New York Times Examines Increasing Scrutiny Of Fertility Industry After Octuplet Birth

The New York Times on Thursday examined how regulators and the fertility industry have begun to view large multiple births as "breakdowns in the system," an issue that has increased debate over how many embryos should be implanted during in vitro fertilization and whether more oversight is warranted. The issue has taken on a renewed focus since the birth of octuplets last month to 33-year-old Nadya Suleman, who has six other children conceived through IVF. According to the Times, nearly one-third of IVF births involve twins or more, and the government and professional medical associations have pushed fertility doctors to lower that number to minimize risks related to multiple births, including infant death, low birth weight, disability and high-cost medical care.

In 2008, the American Society for Reproductive Medicine, an association of fertility doctors, issued guidelines calling for the transfer of no more than two embryos in a woman younger than age 35 and no more than five in women age 35 and older. However, unlike some countries, the U.S. does not enforce the guidelines. The Centers for Disease Control and Prevention collects data on fertility clinic results, but reporting is voluntary. Experts say that many fertility doctors still implant higher numbers of embryos to raise the chances of a pregnancy, the Times reports. The number of triplet births declined from 7% in 1996 to 2% in 2006, a decrease that ASRM considers as one of its successes, according to the Times. However, only 11% of IVF procedures in 2006 involved single embryos, according to CDC data.

The Times reports that efforts to reduce multiple births, such as the guidelines for implanting only one embryo, have caused tension within the fertility industry, a more than $1 billion business. Doctors say patients constantly push for the implantation of multiple embryos. One IVF cycle can cost about $12,000, and "[w]omen who are not successful the first time often try again and again, which can push the cost of having a baby to more than $100,000," the Times reports. The fertility industry in the U.S. has doubled in size since 1996 -- when CDC began tracking data -- and the latest figures show that there are more than 483 clinics and that more than 134,000 procedures have been performed.

Jeffrey Steinberg -- head of Fertility Institutes, a Southern California-based group of fertility clinics -- said, "Every single decision we make about embryo transfers is a tough one, because we don't have a crystal ball." Daniel Potter, medical director of Huntington Reproductive Center in Southern California, said the responsibility of the procedure remains with the doctor, regardless of a patient's requests. He added that if someone came in and wanted to transfer six embryos in a situation" such as Suleman's, then "we have an obligation to protect the patient and not let the patient do things that are unreasonable." Suleman, in an interview on NBC's "Today Show", said that her IVF procedure involved six embryos, and she identified the fertility doctor who performed the procedure as Michael Kamrava of the West Coast IVF Clinic in Beverly Hills, Calif. The Medical Board of California is investigating Kamrava to determine whether there was a violation of standard medical practice. According to the Times, he has "raised eyebrows in the industry" in the past by advocating for a controversial procedure called SEED -- subendometrial embryo delivery, which involves inserting an embryo directly into the uterine lining. Potter said that the procedure's value is not scientifically supported. CDC data from 2006 place Kamrava's clinic among those with the lowest success rates in the country and reveal that the clinic had one of the highest rates of embryos transferred in younger women -- 3.5 embryos versus the average of 2.3 (Saul, New York Times, 2/12).















Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Gender Differences In Lung Cancer Incidence: Smoke Exposure Alters Gene Expression And Estrogen Metabolism In The Lungs Of Mice

Lung cancer rates are increasing substantially in women, particularly in non-smoking women, with no known reason for the increase. Now researchers at Fox Chase Cancer Center may have uncovered a critical piece in the puzzle.



Working in a mouse model of smoking-induced lung cancer, Margie Clapper, Ph.D., Co-leader of the Cancer Prevention and Control Program at Fox Chase Cancer Center, and colleagues found that smoke triggers rapid changes in gene expression in the lungs of female mice, including increasing expression of a network of genes involved in estrogen metabolism. Based on these data, presented at the 2010 annual meeting of the American Association for Cancer Research, the team hypothesizes that estrogen metabolism may contribute to lung cancer in non-smoking women as well.



