Kate Johnson

MONTREAL — Contrary to its effect with other progesterone-only contraceptives, mifepristone increases breakthrough bleeding in patients using the levonorgestrel intrauterine system, according to a new study.

“Mifespristone cannot be recommended as a therapy for breakthrough bleeding in new users of the LNG-IUS [levonorgestrel intrauterine system],” reported Dr. Megan Econimidis of the Keck School of Medicine at the University of Southern California in Los Angeles.

Mifepristone, an antiprogesterone, has been shown to decrease irregular bleeding in users of progesterone-only implants and injectables. It has been suggested that this effect may be due to mifepristone's functional inhibition of progesterone, which leads to the upregulation of endometrial estrogen receptors, she said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

But Dr. Econimidis' study found that, when given to 20 regularly menstruating women who were new starters of the LNG-IUS, mifepristone actually had the opposite effect. “The local effect of the levonorgestrel on the endometrium may be triggering bleeding … [and] may not be allowing the mifepristone to act on the endometrium,” she said in an interview. “In women who are on a progesterone-only implant or injectable, that mechanism, in terms of concentration of levonorgestrel on the endometrium, is less.”

The women in the study, 18-45 years old, were randomized to mifepristone 50 mg or placebo every 2 weeks for six cycles. Treatment was started 2 weeks after LNG-IUS insertion. Subjects recorded their bleeding events in a diary and returned to the clinic for 14 visits during the study period. Endometrial biopsies were taken on day 21 of the menstrual cycle before LNG-IUS insertion, 14 days after insertion, and 7 days after the first dose of mifepristone or placebo.

Over the six cycles, the median number of days of breakthrough bleeding was 57 in the mifepristone group, compared with 26 in the placebo group; this difference was statistically significant. In addition, when all the subjects' cycles were combined, there were 22 (42%) mifepristone cycles with more than 8 days of breakthrough bleeding, compared with 16 (27%) placebo cycles. This difference was not statistically significant.

Endometrial biopsy results showed a decrease in endometrial estrogen receptors after mifepristone treatment, in contrast to other studies of progesterone implants and injectables, which have shown an increase in estrogen receptors after mifepristone, she said.

MONTREAL — Contrary to its effect with other progesterone-only contraceptives, mifepristone increases breakthrough bleeding in patients using the levonorgestrel intrauterine system, according to a new study.

“Mifespristone cannot be recommended as a therapy for breakthrough bleeding in new users of the LNG-IUS [levonorgestrel intrauterine system],” reported Dr. Megan Econimidis of the Keck School of Medicine at the University of Southern California in Los Angeles.

Mifepristone, an antiprogesterone, has been shown to decrease irregular bleeding in users of progesterone-only implants and injectables. It has been suggested that this effect may be due to mifepristone's functional inhibition of progesterone, which leads to the upregulation of endometrial estrogen receptors, she said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

But Dr. Econimidis' study found that, when given to 20 regularly menstruating women who were new starters of the LNG-IUS, mifepristone actually had the opposite effect. “The local effect of the levonorgestrel on the endometrium may be triggering bleeding … [and] may not be allowing the mifepristone to act on the endometrium,” she said in an interview. “In women who are on a progesterone-only implant or injectable, that mechanism, in terms of concentration of levonorgestrel on the endometrium, is less.”

The women in the study, 18-45 years old, were randomized to mifepristone 50 mg or placebo every 2 weeks for six cycles. Treatment was started 2 weeks after LNG-IUS insertion. Subjects recorded their bleeding events in a diary and returned to the clinic for 14 visits during the study period. Endometrial biopsies were taken on day 21 of the menstrual cycle before LNG-IUS insertion, 14 days after insertion, and 7 days after the first dose of mifepristone or placebo.

Over the six cycles, the median number of days of breakthrough bleeding was 57 in the mifepristone group, compared with 26 in the placebo group; this difference was statistically significant. In addition, when all the subjects' cycles were combined, there were 22 (42%) mifepristone cycles with more than 8 days of breakthrough bleeding, compared with 16 (27%) placebo cycles. This difference was not statistically significant.

Endometrial biopsy results showed a decrease in endometrial estrogen receptors after mifepristone treatment, in contrast to other studies of progesterone implants and injectables, which have shown an increase in estrogen receptors after mifepristone, she said.

MONTREAL — Contrary to its effect with other progesterone-only contraceptives, mifepristone increases breakthrough bleeding in patients using the levonorgestrel intrauterine system, according to a new study.

“Mifespristone cannot be recommended as a therapy for breakthrough bleeding in new users of the LNG-IUS [levonorgestrel intrauterine system],” reported Dr. Megan Econimidis of the Keck School of Medicine at the University of Southern California in Los Angeles.

Mifepristone, an antiprogesterone, has been shown to decrease irregular bleeding in users of progesterone-only implants and injectables. It has been suggested that this effect may be due to mifepristone's functional inhibition of progesterone, which leads to the upregulation of endometrial estrogen receptors, she said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

But Dr. Econimidis' study found that, when given to 20 regularly menstruating women who were new starters of the LNG-IUS, mifepristone actually had the opposite effect. “The local effect of the levonorgestrel on the endometrium may be triggering bleeding … [and] may not be allowing the mifepristone to act on the endometrium,” she said in an interview. “In women who are on a progesterone-only implant or injectable, that mechanism, in terms of concentration of levonorgestrel on the endometrium, is less.”

The women in the study, 18-45 years old, were randomized to mifepristone 50 mg or placebo every 2 weeks for six cycles. Treatment was started 2 weeks after LNG-IUS insertion. Subjects recorded their bleeding events in a diary and returned to the clinic for 14 visits during the study period. Endometrial biopsies were taken on day 21 of the menstrual cycle before LNG-IUS insertion, 14 days after insertion, and 7 days after the first dose of mifepristone or placebo.

Over the six cycles, the median number of days of breakthrough bleeding was 57 in the mifepristone group, compared with 26 in the placebo group; this difference was statistically significant. In addition, when all the subjects' cycles were combined, there were 22 (42%) mifepristone cycles with more than 8 days of breakthrough bleeding, compared with 16 (27%) placebo cycles. This difference was not statistically significant.

Endometrial biopsy results showed a decrease in endometrial estrogen receptors after mifepristone treatment, in contrast to other studies of progesterone implants and injectables, which have shown an increase in estrogen receptors after mifepristone, she said.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out to oncologists so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The most common single cancer diagnosis was breast cancer (10 patients). The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

The study found no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved, Dr. Quintero said. However, there were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out to oncologists so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The most common single cancer diagnosis was breast cancer (10 patients). The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

The study found no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved, Dr. Quintero said. However, there were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out to oncologists so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The most common single cancer diagnosis was breast cancer (10 patients). The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

The study found no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved, Dr. Quintero said. However, there were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Women who freeze their eggs at age 33 hoping to pause their biological clocks are actually no better off than if they simply underwent a fresh IVF cycle—if necessary—at age 42, according to new research.

The first metaanalysis of oocyte cryopreservation success rates shows the technique is 4-5 times less efficient than standard in vitro fertilization with fresh oocytes, reported Dr. Kutluk Oktay of Cornell University, New York.

A total of 118 babies worldwide have been born from frozen oocytes—97 from the slow-freeze technique and 11 from vitrification techniques, Dr. Oktay said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society. Previous estimates of about 180 frozen-egg births might have been confused by overlapping reports in the literature, he explained.

