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OBGYN.net Conference CoverageFrom 55th Annual Meeting of ASRM held conjointly with CFAS- Toronto, Ontario, Canada - September, 1999
Roberta Speyer: "Hello, this is Roberta Speyer. We're here at the ASRM meeting in Toronto. I'm talking with Judith Luborsky, and we're going to talk about premature menopause. Judith, tell us a little bit about your background. You have a PhD, not an MD, correct?"
Judith Luborsky, Ph.D.: "Yes. I do research in basic reproductive biology, and clinical and applied reproduction."
Roberta Speyer: "So what brings you to the ASRM?"
Judith Luborsky, Ph.D.: "We're working on some problems with infertility and also trying to understand the basis for why infertility occurs in some women."
Roberta Speyer: "So what have you found? Have you found anything interesting that you'd like to share with our viewers?"
Judith Luborsky, Ph.D.: "Yes. Here's a little story. Maybe forty years ago, it was noticed that some women would go through menopause before the age of forty, and it was always associated - or seemed to be frequently associated - with an autoimmune disease of the adrenal called Addison's Disease."
Roberta Speyer: "Really."
Judith Luborsky, Ph.D.: "Yes. So it was suggested, and there were at that time some studies that showed that there was an autoimmune basis to the ovarian tissue. But it remained in that arena, often being associated with other diseases for a long time, because there wasn't a specific test. So we started working on this about ten years ago, and now we have a test for a marker for it as an autoimmune disease."
Roberta Speyer: "Really, that must make a big difference - is that widely known and distributed?"
Judith Luborsky, Ph.D.: "Yes, we have publications, and it's fairly well accepted that this is a cause of premature menopause. But the surprise came when we started looking at infertility patients who were still having normal menstrual cycles, but their only problems were that they couldn't have babies…"
Roberta Speyer: "They would have sex and have normal menstrual cycles, but they just wouldn't conceive?"
Judith Luborsky, Ph.D.: "Yes, so their infertility was termed "unexplained" - a category."
Roberta Speyer: "Is that after laparoscopy that they couldn't find anything wrong?"
Judith Luborsky, Ph.D.: "All tests were normal. So it turns out a significant proportion of these people, where the doctor can't find an explanation for the infertility, also have the marker for this autoimmune disease."
Roberta Speyer: "That's very interesting. So what do you see as the next step? What does that mean? Is there a way a person can avoid a lot of undo stress by taking this test up front? Elaborate on that... what does that mean to me, as a infertile woman?"
Judith Luborsky, Ph.D.: "It's called an 'ovarian antibody test.' Sometimes doctors have a prescribed procedure they go through, and sometimes those are successful, but then you go through a number of treatments with the hormones and all, and sometimes nothing happens. You just keep going, and you begin to wonder when it will stop or when you're going to get some success. So what this test can do is provide an explanation for the fact that you might have an autoimmune disease. They should also be measuring a couple of other hormones along with this as a part of a panel of measurements that would tell you 'if I don't have the disease, then maybe a couple more tries would be successful, but if I do have it then maybe I should look at alternative ways…"
Roberta Speyer: "To conceive. So if they have it, they're not going to conceive or their chances are…"
Judith Luborsky, Ph.D.: "Lower, but it's not impossible. It shouldn't be totally taken as an absolute, but the success rate is much lower in people that have this."
Roberta Speyer: "How much lower?"
Judith Luborsky, Ph.D.: "About half."
Roberta Speyer: "About half - so is that half of a normal person or half compared to other infertility…?"
Judith Luborsky, Ph.D.: "To other infertility."
Roberta Speyer: "So that is quite low, and they really need to make some choices at that point. So is this test always done as part of the work-up on infertile patients?"
Judith Luborsky, Ph.D.: "No."
Roberta Speyer: "Why not?"
Judith Luborsky, Ph.D.: "Because it's new and people have to get a chance to understand it. People have to request it."
Roberta Speyer: "Tell our viewers the name that they should tell their physicians."
Judith Luborsky, Ph.D.: "It's called an 'ovarian antibody test,' and there are publications. There are several."
Roberta Speyer: "How is the test done? Is it done through a blood test?"
Judith Luborsky, Ph.D.: "Yes, it's a blood test. Also, people should know that there are new things, and that we're trying to discover a therapy. Now that we can identify women who have this, and we know that they might need some different kind of treatment that allows us to really do some specific things instead of just treating them the same way as everyone else."
Roberta Speyer: "Is it possible that if I were a young women in my twenties and I took this test, and I could see that I had this, that it would be more beneficial for me to try to get pregnant younger rather than putting it off indefinitely?"
