Kate Johnson

NEW ORLEANS — The majority of women who are at risk for anxiety and depression following a failed in vitro fertilization cycle can be identified by a one-page screening questionnaire administered before treatment, Christianne M. Verhaak, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

“If you can identify who is at risk before the start of treatment, you can offer them tailored intervention in time to prevent future emotional problems,” said Dr. Verhaak, a clinical psychologist at Radboud University Nijmegen Medical Center in the Netherlands.

She suggested that simply informing patients about the emotional impact of unsuccessful treatment can help them prepare appropriately. “For most patients and their families, the emotional impact of infertility is unknown because it is still not easy for people to talk about,” she said in an interview. “But it is comparable to grief. With grief, people expect an emotional reaction, they understand that is not something that passes after 1 or 2 months—it's something that takes a lot of time and often involves a reconsideration of one's life.”

Her study, which was awarded the Mental Health Professional Group prize paper at the meeting, followed 400 women who were starting in vitro fertilization (IVF) cycles at eight different fertility clinics in the Netherlands. Psychological questionnaires were administered before treatment, after each IVF cycle, and 6 months after the last IVF cycle. The questionnaires included the short version Spielberger State Trait Anxiety Inventory (STAI) to assess state anxiety, the Beck Depression Inventory (BDI) to assess depression, the Illness cognition questionnaire to assess cognitions of helplessness and acceptance regarding infertility, and a social support inventory.

Six months after the end of all IVF treatment, 20% of the women who had failed to become pregnant showed clinically relevant levels of anxiety and 25% showed clinically relevant levels of depression, reported Dr. Verhaak. “What is important is that in these women no recovery had taken place since the end of treatment. A negative response to treatment failure is normal, but in grief studies, recovery is apparent by 6 months, and if it is absent this is considered abnormal.” She added that emotional problems that interfere with daily life are almost always associated with failed, rather than successful, IVF cycles.

“The emotional impact is mostly influenced by the stress of possible childlessness. So if the treatment succeeds, in most cases the stress diminishes considerably,” Dr. Verhaak said.

The study found five pretreatment risk factors that were associated with persistent emotional problems after treatment: anxiety, depression, cognitions of helplessness, reduced cognitions of acceptance, and lack of social support. Patients with at least one of these risk factors had a fourfold chance of developing posttreatment emotional problems compared with patients who had no risk factors, she said.

The researchers then developed a one-page screening tool to identify these risk factors before treatment and validated the tool in a separate group of 512 patients. They found the screening tool identified 74% of the overall cohort correctly as either at risk or not, with a sensitivity of 69% and a specificity of 79%. The sensitivity increased to 70% and the specificity to 87% in the subgroup of women who did not get pregnant.

Dr. Verhaak said the findings suggest that screening all patients is worthwhile before they start IVF; this would include both those with primary and those with secondary infertility. “The longing for a second child is the same as the longing for a first child, and the emotional impact of not getting pregnant is the same in both cases,” she said.

NEW ORLEANS — The majority of women who are at risk for anxiety and depression following a failed in vitro fertilization cycle can be identified by a one-page screening questionnaire administered before treatment, Christianne M. Verhaak, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

“If you can identify who is at risk before the start of treatment, you can offer them tailored intervention in time to prevent future emotional problems,” said Dr. Verhaak, a clinical psychologist at Radboud University Nijmegen Medical Center in the Netherlands.

She suggested that simply informing patients about the emotional impact of unsuccessful treatment can help them prepare appropriately. “For most patients and their families, the emotional impact of infertility is unknown because it is still not easy for people to talk about,” she said in an interview. “But it is comparable to grief. With grief, people expect an emotional reaction, they understand that is not something that passes after 1 or 2 months—it's something that takes a lot of time and often involves a reconsideration of one's life.”

Her study, which was awarded the Mental Health Professional Group prize paper at the meeting, followed 400 women who were starting in vitro fertilization (IVF) cycles at eight different fertility clinics in the Netherlands. Psychological questionnaires were administered before treatment, after each IVF cycle, and 6 months after the last IVF cycle. The questionnaires included the short version Spielberger State Trait Anxiety Inventory (STAI) to assess state anxiety, the Beck Depression Inventory (BDI) to assess depression, the Illness cognition questionnaire to assess cognitions of helplessness and acceptance regarding infertility, and a social support inventory.

Six months after the end of all IVF treatment, 20% of the women who had failed to become pregnant showed clinically relevant levels of anxiety and 25% showed clinically relevant levels of depression, reported Dr. Verhaak. “What is important is that in these women no recovery had taken place since the end of treatment. A negative response to treatment failure is normal, but in grief studies, recovery is apparent by 6 months, and if it is absent this is considered abnormal.” She added that emotional problems that interfere with daily life are almost always associated with failed, rather than successful, IVF cycles.

“The emotional impact is mostly influenced by the stress of possible childlessness. So if the treatment succeeds, in most cases the stress diminishes considerably,” Dr. Verhaak said.

The study found five pretreatment risk factors that were associated with persistent emotional problems after treatment: anxiety, depression, cognitions of helplessness, reduced cognitions of acceptance, and lack of social support. Patients with at least one of these risk factors had a fourfold chance of developing posttreatment emotional problems compared with patients who had no risk factors, she said.

The researchers then developed a one-page screening tool to identify these risk factors before treatment and validated the tool in a separate group of 512 patients. They found the screening tool identified 74% of the overall cohort correctly as either at risk or not, with a sensitivity of 69% and a specificity of 79%. The sensitivity increased to 70% and the specificity to 87% in the subgroup of women who did not get pregnant.

Dr. Verhaak said the findings suggest that screening all patients is worthwhile before they start IVF; this would include both those with primary and those with secondary infertility. “The longing for a second child is the same as the longing for a first child, and the emotional impact of not getting pregnant is the same in both cases,” she said.

NEW ORLEANS — The majority of women who are at risk for anxiety and depression following a failed in vitro fertilization cycle can be identified by a one-page screening questionnaire administered before treatment, Christianne M. Verhaak, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

“If you can identify who is at risk before the start of treatment, you can offer them tailored intervention in time to prevent future emotional problems,” said Dr. Verhaak, a clinical psychologist at Radboud University Nijmegen Medical Center in the Netherlands.

She suggested that simply informing patients about the emotional impact of unsuccessful treatment can help them prepare appropriately. “For most patients and their families, the emotional impact of infertility is unknown because it is still not easy for people to talk about,” she said in an interview. “But it is comparable to grief. With grief, people expect an emotional reaction, they understand that is not something that passes after 1 or 2 months—it's something that takes a lot of time and often involves a reconsideration of one's life.”

Her study, which was awarded the Mental Health Professional Group prize paper at the meeting, followed 400 women who were starting in vitro fertilization (IVF) cycles at eight different fertility clinics in the Netherlands. Psychological questionnaires were administered before treatment, after each IVF cycle, and 6 months after the last IVF cycle. The questionnaires included the short version Spielberger State Trait Anxiety Inventory (STAI) to assess state anxiety, the Beck Depression Inventory (BDI) to assess depression, the Illness cognition questionnaire to assess cognitions of helplessness and acceptance regarding infertility, and a social support inventory.

Six months after the end of all IVF treatment, 20% of the women who had failed to become pregnant showed clinically relevant levels of anxiety and 25% showed clinically relevant levels of depression, reported Dr. Verhaak. “What is important is that in these women no recovery had taken place since the end of treatment. A negative response to treatment failure is normal, but in grief studies, recovery is apparent by 6 months, and if it is absent this is considered abnormal.” She added that emotional problems that interfere with daily life are almost always associated with failed, rather than successful, IVF cycles.

“The emotional impact is mostly influenced by the stress of possible childlessness. So if the treatment succeeds, in most cases the stress diminishes considerably,” Dr. Verhaak said.

The study found five pretreatment risk factors that were associated with persistent emotional problems after treatment: anxiety, depression, cognitions of helplessness, reduced cognitions of acceptance, and lack of social support. Patients with at least one of these risk factors had a fourfold chance of developing posttreatment emotional problems compared with patients who had no risk factors, she said.

The researchers then developed a one-page screening tool to identify these risk factors before treatment and validated the tool in a separate group of 512 patients. They found the screening tool identified 74% of the overall cohort correctly as either at risk or not, with a sensitivity of 69% and a specificity of 79%. The sensitivity increased to 70% and the specificity to 87% in the subgroup of women who did not get pregnant.

Dr. Verhaak said the findings suggest that screening all patients is worthwhile before they start IVF; this would include both those with primary and those with secondary infertility. “The longing for a second child is the same as the longing for a first child, and the emotional impact of not getting pregnant is the same in both cases,” she said.

NEW ORLEANS — A prospective, randomized comparison of two oocyte cryopreservation methods suggests vitrification may be superior to the older slow-freeze technique, Gary D. Smith, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

His results are backed up by a metaanalytic comparison of both methods performed by Dr. Kutluk Oktay from Cornell University, Ithaca, N.Y., and also reported at the meeting. “Your paper is what this field was lacking,” Dr. Oktay told Dr. Smith. “It is these types of studies that will tell us the real story.”

As interest in egg freezing has intensified—both for medical and social indications—so too has the debate about which cryopreservation method is best.

Dr. Smith's preliminary findings from 37 frozen oocyte cycles suggest that vitrification results in better fertilization, cleavage, and biochemical pregnancy rates per thaw, compared with slow freezing. “Whether this translates to a better live birth rate remains to be seen,” said Dr. Smith, director of the gamete cryopreservation laboratory at the University of Michigan, Ann Arbor, who conducted the study in collaboration with Huntington Center for Reproductive Medicine of Brazil, in São Paulo.

The study included women undergoing fresh in vitro fertilization who desired cryopreservation of oocytes instead of embryos. A total of 114 women were randomized to freeze oocytes either by slow freezing or vitrification. There have been 37 thaw cycles to date: 17 from the vitrification group and 20 from the slow-freezing group, he reported. Postthaw survival was not interrupted significantly differently between the two groups; however, fertilization and cleavage were significantly better in the vitrification group (73% and 85%, respectively), compared with the slow-freeze group (57% and 70%, respectively), he said. In addition, the biochemical pregnancy rate per transfer was higher in the vitrification group (62%), compared with the slow-freeze group (22%), although this difference did not reach significance because of the small numbers. Similarly, there were more ongoing and live births per thaw in the vitrification group (44%), compared with the slow-freeze group (22%), but again, numbers were too small to establish significance.

