Warning issued over human egg freezing
Mon, 22 Oct 2007 20:16:53 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Don't count on freezing eggs to offset a ticking biological clock just yet. So say new guidelines for fertility specialists that conclude the procedure remains highly experimental even though it is increasingly offered.
The recommendations are a dash of cold water for a field that proponents believe is slowly coming of age.
But with perhaps 500 births from frozen-and-thawed eggs worldwide, compared with more than 200,000 from frozen embryos, it is a nascent technology.
Now scientists are tweaking techniques to try to improve the odds that a woman who has her eggs removed and frozen will bear healthy children from them years later.
Until then, the American Society for Reproductive Medicine issued a list of warnings that it says women considering the expensive procedure must be given to ensure they make an informed choice.
"There are far fewer published outcomes for ... thawed previously frozen eggs than many might believe," cautions Dr. Marc Fritz of the University of North Carolina, Chapel Hill, who led the ASRM's deliberations.
Sperm routinely are frozen. So are the extra embryos of couples undergoing infertility treatment, for later pregnancy attempts.
Egg freezing evolved more recently, as a means of preserving fertility for young women or girls diagnosed with cancer or other serious illness that would destroy their ovaries. It also is marketed as a way to help women postpone conception, as fertility rapidly declines beyond age 35.
The problem: Eggs contain lots of water, making them more vulnerable to freezing and thawing. Ice crystals can form during either process, injuring or even destroying the eggs.
That makes it far from certain that women who spend more than $10,000 to freeze eggs will have usable ones years later, the reproductive society concluded — calculating a 2 percent to 4 percent chance of a live birth for every thawed egg.
Still, patients with cancer and other illnesses may be appropriate candidates for egg freezing, as long as they're thoroughly warned — because they have no other options, the guidelines say. But the reproductive society said it was too soon for egg freezing to move into the mainstream for healthy women.
Anyone considering it must be told that:
_There are side effects from the ovary-stimulating drugs used to retrieve eggs.
_There's a possibility that none of the stored eggs will survive.
_Women who freeze eggs before age 35 will likely never need to use them.
Most centers that freeze eggs agree that it remains experimental, says Dr. Richard Paulson, director of the University of Southern California's in vitro fertilization program. His own center freezes eggs for three to four healthy women a month.
"That doesn't mean that it shouldn't be made available," adds Paulson, who said in a study of 18 pregnancy attempts with frozen eggs in his center, 10 succeeded. "I inform them very carefully that this may be completely unnecessary ... that the technology may be so advanced five years from now there'll be something entirely new."
But the "experimental" designation obligates fertility centers to track their successes and failures, Paulson adds — so scientists can quickly settle such outstanding questions as whether the technology is safe.
Last week brought reassurance on that front. Chicago researchers found no increased risk of birth defects among published reports of 197 births through July 2006. Separately, doctors at a Bologna, Italy, fertility clinic had similar findings among 105 babies born there.
The bigger question is how to best freeze and thaw eggs, to improve pregnancy attempts. Some eggs are slow-frozen, over an hour or more. Others are flash-frozen by dunking them in liquid nitrogen, a process called vitrification.
University of Michigan researchers compared the techniques, and found slightly more flash-frozen eggs survived thawing. And it took 21 vitrified eggs to generate a pregnancy, compared with 45 slow-frozen ones.
California's Paulson cautions that the jury's still out on which method to use. His own consumer advice: Ask fertility specialists, "How many babies have been born from this technique in your hands?"
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
NYC program gets kids up and running
Mon, 22 Oct 2007 20:45:03 GMTBy KAREN MATTHEWS, Associated Press Writer
NEW YORK - Khalil Colon was sweaty but smiling after 25 jumping jacks and 20 laps around the school gym. A year ago, the 9-year-old said, running made him feel "like I'm about to drop on the middle of the floor."
"But now I can run 20 laps and I'm not even tired," said Khalil.
Twenty laps is the magic number because it's a mile. Khalil is one of 20,000 New York City schoolchildren enrolled in the Mighty Milers, a program run by the New York Road Runners Foundation that aims to get kids up and running.
The program, which targets childhood obesity, is in more than 100 New York City schools plus 20 schools in other states and 20 in Cape Town, South Africa, where a non-governmental organization became interested.
The children earn prizes like medals and certificates each time they notch 26 miles — a marathon — and they can track their progress on personal Web pages.
The running club is best known for putting on the New York City Marathon, which draws world-class runners and hobbyists alike on the annual race through the five boroughs. But foundation Executive Director Cliff Sperber said the purpose of the Mighty Milers isn't to raise a new generation of marathoners.
"The purpose is to give back to the community," he said.
At this year's Nov. 4th marathon, 1,200 runners will collect fundraising pledges for the Mighty Milers and the foundation's other youth programs.
In New York City, a 2003 Health Department survey found that only 53 percent of public elementary school students were at a healthy weight. Overweight children are more likely than their slimmer peers to become overweight or obese adults and to develop health problems including heart disease and diabetes.
Principal Israel Soto said Public School 57 in East Harlem is addressing the obesity challenge through a range of measures including a gym for the staff and nutrition classes for parents.
Mighty Milers fits in with his goal of nurturing healthy bodies and healthy minds.
"The research is very clear that when children are healthy, when you provide opportunities for them to get healthy, it raises their achievement level," he said.
Sperber said Mighty Milers costs just $50 per child per year, including T-shirts, prizes and training for the physical education teachers at participating schools.