Dr. Oktay compared data from the 118 frozen-egg pregnancies with data from a control group of 397 fresh intracytoplasmic sperm injection (ICSI) transfer cycles. Women who had cycles involving frozen eggs had a mean age of 33; those who had ICSI cycles, mean age was 33.6.

Assessment of the number of live births per injected oocyte shows the rates in the frozen-egg cycles were 3.4% (slow freeze) and 4.5% (vitrification), compared with 6.6% in fresh IVF/ICSI and 7.5% with the addition of subsequent frozen-embryo transfers.

There are insufficient data to assess the vitrification method, he said, but compared with slow-freeze oocyte cycles, fresh IVF plus subsequent frozen embryo cycles had an implantation rate per transferred embryo almost four times higher (36.9% vs. 12.8%; odds ratio 3.68).

Similarly, live births per transfer were significantly higher (OR 3.58) in the fresh-IVF/frozen-embryo cycles (50%) compared with slow-freeze oocyte cycles (21.6%).

Egg freezing in women aged 33 has success rates comparable with those achieved using fresh IVF in women aged 41 and 42 years, he concluded.

MONTREAL — Women who freeze their eggs at age 33 hoping to pause their biological clocks are actually no better off than if they simply underwent a fresh IVF cycle—if necessary—at age 42, according to new research.

The first metaanalysis of oocyte cryopreservation success rates shows the technique is 4-5 times less efficient than standard in vitro fertilization with fresh oocytes, reported Dr. Kutluk Oktay of Cornell University, New York.

A total of 118 babies worldwide have been born from frozen oocytes—97 from the slow-freeze technique and 11 from vitrification techniques, Dr. Oktay said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society. Previous estimates of about 180 frozen-egg births might have been confused by overlapping reports in the literature, he explained.

Dr. Oktay compared data from the 118 frozen-egg pregnancies with data from a control group of 397 fresh intracytoplasmic sperm injection (ICSI) transfer cycles. Women who had cycles involving frozen eggs had a mean age of 33; those who had ICSI cycles, mean age was 33.6.

Assessment of the number of live births per injected oocyte shows the rates in the frozen-egg cycles were 3.4% (slow freeze) and 4.5% (vitrification), compared with 6.6% in fresh IVF/ICSI and 7.5% with the addition of subsequent frozen-embryo transfers.

There are insufficient data to assess the vitrification method, he said, but compared with slow-freeze oocyte cycles, fresh IVF plus subsequent frozen embryo cycles had an implantation rate per transferred embryo almost four times higher (36.9% vs. 12.8%; odds ratio 3.68).

Similarly, live births per transfer were significantly higher (OR 3.58) in the fresh-IVF/frozen-embryo cycles (50%) compared with slow-freeze oocyte cycles (21.6%).

Egg freezing in women aged 33 has success rates comparable with those achieved using fresh IVF in women aged 41 and 42 years, he concluded.

MONTREAL — Women who freeze their eggs at age 33 hoping to pause their biological clocks are actually no better off than if they simply underwent a fresh IVF cycle—if necessary—at age 42, according to new research.

The first metaanalysis of oocyte cryopreservation success rates shows the technique is 4-5 times less efficient than standard in vitro fertilization with fresh oocytes, reported Dr. Kutluk Oktay of Cornell University, New York.

A total of 118 babies worldwide have been born from frozen oocytes—97 from the slow-freeze technique and 11 from vitrification techniques, Dr. Oktay said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society. Previous estimates of about 180 frozen-egg births might have been confused by overlapping reports in the literature, he explained.

Dr. Oktay compared data from the 118 frozen-egg pregnancies with data from a control group of 397 fresh intracytoplasmic sperm injection (ICSI) transfer cycles. Women who had cycles involving frozen eggs had a mean age of 33; those who had ICSI cycles, mean age was 33.6.

Assessment of the number of live births per injected oocyte shows the rates in the frozen-egg cycles were 3.4% (slow freeze) and 4.5% (vitrification), compared with 6.6% in fresh IVF/ICSI and 7.5% with the addition of subsequent frozen-embryo transfers.

There are insufficient data to assess the vitrification method, he said, but compared with slow-freeze oocyte cycles, fresh IVF plus subsequent frozen embryo cycles had an implantation rate per transferred embryo almost four times higher (36.9% vs. 12.8%; odds ratio 3.68).

Similarly, live births per transfer were significantly higher (OR 3.58) in the fresh-IVF/frozen-embryo cycles (50%) compared with slow-freeze oocyte cycles (21.6%).

Egg freezing in women aged 33 has success rates comparable with those achieved using fresh IVF in women aged 41 and 42 years, he concluded.

MONTREAL — Preliminary results from an ongoing study of oocyte cryopreservation show “the highest pregnancy rates so far reported,” making egg freezing “a viable clinical option,” according to Dr. John K. Jain, the principal investigator.

“Egg freezing has turned a corner—it's arrived,” said Dr. Jain, of USC Fertility, the nonprofit fertility practice of the University of Southern California's Keck School of Medicine, Los Angeles.

A total of 20 women (mean age 31 years) have been enrolled in the study, which provides them with in vitro fertilization at no charge. To date, five of eight women have become pregnant after having their eggs removed and frozen for 1 month, then thawed and fertilized by intracytoplasmic sperm injection, followed by subsequent embryo transfer.

He reported the findings in a poster at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

A recent metaanalysis of all published frozen-egg pregnancies (118) suggests a worldwide live birth rate of 21.6% per transfer in women with a mean age of 33 years, reported Dr. Kutluk Oktay in a separate presentation at the meeting (see accompanying story). Unpublished data from the World Congress on Human Oocyte Cryopreservation suggest that the highest U.S. success rate until now has been a 34% pregnancy rate per transfer at Assisted Fertility Services of the Community Health Network in Indianapolis.

Dr. Jain attributes the success of his egg freezing protocol to a combination of culture medium and freezing method. The center uses a slow-freeze protocol in sodium-depleted, choline-substituted medium.

Two of the five women have delivered singletons, with the other pregnancies (including a set of triplets) well into their second or third trimesters, he said.

Each transfer procedure included an average of 3.2 embryos, compared with an average of 2.7 embryos per transfer reported in the egg freezing metaanalysis.

The American Society for Reproductive Medicine currently recommends that in women younger than 35, no more than two embryos should be transferred; it also recommends that consideration be given to single embryo transfer in patients with the best prognosis.

The optimal number of embryos to transfer following oocyte cryopreservation is still undetermined, Dr. Jain said.

MONTREAL — Preliminary results from an ongoing study of oocyte cryopreservation show “the highest pregnancy rates so far reported,” making egg freezing “a viable clinical option,” according to Dr. John K. Jain, the principal investigator.

“Egg freezing has turned a corner—it's arrived,” said Dr. Jain, of USC Fertility, the nonprofit fertility practice of the University of Southern California's Keck School of Medicine, Los Angeles.

A total of 20 women (mean age 31 years) have been enrolled in the study, which provides them with in vitro fertilization at no charge. To date, five of eight women have become pregnant after having their eggs removed and frozen for 1 month, then thawed and fertilized by intracytoplasmic sperm injection, followed by subsequent embryo transfer.

