Monday, 28 February, 2011

Granulocyte-colony stimulating factor (G-CSF) significantly improves inadequate endometrium

During in vitro fertilization (IVF) cycles, treatment with a medication called granulocyte-colony stimulating factor (G-CSF) significantly improves inadequate endometrium (lining of the uterus), according to a report published electronically on February 15 in Fertility and Sterility - the official journal of the American Society for Reproductive Medicine (ASRM). The reported case series also suggests that G-CSF treatment may, in general, improve IVF pregnancy chances.

G-CSF is a cytokine (protein molecules that facilitate communication between cells) that has already been FDA approved for other clinical indications.

Researchers from New York City-based Center for Human Reproduction (CHR) and a second NY fertility center reported on four women with highly inadequate endometrium, unresponsive to conventional treatments and facing IVF cycle cancellation. In all four cases, endometrial perfusion of G-CSF expanded the endometrium to a minimal thickness of 7mm within approximately 48 hours, allowing for embryo transfer. Surprisingly, all four patients also conceived.

In approximately 1% of all IVF cycles, the endometrium stays too thin for embryos to successfully implant, even with treatment. In such IVF cycles, patients and physicians face two poor options: they either accept lower pregnancy chances and transfer embryos despite inadequate endometrium, or they can cancel the embryo transfer and freeze all embryos in hope of better future cycles. Unfortunately, women with inadequate endometrium often show inadequate endometrium again in future cycles. This situation was demonstrated by two patients in this reported case series with histories of repeat IVF failures due to thin endometrium.

"Conventional treatments for inadequate endometrium have had spotty success at best. Without G-CSF perfusion, these patients, likely, would not have reached embryo transfer," explains David Barad, MD, Director of Clinical ART at CHR and one of the senior authors of the report. "That all of them also conceived was a big surprise, and is, of course, quite remarkable."

"The efficacy of G-CSF in improving endometrium, and possibly pregnancy rates in general, still needs to be confirmed in randomized controlled trials," adds Norbert Gleicher, MD, lead author of the report and Medical Director of CHR. "Indeed, we already started two such trials to test both hypotheses; but until first results become available later in 2011, we caution against over-interpreting results of this small pilot study."

Saturday, 26 February, 2011

Bribeless In Bihar

Bureaucrats in India’s most corrupt state are facing the heat from their own chief minister

by K.P. Narayana Kumar

Raghuvansh Kunwar could not believe it. For the motor vehicle inspector based in the Aurangabad district of Bihar, the news item in the Hindi daily was more chilling than the December morning. The government was going to throw him out of his
house and start a school there. The announcement was made by Bihar’s human resources development minister, P.K. Sahi,
at a public meeting.

“I was shocked to read the news item,’’ says Kunwar in a tone that barely conceals fear. “I have lived in this house for 20 years
with my wife, children and three brothers and suddenly I was being told to hand over my house.”

The vehicle inspector did not realise then that he was the first prey caught in a new anti-corruption drop-trap devised by
the state government and hailed as a model for other states to follow. Kunwar had been booked under a new law allowing
for summary confiscation of property of government officials found to be having more assets than their income justified.

The state vigilance department, the government’s internal watchdog, had found in 2008 that Kunwar owned property
worth Rs. 54 lakh but was unable to explain how he could afford it. The department has lined up 18 more such cases to
confiscate property valued at Rs. 21 crore before the special courts created under the new legislation, the Special Courts
Act 2009. It is reviewing another 87 cases for possible confiscation of assets.

Kunwar’s case was the first headline-grabber from the Nitish Kumar regime that returned to power with a resounding
mandate that many say was an endorsement of the chief minister’s reputation as a leader with a cause. In its first innings, the administration locked up 54,000 people in a bid to break the criminal-politician nexus that had plunged Bihar into such an anarchic mess — a place that everybody knew where it was but nobody wanted to go, even those who had fled from their ‘native place’ for greener pastures. The third axis in the unholy nexus was the government official for whom the general public is the golden goose.

Blunt Axe No Good

It was not that Nitish Kumar avoided them in his first term. His attempt was to hit all three simultaneously, though the
babudom — cocooned in rules and procedures — turned out to be the most resilient. Kumar set up a Special Vigilance Unit (
SVU) in 2006 to go after the big fish in the government. It was a crack team of former Central Bureau of Investigation (CBI)
officials with a separate headquarters on the rather quirkily named Serpentine Road. The unit soon made headlines as it caught several senior government officials such as a police chief Narayan Mishra and state drug controller Y.K. Jaiswal, with enough wealth to finance the annual budgets of entire villages. State vigilance squads trapped about 400 government officials in the next four years. However, much of it came to nothing as only two of them have been convicted so far. News reports suggest that even the elite SVU managed to file only five First Information Reports (FIRs) in four years.

