For women seeking pregnancy by assisted reproductive technologies, such as in-vitro fertilization (IVF), a new study shows that the health of the uterus is more relevant than egg quality for a newborn to achieve normal birth weight and full gestation. This study, published in Fertility and Sterility, an international journal for obstetricians, offers new information for women with infertility diagnoses considering options for conceiving.
The study was conducted by Dr. William Gibbons, director of The Family Fertility Program at Texas Children's Hospital and professor of obstetrics and gynecology at Baylor College of Medicine, along with colleagues at the Society for Assisted Reproductive Technologies (SART) Marcelle Cedars, MD and Roberta Ness, MD. They reviewed three years of data that compared average birth weight and gestational time for single births born as a result of standard IVF, IVF with donor eggs and IVF with a surrogate. While the ability to achieve a pregnancy is tied to egg/embryo quality, the obstetrical outcomes of birth weight and length of pregnancy are more significantly tied to the uterine environment that is affected by the reason the woman is infertile.
There were more than 300,000 IVF cycles during the time of the study producing more than 70,000 singleton pregnancies.
"This is the first time that a study demonstrated that the health of a women's uterus is a key determinant for a fetus to obtain normal birth weight and normal length of gestation," said Dr. Gibbons. "While obvious issues of uterine fibroids or conditions that alter the shape of the uterus are suspected to affect pregnancy rates, conditions that result in poorer ovarian function to the point of needing donor eggs are not known. Further research is needed to fully understand this complex issue."
As assisted reproductive technologies (ART) in the U.S. mature, increasing attention is directed not just to pregnancy rates but also to the obstetrical outcomes of those resulting pregnancies – meaning the newborn's birth weight, health and gestational age. Currently, about one percent of U.S. births are the result of ART therapies such as IVF, donor eggs, intracytoplasmic sperm injection, embryo cryopreservation, embryo donation, preimplanation genetic diagnosis, and male infertility surgery and medical therapy.
The study explored several scenarios and found that the birth weight associated with standard IVF – in which the patient carried the embryo created with her own egg – was greater than that associated with donor egg cycles, and less than that in gestational carrier cycles. This finding held true even when other factors were considered showing that the woman's own uterus may be a determining factor.
Gibbons said the study also determined that a diagnosis of male infertility did not affect birth weight or gestational age, yet every female infertility diagnosis was associated with lower birth weight and a reduced gestational age.
Patients diagnosed with a uterine health issue, such as fibroids or other factors, had babies with the lowest birth weights and gestational ages. This led the researchers to examine the uterine environment as it relates to the type of therapy being considered.
Gibbons explains that in standard IVF, an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while in donor egg IVF and gestational carrier IVF, the embryo is transferred to a "natural" or unstimulated uterus. Then, the researchers looked at IVF utilizing frozen embryo transfer in which an embryo created with a patient's own egg is transferred to her own unstimulated uterus. They found that babies born of frozen embryo transfer cycles had markedly greater birth weights than those born as a result of standard IVF.
"That finding may help women seeking pregnancy and their physicians to consider frozen embryo transfer as a possible option if the uterine health is not a consideration," said Gibbons. "This study shows us how so many factors are related to a successful outcome and we continue to learn where further research may be needed."
Friday, February 18, 2011
Thursday, February 17, 2011
This Is Not a Lost Scene From Aliens
When I first came across this image on the right, I thought it was from a lost Aliens scene. But it is real. That's Staff Sgt. Sarah Mrak, from the 4th Special Operations Squadron. And she's inside a U.S. Air Force AC-130U aerial gunship.
Yes, an flying gunship. With real cannons. Motherbloodydancing 25mm, 40mm and 105mm side firing cannons, designed to destroy targets on the ground from the air. These planes were developed from the C-130 Hercules, evolving through numerous variants since their inception in the late 60s. The latest model—which appears in these images—is the AC-130U, which was originally introduced in 1995 for close air support, air interdiction and armed reconnaissance. One scary flying beast indeed.
U.S. Air Force photo by Master Sgt. Jeremy T. Lock
by Jesus Diaz
Wednesday, February 16, 2011
Wi-Fi Medicine
Researchers in Boston have developed a system that has taken drug delivery to a whole new level: wireless. The system works with a small, stamp-sized chip implanted into the body. This chip contains 100 reservoirs of medicine that are released at different intervals depending on need. The chip can be monitored and controlled wirelessly. Forgetting to take your daily pills would never be an issue.
The system has been used successfully in dogs for the past six months and MicroCHIPS Inc. is saying that it should begin human testing within five years.
Medicines can't work effectively if patients don't follow their dosing schedule — a problem researchers hope to overcome by delivering drugs using an implanted microchip linked to a wireless control outside the body.
Researchers for MicroCHIPS Inc. say they've successfully controlled drug doses for up to six months in dogs that received implants in an experiment. Inside the implants were postage stamp-sized microchips containing 100 tiny reservoirs of medicine released at different intervals and amounts.
The privately held company says its first test in humans is likely three to five years away and could involve implanted sensors that would monitor a patient's circulatory system or blood glucose to manage heart disease or diabetes.
