Over 40 and Infertile? Go Straight To IVF, Study Says

The latest study on IVF suggests that older women can benefit from a telescoped IVF experience. But is that really good news for couples struggling to get pregnant?

For couples struggling to conceive, the suggestion that fewer cycles of in vitro fertilization (IVF) can lead to pregnancy is certainly welcome news. From the daily hormone injections to the invasive and expensive process of removing eggs to try to fertilize them, IVF brings not just hope but also stress—and many women go through several cycles before they become pregnant, not to mention give birth to a baby.

So the latest study, called the Forty and Over Treatment Trial (FORT-T), published in the journal Fertility and Sterility looks, on the surface of things, to offer a roadmap for infertile couples in their quest to have children. The scientists report on how older couples can optimize their chances of conceiving, while also saving money by avoiding a trial-and-error approach to a successful pregnancy. A closer look at the results could cast a shadow on what appear to be sunny findings, though.

MORE: The Best and Worst States for Infertility

Lead researcher Marlene Goldman, at the Geisel School of Medicine at Dartmouth-Hitchcock Medical Center, concluded that the series of treatments that doctors have followed for years may not give older women the best chances of getting pregnant. Traditionally, doctors start with the least invasive strategy, ovulation-stimulating pills, followed by artificial insemination, and if that doesn’t work, they move on to the more invasive injections of a hormone that activates egg development followed by artificial insemination. If neither of those therapies helps the woman conceive, she then becomes a candidate for IVF. Each treatment is generally tried for at least two menstrual cycles, so it may take some women up to six months before they try IVF.

Goldman and her team wanted to test some encouraging evidence that skipping the first rounds of treatments and moving directly to IVF might help some women, especially older ones. They randomly assigned 154 couples to one of the three treatments: ovulation-stimulating pills followed by artificial insemination; injections of a hormone that activates egg development followed by artificial insemination; or immediate IVF. Those in the first two groups eventually went on to IVF if they failed to get pregnant. Goldman and her colleagues found, however, that the couples who started with IVF were able to achieve pregnancy and a live birth with fewer tries than those who tried the other methods first.

But that doesn’t mean that all infertile couples should do the same.

To start, the study involved a relatively small number of women who had very specific characteristics when it came to their reproductive potential. All had tried unsuccessfully for six months to get pregnant via intercourse, none had tried any infertility treatments, and they all had to have one functioning ovary, a fallopian tube, a certain level of ovarian reserve and no history of a tubal pregnancy.

MORE: How Healthy Are IVF Babies?

There’s also the possibility, says Dr. Tommaso Falcone, chairman of the Obstetrics, Gynecology and Women’s Health Institute at the Cleveland Clinic, that the comparison among the three groups of women isn’t quite fair. If women who start off with the pills or shots get pregnant using those strategies, then those who remain—the women who end up needing IVF—represent a more challenging group to treat. On the other hand, those who started out with IVF will include a mix of those who might more easily get pregnant as well as those who require more intensive treatment. So of course the group that went immediately to IVF would have a higher pregnancy and live birth rate. “These are different populations,” Falcone says.

Previous research done by Goldman shows that conception rates were similar (about 23%) in each group, however, which supports Goldman’s results, and strongly suggests that older women may benefit from moving directly to IVF and skipping the traditional first line infertility therapies.

MORE: IVF Babies Hit Record High

Goldman admits that understanding fertility data remains a challenge, especially considering the fact that the success rates of fertility clinics are self-reported and since certification by the Centers for Disease Control is voluntary. For the clinics that do report, there’s an obvious incentive to keep their success rates (defined as number of live births per IVF cycle) high. Some turn away older couples or those who have already tried unsuccessfully to get pregnant using reproductive technologies. And in states where infertility treatments are not covered by insurance, the numbers may look worse, as couples who try all other, less expensive means first to get pregnant, only turn to IVF when they have saved enough to pay for it. “There is definitely a selection bias, and definitely access issues,” says Goldman. “So just looking at the stats aren’t helpful unless you understand the patient population for that clinic.”

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That puts the burden of figuring out what the numbers mean on couples, who are already juggling difficult emotional, financial and physical challenges that comes with trying to get pregnant. For older women, Goldman’s study may provide some hope—as long as they fit the rather strict criteria of the couples included in the study. As crass as it may seem, fertility services are a product being sold to couples, and as with every purchase, experts warn that the principle of caveat emptor should apply.