Meanwhile, Nitish Kumar was regularly besieged by villagers with tales of corruption on his frequent countryside tours. In
Bihar, big ticket deals are few. The corruption that is endemic is petty. For the general public, it is difficult to get government
certificates and entitlement documents without paying touts. Unlike big deals where money is often received and stashed in
numbered accounts in safe havens or as stocks and bonds, in Bihar the nature of corruption is localised. Ill-gotten money
hardly leaves the country and is invested mostly in real estate or gold. That means empowered officers can easily help track it
down. A vigilance officer pointed out the case of a milk-vendor in Patna. The man is said to own a dozen cars, wealth that he
acquired by laundering money for government officers and politicians. “Most government departments have their own
paan-wallahs, ice-cream vendors and traders who act as collectors for the babus,” says the officer who did not wish to be

Bureaucrats who own black money typically invest it in real estate projects outside Bihar; Bangalore and Noida are particular favourites. But junior level officers such as block development officers, panchayat members and clerks keep their cash in bank accounts and lockers apart from building houses in their village. Having cash stashed in the mattresses also helped if they got caught. They could use the same money to pay off investigators and the game could go on.

It was clear to Nitish Kumar that merely catching a culprit was not enough. A major handicap was that under the Prevention of
Corruption Act, vigilance officials had to get clearance to prosecute an errant bureaucrat from his own department. That took time. He realised that the only way to deter corruption was to take away the wealth itself — ASAP. Kumar put his then attorney general P.K. Sahi on the job. (Sahi would go on to become Nitish Kumar’s minister in the second term).After consulting experts and studying the provisions of the Prevention of Corruption Act, Sahi prepared a draft bill by the end of 2008 and it was passed by the Bihar Assembly in February 2009. It then languished in the union home and law ministries for a year. The delay often prompted Bihar politicians to snigger that the Centre did not want Nitish Kumar to have one more feather in his cap. “The Centre kept asking for one clarification after the other. The delay meant that we could not swing into action before the state elections and the CM himself had to repeatedly follow-up with the Centre,’’ says Sahi. The Bihar Special Courts Act, 2009, was eventually signed into law by the President in March 2010.

Slash And Burn

The Bihar law is not a pioneering one. That credit goes to Orissa, which passed a similar law in 2008 and also set up two special courts. However, it was challenged in court and until recently its validity was uncertain. In Bihar, the Act comes into play when investigating agencies are convinced that an official owns assets in excess of his known sources of income. Now, even as it pursues a corruption case against an official, the state separately seeks to take control of the assets owned by the person. Bihar
has set up six special courts that exclusively deal with this. The vigilance department files a declaration with a special
court that the target has amassed unexplained wealth. The special courts then conduct speedy trials and decide within six months whether the property should be confiscated or not. The property would be returned with interest (at 5 percent
annually) if the person is acquitted.

The Prevention of Corruption Act does not provide for attachment of property and instead has a provision enabling a judge to also impose a fine depending on the value of the ill-gotten property. Former CBI director Joginder Singh says the nation should follow Bihar. “If the property of the accused is confiscated in advance, it will make a huge difference. This will help serve as
a deterrent to officers and also ensure that the accused are not able to influence investigations using money,” says Singh, who has investigated several high-profile cases of corruption, including the fodder-scam in which Lalu Prasad Yadav was prosecuted. A.K. Chauhan, principal secretary, vigilance, says that he has not come across any instance of politicians or high-level officials trying to influence a case. “They know that we report to the CM. So there has not been any attempt so far,” says
Chauhan, who has earlier worked as secretary for co-ordination in the state cabinet and is considered to be someone who
enjoys the chief minister’s trust.

“MLAs have also been warned that they should not call up officers directly and try to influence these cases. The Chief
Minister has made it clear within his own party as well that he will not tolerate anyone trying to influence the officers,”
says Rajya Sabha member Ali Anwar, who is considered to be a close confidant of Nitish Kumar. The results are yet to
show, but the tremors are already being felt.Of course, the law has been challenged in court. Narayan Mishra, the police chief booked by the SVU and facing confiscation of property, has moved the High Court arguing that the law is unconstitutional. “It is a draconian rule with no regard for constitutional rights,” says Mishra. Lawyer Abhinav Shrivastava, who represents six officials
who have challenged the validity of the Act, says the main problem with the legislation is that there is no laid down
procedure to decide which cases under the Prevention of Corruption Act would be transferred to the special courts for attachment. “This would make the entire process subjective and arbitrary,” says the lawyer.A state bureaucrat, who spoke on condition of anonymity, said that there was palpable fear among officials after the government lined up cases for confiscation of property. “The officers are in fear of a crackdown and that is good for the health of the system,” he says.

