to see me just after the cerclage was placed, his face was long.  “Your cervix is very weak. You are only 11 weeks pregnant, but already you are totally effaced and starting to dilate. You will need to be on total bed rest, and make the pregnancy last as long as you can.”

With that I was sent home and spent the next 12 weeks in bed.  At 23 weeks I started spotting and having contractions. I was taken to the hospital where they tried to stop the labor, but could not.  I delivered my second child,  a son who was 1 lb 8oz. with paper thin skin. I could fit my wedding ring over his hand and up his arm.  We were told to expect him to die within an hour of birth due to his prematurity, but he didn’t. He lived an hour, then two then four. Finally they decided to transfer him to a NICU unit in a larger city about 2 hours away by car.  I was alone on the maternity floor, mothers nursing babies, walking the halls calming fussy babies, and my child was a fragile package whisked out of my sight, and off to another hospital far away. Tyler lived for 10 days. He fought hard for life, that one and a half pound baby boy. In the end, death won, and DES had taken its second victim.

We Tried Again and Succeeded

I took a few years off from trying to start a family. I had grieving to do..and healing.  I finally went up to the Medical school where I was first diagnosed as DES exposed and put myself in their care. There was one surgery they thought could offer me hope of having a child. It was a rare experimental surgery called a “Trans abdominal cerclage”.  The procedure was so rare that they asked to film the surgery because there would be medical students who would not see a case like mine during their education. I agreed.  So, I once again became pregnant, and at 11 weeks of pregnancy, I went back to the medical school and had the trans abdominal cerclage placed. Because of my medical history I was told to go to bed again and make the pregnancy last as long as I could. This procedure was a good fix. I carried my third child to term.  Four years later I put myself in their care and had my last child, again at term. These two children are now young women. I feel blessed for the good medicine that allowed me to have these children.

I Am a DES Daughter

DES did not stop with my body, or my children’s lives.  My mother has been diagnosed with breast cancer, something that her DES exposure has put her at risk for. She has had treatment and it looks as though DES will not get to claim her as yet another victim.

My innocence was taken by DES. My first two children died due to DES. My mother has suffered due to DES.  I do not consider myself a victim of DES, however, I am a DES Daughter.

 

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