Public Funding Spurs Couples to Seek Fertility Treatment

After Quebec mandated IVF coverage, study found change in patient demographics

By Kathleen Doheny

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- Public funding of assisted reproductive technology, including in vitro fertilization (IVF) treatments, broadens the range of couples who seek treatment for infertility by attracting a more diverse population, according to new research from Canada.

When the province of Quebec began to fund up to three cycles of IVF in August 2010, researchers compared patients who sought that treatment before and after the mandate.

Afterward, "we found larger numbers of lower income, less well-educated, unemployed people seeking fertility treatment," said Phyllis Zelkowitz, director of research in the department of psychiatry and senior investigator at the Lady Davis Institute of the Jewish General Hospital, in Montreal.

The study is published in the May 16 New England Journal of Medicine.

For the study, Zelkowitz and her colleagues compared data on nearly 3,600 couples. Of those, 436 sought treatment before the policy change, 821 immediately after and 2,316 eight months after the policy change.

The investigators found the proportion of treated couples with college degrees declined from 68 percent to 63 percent eight months later. Unemployed couples seeking treatment rose from 3.6 percent to 11.6 percent. And the proportion of patients with household incomes of $65,000 a year or less increased from about 37 percent to more than 47 percent.

For white couples, the proportion dropped from about 67 percent to 63 percent in the eight-month period, after rising immediately after the policy change.

Zelkowitz also found the rate of couples seeking treatment for secondary infertility doubled from 14 percent to 29 percent. Secondary infertility means being unable to get pregnant or carry a pregnancy to term after having one or more biological children.

The mandated policy change came with stipulations, Zelkowitz said. It approved coverage for up to three treatment cycles of IVF. It mandated the transfer of only one embryo per treatment cycle, with a goal of reducing preterm births, she noted.

Preterm births are more common with multiple pregnancies and are riskier to the babies, experts agree.

"One of the goals of the funding was to reduce preterm births, and they have already done that," Zelkowitz said.

The study findings are in conflict with earlier U.S. studies, which have shown that even when patients have access to public funding for assisted reproductive technology, barriers continue to exist, including social, economic and ethnic obstacles. As a result, these earlier studies suggested, the typical patients remain older, wealthier, more-educated white couples.

In the United States, infertility affects about one of eight women of reproductive age and their partners, according to the American Society for Reproductive Medicine.

Currently, 15 states have passed laws that mandate insurers to cover or offer coverage for infertility diagnosis and treatment, but some states exclude coverage for IVF.

View the original article here

Public Funding Spurs Couples to Seek Fertility Treatment

By Kathleen Doheny
HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- Public funding of assisted reproductive technology, including in vitro fertilization (IVF) treatments, broadens the range of couples who seek treatment for infertility by attracting a more diverse population, according to new research from Canada.

When the province of Quebec began to fund up to three cycles of IVF in August 2010, researchers compared patients who sought that treatment before and after the mandate.

Afterward, "we found larger numbers of lower income, less well-educated, unemployed people seeking fertility treatment," said Phyllis Zelkowitz, director of research in the department of psychiatry and senior investigator at the Lady Davis Institute of the Jewish General Hospital, in Montreal.

The study is published in the May 16 New England Journal of Medicine.

For the study, Zelkowitz and her colleagues compared data on nearly 3,600 couples. Of those, 436 sought treatment before the policy change, 821 immediately after and 2,316 eight months after the policy change.

The investigators found the proportion of treated couples with college degrees declined from 68 percent to 63 percent eight months later. Unemployed couples seeking treatment rose from 3.6 percent to 11.6 percent. And the proportion of patients with household incomes of $65,000 a year or less increased from about 37 percent to more than 47 percent.

For white couples, the proportion dropped from about 67 percent to 63 percent in the eight-month period, after rising immediately after the policy change.

Zelkowitz also found the rate of couples seeking treatment for secondary infertility doubled from 14 percent to 29 percent. Secondary infertility means being unable to get pregnant or carry a pregnancy to term after having one or more biological children.