Dr. Oktay's metaanalysis also suggested the superiority of vitrification over slow freezing. The metaanalysis included studies using either egg-freezing technique and compared their results with success rates for fresh intracytoplasmic sperm injection (ICSI), reported his research fellow, Dr. Aylin Cil, at the meeting.

After excluding studies that did not use ICSI, used immature oocytes, or had missing data, the meta-analysis revealed a total of 214 clinical pregnancies and 159 live births reported from cryopreserved oocytes. Live births per transfer were significantly better in studies using vitrification (37%), compared with slow freezing (16%), although the mean number of embryos transferred was significantly higher in the vitrification group (3.5 vs. 2.5) and the multiple pregnancy rate was also higher (28% vs. 19%). “Supernumerary embryo transfer may at least partially be responsible for the higher success rates with vitrification,” reported Dr. Cil. The mean age of patients also was lower in the vitrification studies (32.3 vs. 33.7).

When comparing either egg freezing technique to fresh ICSI results reported by the Society for Assisted Reproductive Technology, the metaanalysis found similar live birth rates per transfer in vitrification and fresh ICSI (37% and 44%, respectively, a difference that was not statistically significant) in women of the same age. However, slow-freeze results were significantly lower than fresh results in the respective age groups (16% vs. 38%).

“The body of evidence is pointing toward vitrification as the superior method but there is still no definitive study,” commented Dr. Jamie Grifo, director of the division of reproductive endocrinology and infertility at New York University, New York. “The metaanalysis has many limitations and the other study needs more numbers to be definitive.” Dr. Grifo's group also presented a study at the meeting in which 14 infertile patients underwent 15 cycles of egg freezing/thawing and subsequent embryo transfer. All but one of the patients had some eggs vitrified and others slow frozen. To date, there have been six deliveries of eight babies, all healthy, he reported. All but one of the pregnancies resulted from a mixed transfer of embryos derived from both vitrified and slow-frozen eggs.

“It is unclear from this study which cryopreservation method, if any, is superior—we didn't have enough data to answer this question,” Dr. Grifo said in an interview. “We are currently designing a trial where patients are randomized to either method, but the power analysis requires about 45 cycles to have statistically significant data.”

However, he said the important point is that egg freezing can produce results that are comparable with fresh cycles. “We have an ongoing/delivered pregnancy rate of 47% and an implantation rate of 36%. … The playing field between men and women with regard to fertility preservation has been leveled,” he said. “It is hoped that using this technique in cancer patients or patients wishing to preserve fertility by choice will yield even higher success rates than the infertile population included in our study.”

Three human oocytes have been vitrified, warmed, and cultured (A). Embryos are shown 2 days after ICSI (B). Embryos are shown on day 3 of embryo transfer (ET). Photos courtesy Dr. Gary D. Smith

NEW ORLEANS — A prospective, randomized comparison of two oocyte cryopreservation methods suggests vitrification may be superior to the older slow-freeze technique, Gary D. Smith, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

His results are backed up by a metaanalytic comparison of both methods performed by Dr. Kutluk Oktay from Cornell University, Ithaca, N.Y., and also reported at the meeting. “Your paper is what this field was lacking,” Dr. Oktay told Dr. Smith. “It is these types of studies that will tell us the real story.”

As interest in egg freezing has intensified—both for medical and social indications—so too has the debate about which cryopreservation method is best.

Dr. Smith's preliminary findings from 37 frozen oocyte cycles suggest that vitrification results in better fertilization, cleavage, and biochemical pregnancy rates per thaw, compared with slow freezing. “Whether this translates to a better live birth rate remains to be seen,” said Dr. Smith, director of the gamete cryopreservation laboratory at the University of Michigan, Ann Arbor, who conducted the study in collaboration with Huntington Center for Reproductive Medicine of Brazil, in São Paulo.

The study included women undergoing fresh in vitro fertilization who desired cryopreservation of oocytes instead of embryos. A total of 114 women were randomized to freeze oocytes either by slow freezing or vitrification. There have been 37 thaw cycles to date: 17 from the vitrification group and 20 from the slow-freezing group, he reported. Postthaw survival was not interrupted significantly differently between the two groups; however, fertilization and cleavage were significantly better in the vitrification group (73% and 85%, respectively), compared with the slow-freeze group (57% and 70%, respectively), he said. In addition, the biochemical pregnancy rate per transfer was higher in the vitrification group (62%), compared with the slow-freeze group (22%), although this difference did not reach significance because of the small numbers. Similarly, there were more ongoing and live births per thaw in the vitrification group (44%), compared with the slow-freeze group (22%), but again, numbers were too small to establish significance.

Dr. Oktay's metaanalysis also suggested the superiority of vitrification over slow freezing. The metaanalysis included studies using either egg-freezing technique and compared their results with success rates for fresh intracytoplasmic sperm injection (ICSI), reported his research fellow, Dr. Aylin Cil, at the meeting.

After excluding studies that did not use ICSI, used immature oocytes, or had missing data, the meta-analysis revealed a total of 214 clinical pregnancies and 159 live births reported from cryopreserved oocytes. Live births per transfer were significantly better in studies using vitrification (37%), compared with slow freezing (16%), although the mean number of embryos transferred was significantly higher in the vitrification group (3.5 vs. 2.5) and the multiple pregnancy rate was also higher (28% vs. 19%). “Supernumerary embryo transfer may at least partially be responsible for the higher success rates with vitrification,” reported Dr. Cil. The mean age of patients also was lower in the vitrification studies (32.3 vs. 33.7).

When comparing either egg freezing technique to fresh ICSI results reported by the Society for Assisted Reproductive Technology, the metaanalysis found similar live birth rates per transfer in vitrification and fresh ICSI (37% and 44%, respectively, a difference that was not statistically significant) in women of the same age. However, slow-freeze results were significantly lower than fresh results in the respective age groups (16% vs. 38%).

“The body of evidence is pointing toward vitrification as the superior method but there is still no definitive study,” commented Dr. Jamie Grifo, director of the division of reproductive endocrinology and infertility at New York University, New York. “The metaanalysis has many limitations and the other study needs more numbers to be definitive.” Dr. Grifo's group also presented a study at the meeting in which 14 infertile patients underwent 15 cycles of egg freezing/thawing and subsequent embryo transfer. All but one of the patients had some eggs vitrified and others slow frozen. To date, there have been six deliveries of eight babies, all healthy, he reported. All but one of the pregnancies resulted from a mixed transfer of embryos derived from both vitrified and slow-frozen eggs.

“It is unclear from this study which cryopreservation method, if any, is superior—we didn't have enough data to answer this question,” Dr. Grifo said in an interview. “We are currently designing a trial where patients are randomized to either method, but the power analysis requires about 45 cycles to have statistically significant data.”

However, he said the important point is that egg freezing can produce results that are comparable with fresh cycles. “We have an ongoing/delivered pregnancy rate of 47% and an implantation rate of 36%. … The playing field between men and women with regard to fertility preservation has been leveled,” he said. “It is hoped that using this technique in cancer patients or patients wishing to preserve fertility by choice will yield even higher success rates than the infertile population included in our study.”

Three human oocytes have been vitrified, warmed, and cultured (A). Embryos are shown 2 days after ICSI (B). Embryos are shown on day 3 of embryo transfer (ET). Photos courtesy Dr. Gary D. Smith

NEW ORLEANS — A prospective, randomized comparison of two oocyte cryopreservation methods suggests vitrification may be superior to the older slow-freeze technique, Gary D. Smith, Ph.D., reported at the annual meeting of the American Society for Reproductive Medicine.

His results are backed up by a metaanalytic comparison of both methods performed by Dr. Kutluk Oktay from Cornell University, Ithaca, N.Y., and also reported at the meeting. “Your paper is what this field was lacking,” Dr. Oktay told Dr. Smith. “It is these types of studies that will tell us the real story.”

As interest in egg freezing has intensified—both for medical and social indications—so too has the debate about which cryopreservation method is best.

Dr. Smith's preliminary findings from 37 frozen oocyte cycles suggest that vitrification results in better fertilization, cleavage, and biochemical pregnancy rates per thaw, compared with slow freezing. “Whether this translates to a better live birth rate remains to be seen,” said Dr. Smith, director of the gamete cryopreservation laboratory at the University of Michigan, Ann Arbor, who conducted the study in collaboration with Huntington Center for Reproductive Medicine of Brazil, in São Paulo.

The study included women undergoing fresh in vitro fertilization who desired cryopreservation of oocytes instead of embryos. A total of 114 women were randomized to freeze oocytes either by slow freezing or vitrification. There have been 37 thaw cycles to date: 17 from the vitrification group and 20 from the slow-freezing group, he reported. Postthaw survival was not interrupted significantly differently between the two groups; however, fertilization and cleavage were significantly better in the vitrification group (73% and 85%, respectively), compared with the slow-freeze group (57% and 70%, respectively), he said. In addition, the biochemical pregnancy rate per transfer was higher in the vitrification group (62%), compared with the slow-freeze group (22%), although this difference did not reach significance because of the small numbers. Similarly, there were more ongoing and live births per thaw in the vitrification group (44%), compared with the slow-freeze group (22%), but again, numbers were too small to establish significance.

Dr. Oktay's metaanalysis also suggested the superiority of vitrification over slow freezing. The metaanalysis included studies using either egg-freezing technique and compared their results with success rates for fresh intracytoplasmic sperm injection (ICSI), reported his research fellow, Dr. Aylin Cil, at the meeting.

