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The American Fertility Association’s Monthly Newsletter

June 28, 2007

One At A Time, Please

The evidence is in. Well at least the first study is done confirming that IVF can be as effective with a single embryo transfer as it can with multiple embryos.

In fact, the evidence gathered by a team of British doctors indicates that transferring one embryo at a time can actually slightly increase the success rate if the patients are chosen carefully and that 5-day-old embryos called blastocysts are used, The Times, the British newspaper, said.

The study results will support the growing effort to reduce the risk of multiples by limiting the number of embryos transferred. Over the last decade there has been a downward trend – from four or five to two or three. But multiples remain the biggest health problem resulting from IVF. Twins and triples are in greater jeopardy of disability, prematurity, stillbirth and early death than singletons.

Bolstered by the outcome of the study spearheaded by Yacoub Khalaf, of Guy’s Hospital, London, fertility clinics and patients should be encouraged transfer only one – if the conditions are right.

In women under 35 who produce at least four good-quality embryos, one embryo can be transferred without compromising success rates, according to the study.
The chances of an ongoing pregnancy actually climbed slightly for the clinic’s patients under 35: from 35 percent to 41 percent. Their multiple pregnancy rate was almost halved, from 37 to 19 percent, and almost all the twins were conceived by women who used two embryos. Almost 200 Guy’s patients have been treated with the technique, and there have been nearly 100 births or ongoing healthy pregnancies.

The Guy’s team is offering single blastocyst transfer to women over 35 if they produce at least three good quality embryos

Contraceptive Consensus

A startling number of Americans overwhelmingly support birth control, comprehensive sex education and family planning services, according to a poll released earlier this month.

More than 80 percent of 1,011 adults polled in May say they think birth control should be accessible, that it should be dispensed by pharmacists "without discrimination or delay," and it should be covered by health insurance, Celinda Lake, president of Lake Research Partners, which conducted the poll told The Washington Times.

Despite the visible hand-wringing by politicians about public school sex education, 88 percent of adults agreed that not only should the public schools provide such a curriculum, but that it should include information on abstinence and contraception, Lake said.

Once again, events revealed the disjunction between public sentiment and political outcome when House Appropriations subcommittee on labor, health and human services, education and related agencies voted to increase funding for the Community Based Abstinence Education program (CBAE) by $27.8 million, to $141 million. CBAE funds groups that teach youth how to be sexually abstinent but not how to use birth control.

The enormous increase came just weeks after a scathing report commissioned by Congress found that abstinence-only education had zero effect on teen sexual behavior. Indeed reproductive health care advocates fumed that such programs exposed teens to even greater risks of STDs and unwanted pregnancies because they were uninformed about safe sex and were reluctant to come forward to get the health care they need.

Gotta Get Testosterone’d

Men over 50 have a new imperative to exercise – boost testosterone to help dodge early death. A longitudinal study of 800 post-50 men, found those with low levels of the quintessentially male hormone had a 33% increased risk of death over an 18-year period than their high-level peers.

Levels of testosterone were classified as low if they were at the lower limit of the normal range for young adult men.

Testosterone levels drop with age but there is wide variation. In the study, 29% of the men had low levels of the hormone. Moreover, the higher risk of death in men with low testosterone levels could not be explained by smoking, drinking, physical activity level or pre-existing diseases such as diabetes or heart disease.

But study author Dr. Gail Laughlin, assistant professor in the Department of Family and Preventive Medicine at the University of California, San Diego found that that men with lower testosterone levels were three times more likely to have “metabolic syndrome,” a group of factors associated with cardiovascular disease and diabetes. These include waist measurement in excess of 40 inches, high levels of cholesterol, high blood pressure and high blood sugar.

Exercising not only helps control “metabolic sydrome,” but does boost testosterone levels. Supplements, while appealing, have unwanted side effects and are not recommended.

Fueling Baby’s Brain

The sample group is small and the results are sketchy. So far. But a new findings, published in the American Journal of Clinical Nutrition, suggest that women who get adequate DHA (one of the Omega-3 fatty acids) during pregnancy may actually be firing up their infants' cognitive abilities.

Researchers found that 9-month-olds whose mothers had eaten DHA-fortified bars during pregnancy performed better on a test of problem-solving abilities than infants whose mothers had not added DHA to their diets.

