A Growing Array of Options for Fibroids

Not so long ago, women typically had babies in their 20s, developed fibroids in their 30s and underwent hysterectomies in their 40s. For most, at least, that was the typical progression. But these days, as more women hold demanding jobs, many delay childbearing — and most expect more say in their health care. Hysterectomy is just one choice in a growing menu of treatments for uterine fibroids, one of the most common and least discussed of female afflictions.
Several procedures, each new one less invasive than the last, have become available in the last decade, enabling women to avoid major surgery, protect their fertility and return to work within days rather than weeks.
With myomectomy, for example, doctors cut out the fibroids but leave the uterus intact. A technique called uterine artery embolization shrinks fibroids by blocking their blood supply. And with M.R.I.-guided ultrasound, tightly focused ultrasound beams zap fibroids, using magnetic resonance imaging to guide the process.
Moreover, new medicines are in development, including a class of drugs called progesterone receptor modulators that may shrink fibroids without inducing menopause and bone loss, as existing medications do.
All the new treatments, as well as more sophisticated diagnostic techniques, are part of a growing interest in a condition long considered too unpleasant and embarrassing to talk about, even though nearly three-quarters of women are affected.
“Because fibroids are benign, we overlook the significant burden on health,” said Dr. Barbara J. Davis of Millennium Pharmaceuticals, a drug researcher who was the principal investigator for the Fibroid Growth Study, a four-year project tracking 100 women that was sponsored by the National Institutes of Health. The study is one of several reflecting increased interest in, and financing for, fibroid research in the past decade. Although the study is finished, the results are still being analyzed.
Fibroids, which are abnormal, multishaped growths of tissue and fat, appear in only one place in the body: the uterus. The tumors are almost always benign but can grow to the size of a football and cause menstrual bleeding and pelvic pain so severe that some women plan their schedules around their monthly periods. The excessive bleeding is not only disruptive but can also lead to anemia.
Depending on their size and location, fibroids can also reduce fertility by as much as 70 percent and and cause several obstetric complications, including premature birth.
Though scientists still do not know what causes fibroids, they believe the answer will not only lead to new treatments for the disease but also shed light on the origins of cancer.
“If we could understand why fibroids remain benign even though they’re so prevalent and so large, we might be able to learn something about how to stop malignant tumors,” said Cheryl Walker, a researcher at the M.D. Anderson Cancer Center in Texas. Her lab discovered fibroids in a species of rodent called the Eker rat that turned out to be remarkably similar to those found in humans.
“Mother Nature gave us a wonderful model,” said Dr. Walker, who is continuing to study the genetic makeup of the rats’ fibroids as well as their response to potential drugs.
In both Eker rats and humans, pregnancy appears to protect against fibroids. That supports one theory that modern women may be suffering more from the benign tumors than their ancestors, who spent most of their short lives either pregnant or nursing, with fewer menstrual cycles and less hormonal fluctuation to disturb the uterus.
“I call it my broken light bulb hypothesis,” said Dr. Elizabeth A. Stewart, a professor of obstetrics and gynecology at the Mayo Clinic. “If you keep flicking it on and off it will eventually blow.”
Though hysterectomy remains the only foolproof cure for fibroids, alternative treatments continue to gain popularity and surgical techniques continue to be refined. Myomectomy, for example, once required surgery to open up the abdomen. Today it can be done laparoscopically, through a small incision into the navel, or hysteroscopically, by vaginally inserting a telescope through the cervix and into the uterus.
Uterine artery embolization, originally used to treat postpartum hemorrhage, was introduced in the United States in 1997 after first being used for fibroids in France. The patient is sedated, a catheter is inserted into her groin, and tiny plastic pellets are blown in until they plug up the blood vessels feeding the fibroids. The patient is usually released after an overnight stay at the hospital, followed by a week of rest at home.
Once the fibroids are deprived of blood, they usually shrink within a few menstrual cycles. Symptoms like pain, bleeding and frequent urination ease in 85 to 95 percent of patients, said Dr. James B. Spies of Georgetown University, an interventional radiologist who has performed the procedures on thousands of patients, including Secretary of State Condoleezza Rice.
“She went back to work in something like three days, which wasn’t my recommendation, but she’s a very dynamic person,” Dr. Spies said.
In M.R.I.-guided ultrasound, the newest and least invasive of the procedures, tightly focused ultrasound waves burn up the fibroids “like a magnifying glass with the sun’s rays,” said Dr. James Segars, head of fibroid research for the National Institute of Child Health and Human Development. During the outpatient procedure, the woman lies inside an M.R.I. tube, while the images help the doctor focus high-intensity beams on her fibroids.
A big caveat to all these new treatments is that the fibroids can grow back, prompting the need for more procedures. And because the techniques are still so new, their effect on fertility, despite preserving the uterus, is not yet known.
Still, most experts agree that they represent a huge boon to millions of women who have been suffering in silence.
“This is an incredibly interesting disease,” Dr. Walker said. “It’s the elephant in the room in that it has a huge impact on women’s lives, yet you almost don’t hear it discussed because it’s not cancer.”