Following smoke exposure for 3, 8, or 20 weeks, Sibele Meireles, Ph.D., an assistant member in the Clapper Lab, found that 10 genes were differentially expressed in the lungs of smoke-exposed female mice as compared with control animals. The gene most affected by smoke was cytochrome P450 1b1 (Cyp1b1), which is responsible for breaking down toxins and is a key enzyme for estrogen metabolism. Additionally, when the team looked at networks of genes, they saw that genes involved in estrogen metabolism were altered within the lungs of animals exposed to smoke as compared to controls.



"We found a link between hormones and lung cancer through Cyp1b1 when we weren't looking for it -very exciting," says Clapper. "Previous work has suggested that estrogen may play a role in lung cancer, but no one has shown that smoke can actually accelerate the metabolism of estrogen within the lungs; the suggestion from our data."



The investigators hypothesize that estrogen plays a role in the formation and progression of lung cancers, similar to the role it plays in some breast cancers. The idea is consistent with previous studies indicating that women with lung cancer who take hormone replacement therapy have a poorer prognosis than women who do not, regardless of their smoking history. Additionally the observation that estrogen can be detected within the lungs and that its metabolism is upregulated in the lungs of smoke-exposed female mice may provide new insight into why lung cancer is rising so quickly in women, including non-smoking women world wide, according to Clapper.



The investigators decided to look at gene expression changes after short-term smoke exposure in hopes of finding ways to intervene in or reverse the process. "If we can identify the earliest events that happen within the lungs when you begin to smoke, we might be able to use therapeutics to block them as well as lung cancer," says Clapper, who runs a chemoprevention laboratory at Fox Chase.



First author on the study is Sibele I. Meireles of Fox Chase. Co-authors include Suraj Peri, Karthik Devarajan, Michael Slifker, Stacy L. Mosier, and Jing Peng of Fox Chase, Gustavo H. Esteves of University of Para?­ba State, Brazil, Roberto Hirata, Jr., and Jordao Neves of the University of S??o Paulo, Brazil, Manicka V. Vadhanam, Harrell E. Hurst, and Ramesh C. Gupta of the University of Louisville, Kentucky, Luiz F. Reis of the Hospital S?­rio Liban??s, Brazil, and C. Gary Gairola of the University of Kentucky in Lexington.



Source:

Diana Quattrone

Fox Chase Cancer Center

Belly Fat Puts Women At Risk For Osteoporosis

For years, it was believed that obese women were at lower risk for developing osteoporosis, and that excess body fat actually protected against bone loss. However, a study presented today at the annual meeting of the Radiological Society of North America (RSNA) found that having too much internal abdominal fat may, in fact, have a damaging effect on bone health.


"We know that obesity is a major public health problem," said the study's lead author, Miriam A. Bredella, M.D., a radiologist at Massachusetts General Hospital and assistant professor of radiology at Harvard Medical School in Boston. "Now we know that abdominal obesity needs to be included as a risk factor for osteoporosis and bone loss."


According to the Centers for Disease Control and Prevention (CDC), approximately 72 million American adults are considered obese. The CDC defines obesity as having a body mass index (BMI) of 30 or more. Obesity is associated with many health problems including cardiovascular diseases, diabetes, high cholesterol, asthma, sleep apnea and joint diseases. Yet despite all the health issues, it was commonly accepted that women with increased body weight were at lower risk for bone loss.


But not all body fat is the same. Subcutaneous fat lies just below the skin, and visceral or intra-abdominal fat is located deep under the muscle tissue in the abdominal cavity. Genetics, diet and exercise are all contributors to the level of visceral fat that is stored in the body. Excess visceral fat is considered particularly dangerous, because in previous studies it has been associated with increased risk for heart disease.


Dr. Bredella and colleagues set out to evaluate the abdominal subcutaneous, visceral and total fat, as well as bone marrow fat and bone mineral density, in 50 premenopausal women with a mean BMI of 30. Each woman underwent an MR spectroscopy exam to evaluate the bone marrow fat of the L4, the fourth vertebra in the lumbar section of the spine. Then, the bone mineral density of the L4 was assessed using quantitative computed tomography (QCT), which measures bone mass and is used to assess bone loss.