The mandated policy change came with stipulations, Zelkowitz said. It approved coverage for up to three treatment cycles of IVF. It mandated the transfer of only one embryo per treatment cycle, with a goal of reducing preterm births, she noted.

Preterm births are more common with multiple pregnancies and are riskier to the babies, experts agree.

"One of the goals of the funding was to reduce preterm births, and they have already done that," Zelkowitz said.

The study findings are in conflict with earlier U.S. studies, which have shown that even when patients have access to public funding for assisted reproductive technology, barriers continue to exist, including social, economic and ethnic obstacles. As a result, these earlier studies suggested, the typical patients remain older, wealthier, more-educated white couples.

In the United States, infertility affects about one of eight women of reproductive age and their partners, according to the American Society for Reproductive Medicine.

Currently, 15 states have passed laws that mandate insurers to cover or offer coverage for infertility diagnosis and treatment, but some states exclude coverage for IVF.

Assisted reproductive technology is typically defined as fertility treatments in which both eggs and sperm are handled, such as IVF, but not procedures such as taking medicine to stimulate egg production, according to the U.S. Centers for Disease Control and Prevention.

Only about 5 percent of infertile couples need assisted reproductive technology, the society estimates.

For others, egg stimulation or lifestyle changes such as losing weight or stopping smoking can help them achieve a pregnancy.

However, for those who do need IVF, the cost can be prohibitive. A cycle of IVF costs about $12,400, the society estimates.

The study findings about patient demographics changing after public funding became available do not surprise Dr. Wendy Schillings, a fertility specialist in Allentown, Pa. When she meets patients who have only diagnosis covered, she said, they often delay treatment if they need IVF, hoping to save up the money needed.

Couples who don't have IVF coverage often ask for more embryos to be transferred, she said, and she then counsels them on the risks of multiple births.

"Absolutely lower-income couples can do it [seek treatment] and will do it," Schillings said. However, for those with higher incomes, the decision may involve fewer sacrifices, she added.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Phyllis Zelkowitz, Ed.D., director of research, department of psychiatry, and senior investigator, Lady Davis Institute, Jewish General Hospital, Montreal, Canada; Wendy Schillings, M.D., fertility specialist, Allentown, Pa.; May 16, 2013, New England Journal of Medicine

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FDA Proposes Tighter Regulation of Public Defibrillators

Title: FDA Proposes Tighter Regulation of Public Defibrillators
Category: Health News
Created: 3/22/2013 4:36:00 PM
Last Editorial Review: 3/25/2013 12:00:00 AM

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Public Funding Spurs Couples to Seek Fertility Treatment

After Quebec mandated IVF coverage, study found change in patient demographics

By Kathleen Doheny

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- Public funding of assisted reproductive technology, including in vitro fertilization (IVF) treatments, broadens the range of couples who seek treatment for infertility by attracting a more diverse population, according to new research from Canada.

When the province of Quebec began to fund up to three cycles of IVF in August 2010, researchers compared patients who sought that treatment before and after the mandate.

Afterward, "we found larger numbers of lower income, less well-educated, unemployed people seeking fertility treatment," said Phyllis Zelkowitz, director of research in the department of psychiatry and senior investigator at the Lady Davis Institute of the Jewish General Hospital, in Montreal.

The study is published in the May 16 New England Journal of Medicine.

For the study, Zelkowitz and her colleagues compared data on nearly 3,600 couples. Of those, 436 sought treatment before the policy change, 821 immediately after and 2,316 eight months after the policy change.

The investigators found the proportion of treated couples with college degrees declined from 68 percent to 63 percent eight months later. Unemployed couples seeking treatment rose from 3.6 percent to 11.6 percent. And the proportion of patients with household incomes of $65,000 a year or less increased from about 37 percent to more than 47 percent.

For white couples, the proportion dropped from about 67 percent to 63 percent in the eight-month period, after rising immediately after the policy change.