Hindi daily Prabhat Khabar reported that over Rs. 100 crore had been withdrawn from banks in the capital, Patna, in the fortnight following the confiscation of Kunwar’s property. A top bank official confirmed that there has been an increase in
withdrawals from bank branches across the city but was unsure whether panic-driven officials were behind the trend.The state capital, which had acquired a reputation as a crime-hub during Lalu Prasad’s regime, also gained a reputation for scams and middlemen as Bihar led the list of corrupt states in almost every survey carried out between 2000 and 2005.

Renewed Growth

Nitish Kumar’s two terms, when he first re-established law and order and then began weeding out corruption, have brought
new hope to Biharis in the state and those living outside. For long, Patna seemed to be relatively untouched by India’s economic transformation. There are no glitzy malls or international brands that embellish the other cities. There are no hip eating joints or clubs. There is no evidence of any sort of nightlife or even entertainment for families.But the city is changing, slowly. Women move about fearlessly in areas where they would not have dared to venture out just a few years ago. People come out for
shopping and socialising. There is a clear buzz of a consumer economy blooming.The story of change is particularly evident in the new apartment buildings springing up across the city. Real estate developer Narendra Kumar says that property rates in
Patna are comparable to rates in Noida as there is a huge demand and there is shortage of land.“The boom is not entirely fuelled by black money and there is a genuine increase in demand,” says Kumar, who has built and sold over a dozen apartment complexes in the city in the past three years. He says most of the money coming into construction is from people of Bihari origin who live outside the state but are now beginning to hope for a prosperous Bihar. Academician Shaibal Gupta, considered an expert on governance in Bihar, says tough times are ahead for bureaucrats. Next the state is planning to enact a Right to
Services law to ensure efficient government service. Officials will be punished for failure to provide time-bound service.
“There is a lot of pressure on the bureaucracy now like never before,” says Gupta.

This article appeared in Forbes India Magazine of 11 February, 2011

Friday, 25 February, 2011

The world's biggest family

Ziona Chana lives with all of them in a 100-room mansion.His wives take turns to share his bed. It takes 30 whole chickens just to make dinner. He is head of the world's biggest family - and says he is 'blessed' to have his 39 wives.

Ziona Chana also has 94 children, 14-daughters-in-law and 33 grandchildren. They live in a 100-room, four storey house set amidst the hills of Baktwang village in the Indian state of Mizoram, where the wives sleep in giant communal dormitories.

The family is organised with almost military discipline, with the oldest wife Zathiangi organising her fellow partners to perform household chores such as cleaning, washing and preparing meals. One evening meal can see them pluck 30 chickens, peel 132lb of potatoes and boil up to 220lb of rice. Coincidentally, Mr Chana is also head of a sect that allows members to take as many wives as he wants.

He even married ten women in one year, when he was at his most prolific, and enjoys his own double bed while his wives have to make do with communal dormitories. He keeps the youngest women near to his bedroom with the older members of the family sleeping further away - and there is a rotation system for who visits Mr Chana's bedroom.Rinkmini, one of Mr Chana's wives who is 35 years old, said: 'We stay around him as he is the most important person in the house. He is the most handsome person in the village. She says Mr Chana noticed her on a morning walk in the village 18 years ago and wrote her a letter asking for her hand in marriage.

Another of his wives, Huntharnghanki, said the entire family gets along well. The family system is reportedly based on 'mutual love and respect'

And Mr Chana, whose religious sect has 4,00 members, says he has not stopped looking for new wives. 'To expand my sect, I am willing to go even to the U.S. to marry,' he said. One of his sons insisted that Mr Chana, whose grandfather also had many wives, marries the poor women from the village so he can look after them.

Thursday, 24 February, 2011

Myo-Inositol Helps Women To Conceive With PCOS

Myo-inositol is a unique vitamin B-like substance that has become highly regarded as a novel way to help women with PCOS to conceive. It can also help to reduce miscarriage risks and to minimize the risks of severe ovarian hyper-stimulation syndrome (OHSS) in IVF/ART.

Thirty to forty percent of PCOS women have irregularities in their glucose / insulin control mechanisms which is where Myo-inositol works it's magic. Inositol is integral to properly functioning insulin-receptors and providing extra inositol seems to profoundly improve insulin levels and reduce the associated high androgen levels (testosterone and DHEA) without side-effects or toxicity.

Women with PCOS are known to have a defect in their insulin-signaling pathways which are heavily dependent upon inositol-containing substances (phosphoglycan mediators). Supplying extra myo-inositol appears to temporarily correct the mal-functioning insulin pathways and reduce the signs and symptoms of insulin resistance.

Interestingly, inositol has been used in other studies for panic disorders and can have a profoundly calming effect upon the nervous system. Also studies show (6) that high levels of myo-inositol within follicles may be a marker for good follicular development and good oocyte or egg quality.

