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February 25th, 2010
04:27 PM ET

IVF increases risk of stillbirth – or does it?

By Miriam Falco
CNN Medical News Managing Editor

(CNN) - A Danish study suggests that women who have undergone in vitro fertilization or Intracytoplasmic sperm injection to get pregnant, are four times more likely to have their child stillborn, compared with women who conceive naturally or use other types of assisted reproductive technology.

In a study published in the journal "Human Reproduction," researchers looked at more than 20,000 pregnancies and found 742 babies were conceived using IVF, where a woman's egg is fertilized in a petri dish and then placed in a woman's uterus,  or ICSI, where a single sperm is injected into an egg and after a few days the fertilized egg is placed in the woman's uterus (Editor's note: thanks to readers like Kate and Jamie, this sentence has been corrected).  Among the 742 IVF or ICSI pregnancies there were 12 stillbirths.

Researchers emphasize that the overall risk for a stillbirth is still very low. What causes some pregnancies to end prematurely is still unknown and the researcher believes it is linked to treatments. Dr. Kirsten Wisborg, a neonatal consultant at the Aarhus University Hospital in Denmark, the lead author of this new study, said in a press release, "Hopefully the results from our study emphasize the need for continuous follow-up of the outcome of fertility treatments."

However, a Swedish study, published earlier this month, looked at more than 27,000 pregnancies and did not find an increased risk for stillbirths. Dr. Karl Nygren, one of the authors of the Swedish study says in a statement, "We found no increase in stillbirths from IVF/ICSI treatment in this larger group, and this contrasts with the Danish study that found a fourfold increase in the risk of stillbirths between the IVF/ICSI pregnancies and spontaneous pregnancies."

All this information can be very confusing and scary for couples trying to become parents and who are turning to the most invasive reproductive techniques to help them start a family. Dr. James Goldfarb is the director of Infertility Services at the Cleveland Clinic in Ohio. He's also the president of the Society for Assisted Reproductive Technology . Goldfarb tells CNN that regardless of IVF or natural conception, having a stillbirth is always devastating when it happens, and doctors want to know what causes them. He says infection, chromosomal problems, and the placenta separating from the uterus are some known causes, but "most of the time we don't know what caused the stillbirth."

Goldfarb also points out that "it should not surprise anyone to learn that patients getting infertility treatments have a more difficult time conceiving, carrying and delivering health children. That difficulty is what defines the disease of infertility and led those patients to seek treatment in the first place."

So do IVF and ICSI really increase the risk for stillbirth as the Danish study suggests? Goldfarb isn't convinced. "While this is an intriguing paper, it's important that the findings be kept in context. Other studies, even very recent ones from very similar countries, have not found this large an increase in miscarriage rates for IVF pregnancies.”

Goldfarb says in the IVF world, the biggest concern isn't stillbirth – it’s the birth of multiples. Although Nadya Suleman, also known as the Octomom, represents the most extreme case of having multiple babies at once , more twins and triplets have been born since the first IVF baby was conceived 32 years ago. That’s because doctors have been implanting multiple embryos in the hope that it will lead to a pregnancy. When a woman carries multiple fetuses, the risk of complications goes up, including premature birth, which can lead to the babies’ having underdeveloped lungs, brain, and other organs. They may also have difficulties fighting off infections. Limiting the number of embryos being implanted per IVF cycle greatly reduces that risk, Goldfarb said.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


February 25th, 2010
02:33 PM ET

When will we see a herpes cure?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Lloyd Bartley, Bowling Green, Kentucky

“How close are scientists to developing a cure for herpes, figuratively speaking will we be seeing a break through in 10, 20, or even 30 years?”

Answer:

Well, Lloyd, there is good news and bad news on the herpes front. The good news: Researchers have made serious strides and now better understand the mechanism behind herpes outbreaks. The bad news: There is very little funding for that research.

After receiving your question we reached out to a leading herpes expert, Bryan Cullen, the director at the Center for Virology at Duke University. Cullen is hopeful that a cure for herpes could come within 10 years, once funding hurdles are crossed.

Nearly one in five people over age 12 in the U.S. is affected by herpes. It is caused by a virus - either the herpes simplex virus type 1 (HSV-1) or the herpes simplex virus type 2 (HSV-2). Both strains can cause genital herpes, but HSV-1 usually infects the mouth and produces cold sores.

Despite funding challenges, Cullen and his team are inching closer to a cure. They conducted a study recently that identified the pathway herpes takes as it infects. They now know how herpes embeds itself into the cells and how it eludes treatment. Now that they have honed in on the physiology of the disease - and its triggers - researchers believe they are steps closer to creating drugs that could cure herpes.

While we wait for a cure, there are drugs out there that can at least suppress herpes. Three antiviral drugs: acyclovir, valacyclovir, and famciclovir are commonly recommended to quell outbreaks. A physician might recommend taking these drugs when an outbreak occurs to quiet symptoms; or taking them continuously to reduce the likelihood of an outbreak.

And of course the best way to avoid spreading herpes is to abstain from sex, but if you are sexually active, engage in safe-sex practices such as using condoms.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


Filed under: Expert Q&A • Sex • Virus

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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.

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