Zelkowitz also found the rate of couples seeking treatment for secondary infertility doubled from 14 percent to 29 percent. Secondary infertility means being unable to get pregnant or carry a pregnancy to term after having one or more biological children.

The mandated policy change came with stipulations, Zelkowitz said. It approved coverage for up to three treatment cycles of IVF. It mandated the transfer of only one embryo per treatment cycle, with a goal of reducing preterm births, she noted.

Preterm births are more common with multiple pregnancies and are riskier to the babies, experts agree.

"One of the goals of the funding was to reduce preterm births, and they have already done that," Zelkowitz said.

The study findings are in conflict with earlier U.S. studies, which have shown that even when patients have access to public funding for assisted reproductive technology, barriers continue to exist, including social, economic and ethnic obstacles. As a result, these earlier studies suggested, the typical patients remain older, wealthier, more-educated white couples.

In the United States, infertility affects about one of eight women of reproductive age and their partners, according to the American Society for Reproductive Medicine.

Currently, 15 states have passed laws that mandate insurers to cover or offer coverage for infertility diagnosis and treatment, but some states exclude coverage for IVF.

View the original article here

Many Public Pools Contaminated With Human Waste: CDC

Agency offers clear advice to help you avoid infections

By HealthDay staff

HealthDay Reporter

THURSDAY, May 16 (HealthDay News) -- There are few things more inviting than a cool, clear pool on a hot summer day. But a new federal report will have you thinking twice before dipping a toe in the water.

Fifty-eight percent of pool filter samples taken from Atlanta area pools last summer contained E. coli, a bacteria found in human feces.

The report is a sign that swimmers often contaminate pool water when they have a "fecal incident" in the water, or when human waste washes off their bodies because they don't shower thoroughly before hitting the water, according to the report from the U.S. Centers for Disease Control and Prevention.

And while the study only focused on pools in the Atlanta region, the researchers said it's likely that fecal contamination from swimmers is a problem in public pools throughout the country. The study did not look at water parks, residential pools or other types of recreational water.

"Swimming is an excellent way to get the physical activity needed to stay healthy," Michele Hlavsa, chief of the CDC's Healthy Swimming Program, said in an agency news release. "However, pool users should be aware of how to prevent infections while swimming.

"Remember," she added, "chlorine and other disinfectants don't kill germs instantly. That's why it's important for swimmers to protect themselves by not swallowing the water they swim in and to protect others by keeping feces and germs out of the pool by taking a pre-swim shower and not swimming when ill with diarrhea.

The CDC says all swimmers should take the following steps to keep feces out of pools and to prevent infections:

Don't swim if you have diarrhea.Shower with soap before swimming.Take a rinse shower before getting back in the water.Go to the bathroom every 60 minutes.Wash your hands with soap after using the toilet or changing diapers.Don't swallow the water you swim in.

Parents of young children should take the following steps:

Take children on bathroom breaks every 60 minutes or check diapers every 30 to 60 minutes.Change diapers in the bathroom or diaper-changing area and not at poolside where germs can rinse into the water.

Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, said the new study "highlights the importance of practicing good hygiene anytime we swim in a pool, since the potential for contamination with fecal organisms, which could lead to severe diarrheal illnesses, remains an ever present concern.

"From a public health standpoint," he added, "it is especially important for people to avoid swimming when they have diarrhea, as other swimmers could swallow germ-laden water and potentially become ill.

The study reveals a "true public health concern, and reinforces the need to practice safe and effective swim hygiene as the summer approaches," Glatter said.

The study appears in the May 17 issue of the CDC's Morbidity and Mortality Weekly Report. Its release is timed in advance of Recreational Water Illness and Injury Prevention Week, May 20-26. The goal of the prevention week is to "raise awareness about healthy swimming, including ways to prevent recreational water illnesses (RWIs). Germs that cause RWIs are spread by swallowing, breathing in the mists or aerosols from, or having contact with contaminated water in swimming pools, water parks, hot tubs, interactive fountains, water play areas, lakes, rivers, or oceans," according to the CDC.

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