As there seems to be some confusion regarding exactly how to use Myo-Inositol - and how it can be used alongside IVF/ART - here is a brief overview of the studies to date that can help you to understand Myo-inositol's unique value to PCOS women.

In an Italian study in 2007 (1) researchers followed 25 women with oligo-amenorrhea (irregular menses) or amenorrhea (no menses) due to PCOS. Myo-inositol and folic acid were given daily as 'Inofolic' 2g twice a day for 6 months. Eighty eight percent of the women who were treated had at least one menstrual cycle, and of these, seventy two percent continued ovulating normally. Forty percent of the women became pregnant and the study concluded that:

"Myo-inositol is a simple and safe treatment that is capable of restoring spontaneous ovarian activity and consequently fertility in most patients with PCOS. This therapy did not cause multiple pregnancy."

Another Italian study (2) in 2010 compared the effects of Myo-inositol or metformin in PCOS women and then compared these two treatments with the addition of gonadotrophin (r-FSH) for ovulation induction. One hundred and twenty patients took either 1500 mg/day of metformin or a combination of folic acid 400 mcg and Myo-inositol 4 g per day.

In the women that did not conceive a low dose of FSH (37.5 units/day) was added for up to three cycles. Of the women taking just metformin, fifty percent resumed ovulation and eighteen percent became pregnant. FSH treatment was administered to the 'metformin-only' women who did not conceive and a further twenty six percent conceived producing a total pregnancy rate of 36.6%.

Of the women taking myo-inositol and folic acid, sixty-five percent resumed ovulation and thirty percent conceived. FSH was administered to the myo-inositol women who did not conceive and a further twenty nine percent conceived producing a total pregnancy rate of 48.4%.

This study - which showed that myo-iositol can out-perform metformin - concluded that:

"Both metformin and MYO, can be considered as first line treatment for restoring normal menstrual cycles in most patients with PCOS, even if MYO treatment seems to be more effective than metformin."

In yet another Italian study (3) in 2009, Myo-inositol (MYO) was studied as a novel solution to symptoms of PCOS such as hirsutism (excess body hair), acne and hair loss. Fifty PCOS women were give Myo-inositol for six months and after only three months levels of LH, testosterone and free testosterone and insulin were significantly reduced. At the end of the six months hirsutism and acne had decreased also and the study concluded that:

"MYO administration is a simple and safe treatment that ameliorates the metabolic profile of patients with PCOS, reducing hirsutism and acne."

Back to Italy again, in 2008 Myo-inositol was studied (5) specifically with PCOS women who were overweight. Twenty overweight women with PCOS were treated and after 12 weeks of myo-inositol demonstrated that levels of LH, prolactin, testosterone, insulin, LH/FSH, insulin sensitivity and glucose-to-insulin ratios could change significantly. Menstrual cycles were restored in all the patients with irregular or no menstruation. The study concluded that:

"Myo-inositol administration improves reproductive axis functioning in PCOS patients reducing the hyperinsulinemic state that affects LH secretion."

Lastly, a randomized double-blind trial (7) - the gold standard of research - gave 92 women either 400 mcg of folic acid as a placebo or 4 g myo-inositol plus 400 mcg folic acid as the treatment arm. They discovered likewise that ovulation significantly increased as did the frequency of normal progesterone values in the luteal phase and estradiol levels in the myo-inositol group.

This study noted less metabolic benefits to those women who were overweight but also that the myo-inositol group lost a significant amount of weight and had lowered leptin levels. The study concluded that:

"These data support a beneficial effect of myo-inositol in women with oligomenorrhea and polycystic ovaries in improving ovarian function."


(1) Gynecol Endocrinol 2007 Dec;23(12):700-3. Epub 2007 Oct 10. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Papaleo E, et al.
(2) Gynecol Endocrinol 2010 Apr;26(4):275-80. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women. Raffone E, et al.
(3) Gynecol Endocrinol 2009 Aug;25(8):508-13. Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome. Zacche MM, et al.
(4) 2008 Mar;24(3):139-44. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Genazzani AD, et al.
Eur J Obstet Gynecol Reprod Biol 2009 Dec;147(2):120-3. Epub 2009 Oct 2.
Contribution of myo-inositol to reproduction. Papaleo E et al. Eur Rev Med Pharmacol Sci 2007 Sep-Oct;11(5):347-54.
Randomized, double blind placebo-controlled trial: effects of myo-inositol on ovarian function and metabolic factors in women with PCOS. Gerli S, et al. European Review for Medical and Pharmacological Sciences 2007; 11: 347-354

Wednesday, 23 February, 2011

Amazing Electron Microscope Shots

All these pictures are from the book 'Microcosmos', created by Brandon Brill from London. This book includes many scanning electron microscope (SEM) images of insects, human body parts and household items. These are the most amazing images of what is too small to see with the naked eye.

