Your Health

The number of baby boys conceived by a fertility treatment known as ICSI may be lower than what is produced by Mother Nature, a new study suggests.

On average, there are 105 baby boys born for every 100 girls — a natural advantage that helps balance out the higher number of deaths among male fetuses and infants. But in the new study, researchers found that this male-to-female birth ratio seems to be reversed when infants are conceived through intracytoplasmic sperm injection, or ICSI.

Among more than 15,000 U.S. babies born in 2005 via assisted reproduction, the investigators found that a particular ICSI approach appeared to result in a smaller-than-average number of boys.

The effect was seen when ICSI was performed using blastocyst-stage embryos — where embryos are allowed to mature a couple days longer than the traditional norm before they are transferred to the mother. This allows doctors to transfer fewer embryos, reducing the odds of couples having triplets or higher-order births.

Among couples undergoing this procedure, just under 50 percent of births were boys. That compared with a U.S. norm of 52.5 percent for 2005, according to findings published in the journal Fertility & Sterility.

ICSI involves injecting sperm from the father directly into eggs taken from the mother; if one or more embryos develop over the next few days, they are transferred to the mother’s uterus.

ICSI is typically used to treat male fertility problems, such as a low sperm count or poor-quality sperm. However, it is also sometimes used when the cause of a couple’s infertility is unclear, and some fertility clinics opt to use ICSI for all patients.

The full implications of the current findings are not clear, according to the researchers, led by Dr. Barbara Luke of Michigan State University in East Lansing.

About 1 percent of U.S. births result from all assisted reproductive techniques combined, meaning ICSI accounts for only a small number of births. So it is unlikely that the small effects on male-to-female birth ratio seen in this study would have “any major implications for public health,” Luke and her colleagues write.

Still, they conclude, “because our findings suggest that ICSI may reduce the sex ratio, we recommend that ICSI only be done if medically necessary, in an effort to prevent this potential side effect.”

It is not clear why ICSI might reduce the proportion of male births. However, Luke and her colleagues point out, the study found no evidence that male infertility itself was related to a lower sex ratio — supporting the idea that something about the ICSI process is to blame.

If you love the five-week holiday smorgasbord from Thanksgiving to New Year’s, but are already stressing about the added pounds you’ll have to sweat off come Jan. 1, help is at hand.

It’s possible, say nutrition experts, to enjoy holiday eating and make it to 2010 weighing the same as you do today.

It’s all about devising a strategy and thinking about holiday food just a little differently, said Connie Diekman, director of university nutrition at Washington University in St. Louis, and Julie Redfern, manager of the Nutrition Consult Services at Brigham and Women’s Hospital in Boston.

Both are registered dietitians who shared their best holiday eating tips.

First, have a plan. Ponder it before family dinners and parties, said Redfern. For instance, you may decide before going to a family sit-down dinner that you will fix your plate once and it will include lots of vegetables. About one-fourth of the plate will be protein-rich food and about one-fourth carbs. You will not go back for seconds.

Eat before you go. Starving guests are more apt to load up their plates, so Diekman suggests having a piece of fruit smeared with peanut butter or a small container of yogurt prior to heading out. You can then approach the buffet table more relaxed.

Think ”pick and choose,” not ‘’sample.” Picking and choosing is a great strategy, said Redfern, if it involves picking the one dessert or other goodie you love and can’t live without. Instead of sampling all three pies at a holiday dinner, decide which one you’ll wish you had had, and then go for it, she suggested.

Remember, alcohol is loaded with calories. Start off at a party with seltzer water or sparkling water, then switch to alcoholic beverages. Delaying the alcohol may also make you take in fewer calories from foods, Redfern said. “Once you have alcohol, it lessens your resolve,” she said.

Enlist the waiter’s help. If your holiday dinner is in a restaurant, focus on your first course of vegetables, salad or soup, and ask the waiter to hold your main course until you finish, Diekman suggested. You may be fuller than you think, and waiting to eat the main course may mean you’ll eat less.

Take control as hostess. If you’re the holiday host or hostess, you have a lot of work — but also enjoy control. Take advantage of that, Diekman said. “Prepare or serve [ready-make] broth-based soups that are packed with vegetables as a first course,” she said. “Switch from buffets to meals served by the course to pace eating,” she said. It’s probable you’ll eat less overall that way.

If you love gravy, make it from fat-free broth. Include more casserole dishes — you can increase the vegetables with hardly anyone noticing.

Move, even a little. Squeezing in a little exercise, no matter how hectic the schedule, will help, Diekman said. “Walk the mall before you can spend any money,” she suggested. “After spending a predetermined amount, take another mall walk.”

Take a 10-minute walk every day, she said. “Everyone has that time.”

Defend your resolve. Even with the best strategies in play, some people fall apart when face-to-face with those ubiquitous food pushers — those holiday hosts and hostesses who encourage you to eat, eat, eat.

You can resist them, Redfern said. “Start off with a compliment,” she said. Something like: “I love your pie, but I am full.”

This works much better, she said, than telling them you have to cut back. That’s an invitation for them to come back with tough-to-resist lines such as “Oh, it’s only one day,” or “You can afford it.”