A system to release drugs in solid, liquid or gel form could come later, perhaps initially involving a medicine that isn't easily absorbed into the bloodstream when taken orally, said John Santini, president of Bedford-based MicroCHIPS.
The tests, which follow more than a decade of work by MicroCHIPS with help from two professors at the Massachusetts Institute of Technology, were reported Monday in the online edition of Nature Biotechnology.
Other internal drug-delivery methods already are on the market, from insulin pumps to so-called "passive" drug implants that can't be externally controlled.
MicroCHIPS' system is far smaller than insulin pumps — its experimental implant is about the size of a small cookie, and comparable in size to an implantable heart defibrillator. The system also is unique because it uses a wireless device that potentially could control the release of multiple drugs from a single implant in the abdomen, while also monitoring drug levels and adjusting dosing accordingly, Santini said.
The experimental method shows great promise, said Dr. Henry Brem, a Johns Hopkins University neurosurgeon who has experimented with MicroCHIPS-developed chips in government-sponsored research to treat brain tumors in rats.
"It will allow not only targeted therapy, but make the treatment delivery independent of people remembering to take their medicine," said Brem, who said he has no commercial ties to MicroCHIPS.
Tuesday, February 15, 2011
Monday, February 14, 2011
Exoskeleton Helps Paralyzed Man Walk For First Time In Twenty Years
One of the coolest realms of technology currently transitioning from sci-fi to practical is that of exoskeletons. Above is an astonishing video of one such device in action, a medical model that helps a quadriplegic man walk for the first time in 20 years. The exoskeletons are still in development, with the one in the video a prototype that's about to undergo US trials. If this is what an early model can do, can you imagine where we'll be in 10 years with the technology? Here's hoping the FDA finds a way to speed these through approval.
Sunday, February 13, 2011
IVF 'greed': clinics shun cheaper treatment
Private IVF clinics are resisting moves to offer cheaper treatment, which would give more Australian women a chance to conceive a child, because they are worried about their profit margins, according to one of the world's leading fertility experts.
Professor Alan Trounson, who delivered Australia's first test tube baby in 1980, said cheaper IVF was available to women overseas, including a method being trialled in Africa for less than $300 a cycle, plus labour costs. While the method would be more expensive here because of the high price of labour, it could still be provided at a fraction of the price private clinics now charged for their treatments, he said.
Medicare covers about 80 per cent of standard treatment fees but out-of-pocket costs can range from $1000 to $3000 per IVF cycle, making it too expensive for many couples.
Professor Trounson, founder of The Low Cost IVF Foundation, said the low-tech method, which he piloted, was as effective as treatments used now in Australia and should be made available to all women - particularly those in developing countries and on low incomes.
But he said a widespread rollout would be scuppered by those with commercial interests at all stages of the IVF process. ''This should be about freedom of choice, but everywhere you go there's entrenchment,'' Professor Trounson said from San Francisco, where he is president of the California Institute for Regenerative Medicine. ''We've got under-resourced populations that can't access IVF, and the ethics committees say 'well, they shouldn't get a lesser treatment', but that's not a reasoned argument.
''Clinicians who work in this area make an awful lot of money and they have an interest in keeping it that way.''
IVF is an increasingly common procedure in Australia, with more than 85,000 babies born since the technology was introduced. There is a growing global push for low-cost or ''minimally invasive'' IVF amid concerns increasingly expensive drugs and refined technology are making fertility treatment the preserve of the wealthy.
Professor Trounson's low-tech procedure strips treatment back to its early days, with basic equipment and oral drugs that are cheaper and have fewer side effects than hormone injections used in conventional treatment, meaning fewer blood tests and ultrasounds are required.
The drugs stimulate the body to produce one or two eggs per cycle, with a 12 per cent pregnancy rate, compared with 10 to 12 eggs per cycle and a 30 to 35 per cent success rate with conventional IVF. Fertility doctors are divided on its efficacy, with critics saying it is unethical to offer women a ''substandard'' treatment that has a lower pregnancy rate per cycle.
But supporters argue that over several IVF cycles the success rate is comparable. This is because the low-cost method is less gruelling, allowing patients to start another cycle within a month rather than having to delay their next attempt.
The method has been delivered in pilot form in Sudan, Namibia and South Africa for less than $300 a cycle. Some countries, including Japan, are already offering women a low-cost option. Women in Britain can access publicly funded IVF through the National Health Service.
In Australia, a few public hospitals do offer discount IVF but the waiting lists are long.
But Geoff Driscoll, founder of IVF Australia, who left the organisation in 2002, said prices would remain high here as there was no competition between the private equity groups that now owned the major clinics.
''The commercialisation of IVF is a potent disincentive to deliver the product cheaper,'' said Professor Driscoll, who is director of reproductive medicine at the University of New South Wales and is on the scientific board of the Low Cost IVF Foundation.
He said pharmaceutical companies were pushing the most expensive drugs. ''It gets back to the the philosophy of offering [IVF] to the masses. Not everyone needs caviar. Many people can get by with rice.''
