Archive for October, 2009
USA and International Trends in Assisted Reproductive Technology (ART)
Atlanta, GA – Data released at the American Society for Reproductive Medicine Annual Meeting in Atlanta compares ART trends in the US with those around the world. Using data collected through the International Committee Monitoring ART (ICMART), investigators examined data from 2000- 2004. They found that delivery rates in the US were stable at 31% while they improved in Europe from 16% to 22%.
The delivery rate was maintained in the US even as the number of embryos transferred declined from 3.0 to 2.7 embryos per transfer, and the US triplet rate was cut in half from 4.3% to 2.6%. Only Sweden saw a marked reduction in its twin rate over the period, going from 21.8% to only 5.6%.
The same investigators used 2004 data to examine how economic factors influence the risk and benefit calculations of patients and physicians. They found that in countries where government provides free access to Assisted Reproductive Technology (ART) treatment, the utilization rate for those treatments is much higher. For example, in France there were 2,008 cycles for every million inhabitants, while in the US there were only 357 cycles per million people. Improved access not only raises the utilization rate, but changes outcomes, as well. The number of embryos transferred per cycle and the resulting high order multiple births are highest in those countries that do not provide free access.
This relationship was seen within countries, as well. In the USA, individual states with mandatory insurance coverage for IVF treatments saw different results than states without such a mandate. Researchers at the Yale University School of Medicine found that the number of embryos transferred per cycle, cancellation rate, twin rate and multiple live birth rate were all higher in mandated states than in non-mandated ones.
“These studies make it clear that policies that promote access to infertility treatment also promote making those treatments safer and more effective,” stated Elizabeth Ginsburg, MD, President of the Society for Assisted Reproductive Technology (SART).
Contact us for more information about Assisted Reproductive Technology (ART) treatment; Doctor Andrés Juárez Villanueva and Doctor Gustavo Gallardo will be glad to help you.
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Breast Reduction May Lead to Cancer Detection in Patients
There may be some new added benefits to breast reduction surgery. Testing tissue and fat removed during the procedure may lead to increased cancer detection, reports a new study presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference, Oct. 23-27, in Seattle. Two-hundred-two cases were evaluated. Cancerous or pre-cancerous cells were found in 12.4 percent of patients. Age was significantly associated with negative pathologic findings. The rate of cancer was 6.2 percent in women 40 years or older and 7.9 percent in women 50 years or older. None of the lesions were identified on pre-operative mammograms. The authors suggest that increased testing in breast reduction patients can help to identify at-risk patients, especially in breast reduction patients over 40.
By the Numbers:
Nearly 90,000 women had breast reduction surgery in 2008, up 5 percent since 2000, reports the ASPS.
Source: American Society of Plastic Surgeons (ASPS)
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Plastic Surgery 2009 news briefs
Cleavage Rejuvenation, Do-It-Yourself Lasers, Botox® Breast Lift – Hype or Reality?
Whether their effectiveness is fact or fiction, less invasive cosmetic procedures such as cleavage rejuvenation, do-it-yourself (DIY) cosmetic therapies, and using Botox® to “lift” the breasts are making headlines, but are they safe? Plastic surgeons will discuss if these, and more, are cutting edge new discoveries or just “buyer beware” marketing hype at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference, Oct. 23 – 27, in Seattle. Cleavage rejuvenation involves injecting a non-allergenic filler into the cleavage to alleviate wrinkles. DYI cosmetic therapies include hair removal devices, lasers, even fillers that some patients are ordering off the Internet. With a Botox Breast Lift, the toxin is injected into the chest muscles, temporarily paralyzing them, and causing the back muscles to compensate. The patient, in turn, is forced to standup straighter, thereby creating a lifted appearance in the breasts. Plastic surgeons are concerned that these may be some of the procedures consumers are turning to in the weak economy. A new procedure called Awake-Breast Augmentation, where the patient is awake during surgery and gives feedback regarding her preferred size of implant, will be examined. Additionally, the latest information on cosmetic gynecology, laser liposuction, cellulite, new fillers such as Selphyl (being touted as a new blood-based injectable), and more will be discussed.
By the Numbers:
* More than 10.4 million cosmetic minimally-invasive procedures were performed in 2008, according to the ASPS.
* Laser hair removal (1 million procedures) was among the top 5 minimally-invasive procedures and more than 400,000 patients had laser skin resurfacing in 2008.
* Cosmetic breast procedures totaled nearly 400,000 procedures last year.
Source: American Society of Plastic Surgeons
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IVF Kids Are Healthy, Smart and Well-Behaved
Atlanta, GA – Research presented at ASRM’s 65th Annual Meeting addressed questions about how Assisted Reproductive Technology (ART) might affect the development of the children who result.