The One Good Thing About Teens And Sports Drinks

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Researchers confirm a strong connection between sports and energy drinks and smoking, video game playing and sugary soda consumption. But the beverages were also linked to more physical activity among teens.

Considering what we know about kids and sports drinks — briefly, that according to leading health groups like the American Academy of Pediatrics, most children should not be drinking them — the small silver lining, according to a recent study, is that kids who drink them tend to exercise more than those who don’t. But they were also more likely to do things that harm their health, too.

Nicole Larson and her colleagues at the University of Minnesota School of Public Health asked nearly 3000 students in grades 6 through 12 an exhaustive series of 235 questions and concluded that nearly 40% drank a sports drink at least once a week. Both boys and girls consuming sports drinks regularly were more likely to smoke and to play video games, the researchers found. They were also more likely to drink sugary soda and juice. The fact that sports and energy drink consumption are correlated with other risky behaviors, such as smoking, isn’t a surprise (though, to be clear, the researchers do not suggest a cause-effect relationship between the two).

As for the finding that the big sports-drink fans were also more likely to exercise and participate in organized sports? The researchers say that could be due to the fact that sports drink makers often partner with athletic groups to target adolescent athletes specifically.

Consumption of sports and energy drinks has tripled among teens in the past decade and about 12% of U.S. teens still drink a sports or energy drink on any given day. Taken together, the body of research suggests that athletes need to be better educated about the healthiest way to hydrate: drinking water.


The Tiger Mom Effect Is Real, Says Large Study

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But pressure from parents is only part of the reason why Asian-American students excel

The dangerous thing about stereotypes is that they’re often built on a kernel, however small, of truth. And the ones about Asian-Americans aren’t any different – so the latest research appearing in the journal PNAS attempts to get to the bottom of the stereotype of Asian-American academic prowess. Are tiger moms — so-called for their hyper-disciplining parenting and their laser-like focus on achievement and performance — to thank? Deeper financial pockets that can fund tutors and summer school? Or are Asian Americans just smarter than white kids?

I’ve thought about this myself. That stereotype of the over-achieving, over-booked, good-at-math-and-science Asian-American? That’s me. I got good grades in school. I took summer school classes. I read voraciously – in one summer, I read all 100 books on a list that was supposed to sustain us through the four years of high school. I spent every Saturday in back-to-back piano lessons, music theory and ballet classes. My parents assumed I would go to college, and I did. My parents assumed I would go to graduate school, and I did. For a career, I chose to write about health and science.

But I stayed out of the brouhaha when Amy Chua roared about the Tiger Mom, confidently defending her strict and, to some, draconian parenting methods to keep her kids on track to becoming all they could be. Maybe it hit too close to home — there was a lot that was familiar in the way she “encouraged” her kids to practice their musical instruments for hours until they got it right. I remember feeling chained to the piano bench on warm sunny days when all I wanted to do was take a dip in the pool or just hang out with friends. (Did I mention that my piano lessons continued over summer vacation, at my teacher’s house?)

But I think my ambivalence had more to do with a sense that there was something elitist in the argument of Asian-American exceptionalism – that Asian parents were endowed with some special ability to appreciate the value of effort and the importance of pushing their kids to succeed, a skill that remained out of reach to other parents for whatever reason. That wasn’t my experience. I saw the same emphasis on exceptionalism and achievement among my other, non-Asian friends, and wasn’t quite buying the idea that parents from the Far East had a lock on the way to get the most out of their kids.

So I was intrigued by how Amy Hsin and Yu Xie attempted to explain the academic advantage of Asian-Americans over whites. Hsin, from Queens College at the City University of New York, and Xie, from the University of Michigan, quickly found that higher socio-economic status and greater intellect didn’t contribute as much as some researchers have thought to the grade gap. Even recent immigrants who didn’t have much in the way of financial or social support still tended to do better in school than non-Asian students born and raised in the U.S. And from kindergarten throughout high school, Asian-American students score about the same as whites on standardized tests.