The imaging revealed that women with more visceral fat had increased bone marrow fat and decreased bone mineral density. However, there was no significant correlation between either subcutaneous fat or total fat and bone marrow fat or bone mineral density.


"Our results showed that having a lot of belly fat is more detrimental to bone health than having more superficial fat or fat around the hips," Dr. Bredella said.


According to the National Women's Health Information Center, 10 million Americans have osteoporosis and 18 million more have low bone mass, placing them at risk for the disease.


"It is important for the public to be aware that excess belly fat is a risk factor for bone loss, as well as heart disease and diabetes," Dr. Bredella said.


While bone loss is more common in women, the research team is currently conducting a study to determine whether belly fat is also a risk factor for bone loss in men.


Coauthors are Martin Torriani, M.D., Reza Hosseini Ghomi, M.S.E., Bijoy Thomas, M.D., Anne Klibanski, M.D., and Karen Miller, M.D.


Source:

Radiological Society of North America

ABC News' 'World News Tonight' Examines Emotional Aspects Of Egg Donation Among College-Age Women

ABCNews' "World News Tonight" on Friday examined the emotional aspects of egg donation for female college students -- who are the "most desirable market" for fertility clinics because of their age and education -- and the opinions among former egg donors about whether the experience was positive or negative. According to Debora Spar -- a professor at Harvard Business School and author of the book, "The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception" -- women do not think about or are not being counseled about the emotional aspects of donating genetic material. The segment includes comments from a woman who as a college student donated her eggs four times to make money and does not regret her decision, and a woman who as a college student donated her eggs to a family member and now feels she made the wrong choice (Marquez, "World News Tonight," ABCNews, 5/19).

The complete transcript is available online. Video of the segment is available online.


"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Texas Newspapers Call For Comprehensive Sex Education To Address Teen Pregnancy

Two Texas newspapers recently published editorials and an opinion piece responding to a recent Child Trends report that ranked Texas No. 1 in the U.S. for repeat teen pregnancies. According to a recent Dallas Morning News article, despite Texas' high teen pregnancy rate, the state has some of the most restrictive policies in the nation regarding minors' access to prescription birth control. Summaries appear below.

Corpus Christi Caller-Times: The "dismal teen pregnancy rate" in the Corpus Christi area has been "well-documented," a Caller-Times editorial states, adding, "Now is not the time to cut funding for programs aimed to curtail teen pregnancies." The editorial notes that "Texas received more federal dollars than any state to support abstinence education with no money for comprehensive sex education." It adds, "That approach has been an abject failure." According to the editorial, "Insisting on abstinence for teen mothers having their second or third babies, without fact-based knowledge about condoms and other contraceptives, is public policy with blinders on" (Corpus Christi Caller-Times, 9/8).
Houston Chronicle: "We need to face the obvious: Teenagers are having sex. And some of them are having it in middle school -- with repercussions, both public and private, that will last for generations," a Chronicle editorial states. It adds that although sex education is "parents' job, of course, ... astounding numbers show that many parents need help." The editorial continues, "Our schools need to discuss sex and contraception -- and they need to start in middle school." According to the editorial, schools should teach "comprehensive sex ed" because it "helps teenagers to delay intercourse" and "makes them more likely to use condoms if they don't delay." The editorial recommends that the state Legislature pass a law next year requiring schools to provide "medically accurate" information regarding contraception, in addition to promoting abstinence. According to the editorial, "parents should be able to opt out of school sex ed for their kids," but the "default" in schools should be "straight talk about sex" (Houston Chronicle, 9/8).
Texas State Sen. Rodney Ellis/State Rep. Ellen Cohen, Houston Chronicle: "There's been virtually no impact on the reduction in teen pregnancy and births despite more than $1 billion in taxpayer funds invested in teaching young people that they should abstain from sexual relationships," Ellis (D) and Cohen (D) write in a Chronicle opinion piece. They continue, "Clearly, this single-minded approach is failing our teens and taxpayers." Ellis and Cohen write that a bill titled Education Works, which died during the committee process in the last legislative session, "was written to directly address the growing problem of teen pregnancy and births in Texas." According to Ellis and Cohen, the bill "would ensure that teens learn about abstinence, healthy relationships, positive self-image and about birth control so they can protect themselves from a pregnancy or sexually transmitted disease." They add, "The current approach is simply not working for young people, taxpayers and ultimately the state of Texas" (Ellis/Cohen, Houston Chronicle, 9/8).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.


