Fertility treatment raises defect risk

Fri, 09 Feb 2007 08:54:20 GMT
By MARILYNN MARCHIONE, AP Medical Writer
SAN FRANCISCO - Babies conceived through fertility treatments have higher rates of birth defects, but the overall risk is so small that it should not keep couples from having children this way, doctors are reporting.
The news comes from a study of more than 61,000 births in Canada, the largest ever done on this in North America.

"What's important and reassuring is that the absolute risks are still low," at less than 3 percent of all births, said one of the study's leaders, Dr. Mark Walker of the University of Ottawa.

Even so, the risks of certain defects were startlingly high for babies born with the help of technology.

Couples who want to lower the risk should have only one or two embryos implanted at a time, specialists said. The danger of defects from twin, triplet and other multiple births is far greater than any risk posed by the fertility treatments themselves.

Results of the study were to be reported Friday at a meeting of the Society for Maternal-Fetal Medicine in San Francisco.

More than 1 million babies worldwide have been born through assisted reproductive technology, or ART. This includes induced ovulation, artificial insemination, IVF or in vitro fertilization, and more advanced methods like injecting a single sperm into an egg to create an embryo.

As many as 1 to 2 percent of births in the United States and Canada are due to such techniques. They already are known to raise the raise the risk of premature birth and other complications.

But studies have been divided over whether they increase the likelihood of birth defects. A recent scientific review concluded there is some added risk, but that most studies have been too small or flawed to be conclusive.

The Canadian work is important because it's a large study and quantifies the risk of specific birth defects, "a first as far as I know," said Dr. Nancy Green, medical director of the March of Dimes.

Researchers studied 61,208 births in Ontario during 2005, including 1,394 that resulted from fertility treatments. They looked at rates of birth defects and adjusted estimates of risk to reflect differences in the mothers' ages, whether they smoked, the gender of the babies, birth complications and other factors.

Nearly 3 percent of ART babies had a birth defect versus just under 2 percent for babies conceived naturally. That translated to a 58 percent greater risk. The chances of a defect rose as the complexity of reproductive help did — they were highest for IVF and lowest for simply giving medications to spur a woman's ovaries to make more eggs.

The biggest difference was seen in the rate of gastrointestinal problems, such as defects in the abdominal wall or organs not in the right place. Babies conceived through reproductive technology were nearly nine times more likely to have such problems — one in 200 births versus six per 10,000 for the others.

However, "it's still pretty uncommon," said lead researcher Darine El-Chaar of the University of Ottawa.

The chance of cardiovascular defects was more than twice as high — 90 per 10,000 babies conceived through ART versus 40 among those conceived naturally. Defects like malformed limbs also were slightly more common, but not facial defects like cleft palate or problems like spina bifida.

The bottom line: "I don't think women should worry about it," said Dr. Nancy Chescheir, obstetrics chief at Vanderbilt Medical Center, who had no role in the study.

The higher rates seen in this study are no worse than the 3 percent to 4 percent rates usually seen in the general population; the Canadians may have been healthier in general, she said.

Green said the risks are "not overpowering, but they're not insignificant."
The researchers note that people who have trouble conceiving also may have underlying genetic or health factors that could partly account for the higher rates of birth defects.
"We think this should become part of counseling couples that are infertile," especially that the degree of manipulating egg and sperm may affect the risk of defects, El-Chaar said.
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Students wear masks to try to stop flu

Fri, 09 Feb 2007 01:06:09 GMT

ANN ARBOR, Mich. - Hundreds of students on the University of Michigan campus are part of a research study that could change the way the world looks at influenza.
Researchers are trying to determine whether wearing surgical masks and hand sanitizing can prevent the spread of flu or other respiratory illnesses.

There's only one public place in his residence hall where Ken Miguel doesn't wear a surgical mask — the cafeteria.

"It's kind of hard to eat with this thing on," the University of Michigan freshman said recently from behind the blue mask. "It's kind of hard to do a lot of things with this on."

But every day, Miguel, 18, wears the mask while he studies, does laundry and sprints to class. It's gets a little uncomfortable, but it's for a good cause, he says.

Flu hit the university late last month and students in the study have since been divided into three groups: those who only wear masks; those who wear masks and use hand sanitizer; and those who do neither.

They'll fill out surveys every week, answering questions about their physical health and how often they wear the mask, which is optional outside the residence halls. The students will wear the masks until the flu outbreak has died down, but no longer than six weeks, the researchers said.

Funded by the U.S. Centers for Disease Control and Prevention, the research is the first of its kind, said Dr. Allison Aiello, a Michigan epidemiology professor who designed the study with principal investigator Dr. Arnold Monto.