That leaves the work ethic, which Hsin and Xie found accounted for almost all of the grade gap between Asian-American and white students. And that was driven by two factors, both of which have more to do with social and cultural factors than racial ones. Among the more than 5200 Asian-American and white students from two large datasets that followed them from kindergarten into high school, Asian-American students were able to take advantage of social support systems that helped to translate their effort into success. In their communities, families are surrounded by ways to enhance education – from word-of-mouth advice about the best school districts to resources like books, videos and websites, to cram schools for after-school classes. “The Tiger Mom argument neglects these social resources and forces that sustain and reinforce the work ethic,” says Hsin.

In other words, it takes a village. It also takes a culture that may have less to do with race specifically, and more to do with broader social factors such as immigration.“ Asian-American youth are more likely to attribute intellect and academic success to effort rather than innate ability,” she says. That’s a natural outgrowth of the belief that success – in school, in work, and in life — is a meritocratic commodity; the more you put in, the more you get out. When quizzed about whether they thought math skills were innate or learned, most of the white students believed it was a skill you were born with while the Asian-Americans were more likely to think it was learned, and acquired with effort.

The advantage that brings to their GPAs, however, does come with a price. Hsin also found that Asian-American students were more likely to have more self-image problems and more conflicted relationships with their parents than their white counterparts. The pressure to perform seems to take a toll on those who fail to meet expectations as well as those who do – for the latter, the expectation to be successful makes the achievement less satisfactory and less fulfilling.

So Tiger Moms may be on to something, however obvious it may seem: hard work does pay off, albeit at the cost of some self-esteem. But it may be giving them too much credit to say they do it alone. And looking back, I have to admit, however begrudgingly, that all that discipline has probably made me a more organized and confident adult. But don’t tell my mom.


TIME Infectious Disease

WHO Declares Health Emergency on Polio

The World Health Organization declared polio an international health emergency on Monday as the rise in cases threatens eradication efforts and singled out the conflict zones of Syria, Cameroon and Pakistan as worrisome sources of its spread

The recent spread of the polio virus is a public health emergency of international concern, the World Health Organization said Monday.

Ten countries currently report evidence that the virus, which can cause paralysis, is circulating among people. WHO Director-General Margaret Chan recently convened a committee to evaluate international efforts that began 25 years ago to eradicate the disease and the 14-member panel found disturbing evidence that interruptions in vaccination programs have allowed the virus to break through in some parts of the world.

Especially concerning was the fact that three countries—Pakistan, Syria, and Cameroon—showed higher rates of transmission of wild polio virus to other nations even during the disease’s more dormant period. That raises the possibility that when the virus becomes more active, from April into the summer, transmission rates will peak even more. “If the situation as of today and April 2014 is unchecked, it could result in the failure to eradicate globally one of the world’s most serious vaccine preventable diseases,” Dr. Bruce Ayleward, WHO’s assistant director general for polio, emergencies and country collaboration said during a conference call.

The emergency measures require that residents in the three countries actively exporting polio virus receive a dose of either of the two polio vaccines four weeks-to-12 months before traveling, and that they be provided with proof of their immunization. The remaining seven affected countries are encouraged, but not required, to do the same. The WHO recommended these measures remain in place until countries show no new transmission of polio for six months and evidence of eradication efforts, including immunization programs. While not legally binding, the cooperation of affected countries is expected, Ayleward said. The WHO’s action may also help governments to make polio immunization a priority; in 2009, a similar declaration during the H1N1 pandemic allowed nations to prioritize health care services to protect and treat patients affected by the flu.

Health officials have been getting closer to making polio the second disease, after smallpox, to be eradicated by vaccinating children in countries where the wild virus continues to circulate. But social unrest and political conflict have interrupted immunization programs—some health workers have become targets of violence in Pakistan, for example, while growing populations of displaced residents such as refugees who are without access to health care services also provide fertile conditions for the virus to spread. Seven of the 10 countries now reporting wild polio virus have been successful at eliminating the disease in the past, but have been reinfected in recent years.

Chan asked the committee to reconvene in three months to see if the recommendations were effective in controlling the spread of the disease.


6 Ways to Avoid Dying Before Your Time

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It’s no secret that some of our unhealthy habits are driving us early deaths, so the United Nations has calculated exactly how many lives can be saved if we start following the advice of public health officials.

