Should obese, smoking and alcohol consuming women receive assisted reproduction treatment?

The European Society of Human Reproduction and Embryology (ESHRE) has published a position statement on the impact of the life style factors obesity, smoking and alcohol consumption on natural and medically assisted reproduction.

In a literature study the ESHRE Task Force on Ethics and Law summarised the negative effects of obesity, smoking and drinking on the natural reproductive potential of patients, on IVF results, pregnancy complications and outcomes and finally on the health of the future child. The paper was published online on 19 January 2010 in Europe’s leading reproductive medicine journal Human Reproduction. The group made five recommendations.

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

ESHRE acknowledged that this was a complex issue due to personal, patient, professional and societal responsibilities and also in terms of what these responsibilities meant with regard to safety of mother and child and fair and equitable access to treatment. The respect for patient autonomy needed to be balanced with the moral weight of the interests of society and the future child.

Obesity

According to the group obesity negatively affected reproductive potential through interference with hormonal and metabolic mechanisms leading to lower ovulation frequency and reduced chances of conception. The risk of gestational diabetes increased from twofold in overweight women to eightfold for morbidly obese women. The infants of obese mothers were at risk of perinatal death, congenital abnormalities such as neural tube defects (80% increase) and cardiovascular anomalies (30% increase).

Smoking

The risk of infertility was thought to be twice as high in smokers compared to non-smokers. Female smokers needed more time to become pregnant, were less likely to do so spontaneously and had a higher risk of miscarriage. Having an accelerating effect on oocyte depletion, smoking was suggested to lead to an increase in 10 years with regards to IVF outcome. Lower birth weight, a higher risk of oral facial clefts and Sudden Infant Death Syndrome were associated with maternal smoking. Male smokers were at risk of producing sperm of reduced quality and concentration.

Alcohol Consumption

Reduced conception, lower pregnancy rates and higher miscarriage rates were suggested as adverse effects of alcohol consumption. The known effects of alcohol consumption were summarised under Foetal Alcohol Spectrum Disorders (FASD) such as physical anomalies and behavioural and cognitive deficits. Other risks associated with prenatal alcohol consumption were foetal death, preterm labour and compromised foetal growth.

Please feel free to contact Sublimis for information about assisted reproduction treatments and weight loss surgery in Argentina.

Model Estimates Risks and Benefits of Bariatric Surgery for Severely Obese

Chicago — A computerized model suggests that most morbidly obese individuals would likely live longer if they had gastric bypass surgery, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. However, the best decision for individual patients varies based on factors such as age, increasing body mass index and the effectiveness of surgery.

An estimated 5.1 percent of the U.S. population is morbidly obese, often defined as having a body mass index (BMI) of 40 or higher, according to background information in the article. Available evidence suggests that dietary, behavioral and pharmacologic treatments frequently do not result in meaningful weight loss for individuals in this group. Bariatric surgery appears to be the only effective therapy for promoting clinically significant weight loss and improving obesity-related health conditions for the morbidly obese. However, the procedure is not without risk, including in-hospital death.

Daniel P. Schauer, M.D., M.Sc., of the University of Cincinnati Academic Health Center, and colleagues used two nationally representative surveys and a recent large observational trial to construct a model estimating the benefits and risks of gastric bypass surgery for individuals with morbid obesity. The model included data from almost 400,000 individuals nationwide to estimate the risk of death from obesity and its complications; data from 23,281 patients undergoing bariatric surgery to calculate in-hospital death rates following the procedures; and outcomes from participants in a seven-year study to determine the effects of surgery on survival and to calibrate and validate the model.

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Obesity linked to common form of kidney cancer and each extra BMI point increases risk

Being obese could lead to a greater risk of developing the most common form of renal cell cancer, according to research in the January issue of the UK-based urology journal BJUI.

US researchers found that obese patients with kidney tumours have 48 per cent higher odds of developing a clear-cell renal cell cancer (RCC) than patients with a body mass index (BMI) of less than 30. And the odds increase by four per cent for every extra BMI point.

The team at the Memorial Sloan-Kettering Cancer Center in New York, USA, studied 1,640 patients with kidney tumours. They found that 88 per cent had malignant tumours and 61 per cent of these were clear-cell RCCs. The remaining 12 per cent had benign tumours.

When they factored in the patient’s weight, they discovered that there was a significant association between obesity and clear-cell RCC, which accounts for up to 80 per cent of RCC cases and is one of the more lethal variants.

“Recent scientific breakthroughs about what causes clear-cell RCC have led to the development of new targeted therapies” says lead author Dr William T Lowrance.

“This makes it more important than ever to identify those people who face an increased risk of developing this variant, which is on the rise in the USA.

“The widespread use of abdominal imaging has definitely contributed to increased detection of RCC, but fails to account for it entirely.

“A number of studies have suggested that obesity could be a risk factor for RCC, but the exact reason is unknown. Researchers suggest it might be secondary to hormonal changes, decreased immune function, hypertension or diabetes in obese patients.”

The study looked at all patients who had undergone surgery at the Center between January 2000 and December 2007. Patients with hereditary renal cancer syndrome were excluded and BMI data was missing for a further 64, giving a study size of 1,640.

Key findings included:

* Patients had an average age of 62 years, 63 per cent were male and 88 per cent were white.
* 38 per cent of patients had a BMI of 30 or more, which is classified as obese, and this figure rose to 42 per cent in the patients with clear-cell RCC. By contrast, only 31 per cent of the patients with benign tumours were obese.
* 67 per cent of the obese patients had malignant tumours with clear-cell RCC, compared with 57 per cent of the non-obese patients.
* The rates for the other kinds of malignant tumours – including papillary, chromophobe and collecting duct – were similar between the obese and non-obese patients.