Judith Luborsky, Ph.D.: "That's an absolutely excellent question because, yes, you have several options at that point."
Roberta Speyer: "Would it be identified, and is it something I'd always carry - kind of like a DNA test?"
Judith Luborsky, Ph.D.: "No. When the body has an immune reaction to itself, in the initial part of the reaction the antibodies may be there as what we call a 'marker.' It doesn't necessarily cause the disease. But once the course of the cellular reactions has gone, sometimes then the antibody goes away. So it isn't a permanent thing like a gene. It's an expression of some cell activity. For example, many cases of premature menopause and infertility run in families, so if you have two sisters who've already had problems and you are twenty years old and you have this test, then you can say, 'I shouldn't wait until I'm thirty-five.' You can donate eggs and have them frozen for later."
Roberta Speyer: "So there are options."
Judith Luborsky, Ph.D.: "Yes. Or you can go ahead, if you have the relationship and the circumstances, and say, 'I should make this my priority now.' So it's part of a decision process at this point."
Roberta Speyer: "So the take-away message here is, if you know that your family has had these types of troubles, you definitely should be having the test early, and it's the ovarian antibody test. If you are dealing with the inability to conceive, you want to make sure that when you go to your physician you request an ovarian antibody test. That will save you a lot of time and trouble getting to the bottom of your problem. Is there any other time that you would suggest that someone should be aware of this, or does that pretty much cover the spectrum?"
Judith Luborsky, Ph.D.: "I think the most important consideration of women who are either going to want to have children and trying to make decisions about when to do that - or women who are going through treatment when things don't seem to be working, and they're going time and time again - is in making a decision. Also, if they are thirty years old and the menstrual cycles start to stop, if that makes sense, you know that would be part of the conforming test, just like having any other thing, like a thyroid function test."
Roberta Speyer: "Are there other considerations when someone has this antibody? Will there be other ramifications besides infertility or is that pretty much it?"
Judith Luborsky, Ph.D.: "Only when you're talking about going into menopause early. It's just like normal menopause or, I don't want to say 'normal,' but the normal age of…"
Roberta Speyer: "I understand. The same types of dryness…"
Judith Luborsky, Ph.D.: "...that's right, that you would want to inquire about hormone replacement because you don't want to be without estrogen…"
Roberta Speyer: "...especially at a young age because then you have osteoporotic implications, early cardiovascular... absolutely. This is fascinating. It's nice to know what you people work on in labs, working on these things for us. It takes a long time to do something."
Judith Luborsky, Ph.D.: "That's why I thought I would say something here."
Roberta Speyer: "And we really appreciate you taking the time to meet with us today and share this. I think it's fascinating information, and those of you out there viewing this who are having these problems, remember, it's the ovulation antibody test."
Judith Luborsky, Ph.D.: "Ovarian."
Roberta Speyer: "Ovarian. I'm sorry - excuse me. I want to say it enough times because I want to get it right. I'm sure you can all remember it now, even though I can't. It's the ovarian antibody test, and you want to mention that. If your physician doesn't know what you're talking about, what should you do? Go see a reproductive endocrinologist?"
Judith Luborsky, Ph.D.: "A reproductive endocrinologist, or there are papers on Medline, which your web site offers."
Roberta Speyer: "Yes, you can go to Medline."
Judith Luborsky, Ph.D.: "It's under my name."
Roberta Speyer: "The papers are under your name, so I'm going to spell that - Judith Luborsky - and she has published papers. In fact, we'll go ahead and we'll tag some of those and cite them right next to this interview. So if you'd like to read them and find out more about it, bring it in and show it to your physician, feel free. For those of you physicians out there who'd like to look it up and make sure you're providing this service, we'll make it easier for you use. Thank you so much for joining us today."
Luborsky J, Llanes B, Davies S, et al.
Ovarian autoimmunity: greater frequency of autoantibodies in premature menopause and unexplained infertility than in the general population.
Clin Immunol (United States), Mar 1999, 90(3) p368-74
Luborsky JL, Shatavi S, Adamczyk P, et al.
Polycystic ovary syndrome and ovarian autoimmunity--assessment of ovarian antibodies by EIA.
J Reprod Immunol (Ireland), Jan 1999, 42(1) p79-84
Luborsky JL, Visintin I, Boyers S, et al.
Ovarian antibodies detected by immobilized antigen immunoassay in patients with premature ovarian failure.
J Clin Endocrinol Metab (United States), Jan 1990, 70(1) p69-75