With so many of the deaths each year from around the world directly related to poor health choices we make, world health leaders have set a goal of lowering the number of preventable deaths by 25% from 2010 rates by 2025. That would save 37 million lives over 15 years. Reporting in the journal Lancet, public health experts note that the way to prevent those deaths aren’t surprising. But acting on those strategies will take individual and political will. Here’s how the experts hope to do it.

Not smoking.

The UN General Assembly set a target of cutting smoking around the world by 30% by 2025. Already, higher-income nations that have adopted smoking bans in public places and instituted tobacco taxes have seen drops in smoking rates, although residents in lower income nations continue to light up at high rates.

Limiting excessive drinking.

While moderate amounts of alcohol have been linked to some health benefits, overindulging can increase the risk of certain cancers and liver disease, as well as contribute to high blood pressure. Educating people about the risks of excessive drinking, as well as instituting taxes on alcoholic products have been somewhat successful in curbing abuse.

Cutting back on salt.

High sodium diets can increase blood pressure and contribute to heart disease and stroke, and in many developed countries, people eat several times the amount the salt their bodies need. In the U.S., the average American consumes about 800mg more salt every day than health experts consider acceptable. Promoting alternatives, such as the citric acid in lemons, to satisfy the need for salt, can help to bring sodium consumption down.

Getting blood pressure under control.

Lack of exercise and high sodium diets contribute to hypertension, and uncontrolled high blood pressure can lead to stroke and heart disease. Monitoring blood pressure with regular screenings, and treating elevated levels with changes in diet and exercise, or medications if necessary, are the most effective ways to address this risk factor.

Address diabetes

Closely tied to the obesity epidemic that now affects developing as well as developed nations, diabetes can increase the risk of heart disease, kidney disease and other conditions that can shorten life. Studies show that lifestyle changes incorporating healthy diets low in sugar and physical activity can be as effective as medications in keeping blood sugar levels in check.

Reducing obesity.

The global growth in girth is tied to a number of factors, from the proliferation of processed and high calorie foods, to the shift toward sedentary lifestyles. Addressing obesity alone could also have beneficial effects in lowering other chronic conditions such as heart disease, diabetes and hypertension. Public health campaigns highlighting the high calorie content of fast and processed foods, and programs that provide access to fresh fruits and vegetables, including in schools, could be important steps in turning the tide of the global obesity epidemic.


Nearly Half of US Deaths Can Be Prevented With Lifestyle Changes

Researchers at the Centers for Disease Control have concluded that unhealthy habits such smoking, drinking, lack of exercise and poor diets contribute to tens of thousands of premature deaths each year

Death is inevitable, but premature death can be prevented, say health officials. In its first report calculating the number of these deaths in the U.S. that can be avoided, researchers at the Centers for Disease Control (CDC) found that tens of thousands of lives can be saved, mostly by people making changes to their lifestyle.

“We have known now for decades that the ‘actual’ causes of premature death in the United States are not the diseases on death certificates, but the factors that cause those diseases,” says Dr. David Katz, director of Yale University’s Prevention Research Center. And now we have even more national data to prove it.

The analysis, published in the agency’s Morbidity and Mortality Weekly Report, detailed deaths from the five leading causes — heart disease, cancer, lower respiratory illnesses, stroke and unintentional injuries — in each state. These accounted for 63% of deaths in the U.S. between 2008-2010, the latest years for which the data have been studied. When the investigators compared the mortality rates in the three states with the lowest number of deaths by age group to the recorded number of deaths for each of these causes in each state, they determined that up to 40% of them could be avoided.

“That is a stunning advance,” says Katz. “And one tauntingly within reach” if we were to standardize our disease prevention to the best already achieved at the state level.

“It’s yet another demonstration that when it comes to health in this country, your longevity and health are more determined by your zip code than by your genetic code,” Dr. Tom Frieden, director of the CDC, said during a teleconference discussing the report.

The researchers found that 92,000 lives could be saved from early death due to heart disease, 84,500 from cancer and 29,000 from lung diseases, mostly due to smoking.

The eight states with the highest death rates from each of the top five causes included Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Contributing to those elevated rates, says Frieden, are modifiable habits such as smoking, drinking and lack of exercise, as well as unhealthy diets and being overweight.

“There are far too many places in this country where just by the unfortunate fact that you live there you are much more likely to die from a preventable cause,” says Frieden. “You don’t have to move geographically, but we do have to move in terms of policies and programs.”