If you still experience resistance, tell your hostess: “I’d love to take some home for later.” Redfern added: “They don’t need to know if you actually eat it.”

But if you don’t want that temptation — the pumpkin pie calling from the kitchen at midnight — learn to be firm and repetitive as a guest, Redfern said.

”It almost takes three times for them to get the message,” she said. So, repeat, repeat, repeat, cheerfully but firmly.

Men wondering about the long-term side effects of chemotherapy for testicular cancer may now have a road map defining likely outcomes.

A Norwegian study, published today in the Journal of the National Cancer Institute, reveals that long-term side effects vary depending on the dose of chemotherapy given and how many cycles of chemotherapy the men received.

“A continuous aim in the care of testicular cancer patients is to reduce toxicity without comprising the high cure rate,” Dr. Marianne Brydy of Haukeland University Hospital in Bergen, Norway wrote in an email to Reuters Health. “Treatment plans should thus follow the existing guidelines with recommendations for treatment based on risk,” she advised.

Between 4 and 21 years after treatment for testicular cancer, Brydy and colleagues asked 1,402 men about their symptoms of hearing loss, ringing in the ears (tinnitus), numbness or tingling in the hands or feet, and what’s called Raynaud-like phenomena (discoloration of the hands or feet on exposure to cold).

Compared to men who never received chemotherapy, men who had received any chemotherapy reported significantly more trouble with the aforementioned symptoms, even years after treatment.

Among chemotherapy-treated men, 39 percent reported Raynaud-like phenomena, 29 percent reported hearing impairment, and 22 percent reported tinnitus as major symptoms troubling them quite a bit or very much, the investigators found.

They also found that men who were treated with radiation therapy were much more apt to report numbness or tingling in the hands or feet than men who did not receive radiation therapy.

Studying the common chemotherapy drug cisplatin, the researchers found that the men who had the most severe symptoms years later were the ones who had received high-dose treatment with this drug, or had received five or more cycles of the drug.

Men who had received high-dose cisplatin-based chemotherapy were more likely to have long-term problems with ringing in the ears and hearing loss, whereas those who received five or more cycles of chemotherapy were more likely to experience long-term problems with Raynaud-like symptoms and numbness or tingling in the extremities.

Additionally, men in the study group who smoked on a daily basis were more likely to have symptoms of Raynaud’s, numbness or tingling in the hands or feet, and hearing impairment than the men in the study who had never smoked.

Interestingly, note the researchers, the study found no significant difference in symptom severity according to length of time since treatment, suggesting, they say, that side effects likely remain permanent after a certain length of time.

At some point, nearly half of all American children and teens will live in a home that receives food stamps, a new study shows.

Researchers analyzed 30 years (1968 to 1997) of national data collected by the Panel Study of Income Dynamics and found that by the time they were 1 year old, 12.1 percent of U.S. children had lived in households receiving food stamps. That increased to 26.1 percent at 5 years of age; 35.9 percent at 10 years; 43.6 percent by age 15, and 49.2 percent by age 20.

The study also found that by age 20, about one-third of children had lived in households that received food stamps for two or more years, 28.1 percent for three or more years, 26.4 percent for four or more years, and 22.8 percent for five or more years.

Food stamp use was most likely among households with black children and those who lived in households headed by adults who were unmarried or had had less than 12 years of education, the researchers reported in the November issue of the journal Archives of Pediatrics & Adolescent Medicine.

“American children are at a high risk of encountering a spell during which their families are in poverty and food insecurity as indicated through their use of food stamps. Such events have the potential to seriously jeopardize a child’s overall health,” wrote Mark R. Rank, of the George Warren Brown School of Social Work at Washington University, St. Louis, and Thomas A. Hirschl, of Cornell University.

Studies have “repeatedly demonstrated that two of the most detrimental economic conditions affecting a child’s health are poverty and food insecurity,” the researchers noted.

“Understanding the degree to which American children are exposed to the risks of poverty and food insecurity across the length of childhood would appear to be an essential component of pediatric knowledge, particularly in light of the growing emphasis on the importance of community pediatrics,” the study authors added.

Packing on the pounds may be an unintended consequence of the U.S. Food Stamp Program, according to research that shows that getting food stamps may help contribute to obesity, at least among women.

“We can’t prove that the Food Stamp Program causes weight gain, but this study suggests a strong linkage,” Jay Zagorsky, a research scientist at Ohio State University’s Center for Human Resource Research, Columbus, noted in a university-issued statement.

Food stamps, the major U.S. anti-hunger program, help poor people buy groceries.

Zagorsky, along with Patricia Smith of the University of Michigan in Dearborn, studied weight changes over 14 years in nearly 4,000 people in the food stamp program and almost 6,000 not in the program.

They found that the typical female user of food stamps was heavier than the non-user, after taking into account a variety of factors that might influence body weight.

Specifically, the researchers calculated body mass index, or BMI, a measure of weight in relation to height used to gauge how fat or thin a person is. Female food stamp users, they found, had a BMI 1.15 points higher than a similar woman who did not participate in the food stamp program.

