Reproductive history and Creutzfeld–Jakob disease

Roberto Matorras1, Francisco J. Rodríguez-Escudero and Antonia Expósito

Unit of Human Reproduction, Department of Obstetrics and Gynecology, Hospital from Cruces, Pais Vasco University, Vizcaya, Spain

1 To whom correspondence should be addressed. e-mail: rmatorras{at}hcru.osakidetza.net

We are pleased with the contribution of Ward et al. (2004Go), showing that the history of gonadotrophin exposure among patients with variant Creutzfeld–Jakob disease (vCJD) (and also with CJD) is being investigated, as we recommended (Matorras and Rodriguez-Escudero, 2003Go). Indeed, we are also pleased that the results of such an enquiry that, to our knowledge, have not been published previously in a scientific journal, seem to be reassuring.

On the other hand, we apologize that on account of a typographic error, the incidence of CJD instead of that of vCJD was given.

Regarding the interesting data furnished by Ward et al. (2004Go), we were surprised by the low frequency of a history of infertility treatment in both vCJD cases (1/63 = 1.6%) and community controls (2/95 = 2.1%) and also among the cases of sporadic CJD (0/169 = 0%). It is generally accepted that 10–15% of the western population has an infertility problem at some point in their reproductive life. Although the frequency of infertile patients seeking medical assistance is less well known, figures ranging from 39 to 62% have been quoted (Stephen and Chandra, 1995Go; Olsen et al., 1996Go; Collins, 2002Go), with 50% representing the most accepted percentage (ESHRE Capri Workshop Group, 2001Go). Thus one should have expected an ~5% frequency of infertility treatment in both vCJD and controls, as well as in sporadic CJD. The frequency of patients receiving gonadotrophins, however, should be considerably lower. It has been reported that 16% of patients undergoing infertility treatment receive gonadotrophin treatment (Collins, 2002Go). However, following some treatment models, at least 50% may be elegible for gonadotrophin treatment (Effective Health Care, 1992Go).

Thus, it would be of interest to know in detail how the history of infertility treatment was investigated. The authors stated that ‘we obtain a detailed medical history from relatives, which is corroborated using hospital and primary care records’ (Ward et al., 2004Go). Since sometimes the information related to infertility treatment is withheld from the relatives (except for the husband), additional data concerning the methodology followed should be given, to rule out any under-reporting. On the other hand, given the low aforementioned frequencies of infertility, it would be of interest to know the distribution regarding the number of children in vCJD, sporadic CJD and controls.

We fully agree with the conclusion of Ward et al. ‘To date, there is no strong evidence to support the suggestion that vCJD (or in fact sporadic CJD) has been acquired through receiving urinary gonadotrophins’. In our opinion, the available epidemiological data are reassuring, although they do not seem enough to guarantee gonadotrophin safety. We congratulate the authors for their work, and trust they will continue with their endeavour ‘continuing to collect data on a wide range of potential mechanisms of secondary transmission of CJD, including infertility treatment’ (Ward et al., 2004Go).

References

Collins JA (2002) An international survey of the health economics of IVF and ICSI. Hum Reprod Update 8,265–277.[Abstract/Free Full Text]

Effective Health Care (1992) The Management of Subfertility. Effective Health Care Bulletin Number 3. School of Public Health, University of Leeds.

ESHRE Capri Workshop Group (2001) Social determinants of human reproduction. Hum Reprod 16,1518–1526.[Abstract/Free Full Text]

Matorras R and Rodriguez-Escudero FJ (2003) Prions, urinary gonadotropins and recombinant gonadotropins. Hum Reprod 18,1129–1130.[Free Full Text]

Olsen J, Küppers-Chinnow M and Spinelli A (1996) Seeking medical help for subfecundity: a study based upon surveys in five European countries. Fertil Steril 66,96–100.

Stephen EH and Chandra A (1995) Use of infertility services in the United States: 1995. Fam Plann Perspect, 32,132–137.

Ward HJT, Balen A and Will RG (2004) Creutzfeld–Jakob disease and urinary gonadotrophins. Hum Reprod 19,in press.





This Article
Extract
Full Text (PDF )
Alert me when this article is cited
Alert me if a correction is posted
Services
Email this article to a friend
Similar articles in this journal
Similar articles in ISI Web of Science
Similar articles in PubMed
Alert me to new issues of the journal
Add to My Personal Archive
Download to citation manager
Request Permissions
Google Scholar
Articles by Matorras, R.
Articles by Expósito, A.
PubMed
PubMed Citation
Articles by Matorras, R.
Articles by Expósito, A.