He reported the findings in a poster at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

A recent metaanalysis of all published frozen-egg pregnancies (118) suggests a worldwide live birth rate of 21.6% per transfer in women with a mean age of 33 years, reported Dr. Kutluk Oktay in a separate presentation at the meeting (see accompanying story). Unpublished data from the World Congress on Human Oocyte Cryopreservation suggest that the highest U.S. success rate until now has been a 34% pregnancy rate per transfer at Assisted Fertility Services of the Community Health Network in Indianapolis.

Dr. Jain attributes the success of his egg freezing protocol to a combination of culture medium and freezing method. The center uses a slow-freeze protocol in sodium-depleted, choline-substituted medium.

Two of the five women have delivered singletons, with the other pregnancies (including a set of triplets) well into their second or third trimesters, he said.

Each transfer procedure included an average of 3.2 embryos, compared with an average of 2.7 embryos per transfer reported in the egg freezing metaanalysis.

The American Society for Reproductive Medicine currently recommends that in women younger than 35, no more than two embryos should be transferred; it also recommends that consideration be given to single embryo transfer in patients with the best prognosis.

The optimal number of embryos to transfer following oocyte cryopreservation is still undetermined, Dr. Jain said.

MONTREAL — Preliminary results from an ongoing study of oocyte cryopreservation show “the highest pregnancy rates so far reported,” making egg freezing “a viable clinical option,” according to Dr. John K. Jain, the principal investigator.

“Egg freezing has turned a corner—it's arrived,” said Dr. Jain, of USC Fertility, the nonprofit fertility practice of the University of Southern California's Keck School of Medicine, Los Angeles.

A total of 20 women (mean age 31 years) have been enrolled in the study, which provides them with in vitro fertilization at no charge. To date, five of eight women have become pregnant after having their eggs removed and frozen for 1 month, then thawed and fertilized by intracytoplasmic sperm injection, followed by subsequent embryo transfer.

He reported the findings in a poster at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

A recent metaanalysis of all published frozen-egg pregnancies (118) suggests a worldwide live birth rate of 21.6% per transfer in women with a mean age of 33 years, reported Dr. Kutluk Oktay in a separate presentation at the meeting (see accompanying story). Unpublished data from the World Congress on Human Oocyte Cryopreservation suggest that the highest U.S. success rate until now has been a 34% pregnancy rate per transfer at Assisted Fertility Services of the Community Health Network in Indianapolis.

Dr. Jain attributes the success of his egg freezing protocol to a combination of culture medium and freezing method. The center uses a slow-freeze protocol in sodium-depleted, choline-substituted medium.

Two of the five women have delivered singletons, with the other pregnancies (including a set of triplets) well into their second or third trimesters, he said.

Each transfer procedure included an average of 3.2 embryos, compared with an average of 2.7 embryos per transfer reported in the egg freezing metaanalysis.

The American Society for Reproductive Medicine currently recommends that in women younger than 35, no more than two embryos should be transferred; it also recommends that consideration be given to single embryo transfer in patients with the best prognosis.

The optimal number of embryos to transfer following oocyte cryopreservation is still undetermined, Dr. Jain said.

ORLANDO – Contrary to many physicians' fears, disclosing a diagnosis of dementia to patients and their caregivers does not produce negative reactions, and in some cases actually lowers their anxiety and depression levels, according to a survey.

The findings should encourage physicians to be more up front when faced with reporting such a diagnosis, said the study's lead investigator Brian D. Carpenter, Ph.D., of the department of psychology at Washington University, St. Louis.

In a review paper, Dr. Carpenter's team reported that reluctance to disclose a dementia diagnosis is common among physicians (Gerontologist 2004;44:149–58).

“On average, somewhere around 50% of physicians say they don't routinely tell patients and caregivers when there is a diagnosis of dementia because they are worried about an extremely negative, even suicidal, reaction,” he said in an interview. “They just tell them it's normal aging.”

But in his study, which he presented as a poster at the annual meeting of the Gerontological Society of America, Dr. Carpenter found that, among 80 patient-caregiver dyads, initial reactions within 3 days of a diagnosis of dementia were not negative–even among those who did not expect such a diagnosis.

The longitudinal study recruited patients and their caregivers at the time of their initial contact with the Washington University Alzheimer's Disease Research Center. Surveys assessing baseline data on self-reported anxiety and depression were mailed to all subjects as soon as their initial appointment was scheduled. Similar surveys were then obtained by telephone 2–3 days after a diagnosis had been given.

Depression was measured using the Geriatric Depression Scale, and anxiety was measured using the State-Trait Anxiety Inventory. Participants were also asked about their diagnostic expectations in the first survey.

In total, 67% of patients were diagnosed with dementia (21% with mild dementia and 46% with very mild dementia), and the remaining 33% had no dementia.

Regarding diagnostic expectations, caregivers were more accurate than patients when estimating the likelihood of a dementia diagnosis. More than half (52%) were correct when they said they expected a dementia diagnosis, compared with 32% of patients. Among those who said they did not expect a diagnosis of dementia, 15% of caregivers were incorrect, compared with 34% of patients.

Regardless of their diagnostic expectations, patients experienced no change in depression and a decrease in anxiety after receiving their diagnosis, regardless of what the diagnosis was.

The picture was less straightforward for caregivers. Regardless of their expectations, depression levels decreased with a diagnosis of dementia and remained unchanged when it was not diagnosed. Anxiety levels were influenced by their expectations and not by the actual diagnosis. Anxiety decreased when caregivers expected a dementia diagnosis (regardless of the actual diagnosis) and remained unchanged when they did not expect a dementia diagnosis.

“We think many of the patients and caregivers feel better after they receive the news because they anticipate that there's something wrong. They're not really sure what in some cases, and then when they have a diagnosis, a label, sometimes that results in a great sense of relief,” Dr. Carpenter said. “When they get the news, they are also shuttled towards more services so they get a better sense of what they can do to manage their disease.”

Most of the caregivers in the study were family members: 58% were spouses, 23% were children or in-laws; and 6% were other family. Thirteen percent were friends.

The ongoing investigation will measure if and how the subjects' reactions may change with time. Participants will be assessed 1 month, 6 months, and 1 year after the diagnosis, Dr. Carpenter said.

“Our hypothesis is that we will see that patients' depression and anxiety either remains stable or gets better, and the caregivers are actually the ones we are expecting will experience more stress” as patients deteriorate, he said.

“This raises difficult issues for clinicians about who their patient is.” Dr. Carpenter said. “The patient is the person they are diagnosing, but it is the caregivers who have to provide more and more services, while watching this person [who] they care about slowly decline. And so the burden of responsibility for clinicians, we think, is to think more broadly about who the patient is.”

ORLANDO – Contrary to many physicians' fears, disclosing a diagnosis of dementia to patients and their caregivers does not produce negative reactions, and in some cases actually lowers their anxiety and depression levels, according to a survey.

The findings should encourage physicians to be more up front when faced with reporting such a diagnosis, said the study's lead investigator Brian D. Carpenter, Ph.D., of the department of psychology at Washington University, St. Louis.

In a review paper, Dr. Carpenter's team reported that reluctance to disclose a dementia diagnosis is common among physicians (Gerontologist 2004;44:149–58).

“On average, somewhere around 50% of physicians say they don't routinely tell patients and caregivers when there is a diagnosis of dementia because they are worried about an extremely negative, even suicidal, reaction,” he said in an interview. “They just tell them it's normal aging.”

But in his study, which he presented as a poster at the annual meeting of the Gerontological Society of America, Dr. Carpenter found that, among 80 patient-caregiver dyads, initial reactions within 3 days of a diagnosis of dementia were not negative–even among those who did not expect such a diagnosis.

