Does acupuncture boost IVF success?

NEW YORK (Reuters Health) - Acupuncture may help some women conceive through in-vitro fertilization (IVF), a new analysis of past research concludes. But the true benefit in the real world, if any, remains unclear.

The technique has been used for millennia in traditional Chinese medicine, for a whole range of ills.

Ten years ago, a study in Germany was the first clinical trial to report that acupuncture seemed to improve pregnancy rates in women undergoing IVF. But since then research has turned up mixed results.

"I counsel women that the literature is not convincing yet that (acupuncture) helps you get pregnant," said Dr. Frederick Licciardi, who heads the New York University Fertility Center's mind/body program.

At the center, women can opt for acupuncture sessions, yoga and other "mind/body" services, but that's aimed at easing stress and promoting general "wellness" -- not at boosting IVF success, said Licciardi.

Clinical trials on the issue so far have been small, and often of questionable quality.

So for the new study, reported in the journal Fertility and Sterility, Chinese researchers conducted what's called a meta-analysis -- where researchers combine the results of past studies to try to get an idea of the overall picture.

Dr. Cui Hong Zheng and colleagues at Tongji Medical College pooled the results of 24 small clinical trials testing the effects of acupuncture in women undergoing IVF.

The trials varied widely: Many tested needle acupuncture, some electro-acupuncture and some included laser acupuncture in the mix.

The studies also differed in what they used as a "control."

In many trials, IVF patients either received acupuncture or nothing. In others, researchers used a form of "placebo" acupuncture such as applying blunt needles to the skin surface. Some researchers used real needles, but stimulated points not related to fertility, according to traditional medicine.

Zheng's team found that overall, women who had acupuncture had a slightly higher pregnancy rate than women who did not have the therapy -- but no higher birth rate.

The results looked a little different, though, when the researchers excluded five studies that used blunt needles as a control.

When those trials were dropped, women in the remaining studies who received acupuncture fared a little better: 41 percent became pregnant, versus 37 percent of those who did not have acupuncture.

Three of those trials also looked at birth rates. Of women who received acupuncture, 35 percent had a baby, compared with 25 percent of women in the control groups.

According to Zheng's team, the findings suggest that the blunt-needle acupuncture used in some trials is not a truly "inactive" placebo, and may actually have effects similar to the real thing.

And that, the researchers say, may explain why those studies failed to find benefits from real acupuncture.

But Licciardi -- who stressed that he is "not anti-acupuncture" -- was unconvinced.

One of the big problems with the analysis, according to Licciardi, is that it combined studies that were all looking at very different things: different types of acupuncture, different controls, and different timing of the acupuncture sessions.

"They're just too heterogeneous to generalize and draw conclusions," Licciardi said.

He was also skeptical of the researchers' choice to drop certain trials, which then essentially gave them "the results they wanted."

In the bigger context of acupuncture research, finding a good control has long been a problem.

The gold standard for proving that any medical treatment works is to randomly assign patients to receive the treatment or a placebo, with neither the patients nor the researchers knowing who is getting the real thing.

If a trial is testing a drug, it is easy enough to give the control group sugar pills.

But with acupuncture, it has been hard to find a widely accepted placebo version -- one that has no, or at least minimal, physiological effects but is convincing enough that patients think they're getting acupuncture.

The bottom line, according to Licciardi, is that no one yet knows if acupuncture can really make a difference in IVF success. But if a woman wants to try it simply to feel better or de-stress, there would be little harm.

Acupuncture is generally considered safe, with side effects like bruising at the needle site. The cost can vary widely -- and may or may not be covered by insurance -- but a session would typically start at around $100.

"If acupuncture helps you feel well, if it helps you get through the IVF (process), then great," Licciardi said.

As for why acupuncture would help a woman get pregnant with IVF, no one is sure of that either.

There's some evidence that needle stimulation may improve blood flow to the uterus. And researchers are looking at whether acupuncture might make the uterine wall more receptive to the embryo.

SOURCE: http://bit.ly/xUSWrV Fertility and Sterility, online.

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Big Pharma donates drugs for neglected diseases

LONDON (Reuters) - The world's major pharmaceutical companies joined forces with governments and leading global health organizations Monday to donate drugs and scientific know-how to help control or wipe out 10 neglected tropical diseases by 2020.

Drugmakers have been criticized in the past for not doing enough to fight diseases of the poor as they concentrate instead on conditions more prevalent in rich nations, such as high cholesterol.