© 2009 The Advisory Board Company. All rights reserved.

Recommendations On Women And Children's Health At G8 Summit

Governments and other organizations must intensify efforts to improve the health of women and children, particularly in the developing world where the lion's share of deaths occur, says Dr. Philip Baker, an internationally renowned medical researcher in obstetrics & gynecology. Baker is the lead author on a G8 positioning paper that included consultations with 20 of the world's leading medical experts on women and children's health.



The academies of science of Canada, France, Germany, Italy, Japan, Russia, the United Kingdom and the United States have issued a joint set of recommendations for the upcoming G8 summit on how to achieve these goals. Lead author of the position paper is Dr. Philip Baker, professor of obstetrics & gynecology and dean of the Faculty of Medicine & Dentistry at the University of Alberta in Canada.



"The health of families, communities and economies is inextricably tied to the health of women - yet every 100 seconds, a woman dies in pregnancy or childbirth somewhere in the world. Mother and child outcomes are closely linked. Reducing maternal mortality is critical and is also a priority for improving child health," the paper says.



Some of its recommendations include the following:
Governments and other organizations must increase funding and resources for maternal and child health.
Health facilities and staffing need strengthening.
Strategies to improve maternal health should facilitate access to contraception services and measures to reduce unsafe abortion.
Policies which protect women and children from all forms of abuse, injury, exploitation and violence must be promoted.
Maternal and child health research needs strengthening, especially in knowledge translation.

The summit is being hosted by Canada in June.



Source:

Jo-anne Nugent

University of Alberta

Estrogen Therapy Increases Benign Breast Disease Risk

Women who took conjugated equine estrogen, a commonly prescribed form of estrogen, had more than twice the risk of developing specific types of benign breast disease as women who took a placebo, according to a randomized controlled trial published online April 8 in the Journal of the National Cancer Institute.



The impact of conjugated equine estrogen on the risk of developing benign proliferative breast disease, a condition that is associated with increased risk of breast cancer, has been unclear. Some studies have reported an association while others have not. In the Women's Health Initiative study, 10,739 postmenopausal women with hysterectomy were assigned to either conjugated equine estrogen or a placebo. Previous analyses did not show an increase in breast cancer incidence in the women who took estrogen alone after a median follow-up of seven years.



To determine whether the hormone increases the risk of benign proliferative breast disease, Tom Rohan, M.D., Ph.D., of the Albert Einstein College of Medicine in New York and colleagues identified and examined non-cancerous breast biopsies in each of the Women's Health Initiative trial arms.



A total of 232 cases of benign proliferative breast disease were identified, with 155 cases among the women who took estrogen supplements and 77 in the placebo group. The risk of developing benign disease increased by more than two-fold for women taking conjugated equine estrogen, compared with those taking a placebo.



"The prevailing hypothesis concerning the natural history of breast cancer is that benign proliferative breast disease without atypia, proliferative disease with atypia, and in situ cancer represent successive steps preceding the development of invasive breast [cancer]. In keeping with this hypothesis, women with benign proliferative breast disease have an increased risk of subsequent breast cancer," the authors write.



Although the women taking conjugated equine estrogen have not yet shown a significant increased risk of breast cancer in the Women's Health Initiative study, if this hypothesis holds true, they might show increased risk later. Ongoing follow up of the study participants may help to resolve this issue.







The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at jnci.oxfordjournals/.



Source:

Liz Savage

Journal of the National Cancer Institute