After excluding studies that did not use ICSI, used immature oocytes, or had missing data, the meta-analysis revealed a total of 214 clinical pregnancies and 159 live births reported from cryopreserved oocytes. Live births per transfer were significantly better in studies using vitrification (37%), compared with slow freezing (16%), although the mean number of embryos transferred was significantly higher in the vitrification group (3.5 vs. 2.5) and the multiple pregnancy rate was also higher (28% vs. 19%). “Supernumerary embryo transfer may at least partially be responsible for the higher success rates with vitrification,” reported Dr. Cil. The mean age of patients also was lower in the vitrification studies (32.3 vs. 33.7).

When comparing either egg freezing technique to fresh ICSI results reported by the Society for Assisted Reproductive Technology, the metaanalysis found similar live birth rates per transfer in vitrification and fresh ICSI (37% and 44%, respectively, a difference that was not statistically significant) in women of the same age. However, slow-freeze results were significantly lower than fresh results in the respective age groups (16% vs. 38%).

“The body of evidence is pointing toward vitrification as the superior method but there is still no definitive study,” commented Dr. Jamie Grifo, director of the division of reproductive endocrinology and infertility at New York University, New York. “The metaanalysis has many limitations and the other study needs more numbers to be definitive.” Dr. Grifo's group also presented a study at the meeting in which 14 infertile patients underwent 15 cycles of egg freezing/thawing and subsequent embryo transfer. All but one of the patients had some eggs vitrified and others slow frozen. To date, there have been six deliveries of eight babies, all healthy, he reported. All but one of the pregnancies resulted from a mixed transfer of embryos derived from both vitrified and slow-frozen eggs.

“It is unclear from this study which cryopreservation method, if any, is superior—we didn't have enough data to answer this question,” Dr. Grifo said in an interview. “We are currently designing a trial where patients are randomized to either method, but the power analysis requires about 45 cycles to have statistically significant data.”

However, he said the important point is that egg freezing can produce results that are comparable with fresh cycles. “We have an ongoing/delivered pregnancy rate of 47% and an implantation rate of 36%. … The playing field between men and women with regard to fertility preservation has been leveled,” he said. “It is hoped that using this technique in cancer patients or patients wishing to preserve fertility by choice will yield even higher success rates than the infertile population included in our study.”

Three human oocytes have been vitrified, warmed, and cultured (A). Embryos are shown 2 days after ICSI (B). Embryos are shown on day 3 of embryo transfer (ET). Photos courtesy Dr. Gary D. Smith

NEW ORLEANS — Overweight is a significant risk factor for poor in vitro fertilization success rates, particularly in African American women, according to the results of a new study.

“It is highly recommended that patients be encouraged to lose weight,” advised Dr. Mohamed Mitwally, who presented the findings at the annual meeting of the American Society for Reproductive Medicine.

There is conflicting evidence in the literature regarding the impact of obesity on in vitro fertilization (IVF) success rates, said Dr. Mitwally of Wayne State University, Detroit. But many previous studies have not controlled for confounding risk factors, he said.

His study analyzed 193 consecutive patients undergoing IVF, 161 white and 32 black patients. After controlling for age, infertility diagnosis and duration, number of prior IVF cycles, and ovarian stimulation protocol, the study found a significant difference in pregnancy rates among patients with a body mass index (BMI) of 25 kg/m2 or less, compared with those who had a higher BMI.

Overall, patients with lower BMIs had a clinical pregnancy rate of 51% per cycle, compared with a rate of 35% in patients with higher BMIs. Overweight had a negative impact in both white and black women, but it was more pronounced in the latter group, said Dr. Mitwally. Overweight white women had a pregnancy rate of 38%, compared with a rate of 50% in those who were normal weight, while overweight black women had a pregnancy rate of 19%, compared with 67% in those who were normal weight.

NEW ORLEANS — Overweight is a significant risk factor for poor in vitro fertilization success rates, particularly in African American women, according to the results of a new study.

“It is highly recommended that patients be encouraged to lose weight,” advised Dr. Mohamed Mitwally, who presented the findings at the annual meeting of the American Society for Reproductive Medicine.

There is conflicting evidence in the literature regarding the impact of obesity on in vitro fertilization (IVF) success rates, said Dr. Mitwally of Wayne State University, Detroit. But many previous studies have not controlled for confounding risk factors, he said.

His study analyzed 193 consecutive patients undergoing IVF, 161 white and 32 black patients. After controlling for age, infertility diagnosis and duration, number of prior IVF cycles, and ovarian stimulation protocol, the study found a significant difference in pregnancy rates among patients with a body mass index (BMI) of 25 kg/m2 or less, compared with those who had a higher BMI.

Overall, patients with lower BMIs had a clinical pregnancy rate of 51% per cycle, compared with a rate of 35% in patients with higher BMIs. Overweight had a negative impact in both white and black women, but it was more pronounced in the latter group, said Dr. Mitwally. Overweight white women had a pregnancy rate of 38%, compared with a rate of 50% in those who were normal weight, while overweight black women had a pregnancy rate of 19%, compared with 67% in those who were normal weight.

NEW ORLEANS — Overweight is a significant risk factor for poor in vitro fertilization success rates, particularly in African American women, according to the results of a new study.

“It is highly recommended that patients be encouraged to lose weight,” advised Dr. Mohamed Mitwally, who presented the findings at the annual meeting of the American Society for Reproductive Medicine.

There is conflicting evidence in the literature regarding the impact of obesity on in vitro fertilization (IVF) success rates, said Dr. Mitwally of Wayne State University, Detroit. But many previous studies have not controlled for confounding risk factors, he said.

His study analyzed 193 consecutive patients undergoing IVF, 161 white and 32 black patients. After controlling for age, infertility diagnosis and duration, number of prior IVF cycles, and ovarian stimulation protocol, the study found a significant difference in pregnancy rates among patients with a body mass index (BMI) of 25 kg/m2 or less, compared with those who had a higher BMI.

Overall, patients with lower BMIs had a clinical pregnancy rate of 51% per cycle, compared with a rate of 35% in patients with higher BMIs. Overweight had a negative impact in both white and black women, but it was more pronounced in the latter group, said Dr. Mitwally. Overweight white women had a pregnancy rate of 38%, compared with a rate of 50% in those who were normal weight, while overweight black women had a pregnancy rate of 19%, compared with 67% in those who were normal weight.

NEW ORLEANS — The impact of overweight on in vitro fertilization success rates may be age related, Dr. Megan Sneed reported at the annual meeting of the American Society for Reproductive Medicine. Her findings may explain some inconsistencies in the literature on this topic.

“Young patients in particular should be counseled to lose weight to improve their chances with in vitro fertilization, but for women over age 35, weight loss should not delay fertility treatment because their ovarian reserve is in decline,” advised Dr. Sneed of Fertility Centers of Illinois, Chicago, and Advocate Lutheran General Hospital in Park Ridge, Ill.

In a retrospective review of 1,273 fresh in vitro fertilization (IVF) cycles, Dr. Sneed found that body mass index (BMI) did not appear to significantly impact overall outcome—there was no significant difference in clinical pregnancy rate per cycle between normal weight (38.6%), overweight (36.8%), and obese (35.1%) patients. However, when patients' ages were factored into the analysis, overweight and obesity had a pronounced negative influence on the fertility of younger women, with a declining impact in women of older ages.

Specifically, in women aged 20 years, clinical pregnancy rates were found to be as high as 80% per cycle in the normal-weight group, while these rates decreased by as much as 25% in women who were overweight, and by as much as 50% in those who were obese, she said. A nearly identical trend was seen in the 25-year-old age group, while in the 30-year-old group the effect of obesity was much less pronounced, but still present, she said. In this latter group, women with normal BMIs had clinical pregnancy rates of up to 55%, which decreased to as low as 40% in the overweight group and 30% in the obese group. By age 35, there was virtually no impact of BMI on IVF outcome, with clinical pregnancy rates between 35% and 40% at all BMI ranges.

“I believe that these data may change recommendations for weight loss at some IVF centers,” Dr. Sneed said in an interview. “Many centers recommend weight loss to all patients undergoing IVF in an attempt to increase success rates. But in patients over 35, any delay in treatment for weight loss may result in a loss of valuable time since the impact of aging in this group appears to have a more profound effect on IVF outcomes than does weight.”

NEW ORLEANS — The impact of overweight on in vitro fertilization success rates may be age related, Dr. Megan Sneed reported at the annual meeting of the American Society for Reproductive Medicine. Her findings may explain some inconsistencies in the literature on this topic.

“Young patients in particular should be counseled to lose weight to improve their chances with in vitro fertilization, but for women over age 35, weight loss should not delay fertility treatment because their ovarian reserve is in decline,” advised Dr. Sneed of Fertility Centers of Illinois, Chicago, and Advocate Lutheran General Hospital in Park Ridge, Ill.

In a retrospective review of 1,273 fresh in vitro fertilization (IVF) cycles, Dr. Sneed found that body mass index (BMI) did not appear to significantly impact overall outcome—there was no significant difference in clinical pregnancy rate per cycle between normal weight (38.6%), overweight (36.8%), and obese (35.1%) patients. However, when patients' ages were factored into the analysis, overweight and obesity had a pronounced negative influence on the fertility of younger women, with a declining impact in women of older ages.

Specifically, in women aged 20 years, clinical pregnancy rates were found to be as high as 80% per cycle in the normal-weight group, while these rates decreased by as much as 25% in women who were overweight, and by as much as 50% in those who were obese, she said. A nearly identical trend was seen in the 25-year-old age group, while in the 30-year-old group the effect of obesity was much less pronounced, but still present, she said. In this latter group, women with normal BMIs had clinical pregnancy rates of up to 55%, which decreased to as low as 40% in the overweight group and 30% in the obese group. By age 35, there was virtually no impact of BMI on IVF outcome, with clinical pregnancy rates between 35% and 40% at all BMI ranges.

“I believe that these data may change recommendations for weight loss at some IVF centers,” Dr. Sneed said in an interview. “Many centers recommend weight loss to all patients undergoing IVF in an attempt to increase success rates. But in patients over 35, any delay in treatment for weight loss may result in a loss of valuable time since the impact of aging in this group appears to have a more profound effect on IVF outcomes than does weight.”

NEW ORLEANS — The impact of overweight on in vitro fertilization success rates may be age related, Dr. Megan Sneed reported at the annual meeting of the American Society for Reproductive Medicine. Her findings may explain some inconsistencies in the literature on this topic.