Tuesday, 22 February, 2011

Rod Stewart becomes father for the eighth time

Rocker Rod Stewart has become a father for the eighth time at the age of 66, after wife, former model Penny Lancaster, gave birth to a son they have named Aiden.
The British artiste and his wife said that they were "thrilled" to welcome their second child, a brother to their five-year-old son Alastair.
The couple went through three rounds of IVF before 39-year-old Lancaster finally became pregnant and she gave birth on Wednesday, reported Daily Mail online.
A spokesman for the pair said, "Mother and baby are healthy and blissfully happy."
The couple have been together for more than ten years. They were married in 2007 in Italy just outside Portofino, making Lancaster Stewart''s third wife.
Aiden is the star''s eighth child. Aside from Alastair, who was conceived naturally, the newborn joins Kimberley, 30, and Sean, 29, from the singer''s first marriage to Alana Stewart.
Stewart went on to have another daughter, Ruby, 23, with girlfriend Kelly Emberg. He then had Renee, 18, and son Liam, 15, with former wife, model Rachel Hunter.
He also has daughter Sarah Streeter, 46, who he fathered early in his career with art student Susannah Boffey and who was raised by adoptive parents.
But he has announced that Aiden will be his last child.
"I can''t have any more kids, otherwise I''ll be touring until I''m 90," said Stewart.
On a more amusing note, I received a press release from a betting company yesterday who are giving various odds on the future career of young Mr Aiden Stewart, who was less than 24 hours old when it landed in my inbox.
Here’s what you can bet your money on (seriously, do people actually DO this?)
Have a number one hit single before 2030 16/1
Footballer 10/1
Singer 3/1
Model 8/1
Actor 8/1
Other 1/2
Represent the Scottish national football side 25/1
Represent the English national football side 66/1
Odds on Rod still rocking on in 2030 to see his son hit number one in the charts? He’d be 92 by then. Pretty good I reckon, he’s a bit of a legend and I’ve had enough of writing people off as being ‘old’ when they hit 60.

Monday, 21 February, 2011

Fakenham couple’s twins are first babies born after pioneering IVF treatment at Queen Elizabeth Hospital in King’s Lynn

A bouncing pair of twins are the first babies born after specialist IVF treatment at the Queen Elizabeth Hospital.Taylor and Freddie Axton are now just over three months old and doing well.

Their parents Teresa and Mark Axton, who live in Fakenham, knew they would need IVF treatment if they were to have children.

Mr Axton, 42, who works as an engineering surveyor, said: “After a while Terry said to me ‘Have you ever thought about having children.

“Although I’d been married before it just hadn’t happened. The subject was dropped for a while but when we discussed it again Terry said that it would have to be by IVF, so I said ‘OK’

“Terry was referred by her GP at Burnham Market to the fertility service at Bart’s Hospital. But when their clinic in Norwich closed Terry was referred back to her GP.

“At that time the Lynn Fertility Centre was expanding so we opted for treatment in King’s Lynn. The IVF service was fantastic and everyone was brilliant.”

Mrs Axton, 40, had two sons from a previous relationship, one who is now 22 and the younger, aged 17, who was born following IVF treatment.

To qualify for NHS fertility treatment the couple had to meet specific criteria. Once accepted for treatment, Mrs Axton underwent a course of daily hormone injections during which she had ultrasound scan checks on the development of the egg follicles. When these had matured, her eggs were collected at the Arthur Levin’s Day Surgery unit in King’s Lynn.

Mr Axton then drove the eggs from the QEH to Bourn Hall Clinic, in Cambridgeshire, in an incubator plugged into the car cigarette lighter.

“It was pretty nerve-racking. I probably drove a little faster than I should have done,” he said. “Anyway, my part in the proceedings was minor compared to Terry’s achievement.”

Four days later, on February 17, Mrs Axton visited Bourn Hall for the embryos to be implanted, and her follow-up care was carried out by Lynn Fertility Centre at the QEH.

At 12 weeks she learned that she was expecting a boy and a girl. Both were born on October 20, Taylor weighed 4lb 12oz and Freddie weighed 4lb 1oz.

Mrs Axton said: “The staff from Lynn Fertility Centre and The Queen Elizabeth Hospital really were excellent.

“Nothing was too much trouble for them. If we needed help, advice or reassurance at any time of the day or night, someone was always there for us, and we’ll never forget that.”

Hamed Al-Taher, lead consultant at the Lynn Fertility Centre, said the twins’ arrival was a positive landmark for the new IVF service and its partnership with the Bourn Hall Clinic.

“Transport IVF means more patients’ choice and less need to travel for couples receiving IVF without compromising the success of the treatment,” he said.

Sunday, 20 February, 2011

Chromosome counting technique gives IVF a boost

One cycle of IVF, one egg, one embryo and one baby.