Surveying parents, University of Pennsylvania researchers found that children conceived with In Vitro Fertilization (IVF) showed the same number of abnormal childhood behaviors as children conceived without IVF as measured by a validated behavioral assessment instrument. Women who delivered a child at the University of Pennsylvania Hospital between 2000 and 2005 were invited to answer a questionnaire and the Child Behavior Checklist. In total, those who responded had 105 IVF-conceived children and 108 control children. The groups were not different with respect to child age, pregnancy complications, birth weight, gestational age or maternal education. There were statistically significant differences in parental age and family size that are not clinically significant. There were no significant differences between the groups in the prevalence of individual behavioral symptoms. The prevalence of any behavioral symptom was similar between children conceived with (10.5%) and without IVF (10.2%).
In the largest report on achievement test performance of IVF-conceived children to date, researchers from the University of Iowa used scores from the Iowa Tests of Basic Skills (ITBS) to compare achievement test performance of singletons, twins and triplet children conceived through IVF. The IVF database at the University of Iowa Hospital Center was mined for cycles resulting in children presently between eight and 17 years old. Questionnaires on the childrens’ health and education and parents’ education were mailed to parents and 295 couples having 462 children agreed to participate. Of the children, 49% were singletons; 40% were twins and 11% were triplets. Third grade ITBS scores were used to compare the performance of singletons, twins and triplets. Although multiple gestation appears to have a slight detrimental effect on standardized test performance, the overall scores were high and the differences between singletons, twins and triplets were small.
Parents’ infertility influences birthweight and size whether their children are conceived through IVF or spontaneously. Although research suggests that babies born as a result of IVF are smaller and have more adverse outcomes than spontaneously conceived children, the underlying health of the parents may play a role in their offspring’s health regardless of the mode of conception. In a retrospective study, researchers at the University of Washington School of Medicine analyzed data from patients receiving an infertility diagnosis who had a live singleton birth at the hospital between 1999 and 2009. Well-dated spontaneous conceptions were analyzed along with pregnancies from ovulation induction (OI) and from fresh, non-donor IVF cycles. They found that the ART-conceived babies were larger in early gestation than OI and spontaneously conceived babies yet in mid-gestation, ART babies were smaller than spontaneously-conceived and equal in size to OI babies. By the time of delivery, OI conceived babies were smaller than babies conceived spontaneously or through ART. Ultimately, singleton IVF babies were not smaller compared to singletons born to spontaneously conceiving infertility patients.
Elizabeth Ginsburg, MD, President of SART, remarked, “The health and development of children born through ART has always been of great concern. While further study is needed on the ways parents’ underlying conditions and fertility treatments may affect children’s development, we can be reassured that overall, ART children appear to be healthy.”
In vitro maturation (IVM) of eggs is a developing technique which allows IVF to be done without ovarian stimulation. Because data are limited on the outcomes for children born from this treatment, French researchers have embarked on an ongoing prospective observational study.
Thirty-five children born from 32 IVM pregnancies were included in the group and compared to IVF/ Intracytoplasmic Sperm Injection (ICSI) children matched for maternal age, gestational age and singleton or twin birth. Children were clinically examined at one year of age. The researchers found that at one year of age, children resulting from IVM procedures do not differ significantly in developmental or clinical respects from children conceived using IVF/ICSI.
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Fertility Preservation Decision Making in Cancer Patients
Atlanta, GA – New research presented at the American Society for Reproductive Medicine today highlighted the obstacles facing patients as they make decisions about preserving their reproductive options.
Investigators from Brown University used focus groups to explore the feelings of breast cancer patients about fertility preservation. They found that four main themes emerged for these patients:
1) costs, including time, money and emotional costs,
2) safety of the patient and any offspring,
3) prospects for successful treatment, and
4) having sufficient time to process information about fertility preservation.
Researchers at New York University used a more quantitative methodology to examine similar questions. They enrolled 16 patients in a registry, 11 of whom sought fertility preservation treatments. They found 10 of the 16 felt having a child was the most important thing in their lives. Eleven of them were concerned about the impact of their cancer treatment on their fertility. And 11 were unsure about the level of risks they would undertake to achieve their reproductive goals.
Physicians and nurses have important roles to play in counseling cancer patients about their reproductive options. A team from New York examined the current perceptions and practices of oncology nurses. Using an on-line survey, they found that nurses who were knowledgeable about fertility preservation were more than twice as likely to discus the impact of cancer treatments with their patients. More than 90% of the nurses reported that having guidelines would facilitate better discussion of reproductive issues with their patients.
Physicians’ attitudes about the potential for posthumous parenting were explored by a team from Tampa, Florida. They found a slim majority (50.5%) reported not having a view about posthumous parenting, and only 13% supported it. However, less than a quarter (22.8%) agreed with the statement “Patients with poor prognosis should not pursue fertility preservation.”
