VIAGRA Info

A squeeze on finances is now playing a key role in many couples’ decisions about fertility treatments, including whether they will try to conceive using assisted reproductive technology or whether they will discard leftover embryos put into storage, new studies show.

Among the new findings, presented this week at the annual meeting of the American Society for Reproductive Medicine in Atlanta:
More than half (58 percent) of couples diagnosed as infertile who opted not to pursue treatment said cost was the primary reason;
About 7 percent of couples who had leftover embryos in cold storage discarded the embryos from October 2008 to March 2009, a number that was almost three times higher than six months prior;
About 57 percent of young women who donated eggs to infertile couples in 2008 now say they planned to use the money to pay for school, up from 28 percent in 2002-2004.

Given the high cost of fertility treatments, which are often not covered by insurance, experts said they weren’t surprised by the findings. A single cycle of in vitro fertilization (IVF) costs about $12,000, and several cycles may be needed, according to the ASRM.

Yet some fertility experts said they were hesitant to blame the recession on the new numbers. Dr. Peter McGovern, director of the division of reproductive endocrinology and infertility at Hackensack University Medical Center, said his practice is as busy as ever.

“We’re not seeing much of a difference, quite honestly, compared to better times,” McGovern said. “It could be that the drive to reproduce is so important people are somehow making it happen.”

In one study, researchers followed 448 infertile couples from eight fertility clinics for 18 months. Of those, about 27 percent decided not to pursue treatments including in vitro fertilization, in which the egg and sperm are joined outside the womb and then the embryo is placed back into the mother.

About 58 percent of these couples said the primary reason to discontinue treatments was money, 38 percent cited life conflicts such as moving or a death in the family, and 26 percent cited medical futility.

Depression and increasing age also made it less likely a couple would pursue treatment, while those with a college education and higher incomes were more likely to go through with it.

“It’s financially challenging for some patients to pursue fertility treatments,” said Andrew La Barbera, scientific director of the American Society for Reproductive Medicine. “In most states insurance coverage for assisted reproductive technology [ART] is not mandated. Most patients have to pay for ART procedures themselves and it’s not easy.”

Financial stress linked to a worsening economy may be prompting more couples to dispose of leftover embryos being kept in cold storage, a second study found.

Researchers found that between October 2008 and March 2009, about 7 percent of couples discarded frozen embryos, compared to rates between 4.3 percent and 2.3 percent in the two years prior.

Fees to store embryos at minus 310 degrees Fahrenheit can cost several hundred dollars a year. For many couples, deciding what to do with unused embryos is a difficult ethical and emotional decision. The researchers concluded that “extreme economic conditions have forced patients to address an issue they have historically chosen to postpone when financially viable.”

The economic downturn may even be affecting the decisions of egg donors, who are paid between $4,000 to $10,000 to donate eggs to infertile women undergoing IVF.

In another study presented at the ASRM meeting, researchers found little change over the past few years in prospective egg donors’ average age, education level and marital status. However, they did find a change in what donors planned on doing with the money.

Researchers at Reproductive Medicine Associates of New York and Mount Sinai School of Medicine in New York City compared the screening interview records of 54 women who sought to donate eggs between 2002 and 2004 against the records of 46 women who sought to donate eggs in 2008.

About 57 percent of the women said they planned to use the money for schooling in 2008, compared to 28 percent in 2002-2004. Yet fewer said they planned to pay down debt or save the money in 2008 than in the earlier period.

Despite a difficult economic climate, many women who donate eggs do it for reasons beyond the money, McGovern reasoned. Donating eggs requires substantial time, effort and discomfort, including physical and psychological screenings, daily injections of fertility drugs that can cause side-effects including headache, cramping and bloating, multiple trips to the clinic, ultrasounds and blood tests.

“Egg donors don’t tend to be very mercenary,” McGovern said. “I find them to be a very generous group. It’s a lot of work, not like being a sperm donor.”

The outcomes of a twin pregnancy — including the infants’ size and delivery date — might be affected by whether a woman is carrying boys or girls.

Sharing the womb with a female produces better results, in terms of birth weight and other factors, than sharing it with a male, whether the other twin is male or female, according to researchers from the Helen Schneider Hospital for Women and the Sackler School of Medicine at Tel Aviv University in Israel.

“A male fetus affects his co-twin negatively, probably due to the interfetal transport of substances, mainly hormones,” said Dr. Marek Glezerman, a university professor and chairman of the hospital’s obstetrics and gynecology department and a co-author of the study.

But a U.S.-based expert who reviewed the study calls it interesting but no cause to change the way pregnant women are followed during their pregnancies, regardless of whether they are carrying two girls, two boys or one of each.

“I don’t think it translates to changes in clinical practice,” said Dr. Steven Ory, a past president of the American Society for Reproductive Medicine and a fertility specialist in Margate, Fla.

The study is published in the November issue of Obstetrics & Gynecology.

The researchers evaluated 2,704 twin pregnancies, looking only at twins within separate placentas born from 1995 through 2006. Previous studies had not differentiated between twins with common or separate placentas, Glezerman said, and this could have blurred the effect of the fetus’s sex on the outcome of the pregnancies.

About 16 percent of the pregnancies involved female-female twins, 70 percent were male-female and 14 percent were male-male.