It sounds simple, and yet for the 35,000 women who undergo IVF in the UK each year it's unlikely.

Only one in three IVF cycles is successful, each one costing potentially thousands of pounds.

But a new chromosome counting technique pioneered at Oxford University could put paid to all that.

Microarray CGH (comparative genomic hybridisation) is used to check for any significant abnormalities present in the chromosomes of the embryo before implantation in IVF treatment.

A small number of cells are removed from the growing embryo five days after fertilisation and the DNA in them is scanned for any clear problems.

By Philippa Roxby

The results are available within 24 hours, which allows the maximum information to be obtained from the embryo before it is used.

Armed with this knowledge, doctors can then ensure that only embryos with the correct number of chromosomes are transferred in IVF, thereby improving the chances of a successful pregnancy and reducing the likelihood of miscarriage or Down's syndrome.

Dr Dagan Wells developed the technique of applying microarray CGH to embryos at the Nuffield Department of Obstetrics and Gynaecology in Oxford.

He says: "Five days after the egg is fertilised it has more than 100 cells so we can safely take some cells for testing. The tests have worked really well, giving an accuracy rating of 98% - and there is no impact on the embryo of taking these cells either."

The chromosome screening technique is not intended to look for any specific genetic disorders relevant to the couple being treated or anything more subtle than viability.

We think it will help slightly older women who have an increased risk of a Down's syndrome baby and also young women who have a repeated failure of implantation”

"We are only testing for ability to be alive," says Dr Wells.

This gets around the two problems of IVF - the number of faulty embryos produced in a typical IVF cycle and the problem of distinguishing between the faulty and healthy embryos using traditional checks.

Embryos can seem to be growing well under a microscope but may still have chromosome abnormalities, and it's these abnormalities which lead to miscarriage or a Down's syndrome baby at full term.

The CGH technique can also be used at an earlier stage on patients' eggs, rather than on the embryos - created when the sperm has fertilised the egg.

This is particularly advantageous for women who have fewer, good embryos to start with because they will not have to wait until the blastocyst stage - five days after fertilisation - for the embryos to be analysed and transferred.

In some IVF patients - particularly those above the age of 42 - it can become more and more difficult to find 'normal' embryos, because fewer eggs and fewer embryos are produced as women age.

Studies analysing the benefits of CGH to date are promising, but experts agree that more scientific evidence is required before the technique is applied routinely in IVF clinics.

A study of American women in Colorado found that pregnancy rates increased by more than 50% following chromosome screening, but since it is normal to transfer around three embryos during IVF in the US rather than just one in the UK, this enhances the results.

For Dr Wells, it is the implantation rate that is important - the chance that one embryo can make a pregnancy.

Stewart Lavery, consultant gynaecologist and director of the IVF at Hammersmith Hospital in London, has been carrying out CGH for a year.

"It's a really exciting technique which does have potential, but we have to be cautious. We need some good evidence first," he says.

The safety of the technique is certainly not in question. What IVF experts need is evidence of which patients will benefit from CGH and by how much.

Mr Lavery says: "We think it will help slightly older women who have an increased risk of a Down's syndrome baby and also young women who have a repeated failure of implantation."

So it may yet be a long time before it's available on the NHS. But it could make financial sense if it saved on costly IVF cycles, avoided terminations and cut the numbers of miscarriages dealt with in hospital.

What is certain is that in the search for a 'normal' egg and a 'normal' embryo IVF doctors have to use their judgement. Is there such a thing as a 'normal' embryo?

Even for women not going through IVF, becoming pregnant is a very tricky and complicated business. Failure to conceive is common, occurring regularly even before the woman is aware of it.

"We have already beaten the odds just by being alive," says Dr Wells.

For women going through IVF, anything that increases the odds of a baby is all that matters.

Saturday, 19 February, 2011

For Cold Virus, Zinc May Edge Out Even Chicken Soup

Scientists still haven’t discovered a cure for the common cold, but researchers now say zinc may be the next best thing.

A sweeping new review of the medical research on zinc shows that sniffing,sneezing, coughing and stuffy-headed cold sufferers finally have a better option than just tissue and chicken soup. When taken within 24 hours of the first runny nose or sore throat, zinc lozenges, tablets or syrups can cut coldsshort by an average of a day or more and sharply reduce the severity of symptoms, according to the Cochrane Database of Systematic Reviews, a respected medical clearinghouse.

In some of the cited studies, the benefits of zinc were significant. A March 2008 report in The Journal of Infectious Diseases, for example, found that zinc lozenges cut the duration of colds to four days from seven days, and reduced coughing to two days from five.

While the findings are certain to send droves of miserable cold sufferers to the drugstore in search of zinc treatments, the study authors offered no guidance on what type of zinc product to buy. The authors declined to make recommendations about the optimal dose, formulation or duration of zinc use, saying that more work was needed before they could make recommendations.