“Young patients in particular should be counseled to lose weight to improve their chances with in vitro fertilization, but for women over age 35, weight loss should not delay fertility treatment because their ovarian reserve is in decline,” advised Dr. Sneed of Fertility Centers of Illinois, Chicago, and Advocate Lutheran General Hospital in Park Ridge, Ill.

In a retrospective review of 1,273 fresh in vitro fertilization (IVF) cycles, Dr. Sneed found that body mass index (BMI) did not appear to significantly impact overall outcome—there was no significant difference in clinical pregnancy rate per cycle between normal weight (38.6%), overweight (36.8%), and obese (35.1%) patients. However, when patients' ages were factored into the analysis, overweight and obesity had a pronounced negative influence on the fertility of younger women, with a declining impact in women of older ages.

Specifically, in women aged 20 years, clinical pregnancy rates were found to be as high as 80% per cycle in the normal-weight group, while these rates decreased by as much as 25% in women who were overweight, and by as much as 50% in those who were obese, she said. A nearly identical trend was seen in the 25-year-old age group, while in the 30-year-old group the effect of obesity was much less pronounced, but still present, she said. In this latter group, women with normal BMIs had clinical pregnancy rates of up to 55%, which decreased to as low as 40% in the overweight group and 30% in the obese group. By age 35, there was virtually no impact of BMI on IVF outcome, with clinical pregnancy rates between 35% and 40% at all BMI ranges.

“I believe that these data may change recommendations for weight loss at some IVF centers,” Dr. Sneed said in an interview. “Many centers recommend weight loss to all patients undergoing IVF in an attempt to increase success rates. But in patients over 35, any delay in treatment for weight loss may result in a loss of valuable time since the impact of aging in this group appears to have a more profound effect on IVF outcomes than does weight.”

NEW ORLEANS — Patients will not accept elective single embryo transfer as a means of reducing the risk of multiple pregnancy unless it offers them an equal chance of conceiving, compared with the transfer of two embryos, Moniek Twisk said at the annual meeting of the American Society for Reproductive Medicine.

“To reduce the risk of multiple pregnancy it is essential to offer SET [single embryo transfer] that does not negatively affect pregnancy rates,” said Ms. Twisk, a Ph.D. student at Academic Medical Center in Amsterdam. “It is only such an approach that will not jeopardize patient acceptance of SET.”

Her study was a questionnaire-based survey of 244 women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at two fertility centers in the Netherlands. The questionnaire presented various trade-offs in which either SET or double-embryo transfer (DET) were proposed, with different pregnancy rates and numbers of cycles required to achieve pregnancy.

Patients, who were a mean age of 34 years, with a mean infertility duration of 4 years, were told to assume a 25% chance of multiple pregnancy with DET, and a 1% chance with SET.

The study found that even if patients believed their pregnancy chances were the same with either SET or DET, less than half of them would choose SET to reduce the chance of multiple pregnancy. This may be partly due to the fact that, according to other studies, up to 27% of women undergoing IVF say they would actually prefer to have twins rather than a singleton, she commented.

If the patients were told that SET would lower their chances of pregnancy even fewer said they would choose this option. (See sidebar.)

Patients were then asked to consider their willingness to undergo additional cycles of SET to achieve the same success rate as three cycles of DET (without the risk of multiple pregnancy).

Even if three cycles of SET provided the same success rate as three cycles of DET, less than half said they would choose this option, said Ms.Twisk. If subjects were told that four, five, or six cycles of SET could achieve the same pregnancy rate as DET, even fewer said they would accept this option.

The issue of cost for the extra cycles was not explored in the study, Ms. Twisk said in an interview. In the Netherlands patients are usually reimbursed for the first three cycles of IVF, she said.

The results emphasize “unambiguously the overwhelming dominance of pregnancy as the primary goal of treatment for women undergoing IVF/;ICSI, and the absence of willingness to trade off that goal in order to avoid a multiple pregnancy,” Ms. Twisk said.

SET vs. DET Picks Favor the Latter

Willingness to Consider SET Over DET

▸ With identical pregnancy chances, 54% prefer DET.

▸ If SET reduces chances by 1%, 60% prefer DET.

▸ If SET reduces chances by 3%, 76% prefer DET.

▸ If SET reduces chances by 5%, 85% prefer DET.

Willingness to Equalize Pregnancy Chances With Extra SET Cycles

▸ If three DET cycles = three SET cycles, 54% prefer DET.

▸ If three DET cycles = four SET cycles, 60% prefer DET.

▸ If three DET cycles = five SET cycles, 64% prefer DET.

▸ If three DET cycles = six SET cycles, 65% prefer DET.

Source: Ms. Twisk

NEW ORLEANS — Patients will not accept elective single embryo transfer as a means of reducing the risk of multiple pregnancy unless it offers them an equal chance of conceiving, compared with the transfer of two embryos, Moniek Twisk said at the annual meeting of the American Society for Reproductive Medicine.

“To reduce the risk of multiple pregnancy it is essential to offer SET [single embryo transfer] that does not negatively affect pregnancy rates,” said Ms. Twisk, a Ph.D. student at Academic Medical Center in Amsterdam. “It is only such an approach that will not jeopardize patient acceptance of SET.”

Her study was a questionnaire-based survey of 244 women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at two fertility centers in the Netherlands. The questionnaire presented various trade-offs in which either SET or double-embryo transfer (DET) were proposed, with different pregnancy rates and numbers of cycles required to achieve pregnancy.

Patients, who were a mean age of 34 years, with a mean infertility duration of 4 years, were told to assume a 25% chance of multiple pregnancy with DET, and a 1% chance with SET.

The study found that even if patients believed their pregnancy chances were the same with either SET or DET, less than half of them would choose SET to reduce the chance of multiple pregnancy. This may be partly due to the fact that, according to other studies, up to 27% of women undergoing IVF say they would actually prefer to have twins rather than a singleton, she commented.

If the patients were told that SET would lower their chances of pregnancy even fewer said they would choose this option. (See sidebar.)

Patients were then asked to consider their willingness to undergo additional cycles of SET to achieve the same success rate as three cycles of DET (without the risk of multiple pregnancy).

Even if three cycles of SET provided the same success rate as three cycles of DET, less than half said they would choose this option, said Ms.Twisk. If subjects were told that four, five, or six cycles of SET could achieve the same pregnancy rate as DET, even fewer said they would accept this option.

The issue of cost for the extra cycles was not explored in the study, Ms. Twisk said in an interview. In the Netherlands patients are usually reimbursed for the first three cycles of IVF, she said.

The results emphasize “unambiguously the overwhelming dominance of pregnancy as the primary goal of treatment for women undergoing IVF/;ICSI, and the absence of willingness to trade off that goal in order to avoid a multiple pregnancy,” Ms. Twisk said.

SET vs. DET Picks Favor the Latter

Willingness to Consider SET Over DET

▸ With identical pregnancy chances, 54% prefer DET.

▸ If SET reduces chances by 1%, 60% prefer DET.

▸ If SET reduces chances by 3%, 76% prefer DET.

▸ If SET reduces chances by 5%, 85% prefer DET.

Willingness to Equalize Pregnancy Chances With Extra SET Cycles

▸ If three DET cycles = three SET cycles, 54% prefer DET.

▸ If three DET cycles = four SET cycles, 60% prefer DET.

▸ If three DET cycles = five SET cycles, 64% prefer DET.

▸ If three DET cycles = six SET cycles, 65% prefer DET.

Source: Ms. Twisk

NEW ORLEANS — Patients will not accept elective single embryo transfer as a means of reducing the risk of multiple pregnancy unless it offers them an equal chance of conceiving, compared with the transfer of two embryos, Moniek Twisk said at the annual meeting of the American Society for Reproductive Medicine.

“To reduce the risk of multiple pregnancy it is essential to offer SET [single embryo transfer] that does not negatively affect pregnancy rates,” said Ms. Twisk, a Ph.D. student at Academic Medical Center in Amsterdam. “It is only such an approach that will not jeopardize patient acceptance of SET.”

Her study was a questionnaire-based survey of 244 women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at two fertility centers in the Netherlands. The questionnaire presented various trade-offs in which either SET or double-embryo transfer (DET) were proposed, with different pregnancy rates and numbers of cycles required to achieve pregnancy.

Patients, who were a mean age of 34 years, with a mean infertility duration of 4 years, were told to assume a 25% chance of multiple pregnancy with DET, and a 1% chance with SET.

The study found that even if patients believed their pregnancy chances were the same with either SET or DET, less than half of them would choose SET to reduce the chance of multiple pregnancy. This may be partly due to the fact that, according to other studies, up to 27% of women undergoing IVF say they would actually prefer to have twins rather than a singleton, she commented.

If the patients were told that SET would lower their chances of pregnancy even fewer said they would choose this option. (See sidebar.)

Patients were then asked to consider their willingness to undergo additional cycles of SET to achieve the same success rate as three cycles of DET (without the risk of multiple pregnancy).

Even if three cycles of SET provided the same success rate as three cycles of DET, less than half said they would choose this option, said Ms.Twisk. If subjects were told that four, five, or six cycles of SET could achieve the same pregnancy rate as DET, even fewer said they would accept this option.

The issue of cost for the extra cycles was not explored in the study, Ms. Twisk said in an interview. In the Netherlands patients are usually reimbursed for the first three cycles of IVF, she said.

The results emphasize “unambiguously the overwhelming dominance of pregnancy as the primary goal of treatment for women undergoing IVF/;ICSI, and the absence of willingness to trade off that goal in order to avoid a multiple pregnancy,” Ms. Twisk said.

SET vs. DET Picks Favor the Latter

Willingness to Consider SET Over DET

▸ With identical pregnancy chances, 54% prefer DET.

▸ If SET reduces chances by 1%, 60% prefer DET.

▸ If SET reduces chances by 3%, 76% prefer DET.

▸ If SET reduces chances by 5%, 85% prefer DET.

Willingness to Equalize Pregnancy Chances With Extra SET Cycles

▸ If three DET cycles = three SET cycles, 54% prefer DET.