By LESLIE BERGER, NYT

How The Recipient Of The First Full Face Transplant Looks

This image was taken during a press conference which marked the first time Oscar appeared in public since the face transplant took place about four months ago. Prior to the transplant, the patient could only breathe and be fed through tubes, but now he has "a new nose, lips, cheekbone, lower and upper jawbone, palate, teeth, skin and muscles." As a result of those new parts, he is able to speak again—though still requires speech therapy—and is beginning to consume liquids and soft food without the aid of a tube.

Along with happiness about the success of this operation, there appear to be plenty of concerns and jokes regarding the potential dangers of full face transplants, but they're not necessary:

The 30-strong medical team, led by doctor Joan Pere Barret, was at pains to stress that Oscar's face does not look like the face of his donor, but rather is an amalgam of the two. "He absolutely does not look like the donor patient, and I think that's important for society to know. In terms of future donations of faces there is no such danger of this."

So let's not fret about an old John Travolta and Nicolas Cage movie and instead be happy that this man has been given a chance at a somewhat better life than what he had before.

Indian mega-star snapped up by Etihad Airways

One of India's most famous actresses, Katrina Kaif, has been snapped up by Etihad Airways as the airline's new brand ambassador.
Kaif will work with Etihad Airways on a series of initiatives to promote the airline across India and around the world, including addressing Indian communities in key markets such as the UAE, the United States and the United Kingdom.
Kaif has already filmed an internet video for Etihad dancing in the airline’s First class lounge in Abu Dhabi, directed by award-winning Indian film director and choreographer, Farah Khan. The video, which has been distributed online across YouTube and various social networking sites, will be used to promote the partnership between Katrina and Etihad Airways throughout the campaign.
Peter Baumgartner, Etihad Airways’ chief commercial officer, said: “Katrina represents the best of Indian cinema. By challenging the industry as a highly talented newcomer, she has successfully reached the top of her field in a very short period of time. These values ideally match Etihad’s own ambition to be the best airline in the world.”
Kaif added: “Since they first started flying, Etihad Airways has succeeded in becoming one of the biggest names in the airline industry. I have always loved flying with Etihad and I am extremely honoured to work closely with the world’s leading airline.”

Whale Snot Wins Scientist an Ig Nobel Award

The alternative Nobel Prize awards, the Ig Nobels, have been called for another year, with this particular winner making everyone laugh with an rc helicopter that collects whales' mucus and breath. A deserving winner, I think you might agree.

Dr Karina Acevedo-Whitehouse from the Zoological Society of London cleaned up in the engineering category for the helicopter, which has several petri dishes attached for collecting specimens. The other winners in the 21st Ig Nobel awards were equally strange, you'll be pleased to hear.

A Dutch man by the name of Simon Rietveld won the medicine category, for his research into the field of asthma—finding that asthma can be treated by riding on a rollercoaster. You can check out the full list of winners in the humorous science mag Annals of Improbable Research.

Fancy a cuppa? Humble cup of coffee may 'prevent IVF complication'

Researchers today suggested a life-threatening complication of fertility treatment could be prevented by a cup of coffee, after a study identified a possible cause.
In vitro fertilisation has resulted in the birth of many babies since the first 'test tube' baby in 1978.
But around 5 per cent to 10 per cent of women undergoing IVF experience a condition known as ovarian hyperstimulation syndrome (OHSS).
Although the majority of cases are mild, with symptoms including abdominal bloating, nausea and weight gain, in its most serious form it can cause blood clotting disorders, kidney damage and chest pain.
Scientists from Middlesex University and Barts and The London School of Medicine and Dentistry who analysed fluid around the human egg reported finding surprisingly high levels of the chemical adenosine.
They believe OHSS is caused when IVF drug stimulation creates high levels of adenosine, causing the blood vessels to dilate and blood fluid to leak into tissue.
The authors of the study, published in Metabolism Journal, wrote: 'Although adenosine has been detected in follicular fluid before, we were surprised at the extremely high levels detected in this study.'
They described the chemical as a 'significant contender as the molecular cause of OHSS'.
To detect adenosine in blood samples, the scientists used a technique called metabolomics, which involves the study of chemical evidence of cellular processes.
The researchers said a solution could lie in caffeine, which acts as a block to adenosine.
Ray Iles, professor of biomedical science at Middlesex University, said: 'It may be that a cup of strong coffee with every IVF cycle could reduce the chances of OHSS.
'Caffeine competes with adenosine for the same receptors, effectively blocking adenosine's action, and it could therefore potentially treat the cause of this condition.'
Further research is under way at Barts and The London Centre for Reproductive Medicine with IVF patients who have suffered OHSS to find out if caffeine could help avoid the complication