The longitudinal study recruited patients and their caregivers at the time of their initial contact with the Washington University Alzheimer's Disease Research Center. Surveys assessing baseline data on self-reported anxiety and depression were mailed to all subjects as soon as their initial appointment was scheduled. Similar surveys were then obtained by telephone 2–3 days after a diagnosis had been given.

Depression was measured using the Geriatric Depression Scale, and anxiety was measured using the State-Trait Anxiety Inventory. Participants were also asked about their diagnostic expectations in the first survey.

In total, 67% of patients were diagnosed with dementia (21% with mild dementia and 46% with very mild dementia), and the remaining 33% had no dementia.

Regarding diagnostic expectations, caregivers were more accurate than patients when estimating the likelihood of a dementia diagnosis. More than half (52%) were correct when they said they expected a dementia diagnosis, compared with 32% of patients. Among those who said they did not expect a diagnosis of dementia, 15% of caregivers were incorrect, compared with 34% of patients.

Regardless of their diagnostic expectations, patients experienced no change in depression and a decrease in anxiety after receiving their diagnosis, regardless of what the diagnosis was.

The picture was less straightforward for caregivers. Regardless of their expectations, depression levels decreased with a diagnosis of dementia and remained unchanged when it was not diagnosed. Anxiety levels were influenced by their expectations and not by the actual diagnosis. Anxiety decreased when caregivers expected a dementia diagnosis (regardless of the actual diagnosis) and remained unchanged when they did not expect a dementia diagnosis.

“We think many of the patients and caregivers feel better after they receive the news because they anticipate that there's something wrong. They're not really sure what in some cases, and then when they have a diagnosis, a label, sometimes that results in a great sense of relief,” Dr. Carpenter said. “When they get the news, they are also shuttled towards more services so they get a better sense of what they can do to manage their disease.”

Most of the caregivers in the study were family members: 58% were spouses, 23% were children or in-laws; and 6% were other family. Thirteen percent were friends.

The ongoing investigation will measure if and how the subjects' reactions may change with time. Participants will be assessed 1 month, 6 months, and 1 year after the diagnosis, Dr. Carpenter said.

“Our hypothesis is that we will see that patients' depression and anxiety either remains stable or gets better, and the caregivers are actually the ones we are expecting will experience more stress” as patients deteriorate, he said.

“This raises difficult issues for clinicians about who their patient is.” Dr. Carpenter said. “The patient is the person they are diagnosing, but it is the caregivers who have to provide more and more services, while watching this person [who] they care about slowly decline. And so the burden of responsibility for clinicians, we think, is to think more broadly about who the patient is.”

ORLANDO – Contrary to many physicians' fears, disclosing a diagnosis of dementia to patients and their caregivers does not produce negative reactions, and in some cases actually lowers their anxiety and depression levels, according to a survey.

The findings should encourage physicians to be more up front when faced with reporting such a diagnosis, said the study's lead investigator Brian D. Carpenter, Ph.D., of the department of psychology at Washington University, St. Louis.

In a review paper, Dr. Carpenter's team reported that reluctance to disclose a dementia diagnosis is common among physicians (Gerontologist 2004;44:149–58).

“On average, somewhere around 50% of physicians say they don't routinely tell patients and caregivers when there is a diagnosis of dementia because they are worried about an extremely negative, even suicidal, reaction,” he said in an interview. “They just tell them it's normal aging.”

But in his study, which he presented as a poster at the annual meeting of the Gerontological Society of America, Dr. Carpenter found that, among 80 patient-caregiver dyads, initial reactions within 3 days of a diagnosis of dementia were not negative–even among those who did not expect such a diagnosis.

The longitudinal study recruited patients and their caregivers at the time of their initial contact with the Washington University Alzheimer's Disease Research Center. Surveys assessing baseline data on self-reported anxiety and depression were mailed to all subjects as soon as their initial appointment was scheduled. Similar surveys were then obtained by telephone 2–3 days after a diagnosis had been given.

Depression was measured using the Geriatric Depression Scale, and anxiety was measured using the State-Trait Anxiety Inventory. Participants were also asked about their diagnostic expectations in the first survey.

In total, 67% of patients were diagnosed with dementia (21% with mild dementia and 46% with very mild dementia), and the remaining 33% had no dementia.

Regarding diagnostic expectations, caregivers were more accurate than patients when estimating the likelihood of a dementia diagnosis. More than half (52%) were correct when they said they expected a dementia diagnosis, compared with 32% of patients. Among those who said they did not expect a diagnosis of dementia, 15% of caregivers were incorrect, compared with 34% of patients.

Regardless of their diagnostic expectations, patients experienced no change in depression and a decrease in anxiety after receiving their diagnosis, regardless of what the diagnosis was.

The picture was less straightforward for caregivers. Regardless of their expectations, depression levels decreased with a diagnosis of dementia and remained unchanged when it was not diagnosed. Anxiety levels were influenced by their expectations and not by the actual diagnosis. Anxiety decreased when caregivers expected a dementia diagnosis (regardless of the actual diagnosis) and remained unchanged when they did not expect a dementia diagnosis.

“We think many of the patients and caregivers feel better after they receive the news because they anticipate that there's something wrong. They're not really sure what in some cases, and then when they have a diagnosis, a label, sometimes that results in a great sense of relief,” Dr. Carpenter said. “When they get the news, they are also shuttled towards more services so they get a better sense of what they can do to manage their disease.”

Most of the caregivers in the study were family members: 58% were spouses, 23% were children or in-laws; and 6% were other family. Thirteen percent were friends.

The ongoing investigation will measure if and how the subjects' reactions may change with time. Participants will be assessed 1 month, 6 months, and 1 year after the diagnosis, Dr. Carpenter said.

“Our hypothesis is that we will see that patients' depression and anxiety either remains stable or gets better, and the caregivers are actually the ones we are expecting will experience more stress” as patients deteriorate, he said.

“This raises difficult issues for clinicians about who their patient is.” Dr. Carpenter said. “The patient is the person they are diagnosing, but it is the caregivers who have to provide more and more services, while watching this person [who] they care about slowly decline. And so the burden of responsibility for clinicians, we think, is to think more broadly about who the patient is.”

Pregnant women perform fewer intense physical activities, with less duration and frequency than nonpregnant women, and only 16% of pregnant women and 27% of nonpregnant women meet physical activity recommendations, said Ann M. Petersen, Ph.D., and her colleagues at Saint Louis University.

“This study has vital public health implications that can assist physicians to identify patients who are at high risk for inactivity during pregnancy,” the investigators said (Med. Sci. Sports Exerc. 2005;37:1748–53).

“Obstetricians and gynecologists should focus on encouraging continued physical activity during pregnancy among those already active, and should specifically target physical activity promotion among those women performing irregular or no activity,” Dr. Petersen said.

“The message is not getting out that women should continue to exercise during pregnancy, at least at moderate intensity,” study coauthor Terry Leet, Ph.D., noted in a separate written statement. “Only one of every six pregnant women is meeting the current physical activity recommendations of 30 or more minutes of moderate physical activity on most, if not all, days of the week,” Dr. Leet said.

The population-based, cross-sectional study used data from the 1994, 1996, 1998, and 2000 Behavioural Risk Factor Surveillance System (BRFSS) on more than 150,000 women.