You Can Smell Someone’s Gender, Says Science

Researchers find the strongest evidence yet for sex pheromones

Finding a mate is one of the basic instincts of all living beings, and in most of the animal and insect world, it’s all done by smell. Sniffing out gender is something that animals are built to do, both with the appropriate scent-releasing structures to perfume the air with sex pheromones, and the most sensitive odor-detecting organs on the planet.

Now scientists report in the journal Current Biology that people may have that ability as well, even if we aren’t always aware of it. Humans don’t have the same sophisticated olfactory organs as some of our animal counterparts, and while men and women do exude different scents, it’s been harder to confirm that people can pick up on these odors, or that they were working as sex pheromones to attract two people to each other.

MORE: Your Nose Can Smell at Least 1 Trillion Scents

In the latest study on the subject, researchers in China and at the University of Minnesota conducted a small study in which both men and women of different sexual orientation were exposed to male, female or neutral scents without their knowledge on three consecutive days while they viewed a series of computer dots representing a person walking.

Heterosexual men thought the dots showed a more feminine gait when they were exposed to the female hormone estratetraenol. There was a similar effect among heterosexual women, who were biased to see the dots showing a more masculine gait when they smelled the male hormone androstadienone. Gay men responded more like the women to the two hormones, while bisexual or homosexual women showed more varied responses, between those of heterosexual men and women.

MORE: Can Your Smelly Shirt Land You a Better First Date?

“The study shows that people subconsciously extract gender information from chemosensory cues [that depend] on their gender and sexual orientation,” says Wen Zhou, the study’s lead author from the Chinese Academy of Sciences in Beijing, in an email discussion about the findings.

Zhou isn’t quite ready to say that estratetraenol and androstadienone, which are steroid products of estrogen and testosterone, respectively, work as sex pheromones between men and women by acting as sexual stimulants, since the group did not test how smelling varying amounts of the agents affected people’s sensitivities toward gender.

But the findings provide the first hint that gender may have specific scents, and that the human nose and pick up on them. The study also suggests that the human nose may be relaying information about much more than smells that the brain processes on a conscious level. Recent studies, in fact, have confirmed that our olfactory sense is capable of picking up one trillion smells, and that we can pick up whiffs of illness when somebody’s immune system is activated. There’s even evidence that the human nose can smell age – an evolutionarily helpful skill that distinguished younger, more fertile mates from older ones. We are only beginning to understand what the nose knows, and we imagine ensuing research will continue to surprise and baffle us all.


24 Visits to the Nail Salon Could Trigger Skin Cancer

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Study finds that UV lamps at nail salons vary widely in how much radiation they emit

Beauty comes at a price, and for long-lasting manicures, that may include skin cancer. One of the more popular services at nail salons involves baking the paint onto the nail under an ultraviolet (UV) lamp – yes, the kind that emits the same aging and skin-damaging light that can cause melanoma and other malignancies. But advice about how safe it is to get that kind of exposure from the occasional (or even weekly) manicure has been conflicting.

A new report from JAMA Dermatology finds that how much UV light you’re getting exposed to depends on the bulb you put you fingers under—and they vary wildly.

Unlike previous studies, in which scientists analyzed the amount of UV emitted by single devices, Dr. Lyndsay Shipp, a resident at Georgia Regents University’s Medical College of Georgia, and her colleagues measured the amount of irradiation from nail dryers at 16 nail salons in the U.S. Most salon devices emit more UVA than UVB light, and UVA rays penetrate more deeply into skin. Salons use a range of bulbs, however, that emit vastly different amounts of UVA. Because UVA damage to DNA is cumulative, Shipp and her team also calculated that it could take as few as 24 visits to some salons and as many as 625 to others, to reach the point where the UV light triggers cancer-causing DNA damage. (Many lamps also provided inconsistent UV light: “If you’re sticking your hand in the device, your pinky might get a different amount of UV than your thumb,” says Shipp.)

MORE: Nail Polish Sales Hit Record $768 Million in U.S.

Shipp acknowledges that more research is needed. For now, that means the risk in drying your manicure under these lamps is variable. A single manicure won’t give you skin cancer, obviously, but anyone concerned about — or with a family history of — the disease should consider smearing a little sunscreen on their hands or doing it the old-fashioned way: air drying.

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