“Over all, it appears that zinc does have an effect in controlling the common cold,” said Dr. Meenu Singh, the review’s lead author and a professor in the department of pediatrics at the Postgraduate Institute of Medical Education and Research in Chandigarh, India. “But there still needs to be consensus about the dose.”

Zinc experts say that many over-the-counter zinc products may not be as effective as those studied by researchers because commercial lozenges and syrups often are made with different formulations of zinc and various flavors and binders that can alter the effectiveness of the treatment.

“A lot of preparations have added so many things that they aren’t releasing zinc properly,” said Dr. Ananda Prasad, professor in the department of oncology at Wayne State University School of Medicine in Detroit and an early pioneer of research into zinc as an essential mineral. Two of Dr. Prasad’s studies were included in the Cochrane report.

“The public is confused because people have used the wrong dose, they have used the wrong sort of zinc or they have not started the treatment within 24 hours of onset,” he said.

Even so, the new report gives credence to the long-debated theory that zinc can be an effective treatment for colds. While it’s not certain how the mineral curbs colds, it appears to have antiviral properties that prevent the cold virus from replicating or attaching to nasal membranes.

The first study to show that zinc might be a useful treatment for the common cold was published in 1984, but the research was criticized for its poor methods. Since that study, 18 more trials of zinc for colds have been conducted: 11 of them showed it to be a useful treatment, while seven of them showed no benefit, according to the review.

Although a majority of trials have shown some benefit from zinc, many of them have been criticized for failing to “mask” the treatment, meaning the participants most likely knew they were using zinc, which may have skewed the results. At the same time, many of the trials that showed no benefit from zinc have been criticized for using formulations that may have contained ingredients that blunted the effectiveness of zinc.

The Cochrane reviewers selected 15 studies that enrolled a combined 1,360 participants. The studies were all considered to have good methodological quality with a low risk of bias, but they were far from perfect. All the studies compared zinc use with a placebo, but in several studies the zinc users complained about the taste of lozenges, suggesting that some people may have known that they were using zinc rather than a placebo.

Even so, when the data was pooled, the effect shown was strong. The review found that not only did zinc reduce the duration and severity of common cold symptoms, but regular zinc use also worked to prevent colds, leading to fewer school absences and less antibiotic use in children. People who used zinc were also far less likely to have a cold that lasted more than seven days.

The studies used various forms and doses of zinc, including zinc gluconate or zinc acetate lozenges and zinc sulfate syrup, and the dose ranged from 30 to 160 milligrams a day. Several studies in the Cochrane review used zinc acetate lozenges from the Web site, created by George Eby, the researcher who wrote the first zinc study in 1984.

Dr. Prasad said his studies have used zinc acetate lozenges from that contained about 13 milligrams of zinc. Study participants took a lozenge every three to four hours during the day for four consecutive days, resulting in a daily dose of 50 to 65 milligrams a day, he said.

Some cold sufferers have been wary about using zinc since the Food and Drug Administration warned consumers to stop using Zicam nasal sprays and swabs, which contain zinc, after numerous reports that some users lost their sense of smell after using the product. The Cochrane report did not review any studies of nasal zinc products.


Friday, 18 February, 2011

Uterine Health More Important Than Egg Quality

For women seeking pregnancy by assisted reproductive technologies, such as in-vitro fertilization (IVF), a new study shows that the health of the uterus is more relevant than egg quality for a newborn to achieve normal birth weight and full gestation. This study, published in Fertility and Sterility, an international journal for obstetricians, offers new information for women with infertility diagnoses considering options for conceiving.

The study was conducted by Dr. William Gibbons, director of The Family Fertility Program at Texas Children's Hospital and professor of obstetrics and gynecology at Baylor College of Medicine, along with colleagues at the Society for Assisted Reproductive Technologies (SART) Marcelle Cedars, MD and Roberta Ness, MD. They reviewed three years of data that compared average birth weight and gestational time for single births born as a result of standard IVF, IVF with donor eggs and IVF with a surrogate. While the ability to achieve a pregnancy is tied to egg/embryo quality, the obstetrical outcomes of birth weight and length of pregnancy are more significantly tied to the uterine environment that is affected by the reason the woman is infertile.

There were more than 300,000 IVF cycles during the time of the study producing more than 70,000 singleton pregnancies.

"This is the first time that a study demonstrated that the health of a women's uterus is a key determinant for a fetus to obtain normal birth weight and normal length of gestation," said Dr. Gibbons. "While obvious issues of uterine fibroids or conditions that alter the shape of the uterus are suspected to affect pregnancy rates, conditions that result in poorer ovarian function to the point of needing donor eggs are not known. Further research is needed to fully understand this complex issue."