A total of 6,528 pregnant and 143,731 nonpregnant women between the ages of 18 and 44 were categorized into groups based on vigorous or moderate levels of exercise, according to guidelines established by the Centers for Disease Control and the American College of Sports Medicine (ACSM). These consisted of 20 minutes or more of exercise, three or more times per week at an intensity of 6 or more metabolic equivalents or METs, and 30 minutes or more, five or more times per week, at an intensity of 3–5.9 METs, respectively; vigorous or moderate activity not meeting the guidelines (150 minutes or more per week, regardless of frequency, at an intensity of 3 METs or more); irregular physical activity; or no physical activity.

The study found that overall, nonpregnant women were more likely to meet the vigorous and moderate exercise recommendations, compared with pregnant women, and more pregnant women were inactive or performing irregular activity.

Walking was the most common activity reported equally by pregnant (52%) and nonpregnant (45%) women. However, there were notable differences between pregnant and nonpregnant women reporting aerobics (8% vs. 14%), and running and/or jogging (2% vs. 7%). Similar percentages reported gardening (3% and 5%) and swimming (4% and 3%).

The findings confirm the need for a multidisciplinary intervention from school educators, medical school instructors, and faculty aimed at promoting exercise in pregnancy, according to Raul Artal, M.D., professor and chair of the department of obstetrics, gynecology, and women's health at the university.

“It has to start at all levels—early school years, medical schools, physician education. A total effort is needed, and it needs to start in childhood,” Dr. Artal said in an interview. “We don't look at physical education as a health benefit but, instead, always seem to emphasize the competitive aspect. If the competitive aspect could be deemphasized, and we could agree that physical education is part of health maintenance and prevention of disease, then the whole attitude toward exercise would change.”

Dr. Artal was lead author of the American College of Obstetricians and Gynecologists 2002 guidelines on exercise during pregnancy.

According to the authors of the study, evidence-based guidelines should be reassuring to health care providers regarding the safety of exercise in pregnancy. The guidelines, published jointly by the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Society for Exercise Physiology in 2003 (and endorsed in 2004 by the ACSM), show that exercise is not associated with any increase in early pregnancy loss, late pregnancy complications, abnormal fetal growth, or adverse neonatal outcomes. The Physical Activity Readiness Medical Examination for Pregnancy in the guidelines describes the medical clearance for prenatal exercise participation.

“These safety procedures will further educate health care providers about the appropriate promotion of exercise during pregnancy,” the authors said.

Researchers say evidence-based guidelines should reassure medical providers of the safety of exercise in pregnancy. Stanford W. Carpenter

Pregnant women perform fewer intense physical activities, with less duration and frequency than nonpregnant women, and only 16% of pregnant women and 27% of nonpregnant women meet physical activity recommendations, said Ann M. Petersen, Ph.D., and her colleagues at Saint Louis University.

“This study has vital public health implications that can assist physicians to identify patients who are at high risk for inactivity during pregnancy,” the investigators said (Med. Sci. Sports Exerc. 2005;37:1748–53).

“Obstetricians and gynecologists should focus on encouraging continued physical activity during pregnancy among those already active, and should specifically target physical activity promotion among those women performing irregular or no activity,” Dr. Petersen said.

“The message is not getting out that women should continue to exercise during pregnancy, at least at moderate intensity,” study coauthor Terry Leet, Ph.D., noted in a separate written statement. “Only one of every six pregnant women is meeting the current physical activity recommendations of 30 or more minutes of moderate physical activity on most, if not all, days of the week,” Dr. Leet said.

The population-based, cross-sectional study used data from the 1994, 1996, 1998, and 2000 Behavioural Risk Factor Surveillance System (BRFSS) on more than 150,000 women.

A total of 6,528 pregnant and 143,731 nonpregnant women between the ages of 18 and 44 were categorized into groups based on vigorous or moderate levels of exercise, according to guidelines established by the Centers for Disease Control and the American College of Sports Medicine (ACSM). These consisted of 20 minutes or more of exercise, three or more times per week at an intensity of 6 or more metabolic equivalents or METs, and 30 minutes or more, five or more times per week, at an intensity of 3–5.9 METs, respectively; vigorous or moderate activity not meeting the guidelines (150 minutes or more per week, regardless of frequency, at an intensity of 3 METs or more); irregular physical activity; or no physical activity.

The study found that overall, nonpregnant women were more likely to meet the vigorous and moderate exercise recommendations, compared with pregnant women, and more pregnant women were inactive or performing irregular activity.

Walking was the most common activity reported equally by pregnant (52%) and nonpregnant (45%) women. However, there were notable differences between pregnant and nonpregnant women reporting aerobics (8% vs. 14%), and running and/or jogging (2% vs. 7%). Similar percentages reported gardening (3% and 5%) and swimming (4% and 3%).

The findings confirm the need for a multidisciplinary intervention from school educators, medical school instructors, and faculty aimed at promoting exercise in pregnancy, according to Raul Artal, M.D., professor and chair of the department of obstetrics, gynecology, and women's health at the university.

“It has to start at all levels—early school years, medical schools, physician education. A total effort is needed, and it needs to start in childhood,” Dr. Artal said in an interview. “We don't look at physical education as a health benefit but, instead, always seem to emphasize the competitive aspect. If the competitive aspect could be deemphasized, and we could agree that physical education is part of health maintenance and prevention of disease, then the whole attitude toward exercise would change.”

Dr. Artal was lead author of the American College of Obstetricians and Gynecologists 2002 guidelines on exercise during pregnancy.

According to the authors of the study, evidence-based guidelines should be reassuring to health care providers regarding the safety of exercise in pregnancy. The guidelines, published jointly by the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Society for Exercise Physiology in 2003 (and endorsed in 2004 by the ACSM), show that exercise is not associated with any increase in early pregnancy loss, late pregnancy complications, abnormal fetal growth, or adverse neonatal outcomes. The Physical Activity Readiness Medical Examination for Pregnancy in the guidelines describes the medical clearance for prenatal exercise participation.

“These safety procedures will further educate health care providers about the appropriate promotion of exercise during pregnancy,” the authors said.

Researchers say evidence-based guidelines should reassure medical providers of the safety of exercise in pregnancy. Stanford W. Carpenter

Pregnant women perform fewer intense physical activities, with less duration and frequency than nonpregnant women, and only 16% of pregnant women and 27% of nonpregnant women meet physical activity recommendations, said Ann M. Petersen, Ph.D., and her colleagues at Saint Louis University.

“This study has vital public health implications that can assist physicians to identify patients who are at high risk for inactivity during pregnancy,” the investigators said (Med. Sci. Sports Exerc. 2005;37:1748–53).

“Obstetricians and gynecologists should focus on encouraging continued physical activity during pregnancy among those already active, and should specifically target physical activity promotion among those women performing irregular or no activity,” Dr. Petersen said.

“The message is not getting out that women should continue to exercise during pregnancy, at least at moderate intensity,” study coauthor Terry Leet, Ph.D., noted in a separate written statement. “Only one of every six pregnant women is meeting the current physical activity recommendations of 30 or more minutes of moderate physical activity on most, if not all, days of the week,” Dr. Leet said.

The population-based, cross-sectional study used data from the 1994, 1996, 1998, and 2000 Behavioural Risk Factor Surveillance System (BRFSS) on more than 150,000 women.