Scientists say the world is long overdue for a deadly flu epidemic, one that could emerge if the bird flu in Asia mutates to spread easily among people. A pandemic could kill millions of people. Right now there's not enough research to determine whether wearing masks and washing hands would be effective during such an event, Aiello said.

U.S. health officials have made no recommendation about wearing face masks. The government is stockpiling a vaccine officials hope would be effective against a pandemic flu strain but there isn't enough. Cotton masks and hand sanitizer could be a first line of defense.

"We know the clock is ticking, we just don't know when the alarm will go off," said Dr. William Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University. "We already know there's going to be regular influenza annually, and even that's enough to grab our attention."

The results of the Michigan study "will be widely discussed, no matter the outcome," he said.

Schaffner says the study has important "real life" circumstances at its base. College dormitories, where students eat, sleep and study together, are the perfect breeding ground for airborne illnesses, he said.

In Alice Lloyd Hall, one of the dorms chosen for the study, masked students can be seen behind the front desk, hurrying down hallways and studying. About 1,200 students on campus were signed up as of last Wednesday, and more are recruited every day.

For participating, they can receive $100, an incentive for many college students.

Several students acknowledged they're only doing it for the money. Miguel said he'll save the cash for a trip to Peru this summer, while Alicja Sobilo, 18, said she's going shopping.

Some worry that the students aren't taking the science seriously.

"The importance of this research isn't a message that seems to be getting to all of them," said Allison Sponseller, 22, a resident adviser and study recruiter. "My biggest concern is in a week they will all forget about it and stop wearing the masks."
But Schaffner says that's one of the study's advantages.
"That actually will add to the real life aspect of it," he said. "Those of us involved in real life public health know that we can never achieve perfection — it's what we can do in a semi-controlled environment."
Aiello said the researchers are also hoping to get information on how students feel about the masks — whether wearing them is "socially acceptable."
So far, it doesn't look good for the masks. Students say they're "goofy-looking," inconvenient or just plain annoying.
"I wouldn't wear it outside the hall," said Jeff Van Laere, 20. "But I feel obligated to wear it in here. We know how important it is when we sign up for it and we honor that. I'm getting paid for this commitment."

Albuquerque tops fittest city list

Fri, 09 Feb 2007 01:09:42 GMT
SUE MAJOR HOLMES, Associated Press Writer
ALBUQUERQUE, N.M. - Albuquerque's mayor says the city has a lot of options to keep people fit — everything from gyms to hiking and biking.
And because of those options, "Albuquerque is a very fit city," Mayor Martin Chavez said.

New Mexico's largest city was listed as the fittest city in the United States in March's issue of Men's Fitness magazine, up from a 13th-place showing last year.

"Albuquerque is turned on, and recognition like this just fuels that phenomenon," Chavez said. "Nothing succeeds like success, or I guess you could say nothing is better than fitness."

The magazine's nonscientific survey of 50 cities listed Seattle as No. 2 in the most-fit rankings, followed by Colorado Springs; Minneapolis; Tucson, Ariz.; Denver; San Francisco; Baltimore; Portland, Ore.; and Honolulu.

It's Top 10 fattest cities are Las Vegas, Nev., up from No. 2 last year; San Antonio, Texas; Miami; Mesa, Ariz.; Los Angeles; Houston; Dallas; El Paso, Texas; Detroit; and San Jose, Calif.

"This is not a scientific list; this is a commonsense list," said Neal Boulton, editor of Men's Fitness. He said he puts out the fittest and fattest lists each year for one reason — "to motivate folks to look at simple things in their lives they can do to be healthy."

America is always going to be a fast-food nation where people have long commutes and busy lives, he said. But instead of a soft drink during the commute, they can choose water; instead of a fast-food snack, they can eat almonds, he said.

His survey examines lifestyle factors in each city: fast-food restaurants per capita, availability of gyms or bike paths, commute times, how much television watching Nielsen records, federal health statistics on obesity-related injuries and illnesses.

"I can draw attention to the way we're living," Boulton said.

And he wants the lists to be a call to arms for mayors and governors.

"There's a consciousness among mayors that they can motivate the population and go beyond the PR.," he said. "It's more than just having a mayor run the marathon. That doesn't motivate people. What motivates people is starting a Fit City program. ... It takes action."

Chavez points to the neighboring state of Colorado and its largest city, Denver, as doing a good job of marketing indoor and outdoor recreation.

Albuquerque is beginning to tout its recreation as well, particularly 10,678-foot Sandia Mountain on the city's eastern flank and the cottonwood forest, or bosque, that runs along the Rio Grande through the heart of the city.

"Our mountain is right here if you're a runner, a hiker, a mountain biker," Chavez said. "We have a marvelous bosque that runs through heart of city. ... I've always thought we had more assets than they do, but we haven't developed those assets. We're doing that now."