▸ If three DET cycles = four SET cycles, 60% prefer DET.

▸ If three DET cycles = five SET cycles, 64% prefer DET.

▸ If three DET cycles = six SET cycles, 65% prefer DET.

Source: Ms. Twisk

NEW ORLEANS — Couples who conceive after a history of infertility are more likely to have children with health and behavioral problems and to face pregnancy and labor complications, compared with their fertile counterparts, according to preliminary results of a large U.S. study presented at the annual meeting of the American Society for Reproductive Medicine.

The results are independent of maternal age and multiple gestation, and apply whether the couples conceived naturally or with fertility treatment, said principal investigator Mary Croughan, Ph.D., of the University of California, San Francisco.

“Infertility itself appears to play a more important role than the treatment,” Dr. Croughan said. She stressed that despite the increased risks seen in the infertile population, the overall incidence of adverse outcomes in her study was still low. “The vast majority of the children and pregnancies were healthy, but there were certain conditions that were found much more frequently in the infertile group,” she said in an interview.

The results are based on an analysis of 1,296 mothers and their children (average age 6 years) who were conceived after a period of infertility. Roughly one-third of the women had conceived naturally, while the remainder had conceived with some form of fertility treatment (18% medication only, 24% intrauterine insemination, 21% in vitro fertilization/intracytoplasmic sperm injection). They were compared with a control group of 1,153 fertile mothers and their children. The research included roughly 1,000 maternal interviews and a review of more than 19,000 medical records.

After adjusting for maternal age and multiple gestation, the investigators found that children conceived by infertile couples had a threefold increase in “severe” adverse outcomes such as cerebral palsy, mental retardation, autism, seizure disorder, or cancer by 6 years of age, compared with controls. These children also had a 40% increase in “moderate” adverse outcomes, such as attention-deficit hyperactivity disorder, attention-deficit disorder, learning disabilities, behavior disorders, developmental delay, serious vision disorders, or serious hearing disorders, said Dr. Croughan.

Additionally, compared with controls, pregnancies, labor, and deliveries following a period of infertility were more likely to have complications such as preterm labor, eclampsia, chorioamnionitis, and cesarean section. Children born to couples with a history of infertility were also 20% more likely to be born prematurely or with low birth weight, and had twice the incidence of intrauterine growth restriction. They were 30% more likely to be admitted to a neonatal intensive care unit and to stay in the hospital for more than 3 days.

In looking at childhood outcomes only, Dr. Croughan said, “It appears that infertility itself imparts a risk to both pregnancy and outcomes.” Although she has not yet examined the association of various infertility diagnoses and treatments with outcomes, her study did find a significantly increased rate of heart disease (relative risk 2.5) and diabetes (relative risk 3.8) in mothers with a history of infertility, “which would have increased their risks for pregnancy complications and might have contributed to the reasons for their infertility,” she said.

The study highlights an important association between infertility and adverse obstetric and childhood outcomes, but the link should not be misinterpreted as causal or universal, cautioned Dr. David Adamson, president-elect of ASRM and director of Fertility Physicians of Northern California in Palo Alto.

“It's important not to draw the conclusion that these risks are definitely higher for all infertile people,” he said in an interview. “We need to look at this issue prospectively, with larger numbers, and examine subgroups of the infertile population to determine whether specific conditions might increase risk.”

Dr. Croughan said the next step for her study is to examine the association of infertility diagnoses and treatments with outcomes, with a long-term goal of developing clinical guidelines. “We'd like to be able to say to someone with a specific infertility diagnosis, these are your potential risks of adverse pregnancy and childhood outcomes, and if you add fertility treatment this is how that risk changes. There may also be women who could be counseled in advance to decrease their risk,” she said.

NEW ORLEANS — Couples who conceive after a history of infertility are more likely to have children with health and behavioral problems and to face pregnancy and labor complications, compared with their fertile counterparts, according to preliminary results of a large U.S. study presented at the annual meeting of the American Society for Reproductive Medicine.

The results are independent of maternal age and multiple gestation, and apply whether the couples conceived naturally or with fertility treatment, said principal investigator Mary Croughan, Ph.D., of the University of California, San Francisco.

“Infertility itself appears to play a more important role than the treatment,” Dr. Croughan said. She stressed that despite the increased risks seen in the infertile population, the overall incidence of adverse outcomes in her study was still low. “The vast majority of the children and pregnancies were healthy, but there were certain conditions that were found much more frequently in the infertile group,” she said in an interview.

The results are based on an analysis of 1,296 mothers and their children (average age 6 years) who were conceived after a period of infertility. Roughly one-third of the women had conceived naturally, while the remainder had conceived with some form of fertility treatment (18% medication only, 24% intrauterine insemination, 21% in vitro fertilization/intracytoplasmic sperm injection). They were compared with a control group of 1,153 fertile mothers and their children. The research included roughly 1,000 maternal interviews and a review of more than 19,000 medical records.

After adjusting for maternal age and multiple gestation, the investigators found that children conceived by infertile couples had a threefold increase in “severe” adverse outcomes such as cerebral palsy, mental retardation, autism, seizure disorder, or cancer by 6 years of age, compared with controls. These children also had a 40% increase in “moderate” adverse outcomes, such as attention-deficit hyperactivity disorder, attention-deficit disorder, learning disabilities, behavior disorders, developmental delay, serious vision disorders, or serious hearing disorders, said Dr. Croughan.

Additionally, compared with controls, pregnancies, labor, and deliveries following a period of infertility were more likely to have complications such as preterm labor, eclampsia, chorioamnionitis, and cesarean section. Children born to couples with a history of infertility were also 20% more likely to be born prematurely or with low birth weight, and had twice the incidence of intrauterine growth restriction. They were 30% more likely to be admitted to a neonatal intensive care unit and to stay in the hospital for more than 3 days.

In looking at childhood outcomes only, Dr. Croughan said, “It appears that infertility itself imparts a risk to both pregnancy and outcomes.” Although she has not yet examined the association of various infertility diagnoses and treatments with outcomes, her study did find a significantly increased rate of heart disease (relative risk 2.5) and diabetes (relative risk 3.8) in mothers with a history of infertility, “which would have increased their risks for pregnancy complications and might have contributed to the reasons for their infertility,” she said.

The study highlights an important association between infertility and adverse obstetric and childhood outcomes, but the link should not be misinterpreted as causal or universal, cautioned Dr. David Adamson, president-elect of ASRM and director of Fertility Physicians of Northern California in Palo Alto.

“It's important not to draw the conclusion that these risks are definitely higher for all infertile people,” he said in an interview. “We need to look at this issue prospectively, with larger numbers, and examine subgroups of the infertile population to determine whether specific conditions might increase risk.”

Dr. Croughan said the next step for her study is to examine the association of infertility diagnoses and treatments with outcomes, with a long-term goal of developing clinical guidelines. “We'd like to be able to say to someone with a specific infertility diagnosis, these are your potential risks of adverse pregnancy and childhood outcomes, and if you add fertility treatment this is how that risk changes. There may also be women who could be counseled in advance to decrease their risk,” she said.

NEW ORLEANS — Couples who conceive after a history of infertility are more likely to have children with health and behavioral problems and to face pregnancy and labor complications, compared with their fertile counterparts, according to preliminary results of a large U.S. study presented at the annual meeting of the American Society for Reproductive Medicine.

The results are independent of maternal age and multiple gestation, and apply whether the couples conceived naturally or with fertility treatment, said principal investigator Mary Croughan, Ph.D., of the University of California, San Francisco.

“Infertility itself appears to play a more important role than the treatment,” Dr. Croughan said. She stressed that despite the increased risks seen in the infertile population, the overall incidence of adverse outcomes in her study was still low. “The vast majority of the children and pregnancies were healthy, but there were certain conditions that were found much more frequently in the infertile group,” she said in an interview.

The results are based on an analysis of 1,296 mothers and their children (average age 6 years) who were conceived after a period of infertility. Roughly one-third of the women had conceived naturally, while the remainder had conceived with some form of fertility treatment (18% medication only, 24% intrauterine insemination, 21% in vitro fertilization/intracytoplasmic sperm injection). They were compared with a control group of 1,153 fertile mothers and their children. The research included roughly 1,000 maternal interviews and a review of more than 19,000 medical records.

After adjusting for maternal age and multiple gestation, the investigators found that children conceived by infertile couples had a threefold increase in “severe” adverse outcomes such as cerebral palsy, mental retardation, autism, seizure disorder, or cancer by 6 years of age, compared with controls. These children also had a 40% increase in “moderate” adverse outcomes, such as attention-deficit hyperactivity disorder, attention-deficit disorder, learning disabilities, behavior disorders, developmental delay, serious vision disorders, or serious hearing disorders, said Dr. Croughan.

Additionally, compared with controls, pregnancies, labor, and deliveries following a period of infertility were more likely to have complications such as preterm labor, eclampsia, chorioamnionitis, and cesarean section. Children born to couples with a history of infertility were also 20% more likely to be born prematurely or with low birth weight, and had twice the incidence of intrauterine growth restriction. They were 30% more likely to be admitted to a neonatal intensive care unit and to stay in the hospital for more than 3 days.

In looking at childhood outcomes only, Dr. Croughan said, “It appears that infertility itself imparts a risk to both pregnancy and outcomes.” Although she has not yet examined the association of various infertility diagnoses and treatments with outcomes, her study did find a significantly increased rate of heart disease (relative risk 2.5) and diabetes (relative risk 3.8) in mothers with a history of infertility, “which would have increased their risks for pregnancy complications and might have contributed to the reasons for their infertility,” she said.

The study highlights an important association between infertility and adverse obstetric and childhood outcomes, but the link should not be misinterpreted as causal or universal, cautioned Dr. David Adamson, president-elect of ASRM and director of Fertility Physicians of Northern California in Palo Alto.

“It's important not to draw the conclusion that these risks are definitely higher for all infertile people,” he said in an interview. “We need to look at this issue prospectively, with larger numbers, and examine subgroups of the infertile population to determine whether specific conditions might increase risk.”