Preterm deliveries were most common among women carrying male-male twins, the study found. Of the male-male twins, 9.2 percent were delivered at less than 31 weeks, compared with 7.5 percent of the male-female twins and 5.5 percent of the female-female twins. Earlier studies have found a higher risk for premature delivery for a male fetus compared with a female.

In the new study, birth weight was higher, on average, for boys than girls: 4.95 pounds, compared with 4.75. But boys in the boy-boy pairs had lower average birth weights than boys in the boy-girl pairs: 4.85 pounds versus 4.99. Boys in the boy-boy pairs also had lower growth rates than boys in boy-girl pairs.

Girls in the girl-girl pairs had fewer respiratory and neurological problems than those in the girl-boy pairs.

The researchers attribute the findings to what they call a “male offending factor,” which means that the presence of a male fetus negatively affects the prospects of the co-twin in the womb, whether that co-twin is a sister or a brother.

However, the reasons for this aren’t clear. The researchers speculate that one possibility is that male fetuses who share the womb with females could be more successful in competing for nutrients because females tend to grow more slowly. As a result, a boy in a boy-girl pair might end up weighing more than one in a boy-boy pair. Hormonal influences might help explain the differences, too.

None of this should worry expectant mothers, says another U.S. expert.

“Look at this study with a grain of salt and move on,” said Dr. Abdulla Al-Khan, director of perinatal diagnostics and therapeutics in the maternal-fetal medicine division at Hackensack University Medical Center in New Jersey. The study’s findings have not been noticeable, he said, at his hospital. They deliver more than 6,000 babies a year, including twins, he said, and women carrying twins are already followed closely to monitor the babies’ progress.

Both Al-Khan and Ory also pointed out some of the study’s limitations. It is retrospective, looking back, which they said makes it subject to bias. And, Al-Khan said, it’s not clear whether the twins were conceived spontaneously or through fertility treatments, which might have affected the results.

Since routine vaccination of infants against rotavirus started in the United States in 2006, there’s been a substantial reduction in the number of cases of rotavirus disease in children, a new government study shows.

Rotavirus is the leading cause worldwide of severe acute diarrhea in children younger than 5. Before 2006, rotavirus caused 20 to 60 deaths each year in the United States, along with 55,000 to 70,000 hospitalizations, 205,000 to 272,000 emergency department visits, and 410,000 outpatient visits among children younger than 5.

An analysis of data from a national network of sentinel laboratories showed that the 2007-2008 and 2008-2009 rotavirus seasons were both shorter and began later than pre-vaccine seasons (2000 to 2006), wrote researchers from the U.S. Centers for Disease Control and Prevention. Specifically, onset of the rotavirus season in 2007-2008 was 11 weeks later than the median for 2000 to 2006, and the number of positive test results was 64 percent lower than in the pre-vaccine seasons.

There were 15 percent more positive rotavirus test results in the 2008-2009 season than in the 2007-2008 seasons, but the number of positive test results for both seasons were substantially lower than during the 2000 to 2006 seasons, the study found.

While cases of rotavirus disease have decreased since the introduction of rotavirus vaccination, continued surveillance is needed to better understand the impact of the rotavirus vaccine, the researchers said.

Vaginal hysterectomy is the safest and most cost-effective method to remove the uterus for noncancerous reasons, according to a new Committee Opinion released today by The American College of Obstetricians and Gynecologists (ACOG) and published in the November issue of Obstetrics & Gynecology. In general, based on the medical evidence, vaginal hysterectomy is associated with better outcomes and fewer complications than either laparoscopic or abdominal hysterectomy.

Hysterectomy (removal of the uterus) is one of the most frequently performed surgical procedures in the US. Approximately 600,000 hysterectomies are performed each year. The most common reason for hysterectomy is fibroids (40.7%), followed by endometriosis (17.7%), and uterine prolapse (14.5%). Hysterectomy can be performed by several methods: via an open incision in the abdomen; through small incisions in the abdomen with the aid of a laparoscope; or through a small incision in the vagina. The standard procedure to remove the uterus has been through an open incision in the abdomen, but it is more invasive and requires the longest recovery time when compared to newer techniques which generally have shorter hospital stays and a faster return to normal activity for women. However, current national data show that the standard abdominal hysterectomy method is performed in 66% of cases. Vaginal hysterectomy is performed in 22% of cases and laparoscopic hysterectomy in 12% of cases.

“Vaginal hysterectomy is better for women in terms of fewer complications and quicker recoveries compared with abdominal or laparoscopic surgery,” says Cheryl B. Iglesia, MD, of Washington Hospital Center in Washington, DC, and chair of ACOG’s Committee on Gynecologic Practice. “Vaginal hysterectomy also is the most cost-effective method.”

Although vaginal hysterectomy is the approach of choice, it’s not always feasible in every situation. “The paramount concern is that we provide the safest procedure for our patients. That being said, based on the national data, it’s pretty clear that more hysterectomies in the US could be performed using the less invasive vaginal approach than are currently being done,” says Dr. Iglesia.

Physicians should consider which surgical procedure is safest and the most cost-effective to meet the needs of each patient undergoing hysterectomy, according to ACOG. A number of factors may influence the route of hysterectomy, including the size and shape of the vagina and uterus; accessibility to the uterus; surgeon training and experience; extent of disease; available hospital technology, devices, and support; and the preference of the informed patient.