A total of 6,528 pregnant and 143,731 nonpregnant women between the ages of 18 and 44 were categorized into groups based on vigorous or moderate levels of exercise, according to guidelines established by the Centers for Disease Control and the American College of Sports Medicine (ACSM). These consisted of 20 minutes or more of exercise, three or more times per week at an intensity of 6 or more metabolic equivalents or METs, and 30 minutes or more, five or more times per week, at an intensity of 3–5.9 METs, respectively; vigorous or moderate activity not meeting the guidelines (150 minutes or more per week, regardless of frequency, at an intensity of 3 METs or more); irregular physical activity; or no physical activity.

The study found that overall, nonpregnant women were more likely to meet the vigorous and moderate exercise recommendations, compared with pregnant women, and more pregnant women were inactive or performing irregular activity.

Walking was the most common activity reported equally by pregnant (52%) and nonpregnant (45%) women. However, there were notable differences between pregnant and nonpregnant women reporting aerobics (8% vs. 14%), and running and/or jogging (2% vs. 7%). Similar percentages reported gardening (3% and 5%) and swimming (4% and 3%).

The findings confirm the need for a multidisciplinary intervention from school educators, medical school instructors, and faculty aimed at promoting exercise in pregnancy, according to Raul Artal, M.D., professor and chair of the department of obstetrics, gynecology, and women's health at the university.

“It has to start at all levels—early school years, medical schools, physician education. A total effort is needed, and it needs to start in childhood,” Dr. Artal said in an interview. “We don't look at physical education as a health benefit but, instead, always seem to emphasize the competitive aspect. If the competitive aspect could be deemphasized, and we could agree that physical education is part of health maintenance and prevention of disease, then the whole attitude toward exercise would change.”

Dr. Artal was lead author of the American College of Obstetricians and Gynecologists 2002 guidelines on exercise during pregnancy.

According to the authors of the study, evidence-based guidelines should be reassuring to health care providers regarding the safety of exercise in pregnancy. The guidelines, published jointly by the Society of Obstetricians and Gynaecologists of Canada, and the Canadian Society for Exercise Physiology in 2003 (and endorsed in 2004 by the ACSM), show that exercise is not associated with any increase in early pregnancy loss, late pregnancy complications, abnormal fetal growth, or adverse neonatal outcomes. The Physical Activity Readiness Medical Examination for Pregnancy in the guidelines describes the medical clearance for prenatal exercise participation.

“These safety procedures will further educate health care providers about the appropriate promotion of exercise during pregnancy,” the authors said.

Researchers say evidence-based guidelines should reassure medical providers of the safety of exercise in pregnancy. Stanford W. Carpenter

MONTREAL — Patient resistance to having a single embryo transferred after in vitro fertilization may be overcome by education, according to Christopher Newton, Ph.D.

Patient goals in requesting multiple embryo transfer may be quite different, however, so their educational needs may vary. Some patients are focused on simply increasing their chances of conceiving. “They think more is better in terms of getting pregnant,” Dr. Newton, a psychologist at London (Ontario) Health Sciences Center, said in an interview.

But there is also a subset of patients who would prefer a twin pregnancy to a singleton one, he reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Newton surveyed 79 female IVF patients and 53 male partners about their attitudes toward single embryo transfer (SET). He found that 75% of participants rated double embryo transfer (DET) as highly desirable, and 72% rated a twin pregnancy as highly desirable.

Some participants preferred DET to SET because they saw it as a means to increase their chances of pregnancy; others considered DET as a way of optimizing their chance of conceiving twins.

When provided with accurate information about the risks associated with twin pregnancies and the success rates of SET versus DET, the participants' desire for twins decreased and they reported more acceptance of SET. However, women remained more resistant to SET than men.

A separate study presented at the meeting found that infertile women are twice as likely as fertile women to prefer a multiple pregnancy over a singleton pregnancy.

A comparison of 440 general gynecology patients (fertile) with 464 infertility patients found that 20% of the latter expressed a desire for a multiple pregnancy, compared with 10% of the fertile group, reported lead investigator Ginny L. Ryan, M.D., of the University of Iowa, Iowa City.

In the combined population, a lack of knowledge about the risks of a multiple pregnancy along with nulliparity and a diagnosis of infertility independently predicted a desire for multiples.

“We've now started an educational campaign to see if we're impacting their knowledge,” Dr. Ryan said in an interview.

“We started a mandatory single embryo transfer policy in our best responders last year, so we're in a luxurious position where we can actually tell our patients that this isn't going to decrease their pregnancy rate and it will greatly decrease their multiple rate.”

MONTREAL — Patient resistance to having a single embryo transferred after in vitro fertilization may be overcome by education, according to Christopher Newton, Ph.D.

Patient goals in requesting multiple embryo transfer may be quite different, however, so their educational needs may vary. Some patients are focused on simply increasing their chances of conceiving. “They think more is better in terms of getting pregnant,” Dr. Newton, a psychologist at London (Ontario) Health Sciences Center, said in an interview.

But there is also a subset of patients who would prefer a twin pregnancy to a singleton one, he reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Newton surveyed 79 female IVF patients and 53 male partners about their attitudes toward single embryo transfer (SET). He found that 75% of participants rated double embryo transfer (DET) as highly desirable, and 72% rated a twin pregnancy as highly desirable.

Some participants preferred DET to SET because they saw it as a means to increase their chances of pregnancy; others considered DET as a way of optimizing their chance of conceiving twins.

When provided with accurate information about the risks associated with twin pregnancies and the success rates of SET versus DET, the participants' desire for twins decreased and they reported more acceptance of SET. However, women remained more resistant to SET than men.

A separate study presented at the meeting found that infertile women are twice as likely as fertile women to prefer a multiple pregnancy over a singleton pregnancy.

A comparison of 440 general gynecology patients (fertile) with 464 infertility patients found that 20% of the latter expressed a desire for a multiple pregnancy, compared with 10% of the fertile group, reported lead investigator Ginny L. Ryan, M.D., of the University of Iowa, Iowa City.

In the combined population, a lack of knowledge about the risks of a multiple pregnancy along with nulliparity and a diagnosis of infertility independently predicted a desire for multiples.

“We've now started an educational campaign to see if we're impacting their knowledge,” Dr. Ryan said in an interview.

“We started a mandatory single embryo transfer policy in our best responders last year, so we're in a luxurious position where we can actually tell our patients that this isn't going to decrease their pregnancy rate and it will greatly decrease their multiple rate.”

MONTREAL — Patient resistance to having a single embryo transferred after in vitro fertilization may be overcome by education, according to Christopher Newton, Ph.D.

Patient goals in requesting multiple embryo transfer may be quite different, however, so their educational needs may vary. Some patients are focused on simply increasing their chances of conceiving. “They think more is better in terms of getting pregnant,” Dr. Newton, a psychologist at London (Ontario) Health Sciences Center, said in an interview.

But there is also a subset of patients who would prefer a twin pregnancy to a singleton one, he reported at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Newton surveyed 79 female IVF patients and 53 male partners about their attitudes toward single embryo transfer (SET). He found that 75% of participants rated double embryo transfer (DET) as highly desirable, and 72% rated a twin pregnancy as highly desirable.

Some participants preferred DET to SET because they saw it as a means to increase their chances of pregnancy; others considered DET as a way of optimizing their chance of conceiving twins.

When provided with accurate information about the risks associated with twin pregnancies and the success rates of SET versus DET, the participants' desire for twins decreased and they reported more acceptance of SET. However, women remained more resistant to SET than men.