For the average American woman standing 5 feet 4 inches tall this means an increase in 5.8 pounds of body weight.

Zagorsky and Smith also found that BMI increased faster when participants were getting food stamps than when they were not, and increased more the longer they were in the food stamp program.

The average food stamp users saw their BMI go up 0.4 points per year when they were receiving food stamps, compared to 0.07 points per year before and 0.2 points per year after they no longer received food stamps.

“While food stamps may help fight hunger, they may have the unintended consequence of encouraging weight gain among women,” Zagorsky said in the statement. “Every way we looked at the data, it was clear that the use of food stamps was associated with weight gain,” he added.

“While this association does not prove that the Food Stamp Program causes weight gain, it does suggest that program changes to encourage the consumption of high-nutrient, low-calorie foods should be considered,” Zagorsky and Smith note in the latest issue of Economics and Human Biology.

In 2008, roughly 28 million people — or almost 1 in 11 Americans — received benefits from the food stamp program in a given month.

Food stamp participants, the researchers say, may choose cheap, calorie-dense, high-fat, processed foods over healthier, more expensive food, maybe because food stamps don’t provide enough money to buy healthy foods, Zagorsky contends.

In 2002, the average recipient received $81 in food stamps per month. “That figure was shocking to me,” Zagorsky said. “I think it would be very difficult for a shopper to regularly buy healthy, nutritious food on that budget.”

Modifying the food stamp program to include economic incentives to buy and eat healthier foods “might be an important tool for fighting obesity,” Zagorsky offers.

People on food stamps, for example, could be required to take a course on nutrition and food stamp users who purchase fresh fruit and vegetables and other low-fat products could be given more benefits or receive discounts on these products, he said.

Long-term heroin addicts who were given “medical heroin” were able to stay in treatment longer than those given methadone, a Canadian study has found.

In addition, rates of illicit drug use and illegal activity declined among the participants, who had failed earlier attempts at treatment, according to the study.

“Without [medical heroin], these people who’ve already been written off as beyond help would be on street drugs, exposing themselves to harms like overdose, HIV and illegal activities,” explained the study’s senior author, Dr. Martin Schechter, a professor and director of the School of Population and Public Health at the University of British Columbia. “But, if we can get them into a clinic while keeping them safe and stabilizing their lives, we can get them out of that 24-hour cycle and get them in touch with people like doctors and nurses.”

“Sooner or later, they may seek counseling and other treatments,” Schechter said. “And, in the meantime, you’re saving a lot of money in health care because the treatment is far less expensive to the community than the alternative.”

As many as a million people in North America are addicted to opioids, and the majority of them are addicted to heroin, according to background information in the study, which is in the Aug. 20 issue of the New England Journal of Medicine.

Methadone is a standard treatment drug given to replace heroin. However, about 15 to 25 percent of people addicted to heroin don’t have a good response to methadone, according to the study. In some European countries, researchers have examined the use of injectable medical heroin — diacetylmorphine, the active ingredient in heroin — to treat addicts who’ve failed other treatment options. In the United Kingdom, it’s recommended that medical heroin be used as a treatment of last resort.

The Canadian study sought to examine a North American population, though the authors acknowledged that the study could not have been conducted in the United States because of “financial and logistical barriers.”

The study involved 251 people, all older than 25, who had been using opioids for at least five years and were currently injecting opioids daily. By random assignment, oral methadone was given to 111 participants, 115 were given medical heroin injections and 25 were given injections of hydromorphone (Dilaudid), a narcotic medication that has similar effects to medical heroin.

Almost 88 percent of those in the medical heroin group stayed in the study, compared with 54 percent of the methadone group. The reduction in the rate of illicit drug use or other illegal activities was 67 percent in the medical heroin group and 48 percent in the methadone group.

Ten people overdosed, none fatally, during the study period, and six people had seizures. Because of those risks, the authors wrote, medical heroin should only be used in a setting where prompt medical interventions are available.

On the whole, Schechter said, the approach is one worth considering.

“People need to have an open mind when it comes to the treatment of addiction,” he said. “This treatment is good for the people addicted to heroin and very good for the community. It saves money and gets rid of black market criminal activity.”

Though medical heroin is not likely to be approved for addiction treatment in the United States, Schechter said, the study did find that hydromorphone had similar advantages and is already approved for use in the United States. However, the study did not include enough people in the hydromorphone group, he said, so more research is needed.

An addiction medicine specialist, Dr. Joshua D. Lee, a professor of medicine at New York University Langone Medical Center in New York City, described the treatment as a “potentially effective approach to managing long-term heroin addiction” that has not responded to other treatments.

“While this doesn’t get them off heroin, you’re taking a potentially unsafe, toxic thing — the package from the dealer down the street — and you’re putting it in a clinic setting where there’s support if someone overdoses,” Lee said. “It could kill the street drug trade and cause positive effects in the neighborhood.”

“Methadone is life-saving for some people, but some long-term users just aren’t interested in methadone, and it’s a real public health problem,” he added. “We have to develop alternatives to methadone maintenance.”