But in the largest coordinated effort yet to fight diseases such as Guinea worm disease, leprosy and sleeping sickness, the group promised to give away 14 billion doses of medicines by the end of this decade.

They will also share expertise and drug discovery work to invent new medicines for neglected tropical diseases (NTDs) that as yet have no treatments.

The AIDS pandemic forced drugmakers in the past decade to pay more attention to the developing world, and a new focus on the economic potential of emerging markets has provided an incentive to promote their brands in poorer countries.

In a project expected to affect the lives of a billion people worldwide, the partnership pledged more than $785 million to support NTD research and development (R&D) and strengthen drug distribution and treatment programs.

World Health Organization (WHO) director general Margaret Chan, who announced the deal in London, said it "changes the face" of NTDs -- illnesses that needlessly disable, blind and kill millions of the world's poorest people.

"These ancient diseases are now being brought to their knees with stunning speed," she told an audience at the Royal College of Physicians in the British capital.

"With the boost to this momentum being made today, I am confident almost all of these diseases can be eliminated or controlled by the end of this decade."

NTDs disproportionally affect people in the poorest countries of the world. Experts estimate more than a billion people are affected by them, including more than 500 million children.

"Maybe as the decade goes on people will be wondering whether we should still call these diseases 'neglected'," said Microsoft chairman and philanthropist Bill Gates.

The WHO's first global report on neglected tropical diseases in 2010 said that while they cost billions of dollars in lost productivity, they are often ignored because they affect mainly poor people and do not offer a profitable market for drugmakers.

NTDs include illnesses such as sleeping sickness, which is transmitted through tsetse fly bites and threatens millions of people in Africa, and Chagas disease, a debilitating condition caused by a parasite transmitted in infected feces of blood-sucking bugs. An estimated 10 million people are infected with Chagas, mostly in Latin America where the disease is endemic.

"HORRIFIC"

Speaking for chief executives of the drug firms involved in the partnership, Andrew Witty, GlaxoSmithKline's CEO described the impact of the diseases as "horrific" and said he hoped the scale of this new cooperation would beat them.

"No one company or organization can do it alone," he said. "It's great to have this commitment, and it's even better to have a deadline."

Adding the new pledges to existing individual commitments, 13 drug companies including Pfizer, Merck, Johnson & Johnson, Sanofi, GlaxoSmithKline, Novartis and others will donate an average of 1.4 billion treatments a year to people suffering from NTDs.

The International Federation of Pharmaceutical Manufacturers and Associations (IFPMA) said new R&D collaborations and deals with drugmakers and the Drugs for Neglected Diseases initiative (DNDi) would also give "unprecedented" access to libraries of chemical compounds that may lead to new treatments.

Extra funding for the project came from Britain, the United States and United Arab Emirates, the Gates Foundation and the Children's Investment Fund Foundation. The World Bank agreed to extend financing to help African countries build health systems better able to integrate NTD elimination and control.

Gates, whose foundation announced a five-year, $363 million commitment to support NTD product and operational research, said the collaboration would help millions of people build self-sufficiency and overcome the need for aid and serve as a model for tackling future global development challenges.

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Don't blame C-sections for fat kids: study

NEW YORK (Reuters Health) - Kids born by Cesarean section are no more likely to become obese than if they are born vaginally, a new study concludes.

Past research from Brazil had found a link between excessive poundage and C-sections, leading some scientists to suggest that not being exposed to bacteria from the birth canal could make babies fatter. (See Reuters Health story of May 12, 2011.)

But according to the latest findings, that doesn't appear to be the case.

"We thought from the beginning that probably what happened with the previous study is that they didn't adjust for all of the confounders," said Fernando Barros of the Catholic University of Pelotas. "If a mother gives birth by C-section, she's different than a mother who has a vaginal birth."

For the new research, Barros and his colleagues used data on three groups of several thousand people born in Southern Brazil in 1982, 1993 or 2004.

Researchers contacted the kids at different ages until the oldest had turned 23. Those born by C-section were more likely to be heavy, with obesity rates between nine and 16 percent, compared to rates of seven to 10 percent among kids born vaginally.

However, that difference vanished once the researchers accounted for factors that could have influenced the results such as family income, birth weight, schooling and the mother's weight, height, age and smoking habits.