The study included 29 women in their 24th week of pregnancy. Half were randomly assigned to eat a cereal bar supplemented with 300 mg of DHA from fish oil, while the rest were given a bar with added corn oil to serve as a comparison. On average, the women ate five bars per week.

Their babies underwent standard tests of infant problem-solving and memory at the age of 9 months. The problem-solving task tested the infants' ability to retrieve a toy that was covered by a cloth.

In general, the researchers found, babies in the DHA group performed better on the test than those in the comparison group. There was no difference between the two groups on the memory test.

Just something to think about.

MOST FERTILTIY PATIENTS WOULD DONATE SURPLUS EMBRYOS TO STEM CELL RESEARCH; BUSH VETOS LEGISLATION TO MAKE THAT POSSIBLE

Just as President Bush wielded his veto power to knock down expanded federal funding for stem cell research, a new study revealed that the majority of fertility patients would likely donate their unused embryos for just such research. If such an option were available.

The just-published findings of the joint Duke University Medical Center-Johns Hopkins University survey of more than 1,000 fertility patients, mirrors The American Fertility Assocation’s own observations about attitudes among its members. In large measure and for a variety of reasons, the frozen embryos that were created after painful battles against reproductive disorders, will not be used for family building. For many couples, donating them to research is a life-affirming choice that allows for closure.

The survey found that 49 percent of those who responded indicated that they were likely to donate some or all of their excess embryos to research in general. That number increased to about 60 percent when the question targeted stem cell research in particular, focusing on research aimed at developing treatments for human disease or for infertility.

According to the study, the other alternatives for embryo disposition – including donation to another infertile couple or thawing without intent to transfer, were far less preferable than donation to research.

The implications of the study for research are vast. It suggests that the number of embryos potentially available for stem cell research may be 10 times higher than previous estimates, resulting in a potential 100-fold increase in the number of stem cell lines -- groups of stem cells derived from a single source -- available for federally funded research.

In vetoing the measure, “We’re concerned that federal policy fails to consider the preferences of the majority of our members and most Americans,” according to Pamela Madsen, The AFA executive director. “The veto establishes a fundamental roadblock, preventing people from doing what they may consider is the right thing. It is an egregious incursion by the government into the private realm of personal choice and individual freedom.”

UNITED HEALTHCARE MEMBER ALERT:
CHANGE IN PRESCRIPTION FULFILLMENT BENEFIT

Moving to the next phase of a plan to manage fertility medication dispensing, United Healthcare (UNH) will begin directing the thousands of fertility patients covered by the insurance-managed care goliath, to get their meds from mail order specialist, Freedom Fertility Pharmacy.

UNH members who are used to filling prescriptions through local or neighborhood pharmacies should speak to their physicians about any changes they may need to make to their routine when shifting to the mail order model.

United Healthcare’s members will retain the option of going to their local pharmacy but at a price. A hefty one.

In a letter giving the heads up to doctors, UNH explained, that beginning July 1, their members who participate in the UNH specialty pharmacy program will get notice that they should look no further than Freedom.

“ Such members who wish to fill their infertility prescription at pharmacies other than Freedom Fertility will need to pay the entire cost of the prescriptions and then file paper claims to UNH for reimbursement, “ the letter said. “Members’ out of pocket costs for infertility drugs will be higher at pharmacies other than the designated specialty pharmacy.”

It advised doctors to begin using Freedom’s order forms for medications for participants in UNH’s specialty pharmacy program asap, “to minimize disruption to your patients.”

The UNH decision raised alarms among Freedom competitors and smaller independent pharmacists who stand to lose a big chunk of business, according many specialty pharmacy owners.

Indeed, this reignites the public debate over legislation pending in the New York State legislature to create the state pharmaceutical local choice program. One goal of the legislation is to preserve the consumer option to deal with any pharmacy and receive the same levels of reimbursement from insurance companies.

In its letter, UNH said that Freedom was chosen” …based on its clinical expertise in the infertility therapeutic classes, quality of services and cost.”

The American Fertility Association, 305 Madison Avenue Suite 449, New York NY 10165.
Support Line: 888-917-3777. Fax: 718-601-7722. www.theafa.org