“As fertility preservation options for cancer patients continue to improve, the demands for quality information sharing between patients and their doctors and nurses must continue to improve, as well,” said R. Dale McClure, MD, President of the American Society for Reproductive Medicine.
For more information about Assisted Reproductive Technology do not hesitate to contact us.
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Reproductive Health Findings for Bariatric Patients: Obesity at Young Age Increases Likelihood of Infertility and Polycystic Ovarian Syndrome; Chances of Pregnancy and Live Birth Are Good
In an observational study of the reproductive health of women undergoing bariatric surgery, researchers analyzed data from 1,538 patients treated at six US clinical sites participating in the Longitudinal Assessment of Bariatric Surgery (LABS) study, supported by the National Institutes of Health.
The participants were measured for height and weight and answered questions about their sexual history, pregnancy history, infertility history, history of polycystic ovarian syndrome (PCOS), history of contraceptive use, and plans for future pregnancy. The participants also completed a validated self-administered weight history, giving their weights at 18, 25 and 30 years.
The researchers found that women who became obese by age 18 were more likely to have a history of infertility and polycystic ovarian syndrome and less likely to become pregnant than women who became obese later in life. However, the overall percentages of LABS-2 participants who had at least one pregnancy (79%) and at least one live birth (74%) were comparable to the general US population.
While about half of the women surveyed between ages 18 and 44 and not reporting menopause, sterilization, partner sterilization, or other impediments to pregnancy said that they would never try to become pregnant after bariatric surgery, 30% of women in this category thought the possibility of future pregnancy was very important. Of those women, almost 33% planned to get pregnant within two years of having bariatric surgery.
“As the incidence of obesity increases in the United States, women’s health care practitioners are likely to care for a substantial number of patients who will undergo bariatric surgery. Studies like this one are extremely useful to help us determine how to advise these patients and best meet their needs,” remarked William Gibbons, MD, President-Elect of the American Society for Reproductive Medicine.
For more information about bariatric surgery and Assisted Reproductive Technology do not hesitate to contact us.
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Cosmetic eyelid surgery can boost quality of life for patients
New research released at world’s largest ENT meeting
San Diego, CA – Cosmetic surgery that repairs droopy eyelids, also known as blepharoplasty, has an overall positive impact on patients’ quality of life (QOL).
In a paper presented at the 2009 American Academy of Otolaryngology – Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO in San Diego, researchers administered a retrospective questionnaire survey of 26 adult patients undergoing bilateral upper and lower lid cosmetic blepharoplasty. The authors used the Glasgow Benefit Inventory (GBI), which is a validated QOL questionnaire that aims to assess the impact of an otolaryngologic intervention on a patient. Patients undergoing surgery for non-cosmetic indications, or those who had additional cosmetic procedures performed, were excluded.
Before and After Blepharoplasty Procedure
Blepharoplasty (BLEF-uh-ro-plas-te) is surgery to repair droopy eyelids by removing excess skin, muscle and fat. Eyelids stretch and lose elasticity as people age. As a result, excess fat may gather above and below the eyelids, causing sagging eyebrows, drooping upper lids and bags under your eyes. Besides making patients look older, severely sagging skin around the eyes can also impair vision.
Results of the questionnaire indicated that the procedure had a positive impact on QOL for almost all the outcome measures used in the GBI. The authors noted that most patients who undergo a blepharoplasty procedure do so to feel better about their appearance and improve their self esteem. They note that this study is the first to confirm that patients do receive the QOL benefits that they are hoping to achieve with the plastic surgery.
For more information about having a blepharoplasty abroad do not hesitate to contact us.
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Nose job recipients may want to consider chin augmentation as well
San Diego, CA – In order to ensure an aesthetically-balanced face, surgeons performing rhinoplasty should also assess the patient’s need for chin augmentation, according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA. In fact, the research suggests that the focus on what complications may arise has changed.
The chin and nose form an important part of a patient’s profile, and according to the authors, not addressing it could contribute to post operative disappointment with the rhinoplasty.
The study’s authors evaluated pictures of their institution’s 100 most recent patients to undergo rhinoplasty, using four popular assessment methods (Silver, Legan, Merriford, and Gonzales-Ulloa). Based on these evaluations, between 17 and 62 percent of men, and 39 and 81 percent of women could have benefitted from further assessment with a view to chin augmentation. Twenty-one percent of men scored positive on three or more methods, 58 percent for women.
The authors contend that while the “perfect face” is a misnomer, balanced features are nonetheless valued in all cultures, and reflect substantially a patient’s physical impression on others. In cases where surgical modifications are made, the authors believe the surgeon has a responsibility to inform their patients of the impact the procedure will have on their overall look prior to the surgery.
For more information about plastic surgery procedures do not hesitate to contact us.
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