“We also looked at other health and lifestyle factors, like diabetes, hypertension and smoking” adds Dr Lowrance. “This showed that the only other factors that were independent predictors of clear-cell RCC were male gender and tumour size.”

The researchers conclude that BMI is an independent predictor of clear-cell RCC and that as BMI increases, the odds of having a clear-cell RCC also increases.

“Although we still need to find out more about the pathology of clear-cell RCC, this study is useful as it provides individual predictors of the chance of developing this form of cancer” concludes Dr Lowrance. “Of these, obesity provides the strongest association.”

Source: Wiley.com

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New Study Finds Low Mortality Risk Following Knee and Hip Replacement

Risks Lower 26 Days After Surgery

Rosemont, IL – Total hip and total knee replacement surgeries are highly successful and very common procedures for people experiencing pain associated with degenerative joints. With a new hip or knee, and postoperative care prescribed by their doctors, most patients are able to regain a more active lifestyle with considerably less pain.

According to a new study published in the January 2010 issue of The Journal of Bone and Joint Surgery (JBJS), the risk of early postoperative mortality – or death following surgery — was slightly increased for the first 26 days after the elective surgery. The risk of mortality was estimated to be 0.1 percent.

The size of the study and the precise statistical tools used show the increase in early postoperative mortality was highest immediately after the operation. Then, 26 days after the surgery, the increased risk of death was negligible.

“Previous studies suggesting that increased mortality exists for as long as 60 or 90 days post hip or knee replacement surgery may be wrong,” said lead author of the study, Stein Atle Lie, PhD, MSc and professor in the Department of Surgical Sciences at the University of Bergen, Norway who led the study with colleagues from the Department of Orthopaedic Surgery, and the Norwegian Arthroplasty Register at the Haukeland University Hospital in Bergen, Norway. “We believe the risk is tied to a much shorter duration.”

The study included data on 81,856 patients with a total knee replacement and 106,254 patients with a total hip replacement from the Australian Orthopaedic Joint Replacement Registry and the Norwegian Arthroplasty Register. Only patients between 50 and 80 years of age with osteoarthritis were included.

The study found the most important risk factors for increased early postoperative mortality were:

* Male gender; and
* Age, older than 70 years old.

“This very low postoperative mortality after hip and knee replacements should be reassuring for patients considering these surgeries,” explains study co-author Lars B. Engesaeter, MD, PhD and Head of Norwegian Arthroplasty Register, Haukeland University Hospital in Bergen, Norway.

People considering hip or knee replacement should talk to their orthopaedic surgeon about any added risk in relation to their age and follow recovery guidelines closely. Other questions to consider prior to surgery can be found at www.orthoinfo.org.

“We conducted this study to help people contemplating hip or knee replacement,” continues Dr. Lie. “As with all surgeries, there is some increased risk of postoperative mortality. However, we were pleased to find the mortality rate is so minimal — less than one percent — following hip and knee replacements.”

Source: American Academy of Orthopaedic Surgeons

For more information about hip and knee replacements or any other orthopaedic procedure please feel free to contact us that Doctor Juan Sanchez Pulgar will be glad to help you.

Obesity Now Poses As Great a Threat to Quality of Life As Smoking

San Diego, CA – As the US population becomes increasingly obese while smoking rates continue to decline, obesity has become an equal, if not greater, contributor to the burden of disease and shortening of healthy life in comparison to smoking. In an article published in the February 2010 issue of the American Journal of Preventive Medicine, researchers from Columbia University and The City College of New York calculate that the Quality-Adjusted Life Years (QALYs) lost due to obesity is now equal to, if not greater than, those lost due to smoking, both modifiable risk factors.

QALYs use preference-based measurements of Health-Related Quality of Life (HRQOL) which allow a person to state a relative preference for a given health outcome. Since one person may value a particular outcome differently than another person, these measures capture how each respondent views his or her own quality of life.

The 1993–2008 Behavioral Risk Factor Surveillance System (BRFSS), the largest ongoing state-based health survey of US adults, has conducted interviews of more than 3,500,000 individuals; annual interviews started with 102,263 in 1993 and culminated with 406,749 in 2008. This survey includes a set of questions that measures HRQOL, asking about recent poor health days and tracking overall physical and mental health of the population. The authors analyzed these data and converted the measures to QALYs lost due to smoking and obesity.

From 1993 to 2008, when the proportion of smokers among US adults declined 18.5%, smoking-related QALYs lost were relatively stable at 0.0438 QALYs lost per population. During the same period, the proportion of obese people increased 85% and this resulted in 0.0464 QALYs lost. Smoking had a bigger impact on deaths while obesity had a bigger impact on illness.

Investigators Haomiao Jia, PhD and Erica I. Lubetkin, MD, MPH, state, “Although life expectancy and QALE have increased over time, the increase in the contribution of mortality to QALYs lost from obesity may result in a decline in future life expectancy. Such data are essential in setting targets for reducing modifiable health risks and eliminating health disparities.”

The article is “Trends in Quality-Adjusted Life-Years Lost Contributed by Smoking and Obesity” by Haomiao Jia, PhD, and Erica I. Lubetkin, MD, MPH. The article appears in the American Journal of Preventive Medicine, Volume 38, Issue 2 (February 2010) published by Elsevier.

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