Building a Brighter Kid- Consider IVF

Most parents-in-waiting like to daydream that their unborn child might develop a cure for cancer or improve upon the theory of relativity — in short, save the world. Now, new research indicates that your best shot of birthing a brainy baby might be to first conceive via in vitro fertilization (IVF).
According to a University of Iowa (UI) study published in the October issue of the journal Human Reproduction, IVF babies scored better than age- and gender-matched peers on the Iowa Test of Basic Skills – a widely used test that evaluates students' abilities — and the Iowa Test for Educational Development (ITBS/ED), which is generally considered an objective measure of educational outcomes. Researchers found that children conceived by IVF score at least as well as their peers on academic tests at all ages from grade 3 to 12.
The study should soothe parents who are concerned about adverse effects of fertility treatments on babies' cognitive skills. Although IVF is considered safe, there isn't much in the way of long-term data on health outcomes. The Iowa study tracked children to an older age than previous research.
"Our findings are reassuring for clinicians and patients as they suggest that being conceived through IVF does not have any detrimental effects on a child's intelligence or cognitive development," says lead study author Bradley Van Voorhis, a professor of obstetrics and gynecology and director of the Center for Advanced Reproductive Care at UI Hospitals and Clinics.
Van Voorhis and his fellow researchers measured the academic performance of 423 Iowa children, ages 8 to 17, who were conceived by IVF against the performance of 372 age- and gender-matched children from the same schools. The researchers also took into account whether different characteristics of the children, parents or IVF methods had an effect on children's test scores.
The study found that IVF children scored above average on standardized tests compared to their peers. The research also linked other factors to higher test scores, namely older age of the mother, higher education levels of both parents and lower levels of divorce.
“The likelihood is this has to do with nature and not nurture,” says Robert Stillman, medical director at Shady Grove Fertility Center in Rockville, Md., which has the country's largest fertility program. “Those fortunate enough to be able to afford IVF in an arena where there's little insurance coverage may very well have the means to provide a high level of education for their children.”
Would-be parents relying on assisted reproduction techniques are sometimes concerned that using frozen rather than fresh embryos is less than ideal. After all, aren't fresh veggies better than frozen ones? Yet the Iowa study debunked that, showing that children's test scores didn't fluctuate as a result of various methods of insemination or reliance on fresh vs. frozen embryos.
Deliberating between transferring one or more embryos? You might be interested to learn that the researchers found that single babies performed better than twins, who performed better than triplets — if only every so slightly. But even the triplets performed better than the average score of children conceived the old-fashioned way.
Still, that's no reason to rush into IVF if you don't have to. Says Stillman: “This is an argument not for doing IVF to have brighter kids but for having insurance coverage so everyone can have a child if they're having trouble getting pregnant.”

Anger at IVF treatment for jailed terrorist couple

Fernando Garcia Jodra, 40, and his girlfriend Nerea Bengoa Zarisolo, 39, are hoping to become parents despite the fact that both have been condemned to minimum jail terms of 30 years after being found guilty in 2004 of four murders.

They are held in separate prisons and are not allowed physical contact, communicating only by letters, which are checked and censored. It is their right, however, under Spanish law, to apply to have IVF treatment in jail.

If the couple conceive a child it will remain with the mother in prison until it is at least 3 years old. Angeles Pedraza, the president of the Victims of Terrorism Association, said the treatment was unacceptable.

“This is a kick in the face for the victims,” she said. “How many families have been destroyed by Eta’s barbarity? The only family unity they can enjoy is to go to the cemetery to remember their dead.”

Media reports in Spain suggested that the treatment could cost as much as $8260. Prison authorities refused to comment.