Albuquerque also is beginning to develop recreation-related jobs, so recognition as a fit city brings an economic advantage, he said.

"Less tangible, but no less meaningful, is the way people see us: 'We didn't know about that about Albuquerque.' ... Those things change the way people see us, make us more investment-worthy and friendly," Chavez said.

Albuquerque — where about 40 percent of the population is Hispanic — has plenty of Mexican restaurants, a cuisine not known for its low-fat content.
Chavez said the traditional American diet is high in fat, "not just Mexican food but every good food."
However, nearly every restaurant offers some heart-healthy menu items, and Chavez said fit Albuquerque residents choose those.
"All Mexican food is healthy," he joked. "That's my story and I'm sticking to it."

Study raises hope for Rett syndrome cure

Fri, 09 Feb 2007 01:04:51 GMT
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Scientists are raising the first hope of recovery from an autism-like disease that leaves thousands of girls unable to talk or walk — with an experiment that erased symptoms of the disorder in genetically engineered mice.
Thursday's report challenges the long-held belief that the brain damage from Rett syndrome is permanent, but it comes with a big warning: Researchers don't know how to even try such treatment in people yet, making the discovery one of both optimism and continued frustration.

"The thing that keeps your feet on the ground with this study is it shows the principle of reversibility, but doesn't give you any clue about how to accomplish that," cautioned lead researcher Dr. Adrian Bird, a geneticist at Scotland's Edinburgh University.

Still, parents rejoiced at the research, saying it gave them hope that even if finding actual therapies takes another decade, their severely disabled daughters still may have a chance to improve.

"To think even 10 or 20 years down the road ... she could learn to talk and walk," said Jennifer Endres of her daughter Jillian, 4, who smiles delightedly as she watches other children play but can't even hold a toy in her own hands. "If it can happen in Jillian's lifetime, that means the world to us."

And the work, published Thursday by the journal Science, could affect more than Rett syndrome, because the same genetic culprit plays a role in certain forms of autism and other brain diseases, too.

"In this class of disorders, now we have a great hope that if we figure out a way to manipulate the function of the neurons ... we have a chance of recovery," said Dr. Huda Zoghbi of the Baylor College of Medicine. Zoghbi discovered Rett's genetic culprit in 1999.

Rett syndrome is rare, afflicting roughly one in 10,000 girls.

But Rett is the most physically disabling of the family of autism diseases. Girls are born healthy but then the culprit gene somehow mutates, destroying speech and normal movement. A classic sign is hands that can do nothing but wring. Many children never walk; those that do have a stiff-legged gait. Symptoms usually appear between 6 and 18 months of age. Patients can live to adulthood, although many die of infections before then.

What goes awry: a gene called MECP2 that is supposed to switch off other genes involved in the maturation of neurons. When MECP2 shuts off in Rett syndrome, girls' brain cells don't die, but they don't keep developing.

The question is whether switching that gene back on could restore neuronal function. Even Bird didn't think so — he was stunned by his own team's finding.

First the Scottish researchers switched off MECP2 in male mice by inserting a chemical roadblock into the gene that they could switch on and off with medication. When the gene was switched off, baby mice hardly moved and died within weeks.

The first attempt at switching the gene back on killed half the mice, apparently by flooding their cells with too much of MECP2's protein. So the scientists tried again, this time gradually increasing gene activity — and rescuing all but one mouse. Video shows the treated animals scurrying around just like normal rodents.

The real test was in female mice. Why? The mutated gene is carried on just one of females' two X chromosomes, giving them some normal gene function so they don't show symptoms until they're older. If even adult female mice could be saved, it would signal hope for girls — and it worked.

"We expected that at best we'd get a reduction in the severity of the symptoms. To have them go away virtually completely was a big surprise," Bird said.

The experiments couldn't test cognitive functions, such as speech, just physical ones.

But "the work is really beautiful," said Dr. Uta Francke of Stanford University, a co-discoverer of culprit MECP2 who has studied and cared for Rett patients for 20 years. "They have very convincing evidence" that damage once thought permanent is reversible.

The Rett Syndrome Research Foundation, a parents' group that co-funded the research, now will push scientists to develop human treatments.
"We were worried there was this narrow window of opportunity within which you had to intervene," said foundation co-founder Monica Coenraads, whose 10-year-old daughter Chelsea has Rett syndrome. The new study dispels that notion, and "gives scientists every reason to explore the next steps on every front, from gene therapy to drug discovery."
Gene therapy probably is a long shot, specialists agree. More practical would be to figure out what other genes MECP2 governs and how to use medications to manipulate those downstream effects, Zoghbi said.

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