Dr. Croughan said the next step for her study is to examine the association of infertility diagnoses and treatments with outcomes, with a long-term goal of developing clinical guidelines. “We'd like to be able to say to someone with a specific infertility diagnosis, these are your potential risks of adverse pregnancy and childhood outcomes, and if you add fertility treatment this is how that risk changes. There may also be women who could be counseled in advance to decrease their risk,” she said.

NEW ORLEANS — Premenopausal vasomotor symptoms, particularly night sweats, are a previously unrecognized risk factor for low bone mineral density, according to Dr. Lubna Pal from the Albert Einstein College of Medicine, New York.

Her study won the prize paper from the Society for Reproductive Endocrinology and Infertility at the annual meeting of the American Society for Reproductive Medicine.

Based on these data, “I would advise providers to specifically ask about vasomotor symptoms in premenopausal women and, for those who are symptomatic, to focus on unmasking additional factors that may enhance their fracture risk, such as low body mass; family or personal history of fractures; or smoking,” she said in an interview. “I don't think we are there yet in terms of recommending bone density screening for this population … but these women need to be advised that a further deterioration in their bone density parameters is likely to occur in the postmenopausal period.”

The cross-sectional study included 86 premenopausal infertile women aged 42 years or younger without premature ovarian failure or oophorectomy. A questionnaire was used to ask about the presence and frequency of vasomotor symptoms, including hot flashes and night sweats.

The study also measured subjects' bone mineral density (BMD) and levels of serum N-telopeptide (NTx), a marker of bone turnover.

A total of 12% of respondents reported one or both vasomotor symptoms, and 21% of respondents had evidence of low BMD, reported Dr. Pal. There was a significant correlation between vasomotor symptoms and low BMD, with 62.5% of symptomatic women showing evidence of low BMD, compared with 14% of asymptomatic women (odds ratio 10.18). Similarly, 36% of women with low BMD reported vasomotor symptoms, compared with 5% of those with normal BMD.

After controlling for age, body mass index, menstrual regularity, race, and smoking, the study found that vasomotor symptoms (night sweats and/or hot flashes) were independent predictors of low bone density in the study population. The magnitude of this association was most robust for night sweats, with an adjusted odds ratio (AOR) of 52.47, followed by both symptoms combined (AOR 24.10), and then hot flashes alone (AOR 15.10).

The presence of night sweats was also an independent predictor of bone turnover, with higher levels of serum NTx seen in symptomatic compared with asymptomatic women, she said.

And finally, levels of inhibin B, a marker of ovarian reserve, were also significantly lower in women with night sweats compared with asymptomatic women, “suggesting that declining ovarian reserve may be a unifying physiologic mechanism tying vasomotor symptoms to both increased bone turnover and low bone density in this young population,” she said.

NEW ORLEANS — Premenopausal vasomotor symptoms, particularly night sweats, are a previously unrecognized risk factor for low bone mineral density, according to Dr. Lubna Pal from the Albert Einstein College of Medicine, New York.

Her study won the prize paper from the Society for Reproductive Endocrinology and Infertility at the annual meeting of the American Society for Reproductive Medicine.

Based on these data, “I would advise providers to specifically ask about vasomotor symptoms in premenopausal women and, for those who are symptomatic, to focus on unmasking additional factors that may enhance their fracture risk, such as low body mass; family or personal history of fractures; or smoking,” she said in an interview. “I don't think we are there yet in terms of recommending bone density screening for this population … but these women need to be advised that a further deterioration in their bone density parameters is likely to occur in the postmenopausal period.”

The cross-sectional study included 86 premenopausal infertile women aged 42 years or younger without premature ovarian failure or oophorectomy. A questionnaire was used to ask about the presence and frequency of vasomotor symptoms, including hot flashes and night sweats.

The study also measured subjects' bone mineral density (BMD) and levels of serum N-telopeptide (NTx), a marker of bone turnover.

A total of 12% of respondents reported one or both vasomotor symptoms, and 21% of respondents had evidence of low BMD, reported Dr. Pal. There was a significant correlation between vasomotor symptoms and low BMD, with 62.5% of symptomatic women showing evidence of low BMD, compared with 14% of asymptomatic women (odds ratio 10.18). Similarly, 36% of women with low BMD reported vasomotor symptoms, compared with 5% of those with normal BMD.

After controlling for age, body mass index, menstrual regularity, race, and smoking, the study found that vasomotor symptoms (night sweats and/or hot flashes) were independent predictors of low bone density in the study population. The magnitude of this association was most robust for night sweats, with an adjusted odds ratio (AOR) of 52.47, followed by both symptoms combined (AOR 24.10), and then hot flashes alone (AOR 15.10).

The presence of night sweats was also an independent predictor of bone turnover, with higher levels of serum NTx seen in symptomatic compared with asymptomatic women, she said.

And finally, levels of inhibin B, a marker of ovarian reserve, were also significantly lower in women with night sweats compared with asymptomatic women, “suggesting that declining ovarian reserve may be a unifying physiologic mechanism tying vasomotor symptoms to both increased bone turnover and low bone density in this young population,” she said.

NEW ORLEANS — Premenopausal vasomotor symptoms, particularly night sweats, are a previously unrecognized risk factor for low bone mineral density, according to Dr. Lubna Pal from the Albert Einstein College of Medicine, New York.

Her study won the prize paper from the Society for Reproductive Endocrinology and Infertility at the annual meeting of the American Society for Reproductive Medicine.

Based on these data, “I would advise providers to specifically ask about vasomotor symptoms in premenopausal women and, for those who are symptomatic, to focus on unmasking additional factors that may enhance their fracture risk, such as low body mass; family or personal history of fractures; or smoking,” she said in an interview. “I don't think we are there yet in terms of recommending bone density screening for this population … but these women need to be advised that a further deterioration in their bone density parameters is likely to occur in the postmenopausal period.”

The cross-sectional study included 86 premenopausal infertile women aged 42 years or younger without premature ovarian failure or oophorectomy. A questionnaire was used to ask about the presence and frequency of vasomotor symptoms, including hot flashes and night sweats.

The study also measured subjects' bone mineral density (BMD) and levels of serum N-telopeptide (NTx), a marker of bone turnover.

A total of 12% of respondents reported one or both vasomotor symptoms, and 21% of respondents had evidence of low BMD, reported Dr. Pal. There was a significant correlation between vasomotor symptoms and low BMD, with 62.5% of symptomatic women showing evidence of low BMD, compared with 14% of asymptomatic women (odds ratio 10.18). Similarly, 36% of women with low BMD reported vasomotor symptoms, compared with 5% of those with normal BMD.

After controlling for age, body mass index, menstrual regularity, race, and smoking, the study found that vasomotor symptoms (night sweats and/or hot flashes) were independent predictors of low bone density in the study population. The magnitude of this association was most robust for night sweats, with an adjusted odds ratio (AOR) of 52.47, followed by both symptoms combined (AOR 24.10), and then hot flashes alone (AOR 15.10).

The presence of night sweats was also an independent predictor of bone turnover, with higher levels of serum NTx seen in symptomatic compared with asymptomatic women, she said.

And finally, levels of inhibin B, a marker of ovarian reserve, were also significantly lower in women with night sweats compared with asymptomatic women, “suggesting that declining ovarian reserve may be a unifying physiologic mechanism tying vasomotor symptoms to both increased bone turnover and low bone density in this young population,” she said.

MONTREAL – Sleep apnea patients receiving continuous positive airway pressure therapy have changes in brain function that can be seen with functional magnetic resonance imaging when the therapy is withdrawn for just 2 consecutive nights.

“The brains of these patients must work harder, and possibly in less efficient ways, to perform at the same level [as when they are on the therapy],” said Mark S. Aloia, Ph.D., who reported the findings at the 8th World Congress on Sleep Apnea.

His study included eight subjects with moderate to severe sleep apnea who were compliant with continuous positive airway pressure (CPAP) therapy. The subjects were asked to complete a cognitive function test called the N-back test while undergoing functional magnetic resonance imaging (fMRI) of their brains. The testing was performed both when patients were compliant with CPAP (at least 2 consecutive nights) and when the therapy had been withdrawn for 2 consecutive nights.

While subjects performed similarly both on and off CPAP therapy (because of extensive task training), the fMRI showed significant differences in which regions of their brains were activated in the presence or absence of CPAP, said Dr. Aloia, who serves as director of sleep research at National Jewish Medical and Research Center in Denver.

Specifically, there was significantly greater activation of the left middle frontal gyrus and a trend toward greater activation of the right inferior parietal regions when CPAP was withdrawn. In contrast, when patients had been treated with CPAP, there was significantly more activation of the right middle frontal gyrus.

The findings lend support to the hypothesis that untreated sleep apnea creates an inefficiency in brain function, Dr. Aloia said. “There seems to be a compensatory response of the brain off CPAP such that subjects are using more brain resources to perform at the same level,” he said in an interview.

In addition to altering brain function, there is also evidence that sleep apnea impairs certain cognitive functions–and CPAP can reverse some of this impairment, Dr. Aloia added. In another study currently in press, he found that sleep apnea patients with impaired memory were eight times more likely to normalize their memory if they received adequate CPAP therapy–defined as 3 months of 6 or more hours per night–compared with patients who were less compliant with CPAP, averaging 1 hour or less a night.

Dr. Aloia and his colleagues also have done imaging studies that show differences in white matter in the brains of patients with severe sleep apnea, compared with those with mild disease–suggesting that some of the changes in brain functioning among sleep apnea patients could be caused by microvascular damage.

“From a neuropsychological perspective, we see fine motor discoordination, memory, and executive problems in microvascular disease,” he said. “So, we posited the idea that the relationship we know between apnea and cardiovascular disease probably extends to vessels in the brain.”

It is possible that CPAP therapy might reverse some of this ischemia, Dr. Aloia said.

Functional magnetic resonance imaging shows that activity in the brain increases (red areas) when continuous positive airway pressure is withdrawn. Courtesy Dr. Mark S. Aloia

MONTREAL – Sleep apnea patients receiving continuous positive airway pressure therapy have changes in brain function that can be seen with functional magnetic resonance imaging when the therapy is withdrawn for just 2 consecutive nights.