"When you factor in all of these other factors, the relationship between obesity and Cesarean sections disappears," said Barros, whose findings are published in the American Journal of Clinical Nutrition.

The earlier Brazilian study left out many of those factors, including maternal height and weight, Barros' team writes in its report.

"The most simple explanation would be that more obese women require more Cesarean sections than lean women... and it's really not the C-section itself," said Dr. David Ludwig, director of the Optimal Weight for Life Clinic at Children's Hospital Boston, who wasn't involved in the study.

The new research is of particular interest in Brazil, because in 2009 more than half of the babies there were born by C-section. In the U.S., the number has been on the rise for years and is now over 30 percent.

Some believe that C-section babies are different because they are not exposed to bacteria in the birth canal like babies born vaginally. The theory is part of the hygiene hypothesis, which suggests a person's immune system develops differently when they're not exposed to beneficial bacteria early in life.

"We're not saying this hypothesis is not interesting. It is. We're just saying, right now, without data, we cannot confirm the finding," said Barros.

He cautioned that people in his study had only been followed until early adulthood, so he cannot say if there is a potential association later in life.

Ludwig told Reuters Health that things like a pregnant woman's diet and smoking habits and whether or not she has diabetes might influence a developing fetus.

Both Ludwig and Barros said women should avoid medically unnecessary C-sections, even if they don't raise the chances of having obese kids, because they carry other risks.

SOURCE: http://bit.ly/zjs00B American Journal of Clinical Nutrition, online.

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Carpooling parents don't always use booster seats

NEW YORK (Reuters Health) - Parents use booster seats inconsistently when carpooling with young kids, according to a new study.

Laws on when the seats must be used vary by state, but guidelines from groups including the American Academy of Pediatrics recommend boosters from the time kids outgrow their car seats until they hit four feet, nine inches tall -- the height of the average 11-year-old.

The new report suggests that most parents of four- to eight-year-olds have a booster seat for their kids in their own cars, but don't always make sure boosters are used when they carpool.

"Until children reach a certain size, the seatbelt doesn't fit them properly enough to maximize the protection that seatbelts offer when you're bigger and taller," said Andrea Gielen, head of the Center for Injury Research and Policy at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Booster seats, she told Reuters Health, position smaller bodies to get the most benefit from the seatbelt in case of a crash.

"The study shows that parents are missing opportunities to protect their kids in the car on every ride," said Gielen, who wasn't involved in the research.

The new data come from an online survey of 681 U.S. parents conducted in early 2010.

Along with a range of questions related to kids' health and family dynamics, parents were asked about their own use of booster seats and how they felt about the seats when it came to carpooling.

Three-quarters of the parents said they used a safety seat for their own child in their car. Parents of younger kids, and those that lived in states that required the use of booster seats, were most likely to use boosters.

The majority of survey participants also said they either frequently or occasionally carpooled with another family.

Among parents who used a booster seat in their own car and said they carpooled, 79 percent reported that they would always ask another driver to put their kid in a booster seat. Just over half of them said they would make sure their kid was always in a booster when in the car with friends who didn't use the seats, according to the report, published Monday in the journal Pediatrics.

That may have to do with practical issues of transporting and passing off the seats, or with social norms regarding interactions between parents with different safety practices, researchers said.

"I wish I could say (the finding) was surprising," said Dr. Michelle Macy, from the University of Michigan in Ann Arbor, who worked on the study.

"But it does fit my experience that it can be a little bit of an awkward topic to broach with parents and it does require a little more planning."

Still, neither of those reasons should hold parents back from making sure their child is always in a booster seat, according to Dr. Mark Zonfrillo, a child safety researcher and emergency medicine doctor at The Children's Hospital of Philadelphia.

"If you were to send your child to one of their friend's houses and they needed some kind of medication, they had a chronic illness, you'd send them with the medication," said Zonfrillo, who wasn't involved in the new study -- and there's no reason booster seats should be any different.

"We know they're highly effective," he told Reuters Health. "They also happen to be the most convenient and portable of all child restraints, and they're really cheap."

The seats start at about $20, and researchers also pointed to car seat loaner programs where families can get boosters for free.

Macy said that the findings also show the importance of pushing for state laws that meet guidelines for booster seat use, noting that most laws now only require boosters up to age eight -- when the majority of kids still won't be adequately protected by a seatbelt alone.

SOURCE: http://bit.ly/jsoh2P Pediatrics, online.

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