A separate study presented at the meeting found that infertile women are twice as likely as fertile women to prefer a multiple pregnancy over a singleton pregnancy.

A comparison of 440 general gynecology patients (fertile) with 464 infertility patients found that 20% of the latter expressed a desire for a multiple pregnancy, compared with 10% of the fertile group, reported lead investigator Ginny L. Ryan, M.D., of the University of Iowa, Iowa City.

In the combined population, a lack of knowledge about the risks of a multiple pregnancy along with nulliparity and a diagnosis of infertility independently predicted a desire for multiples.

“We've now started an educational campaign to see if we're impacting their knowledge,” Dr. Ryan said in an interview.

“We started a mandatory single embryo transfer policy in our best responders last year, so we're in a luxurious position where we can actually tell our patients that this isn't going to decrease their pregnancy rate and it will greatly decrease their multiple rate.”

MONTREAL — Anal incontinence is four times more prevalent than previously thought, and it affects older men and women almost equally, according to what British researchers describe as the first systematic review of the prevalence of this disorder.

“Age, not gender, is the most important factor, and obstetric trauma does not have a major effect,” Philip Toozs-Hobson, M.D., reported at the annual meeting of the International Continence Society.

The review of 29 studies with a total of 69,152 participants found an overall rate of anal incontinence of 3.5% in men and 4.5% in women across all age groups.

Such findings suggest “that the 1% rate presumed by government agencies is an underestimate,” said Dr. Toozs-Hobson, a consultant gynecologist at Birmingham (England) Women's Hospital.

Moreover, the effects of obstetric trauma could not be seen in these data, he said.

“It has long been thought that the incidence of anal incontinence is higher in women because trauma occurs to the anal sphincter during childbirth,” he said.

“However, this study does not provide evidence that women under 60 years have significantly higher rates of incontinence, when compared with men of similar age.”

When data were broken down according to age, the prevalences for men and women under age 60 years were 0.8% and 1.6%, respectively.

While the rates were much higher in people over age 60 years—they remained similar across the genders, at 5.1% for men and 6.2% for women, he said.

“Many experts believe that the effects of obstetric trauma may only appear in older age, but we did not find significant interaction between age and gender,” he said.

Since anal incontinence is increasingly becoming recognized as a significant cause of physical and psychological morbidity, these data have implications for community health care providers, Dr. Toozs-Hobson noted at the meeting.

MONTREAL — Anal incontinence is four times more prevalent than previously thought, and it affects older men and women almost equally, according to what British researchers describe as the first systematic review of the prevalence of this disorder.

“Age, not gender, is the most important factor, and obstetric trauma does not have a major effect,” Philip Toozs-Hobson, M.D., reported at the annual meeting of the International Continence Society.

The review of 29 studies with a total of 69,152 participants found an overall rate of anal incontinence of 3.5% in men and 4.5% in women across all age groups.

Such findings suggest “that the 1% rate presumed by government agencies is an underestimate,” said Dr. Toozs-Hobson, a consultant gynecologist at Birmingham (England) Women's Hospital.

Moreover, the effects of obstetric trauma could not be seen in these data, he said.

“It has long been thought that the incidence of anal incontinence is higher in women because trauma occurs to the anal sphincter during childbirth,” he said.

“However, this study does not provide evidence that women under 60 years have significantly higher rates of incontinence, when compared with men of similar age.”

When data were broken down according to age, the prevalences for men and women under age 60 years were 0.8% and 1.6%, respectively.

While the rates were much higher in people over age 60 years—they remained similar across the genders, at 5.1% for men and 6.2% for women, he said.

“Many experts believe that the effects of obstetric trauma may only appear in older age, but we did not find significant interaction between age and gender,” he said.

Since anal incontinence is increasingly becoming recognized as a significant cause of physical and psychological morbidity, these data have implications for community health care providers, Dr. Toozs-Hobson noted at the meeting.

MONTREAL — Anal incontinence is four times more prevalent than previously thought, and it affects older men and women almost equally, according to what British researchers describe as the first systematic review of the prevalence of this disorder.

“Age, not gender, is the most important factor, and obstetric trauma does not have a major effect,” Philip Toozs-Hobson, M.D., reported at the annual meeting of the International Continence Society.

The review of 29 studies with a total of 69,152 participants found an overall rate of anal incontinence of 3.5% in men and 4.5% in women across all age groups.

Such findings suggest “that the 1% rate presumed by government agencies is an underestimate,” said Dr. Toozs-Hobson, a consultant gynecologist at Birmingham (England) Women's Hospital.

Moreover, the effects of obstetric trauma could not be seen in these data, he said.

“It has long been thought that the incidence of anal incontinence is higher in women because trauma occurs to the anal sphincter during childbirth,” he said.

“However, this study does not provide evidence that women under 60 years have significantly higher rates of incontinence, when compared with men of similar age.”

When data were broken down according to age, the prevalences for men and women under age 60 years were 0.8% and 1.6%, respectively.

While the rates were much higher in people over age 60 years—they remained similar across the genders, at 5.1% for men and 6.2% for women, he said.

“Many experts believe that the effects of obstetric trauma may only appear in older age, but we did not find significant interaction between age and gender,” he said.

Since anal incontinence is increasingly becoming recognized as a significant cause of physical and psychological morbidity, these data have implications for community health care providers, Dr. Toozs-Hobson noted at the meeting.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out [to physicians] so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

There were no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved. There were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out [to physicians] so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

There were no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved. There were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Most female cancer patients appear to have normal reproductive capacity before cancer therapy, making them excellent candidates for fertility preservation, according to results of one of the first studies to compare ovarian stimulation outcomes in cancer patients and controls.

“We need to get this message out [to physicians] so they can better inform their patients,” Rodolfo Quintero, M.D., said at the joint annual meeting of the American Society for Reproductive Medicine and the Canadian Fertility and Andrology Society.

Dr. Quintero reviewed the ovarian stimulation outcomes of 32 cancer patients seeking oocyte or embryo cryopreservation for fertility preservation before chemotherapy or radiation, and compared them with 31 age-matched controls who were undergoing ovarian stimulation for in vitro fertilization because of male factor infertility.

The average age of the cancer patients was 30.8 years, compared with 31.5 years in the control group. Cancer patients underwent a combined total of 35 ovarian stimulation cycles, compared with 42 cycles in the control group, said Dr. Quintero, a fellow in reproductive endocrinology and infertility at Stanford (Calif.) University Medical Center.

There were no significant differences between groups in terms of the number of stimulation days, the amount of gonadotropins used, or the number of eggs retrieved. There were two cycle cancellations and one failed oocyte retrieval in the cancer group, versus none in the controls.

MONTREAL — Obstetric anal sphincter injuries can cause fecal incontinence for decades, and also may wreak havoc on a couple's sex life, according to Jan Willem de Leeuw, M.D., a consultant ob.gyn. from the Ikazia Ziekenhuis hospital in Rotterdam, the Netherlands.

“Women told us that they were very surprised that we were asking about fecal incontinence during sex, but that it was a real problem. The women who were incontinent during intercourse and other sexual behavior were very reluctant to engage in sexual activity,” Dr. de Leeuw said in an interview.

In a study he presented at the annual meeting of the International Continence Society, Dr. de Leeuw identified 171 women who were surgically treated for obstetric anal sphincter injuries immediately after delivery from 1971 to 1990.