“The brains of these patients must work harder, and possibly in less efficient ways, to perform at the same level [as when they are on the therapy],” said Mark S. Aloia, Ph.D., who reported the findings at the 8th World Congress on Sleep Apnea.

His study included eight subjects with moderate to severe sleep apnea who were compliant with continuous positive airway pressure (CPAP) therapy. The subjects were asked to complete a cognitive function test called the N-back test while undergoing functional magnetic resonance imaging (fMRI) of their brains. The testing was performed both when patients were compliant with CPAP (at least 2 consecutive nights) and when the therapy had been withdrawn for 2 consecutive nights.

While subjects performed similarly both on and off CPAP therapy (because of extensive task training), the fMRI showed significant differences in which regions of their brains were activated in the presence or absence of CPAP, said Dr. Aloia, who serves as director of sleep research at National Jewish Medical and Research Center in Denver.

Specifically, there was significantly greater activation of the left middle frontal gyrus and a trend toward greater activation of the right inferior parietal regions when CPAP was withdrawn. In contrast, when patients had been treated with CPAP, there was significantly more activation of the right middle frontal gyrus.

The findings lend support to the hypothesis that untreated sleep apnea creates an inefficiency in brain function, Dr. Aloia said. “There seems to be a compensatory response of the brain off CPAP such that subjects are using more brain resources to perform at the same level,” he said in an interview.

In addition to altering brain function, there is also evidence that sleep apnea impairs certain cognitive functions–and CPAP can reverse some of this impairment, Dr. Aloia added. In another study currently in press, he found that sleep apnea patients with impaired memory were eight times more likely to normalize their memory if they received adequate CPAP therapy–defined as 3 months of 6 or more hours per night–compared with patients who were less compliant with CPAP, averaging 1 hour or less a night.

Dr. Aloia and his colleagues also have done imaging studies that show differences in white matter in the brains of patients with severe sleep apnea, compared with those with mild disease–suggesting that some of the changes in brain functioning among sleep apnea patients could be caused by microvascular damage.

“From a neuropsychological perspective, we see fine motor discoordination, memory, and executive problems in microvascular disease,” he said. “So, we posited the idea that the relationship we know between apnea and cardiovascular disease probably extends to vessels in the brain.”

It is possible that CPAP therapy might reverse some of this ischemia, Dr. Aloia said.

Functional magnetic resonance imaging shows that activity in the brain increases (red areas) when continuous positive airway pressure is withdrawn. Courtesy Dr. Mark S. Aloia

MONTREAL – Sleep apnea patients receiving continuous positive airway pressure therapy have changes in brain function that can be seen with functional magnetic resonance imaging when the therapy is withdrawn for just 2 consecutive nights.

“The brains of these patients must work harder, and possibly in less efficient ways, to perform at the same level [as when they are on the therapy],” said Mark S. Aloia, Ph.D., who reported the findings at the 8th World Congress on Sleep Apnea.

His study included eight subjects with moderate to severe sleep apnea who were compliant with continuous positive airway pressure (CPAP) therapy. The subjects were asked to complete a cognitive function test called the N-back test while undergoing functional magnetic resonance imaging (fMRI) of their brains. The testing was performed both when patients were compliant with CPAP (at least 2 consecutive nights) and when the therapy had been withdrawn for 2 consecutive nights.

While subjects performed similarly both on and off CPAP therapy (because of extensive task training), the fMRI showed significant differences in which regions of their brains were activated in the presence or absence of CPAP, said Dr. Aloia, who serves as director of sleep research at National Jewish Medical and Research Center in Denver.

Specifically, there was significantly greater activation of the left middle frontal gyrus and a trend toward greater activation of the right inferior parietal regions when CPAP was withdrawn. In contrast, when patients had been treated with CPAP, there was significantly more activation of the right middle frontal gyrus.

The findings lend support to the hypothesis that untreated sleep apnea creates an inefficiency in brain function, Dr. Aloia said. “There seems to be a compensatory response of the brain off CPAP such that subjects are using more brain resources to perform at the same level,” he said in an interview.

In addition to altering brain function, there is also evidence that sleep apnea impairs certain cognitive functions–and CPAP can reverse some of this impairment, Dr. Aloia added. In another study currently in press, he found that sleep apnea patients with impaired memory were eight times more likely to normalize their memory if they received adequate CPAP therapy–defined as 3 months of 6 or more hours per night–compared with patients who were less compliant with CPAP, averaging 1 hour or less a night.

Dr. Aloia and his colleagues also have done imaging studies that show differences in white matter in the brains of patients with severe sleep apnea, compared with those with mild disease–suggesting that some of the changes in brain functioning among sleep apnea patients could be caused by microvascular damage.

“From a neuropsychological perspective, we see fine motor discoordination, memory, and executive problems in microvascular disease,” he said. “So, we posited the idea that the relationship we know between apnea and cardiovascular disease probably extends to vessels in the brain.”

It is possible that CPAP therapy might reverse some of this ischemia, Dr. Aloia said.

Functional magnetic resonance imaging shows that activity in the brain increases (red areas) when continuous positive airway pressure is withdrawn. Courtesy Dr. Mark S. Aloia

BOSTON — With virtual colonoscopy expected to soon take center stage along with other colorectal screening tools, the management of colorectal polyps is poised for a major shift, according to several experts.

Virtual colonoscopy's main attraction—its minimally invasive quality—is also its main weakness. A problematic lesion that is found on virtual colonoscopy (VC) cannot be immediately removed, as it can during conventional optical colonoscopy (OC), although same-day OC with polypectomy following VC is often an option.

“The central issue is whether some of these polyps can be left,” said Dr. Joseph Ferrucci of Boston University. “Optical colonoscopy with polypectomy for all visualized polyps may be therapeutic overkill,” he said in an interview at an international symposium on virtual colonoscopy that was sponsored by the university.

Most physicians agree that small polyps (under 5 mm) can be safely left in place, and large polyps (more than 9 mm) should be removed immediately. The debate lies with medium-sized polyps measuring 6–9 mm, Dr. Ferrucci said. During OC, such polyps are normally removed because the opportunity is there, but there is no strong evidence to support this practice, and there is a growing body of evidence against it.

“The data [show] that an overaggressive approach to polypectomy has consequences. People are asking [if it's] sensible,” said Robert Smith, Ph.D., director of cancer screening for the American Cancer Society. Therapeutic colonoscopy is also much more expensive than a screening OC, he said in an interview.

Dr. Perry Pickhardt of the University of Wisconsin, Madison, said VC can act as a filter for determining the need for polypectomy. The medical school at the University of Wisconsin, one of the few to secure third-party coverage for VC, has used the tool to significantly reduce the number of polypectomies.

In a comparison of 2,202 patients receiving primary VC screening and 2,210 patients receiving primary OC screening, 7% of the VC group went on to receive an OC because of detection of a medium-sized polyp, with a resulting 325 polypectomies. The primary OC group ended up with 1,696 polypectomies. Despite that difference, the percentage of polyps identified as advanced adenomas was 3% in both groups, Dr. Pickhardt said. “VC is an effective filter for selective therapeutic OC, resulting in a more efficient use of costly and invasive resources.

BOSTON — With virtual colonoscopy expected to soon take center stage along with other colorectal screening tools, the management of colorectal polyps is poised for a major shift, according to several experts.

Virtual colonoscopy's main attraction—its minimally invasive quality—is also its main weakness. A problematic lesion that is found on virtual colonoscopy (VC) cannot be immediately removed, as it can during conventional optical colonoscopy (OC), although same-day OC with polypectomy following VC is often an option.

“The central issue is whether some of these polyps can be left,” said Dr. Joseph Ferrucci of Boston University. “Optical colonoscopy with polypectomy for all visualized polyps may be therapeutic overkill,” he said in an interview at an international symposium on virtual colonoscopy that was sponsored by the university.

Most physicians agree that small polyps (under 5 mm) can be safely left in place, and large polyps (more than 9 mm) should be removed immediately. The debate lies with medium-sized polyps measuring 6–9 mm, Dr. Ferrucci said. During OC, such polyps are normally removed because the opportunity is there, but there is no strong evidence to support this practice, and there is a growing body of evidence against it.

“The data [show] that an overaggressive approach to polypectomy has consequences. People are asking [if it's] sensible,” said Robert Smith, Ph.D., director of cancer screening for the American Cancer Society. Therapeutic colonoscopy is also much more expensive than a screening OC, he said in an interview.

Dr. Perry Pickhardt of the University of Wisconsin, Madison, said VC can act as a filter for determining the need for polypectomy. The medical school at the University of Wisconsin, one of the few to secure third-party coverage for VC, has used the tool to significantly reduce the number of polypectomies.

In a comparison of 2,202 patients receiving primary VC screening and 2,210 patients receiving primary OC screening, 7% of the VC group went on to receive an OC because of detection of a medium-sized polyp, with a resulting 325 polypectomies. The primary OC group ended up with 1,696 polypectomies. Despite that difference, the percentage of polyps identified as advanced adenomas was 3% in both groups, Dr. Pickhardt said. “VC is an effective filter for selective therapeutic OC, resulting in a more efficient use of costly and invasive resources.

BOSTON — With virtual colonoscopy expected to soon take center stage along with other colorectal screening tools, the management of colorectal polyps is poised for a major shift, according to several experts.

Virtual colonoscopy's main attraction—its minimally invasive quality—is also its main weakness. A problematic lesion that is found on virtual colonoscopy (VC) cannot be immediately removed, as it can during conventional optical colonoscopy (OC), although same-day OC with polypectomy following VC is often an option.

“The central issue is whether some of these polyps can be left,” said Dr. Joseph Ferrucci of Boston University. “Optical colonoscopy with polypectomy for all visualized polyps may be therapeutic overkill,” he said in an interview at an international symposium on virtual colonoscopy that was sponsored by the university.

Most physicians agree that small polyps (under 5 mm) can be safely left in place, and large polyps (more than 9 mm) should be removed immediately. The debate lies with medium-sized polyps measuring 6–9 mm, Dr. Ferrucci said. During OC, such polyps are normally removed because the opportunity is there, but there is no strong evidence to support this practice, and there is a growing body of evidence against it.