As assisted reproductive technologies (ART) in the U.S. mature, increasing attention is directed not just to pregnancy rates but also to the obstetrical outcomes of those resulting pregnancies – meaning the newborn's birth weight, health and gestational age. Currently, about one percent of U.S. births are the result of ART therapies such as IVF, donor eggs, intracytoplasmic sperm injection, embryo cryopreservation, embryo donation, preimplanation genetic diagnosis, and male infertility surgery and medical therapy.

The study explored several scenarios and found that the birth weight associated with standard IVF – in which the patient carried the embryo created with her own egg – was greater than that associated with donor egg cycles, and less than that in gestational carrier cycles. This finding held true even when other factors were considered showing that the woman's own uterus may be a determining factor.

Gibbons said the study also determined that a diagnosis of male infertility did not affect birth weight or gestational age, yet every female infertility diagnosis was associated with lower birth weight and a reduced gestational age.

Patients diagnosed with a uterine health issue, such as fibroids or other factors, had babies with the lowest birth weights and gestational ages. This led the researchers to examine the uterine environment as it relates to the type of therapy being considered.

Gibbons explains that in standard IVF, an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while in donor egg IVF and gestational carrier IVF, the embryo is transferred to a "natural" or unstimulated uterus. Then, the researchers looked at IVF utilizing frozen embryo transfer in which an embryo created with a patient's own egg is transferred to her own unstimulated uterus. They found that babies born of frozen embryo transfer cycles had markedly greater birth weights than those born as a result of standard IVF.

"That finding may help women seeking pregnancy and their physicians to consider frozen embryo transfer as a possible option if the uterine health is not a consideration," said Gibbons. "This study shows us how so many factors are related to a successful outcome and we continue to learn where further research may be needed."

Thursday, 17 February, 2011

This Is Not a Lost Scene From Aliens

When I first came across this image on the right, I thought it was from a lost Aliens scene. But it is real. That's Staff Sgt. Sarah Mrak, from the 4th Special Operations Squadron. And she's inside a U.S. Air Force AC-130U aerial gunship.

Yes, an flying gunship. With real cannons. Motherbloodydancing 25mm, 40mm and 105mm side firing cannons, designed to destroy targets on the ground from the air. These planes were developed from the C-130 Hercules, evolving through numerous variants since their inception in the late 60s. The latest model—which appears in these images—is the AC-130U, which was originally introduced in 1995 for close air support, air interdiction and armed reconnaissance. One scary flying beast indeed.

U.S. Air Force photo by Master Sgt. Jeremy T. Lock

by Jesus Diaz

Wednesday, 16 February, 2011

Wi-Fi Medicine

Researchers in Boston have developed a system that has taken drug delivery to a whole new level: wireless. The system works with a small, stamp-sized chip implanted into the body. This chip contains 100 reservoirs of medicine that are released at different intervals depending on need. The chip can be monitored and controlled wirelessly. Forgetting to take your daily pills would never be an issue.

The system has been used successfully in dogs for the past six months and MicroCHIPS Inc. is saying that it should begin human testing within five years.

Medicines can't work effectively if patients don't follow their dosing schedule — a problem researchers hope to overcome by delivering drugs using an implanted microchip linked to a wireless control outside the body.

Researchers for MicroCHIPS Inc. say they've successfully controlled drug doses for up to six months in dogs that received implants in an experiment. Inside the implants were postage stamp-sized microchips containing 100 tiny reservoirs of medicine released at different intervals and amounts.

The privately held company says its first test in humans is likely three to five years away and could involve implanted sensors that would monitor a patient's circulatory system or blood glucose to manage heart disease or diabetes.

A system to release drugs in solid, liquid or gel form could come later, perhaps initially involving a medicine that isn't easily absorbed into the bloodstream when taken orally, said John Santini, president of Bedford-based MicroCHIPS.

The tests, which follow more than a decade of work by MicroCHIPS with help from two professors at the Massachusetts Institute of Technology, were reported Monday in the online edition of Nature Biotechnology.

Other internal drug-delivery methods already are on the market, from insulin pumps to so-called "passive" drug implants that can't be externally controlled.

MicroCHIPS' system is far smaller than insulin pumps — its experimental implant is about the size of a small cookie, and comparable in size to an implantable heart defibrillator. The system also is unique because it uses a wireless device that potentially could control the release of multiple drugs from a single implant in the abdomen, while also monitoring drug levels and adjusting dosing accordingly, Santini said.

The experimental method shows great promise, said Dr. Henry Brem, a Johns Hopkins University neurosurgeon who has experimented with MicroCHIPS-developed chips in government-sponsored research to treat brain tumors in rats.

"It will allow not only targeted therapy, but make the treatment delivery independent of people remembering to take their medicine," said Brem, who said he has no commercial ties to MicroCHIPS.