Gab Kovacs, international medical director with private clinic Monash IVF, argued that Australian treatment was relatively affordable. Optimal treatment incurred costs for services including nurses, embryologists, doctors, counsellors, laboratory work and blood tests which might not be available with a low-cost model.
''It's not up to the IVF units to look after people who can't afford it, it's up to the government,'' Professor Kovacs said.
''This is not a medical decision, it's a social decision, and our politicians have to decide whether IVF is something that should be made available to poor people free of charge.''
Jill Stark
February 13, 2011
Professor Alan Trounson, who delivered Australia's first test tube baby in 1980, said cheaper IVF was available to women overseas, including a method being trialled in Africa for less than $300 a cycle, plus labour costs. While the method would be more expensive here because of the high price of labour, it could still be provided at a fraction of the price private clinics now charged for their treatments, he said.
Medicare covers about 80 per cent of standard treatment fees but out-of-pocket costs can range from $1000 to $3000 per IVF cycle, making it too expensive for many couples.
Professor Trounson, founder of The Low Cost IVF Foundation, said the low-tech method, which he piloted, was as effective as treatments used now in Australia and should be made available to all women - particularly those in developing countries and on low incomes.
But he said a widespread rollout would be scuppered by those with commercial interests at all stages of the IVF process. ''This should be about freedom of choice, but everywhere you go there's entrenchment,'' Professor Trounson said from San Francisco, where he is president of the California Institute for Regenerative Medicine. ''We've got under-resourced populations that can't access IVF, and the ethics committees say 'well, they shouldn't get a lesser treatment', but that's not a reasoned argument.
''Clinicians who work in this area make an awful lot of money and they have an interest in keeping it that way.''
IVF is an increasingly common procedure in Australia, with more than 85,000 babies born since the technology was introduced. There is a growing global push for low-cost or ''minimally invasive'' IVF amid concerns increasingly expensive drugs and refined technology are making fertility treatment the preserve of the wealthy.
Professor Trounson's low-tech procedure strips treatment back to its early days, with basic equipment and oral drugs that are cheaper and have fewer side effects than hormone injections used in conventional treatment, meaning fewer blood tests and ultrasounds are required.
The drugs stimulate the body to produce one or two eggs per cycle, with a 12 per cent pregnancy rate, compared with 10 to 12 eggs per cycle and a 30 to 35 per cent success rate with conventional IVF. Fertility doctors are divided on its efficacy, with critics saying it is unethical to offer women a ''substandard'' treatment that has a lower pregnancy rate per cycle.
But supporters argue that over several IVF cycles the success rate is comparable. This is because the low-cost method is less gruelling, allowing patients to start another cycle within a month rather than having to delay their next attempt.
The method has been delivered in pilot form in Sudan, Namibia and South Africa for less than $300 a cycle. Some countries, including Japan, are already offering women a low-cost option. Women in Britain can access publicly funded IVF through the National Health Service.
In Australia, a few public hospitals do offer discount IVF but the waiting lists are long.
But Geoff Driscoll, founder of IVF Australia, who left the organisation in 2002, said prices would remain high here as there was no competition between the private equity groups that now owned the major clinics.
''The commercialisation of IVF is a potent disincentive to deliver the product cheaper,'' said Professor Driscoll, who is director of reproductive medicine at the University of New South Wales and is on the scientific board of the Low Cost IVF Foundation.
He said pharmaceutical companies were pushing the most expensive drugs. ''It gets back to the the philosophy of offering [IVF] to the masses. Not everyone needs caviar. Many people can get by with rice.''
Gab Kovacs, international medical director with private clinic Monash IVF, argued that Australian treatment was relatively affordable. Optimal treatment incurred costs for services including nurses, embryologists, doctors, counsellors, laboratory work and blood tests which might not be available with a low-cost model.
''It's not up to the IVF units to look after people who can't afford it, it's up to the government,'' Professor Kovacs said.
''This is not a medical decision, it's a social decision, and our politicians have to decide whether IVF is something that should be made available to poor people free of charge.''
Jill Stark
February 13, 2011
Saturday, February 12, 2011
Appendix removed through vagina
On March 26, 2008, surgeons at UC San Diego Medical Center removed an inflamed appendix through a patient’s vagina, a first in the United States. Following the 50-minute procedure, the patient, Diana Schlamadinger, reported only minor discomfort. Removal of diseased organs through the body’s natural openings offers patients a rapid recovery, minimal pain, and no scarring.
The procedure, called Natural Orifice Translumenal Endoscopic Surgery (NOTES), involves passing surgical instruments through a natural orifice, such as the mouth or vagina, to remove a diseased organ such as an appendix or gallbladder. Only one incision is made through the belly button for the purpose of inserting a two millimeter camera into the abdominal cavity so the surgeons can safely access the surgical site…
Schlamadinger, a third-year graduate student at UC San Diego working toward her Ph.D. in chemistry, reported her pain as a ’1′ or a ’0.5′ on a scale of 1 to 10, with 1 being the lowest. The opportunity to participate in the clinical trial was attractive to the scientist in her.
Subscribe to:
Posts (Atom)