At P.S. 57 this past week, physical education teacher Maisha Cadet-Duval had 28 fourth-graders counting their laps as they ran or walked around the gym.
When they had completed 20, they jumped rope and then got out mats for sit-ups. The class ended with a spirited game of beach-ball volleyball.
Cadet-Duval said the students are more fit thanks to Mighty Milers.
"Last year when we first started the program, after the second lap they were done," she said.
Nine-year-old Cierra Agosto said she loves the program.
"When we didn't have Mighty Milers, we didn't have so many activities," she said. "We never got to do push-ups and sit-ups before."
Cierra boasted that her friend Katherine Rojas, also 9, is the fastest runner in the class; she can do a lap in 15 seconds.
"That makes me feel good about myself," said Katherine, petite and ponytailed. "And it helps you get muscles."
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On the Net:
Road Runners Foundation: http://www.nyrrfoundation.org/
Vaccine plan for flu pandemic drafted
Mon, 22 Oct 2007 21:28:48 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Pregnant women, babies and toddlers would join doctors, emergency workers and soldiers at the head of the line for scarce vaccine if a super-strain of flu triggers the next pandemic, says a draft government plan to be released Tuesday.
Once more vaccine is brewed, older children along with workers who keep the electricity, water and phones running could be next to roll up their sleeves.
At the end of the line: The elderly and healthy younger adults.
It's a priority list quite different from the usual winter pleas for older Americans to get vaccinated against regular flu. And it reflects growing agreement that curbing a super-flu would require protecting workers who care for the sick and maintain crucial services — plus targeting the people most likely to spread flu, not just die from it.
"Children are not only highly susceptible to influenza, children are also very good at spreading it," said William Raub, emergency planning chief at the Department of Health and Human Services. "Protecting them also protects those in the population."
The list will prove no surprise to state and local health authorities struggling to plan how they would ration vaccine for a panicked population. The Bush administration has long signaled its key priority groups.
But the new draft plan puts a rationale for step-by-step vaccination to paper, opening it to formal debate before the list is finalized — not as set-in-stone rules, but as guidelines for states.
"Some local discretion is going to be imperative here," Raub said.
Pandemics can strike when the easy-to-mutate flu virus shifts to a strain that people have never experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu known as H5N1 might trigger one if it starts spreading easily from person to person.
Vaccine must be custom-brewed to each circulating flu strain, something that would take several months after a pandemic began. The government is stockpiling vaccine against the current bird flu strain in hopes it could offer some protection while better shots are brewed. That stockpile is expected to contain enough for 13 million people by year's end, said HHS spokesman Bill Hall.
The eventual goal is to stockpile enough for 20 million people, roughly the number the draft plan designates to be first in line.
A bigger question is whether health authorities would be physically able to vaccinate that many people — if there are enough syringes stockpiled and plans for how to use them, said Kim Elliott of the Trust for America's Health, a public health advocacy group that tracks the preparations.
"We can't just rest on our laurels that we have priority groups in place. We have to think about how we get it into arms," she said.
The draft plan provides flexibility if the next pandemic isn't as deadly as feared. A more severe outbreak requires more aggressive rationing to protect critical workers, while a milder one could allow for more widespread shots.
W.Va. leads nation in pregnant smokers
Mon, 22 Oct 2007 20:50:22 GMTCHARLESTON, W.Va. - More than a fourth of pregnant women in West Virginia smoked last year, putting themselves and their babies at risk.
The state's 27.3 percent maternal smoking rate was the highest rate in the country and nearly triple the national average, according to a recent report from the state Department of Health and Human Resource's Health Statistics Center. The state's rate was up slightly over the previous year and has hovered around 25 percent the past 10 years.
McDowell County had the highest rate of pregnant smokers, at more than 42 percent, the report said. The lowest rate, 15.8 percent, was in Monongalia County.
All total, smoking mothers across the state gave birth to about 5,500 babies last year.
"West Virginia has a virtual sustained epidemic of maternal smoking during pregnancy," said Dan Christy, who directs the Health Statistics Center. "It isn't healthy, and it's endangering the baby."
Smoking during pregnancy increases the risk of low-birth weight and premature babies, and can lead to a host of illnesses, including heart disease, breathing difficulties and mental health problems.
National researchers suggest pregnant smokers are typically poor, less educated and have less access to health care. The state's study found that a lack of education played a major role in West Virginia's numbers.
Christy noted that some women at a recent focus group meeting said they smoked during pregnancy because they thought they would have easier deliveries if their babies were smaller.
The state study found that more than half of women who didn't graduate from high school smoked while pregnant. It also found that more than 40 percent of West Virginia women covered by government-funded Medicaid health insurance smoked during pregnancy.
Christy said it's obvious that existing programs to curb smoking among pregnant women are not working.
National research released last month indicated the "quit for your baby" message is too simplistic an approach for many women. It also suggested that many pregnant women who smoke may also suffer from depression, which makes it even more difficult to kick the habit.
A committee of state health advocates recently issued a list of recommendations that include increasing the state excise tax on tobacco products and expanding the state tobacco "Quitline," which offers free smoking-cessation services to all pregnant women.
The committee also urged the state to increase funding for tobacco-prevention programs from $6 million a year to $14 million, as recommended by the Centers for Disease Control and Prevention.
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Information from: The Charleston Gazette, http://www.wvgazette.com