“The data [show] that an overaggressive approach to polypectomy has consequences. People are asking [if it's] sensible,” said Robert Smith, Ph.D., director of cancer screening for the American Cancer Society. Therapeutic colonoscopy is also much more expensive than a screening OC, he said in an interview.

Dr. Perry Pickhardt of the University of Wisconsin, Madison, said VC can act as a filter for determining the need for polypectomy. The medical school at the University of Wisconsin, one of the few to secure third-party coverage for VC, has used the tool to significantly reduce the number of polypectomies.

In a comparison of 2,202 patients receiving primary VC screening and 2,210 patients receiving primary OC screening, 7% of the VC group went on to receive an OC because of detection of a medium-sized polyp, with a resulting 325 polypectomies. The primary OC group ended up with 1,696 polypectomies. Despite that difference, the percentage of polyps identified as advanced adenomas was 3% in both groups, Dr. Pickhardt said. “VC is an effective filter for selective therapeutic OC, resulting in a more efficient use of costly and invasive resources.

BOSTON — The debut of virtual colonoscopy as a mainstream option for colorectal cancer screening may be just months away, experts said at an international symposium on virtual colonoscopy sponsored by Boston University.

The much-anticipated results of the American College of Radiology Imaging Network's (ACRIN) national trial, are expected to be announced by late March 2007. The results are expected to show virtual colonoscopy (VC), also known as CT colonography, in a favorable light in comparison with conventional optical colonoscopy (OC), said one of the investigators, Dr. Judy Yee of the University of California, San Francisco.

The American Cancer Society expects to announce its updated colorectal cancer screening guidelines at about the same time, said Robert Smith, Ph.D., the society's director of cancer screening.

To date, the ACRIN trial has enrolled 2,468 of the 2,607 subjects needed to complete its comparison of both screening modalities, and the trial is scheduled to conclude in late November, said Dr. Yee.

“Where will the results fall?” she asked. In terms of the three most important multicenter trials comparing VC and OC, the excellent performance of VC in the landmark Pickhardt trial (New Engl. J. Med. 2003;349:2191–2200) was not replicated in the two more recent trials (JAMA 2004;291:1713–19, and Lancet 2005;365:305–11), Dr. Yee said.

“I don't think I am going out on a limb by saying the ACRIN results will fall right between,” she said. “I don't think the ACRIN trial will be able to achieve the 92% sensitivity [for VC] seen in the Pickhardt trial, but taking an educated guess I would say that sensitivity will fall maybe somewhere between 80% and 90%.”

Results like that would launch VC into the mainstream, predicted Dr. Joseph Ferrucci of Boston University. “We hope they will be the data that will be the final tipping point for the American Cancer Society to amend its guidelines to include VC,” he said in an interview.

Dr. Smith agreed that the ACRIN trial results will be important, but he would not comment on how they would influence the American Cancer Society's guidelines.

“I can't tell you whether we are going to wait [for the ACRIN results] or not,” he said in an interview. “We know the ACRIN timetable, and we are working on our guidelines now. If we are not done by the time the ACRIN results are out, we will most certainly want to see them at the earliest opportunity. We live in an electronic age, which means our guidelines process is always active. The potential is always there to adjust the guidelines in very short order if necessary.”

Recognition by the American Cancer Society of VC's strength as a colorectal cancer screening tool would likely carry it over the threshold toward full public and medical acceptance, said Dr. Perry Pickhardt of the University of Wisconsin, Madison, principal investigator of the 2003 landmark trial.

“This is an exciting time for VC as we move from validation into implementation,” said Dr. Pickhardt, adding that the next step needs to be acceptance by third-party payers. “We are treading water now waiting for widespread reimbursement.”

Dr. Smith agreed that the reaction of the American Cancer Society to the ACRIN results will be important. If VC is added to the society's guidelines, it is reasonable to expect a resulting improvement in competence among those who perform the test, greater overall investment in the approach, and greater public awareness, he said.

The end result will hopefully be better patient compliance with screening, Dr. Pickhardt said. “Currently, more than 40 million adults over the age of 50 are not being screened,” he said.

BOSTON — The debut of virtual colonoscopy as a mainstream option for colorectal cancer screening may be just months away, experts said at an international symposium on virtual colonoscopy sponsored by Boston University.

The much-anticipated results of the American College of Radiology Imaging Network's (ACRIN) national trial, are expected to be announced by late March 2007. The results are expected to show virtual colonoscopy (VC), also known as CT colonography, in a favorable light in comparison with conventional optical colonoscopy (OC), said one of the investigators, Dr. Judy Yee of the University of California, San Francisco.

The American Cancer Society expects to announce its updated colorectal cancer screening guidelines at about the same time, said Robert Smith, Ph.D., the society's director of cancer screening.

To date, the ACRIN trial has enrolled 2,468 of the 2,607 subjects needed to complete its comparison of both screening modalities, and the trial is scheduled to conclude in late November, said Dr. Yee.

“Where will the results fall?” she asked. In terms of the three most important multicenter trials comparing VC and OC, the excellent performance of VC in the landmark Pickhardt trial (New Engl. J. Med. 2003;349:2191–2200) was not replicated in the two more recent trials (JAMA 2004;291:1713–19, and Lancet 2005;365:305–11), Dr. Yee said.

“I don't think I am going out on a limb by saying the ACRIN results will fall right between,” she said. “I don't think the ACRIN trial will be able to achieve the 92% sensitivity [for VC] seen in the Pickhardt trial, but taking an educated guess I would say that sensitivity will fall maybe somewhere between 80% and 90%.”

Results like that would launch VC into the mainstream, predicted Dr. Joseph Ferrucci of Boston University. “We hope they will be the data that will be the final tipping point for the American Cancer Society to amend its guidelines to include VC,” he said in an interview.

Dr. Smith agreed that the ACRIN trial results will be important, but he would not comment on how they would influence the American Cancer Society's guidelines.

“I can't tell you whether we are going to wait [for the ACRIN results] or not,” he said in an interview. “We know the ACRIN timetable, and we are working on our guidelines now. If we are not done by the time the ACRIN results are out, we will most certainly want to see them at the earliest opportunity. We live in an electronic age, which means our guidelines process is always active. The potential is always there to adjust the guidelines in very short order if necessary.”

Recognition by the American Cancer Society of VC's strength as a colorectal cancer screening tool would likely carry it over the threshold toward full public and medical acceptance, said Dr. Perry Pickhardt of the University of Wisconsin, Madison, principal investigator of the 2003 landmark trial.

“This is an exciting time for VC as we move from validation into implementation,” said Dr. Pickhardt, adding that the next step needs to be acceptance by third-party payers. “We are treading water now waiting for widespread reimbursement.”

Dr. Smith agreed that the reaction of the American Cancer Society to the ACRIN results will be important. If VC is added to the society's guidelines, it is reasonable to expect a resulting improvement in competence among those who perform the test, greater overall investment in the approach, and greater public awareness, he said.

The end result will hopefully be better patient compliance with screening, Dr. Pickhardt said. “Currently, more than 40 million adults over the age of 50 are not being screened,” he said.

BOSTON — The debut of virtual colonoscopy as a mainstream option for colorectal cancer screening may be just months away, experts said at an international symposium on virtual colonoscopy sponsored by Boston University.

The much-anticipated results of the American College of Radiology Imaging Network's (ACRIN) national trial, are expected to be announced by late March 2007. The results are expected to show virtual colonoscopy (VC), also known as CT colonography, in a favorable light in comparison with conventional optical colonoscopy (OC), said one of the investigators, Dr. Judy Yee of the University of California, San Francisco.

The American Cancer Society expects to announce its updated colorectal cancer screening guidelines at about the same time, said Robert Smith, Ph.D., the society's director of cancer screening.

To date, the ACRIN trial has enrolled 2,468 of the 2,607 subjects needed to complete its comparison of both screening modalities, and the trial is scheduled to conclude in late November, said Dr. Yee.

“Where will the results fall?” she asked. In terms of the three most important multicenter trials comparing VC and OC, the excellent performance of VC in the landmark Pickhardt trial (New Engl. J. Med. 2003;349:2191–2200) was not replicated in the two more recent trials (JAMA 2004;291:1713–19, and Lancet 2005;365:305–11), Dr. Yee said.

“I don't think I am going out on a limb by saying the ACRIN results will fall right between,” she said. “I don't think the ACRIN trial will be able to achieve the 92% sensitivity [for VC] seen in the Pickhardt trial, but taking an educated guess I would say that sensitivity will fall maybe somewhere between 80% and 90%.”

Results like that would launch VC into the mainstream, predicted Dr. Joseph Ferrucci of Boston University. “We hope they will be the data that will be the final tipping point for the American Cancer Society to amend its guidelines to include VC,” he said in an interview.

Dr. Smith agreed that the ACRIN trial results will be important, but he would not comment on how they would influence the American Cancer Society's guidelines.

“I can't tell you whether we are going to wait [for the ACRIN results] or not,” he said in an interview. “We know the ACRIN timetable, and we are working on our guidelines now. If we are not done by the time the ACRIN results are out, we will most certainly want to see them at the earliest opportunity. We live in an electronic age, which means our guidelines process is always active. The potential is always there to adjust the guidelines in very short order if necessary.”

Recognition by the American Cancer Society of VC's strength as a colorectal cancer screening tool would likely carry it over the threshold toward full public and medical acceptance, said Dr. Perry Pickhardt of the University of Wisconsin, Madison, principal investigator of the 2003 landmark trial.

“This is an exciting time for VC as we move from validation into implementation,” said Dr. Pickhardt, adding that the next step needs to be acceptance by third-party payers. “We are treading water now waiting for widespread reimbursement.”

Dr. Smith agreed that the reaction of the American Cancer Society to the ACRIN results will be important. If VC is added to the society's guidelines, it is reasonable to expect a resulting improvement in competence among those who perform the test, greater overall investment in the approach, and greater public awareness, he said.

The end result will hopefully be better patient compliance with screening, Dr. Pickhardt said. “Currently, more than 40 million adults over the age of 50 are not being screened,” he said.