In 1995, these women and 131 controls, who were matched for parity and date of delivery, were mailed a questionnaire that asked about fecal and urinary incontinence. Women who responded were then sent a second similar questionnaire about 10 years later that contained additional questions about sexuality. The median follow-up period was 24 years.

Responses from the first questionnaire showed that the prevalence of anorectal complaints was much higher in the patients who had sphincter injury, compared with controls (40% vs. 15%). Similarly, fecal incontinence, urgency, and soiling were reported by 31%, 26%, and 10% of the patients, respectively, compared with 13%, 6%, and 1% of the controls.

Ten years later, the second questionnaire produced similar responses. Anorectal complaints were reported by 64% of sphincter injury patients, compared with 24% of controls. Fecal incontinence, urgency, and soiling were reported by 56%, 31%, and 15% of sphincter injury patients, respectively, compared with 16%, 12%, and 4% of controls.

Unlike the prevalence of urinary incontinence, which tends to equalize with increasing age between women who have delivered vaginally and those who have not, there was no such effect seen with fecal incontinence, Dr. de Leeuw said.

Perhaps the most interesting finding was the “hidden problem” of fecal incontinence during sex, he said. Few physicians think to ask about this, yet 13% of the sphincter injury patients reported this problem, compared with none of the controls.

In addition, superficial dyspareunia was more common in the patients (22%), compared with the controls (9%).

Menopausal status appeared irrelevant. “Our results do not corroborate the widespread theory that postmenopausal status has a deteriorating effect on these complaints,” he said.

Of the sphincter injury patients who were free of anorectal complaints at the first questionnaire, 46% developed anorectal complaints by the second questionnaire—but only 32% of these women were postmenopausal, he said.

The study's findings about the long-lasting and intimate consequences of obstetric sphincter damage underscore the need for primary prevention of these injuries, he said.

“This is of primary importance. I am still waiting for the randomized trial between midline and mediolateral episiotomies, because I think that midline episiotomies are a major risk factor, and this is quite common in the United States. I don't understand it.”

MONTREAL — Obstetric anal sphincter injuries can cause fecal incontinence for decades, and also may wreak havoc on a couple's sex life, according to Jan Willem de Leeuw, M.D., a consultant ob.gyn. from the Ikazia Ziekenhuis hospital in Rotterdam, the Netherlands.

“Women told us that they were very surprised that we were asking about fecal incontinence during sex, but that it was a real problem. The women who were incontinent during intercourse and other sexual behavior were very reluctant to engage in sexual activity,” Dr. de Leeuw said in an interview.

In a study he presented at the annual meeting of the International Continence Society, Dr. de Leeuw identified 171 women who were surgically treated for obstetric anal sphincter injuries immediately after delivery from 1971 to 1990.

In 1995, these women and 131 controls, who were matched for parity and date of delivery, were mailed a questionnaire that asked about fecal and urinary incontinence. Women who responded were then sent a second similar questionnaire about 10 years later that contained additional questions about sexuality. The median follow-up period was 24 years.

Responses from the first questionnaire showed that the prevalence of anorectal complaints was much higher in the patients who had sphincter injury, compared with controls (40% vs. 15%). Similarly, fecal incontinence, urgency, and soiling were reported by 31%, 26%, and 10% of the patients, respectively, compared with 13%, 6%, and 1% of the controls.

Ten years later, the second questionnaire produced similar responses. Anorectal complaints were reported by 64% of sphincter injury patients, compared with 24% of controls. Fecal incontinence, urgency, and soiling were reported by 56%, 31%, and 15% of sphincter injury patients, respectively, compared with 16%, 12%, and 4% of controls.

Unlike the prevalence of urinary incontinence, which tends to equalize with increasing age between women who have delivered vaginally and those who have not, there was no such effect seen with fecal incontinence, Dr. de Leeuw said.

Perhaps the most interesting finding was the “hidden problem” of fecal incontinence during sex, he said. Few physicians think to ask about this, yet 13% of the sphincter injury patients reported this problem, compared with none of the controls.

In addition, superficial dyspareunia was more common in the patients (22%), compared with the controls (9%).

Menopausal status appeared irrelevant. “Our results do not corroborate the widespread theory that postmenopausal status has a deteriorating effect on these complaints,” he said.

Of the sphincter injury patients who were free of anorectal complaints at the first questionnaire, 46% developed anorectal complaints by the second questionnaire—but only 32% of these women were postmenopausal, he said.

The study's findings about the long-lasting and intimate consequences of obstetric sphincter damage underscore the need for primary prevention of these injuries, he said.

“This is of primary importance. I am still waiting for the randomized trial between midline and mediolateral episiotomies, because I think that midline episiotomies are a major risk factor, and this is quite common in the United States. I don't understand it.”

MONTREAL — Obstetric anal sphincter injuries can cause fecal incontinence for decades, and also may wreak havoc on a couple's sex life, according to Jan Willem de Leeuw, M.D., a consultant ob.gyn. from the Ikazia Ziekenhuis hospital in Rotterdam, the Netherlands.

“Women told us that they were very surprised that we were asking about fecal incontinence during sex, but that it was a real problem. The women who were incontinent during intercourse and other sexual behavior were very reluctant to engage in sexual activity,” Dr. de Leeuw said in an interview.

In a study he presented at the annual meeting of the International Continence Society, Dr. de Leeuw identified 171 women who were surgically treated for obstetric anal sphincter injuries immediately after delivery from 1971 to 1990.

In 1995, these women and 131 controls, who were matched for parity and date of delivery, were mailed a questionnaire that asked about fecal and urinary incontinence. Women who responded were then sent a second similar questionnaire about 10 years later that contained additional questions about sexuality. The median follow-up period was 24 years.

Responses from the first questionnaire showed that the prevalence of anorectal complaints was much higher in the patients who had sphincter injury, compared with controls (40% vs. 15%). Similarly, fecal incontinence, urgency, and soiling were reported by 31%, 26%, and 10% of the patients, respectively, compared with 13%, 6%, and 1% of the controls.

Ten years later, the second questionnaire produced similar responses. Anorectal complaints were reported by 64% of sphincter injury patients, compared with 24% of controls. Fecal incontinence, urgency, and soiling were reported by 56%, 31%, and 15% of sphincter injury patients, respectively, compared with 16%, 12%, and 4% of controls.

Unlike the prevalence of urinary incontinence, which tends to equalize with increasing age between women who have delivered vaginally and those who have not, there was no such effect seen with fecal incontinence, Dr. de Leeuw said.

Perhaps the most interesting finding was the “hidden problem” of fecal incontinence during sex, he said. Few physicians think to ask about this, yet 13% of the sphincter injury patients reported this problem, compared with none of the controls.

In addition, superficial dyspareunia was more common in the patients (22%), compared with the controls (9%).

Menopausal status appeared irrelevant. “Our results do not corroborate the widespread theory that postmenopausal status has a deteriorating effect on these complaints,” he said.

Of the sphincter injury patients who were free of anorectal complaints at the first questionnaire, 46% developed anorectal complaints by the second questionnaire—but only 32% of these women were postmenopausal, he said.

The study's findings about the long-lasting and intimate consequences of obstetric sphincter damage underscore the need for primary prevention of these injuries, he said.

“This is of primary importance. I am still waiting for the randomized trial between midline and mediolateral episiotomies, because I think that midline episiotomies are a major risk factor, and this is quite common in the United States. I don't understand it.”