Patrice Wendling

CHANDLER, ARIZ. — The idea of using suspended animation in trauma care was unthinkable just 5 years ago, but surgeons now stand at the cusp of the first clinical trial in humans.

The nonrandomized, phase II trial will use emergency preservation and resuscitation (EPR), as it is now called, to buy surgeons time for victims of blunt or penetrating trauma who have exsanguinated to the point of cardiac arrest.

Hypothermia is achieved via a flush of ice-cold saline pumped into the aorta until the brain is cooled to a tympanic membrane temperature of less than 10°C. Patients can then undergo surgical interventions to control bleeding, followed by rewarming and resuscitation with cardiopulmonary bypass, principal investigator Dr. Samuel Tisherman explained at the annual meeting of the Eastern Association for the Surgery of Trauma.

Patients in the Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) trial must have at least one sign of life present within the 5-minute period prior to ED arrival or in the ED, and have no response to open-chest cardiopulmonary resuscitation with clamping the aorta or remain pulseless for 5 minutes despite aggressive resuscitative efforts.

Informed consent is impossible, said Dr. Tisherman, professor of critical care medicine and surgery and associate director of the Safar Center for Resuscitation Research at the University of Pittsburgh. “Why do it? Because we know our outcomes are so bad. These patients have almost no chance of survival with current therapy,” he said.

Standard resuscitation for patients in cardiac arrest from blunt or penetrating injuries includes emergency department thoracotomy (EDT), open cardiac massage, and fluid resuscitation. A recent analysis of 283 consecutive penetrating injury cases showed that patients with multiple cardiac or great-vessel gunshot wounds, regardless of ED signs of life, were “nearly unsalvageable”; only 1 patient survived EDT (J. Trauma 2009;67:1250–7).

Hypothermia is commonly used in elective pediatric and neurologic surgery, and is effective for cardiac arrest. In trauma care, however, hypothermia has been considered unfeasible because of three hurdles, coinvestigator Dr. Hasan B. Alam said at the meeting. The procedure is performed in a chaotic environment on patients who are typically in shock; it is technically challenging to cool the patient in less than 5 minutes, as opposed to the slow hypothermia induced in elective cases; and hypothermia has long been thought to exacerbate bleeding and coagulopathy in trauma patients.

Active rewarming can actually reverse coagulopathy, and although trauma patients may bleed more during hypothermic arrest, some systems allow for blood to be recirculated back into the patient, said Dr. Alam of Massachusetts General Hospital and Harvard University, both in Boston.

The goal of the multicenter trial is to limit EPR to less than 60 minutes. The hypothesis is that aortic arch flush can be initiated within 5 minutes of pulselessness, decreasing the tympanic membrane temperature to less than 20°C in 15 minutes.

A meeting attendee commented that death isn't the worst or most expensive outcome in these patients, noting the trial's potential for extremely poor outcomes. Data have shown that encephalopathy can begin 4 minutes after the cessation of blood flow in normothermic patients.

“The cheapest thing is a quick death,” Dr. Alam replied. “It's expensive if the heart comes back but the brain does not. But if we don't do this, we won't push ahead.”

The primary end point of the EPR-CAT trial is survival to hospital discharge without major disability, with the secondary outcome being neurologic function at 6 months.

Despite many medical and ethical questions, the trial is moving ahead; medical protocols have been submitted at two of the eight participating centers. Researchers expect to treat the first patient sometime in the second half of 2010, Dr. Tisherman said. The Food and Drug Administration will keep a close eye on the trial.

Disclosures: The trial is sponsored by the University of Pittsburgh. Dr. Tisherman disclosed no financial conflicts of interest.

CHANDLER, ARIZ. — The idea of using suspended animation in trauma care was unthinkable just 5 years ago, but surgeons now stand at the cusp of the first clinical trial in humans.

The nonrandomized, phase II trial will use emergency preservation and resuscitation (EPR), as it is now called, to buy surgeons time for victims of blunt or penetrating trauma who have exsanguinated to the point of cardiac arrest.

Hypothermia is achieved via a flush of ice-cold saline pumped into the aorta until the brain is cooled to a tympanic membrane temperature of less than 10°C. Patients can then undergo surgical interventions to control bleeding, followed by rewarming and resuscitation with cardiopulmonary bypass, principal investigator Dr. Samuel Tisherman explained at the annual meeting of the Eastern Association for the Surgery of Trauma.

Patients in the Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) trial must have at least one sign of life present within the 5-minute period prior to ED arrival or in the ED, and have no response to open-chest cardiopulmonary resuscitation with clamping the aorta or remain pulseless for 5 minutes despite aggressive resuscitative efforts.

Informed consent is impossible, said Dr. Tisherman, professor of critical care medicine and surgery and associate director of the Safar Center for Resuscitation Research at the University of Pittsburgh. “Why do it? Because we know our outcomes are so bad. These patients have almost no chance of survival with current therapy,” he said.

Standard resuscitation for patients in cardiac arrest from blunt or penetrating injuries includes emergency department thoracotomy (EDT), open cardiac massage, and fluid resuscitation. A recent analysis of 283 consecutive penetrating injury cases showed that patients with multiple cardiac or great-vessel gunshot wounds, regardless of ED signs of life, were “nearly unsalvageable”; only 1 patient survived EDT (J. Trauma 2009;67:1250–7).

Hypothermia is commonly used in elective pediatric and neurologic surgery, and is effective for cardiac arrest. In trauma care, however, hypothermia has been considered unfeasible because of three hurdles, coinvestigator Dr. Hasan B. Alam said at the meeting. The procedure is performed in a chaotic environment on patients who are typically in shock; it is technically challenging to cool the patient in less than 5 minutes, as opposed to the slow hypothermia induced in elective cases; and hypothermia has long been thought to exacerbate bleeding and coagulopathy in trauma patients.

Active rewarming can actually reverse coagulopathy, and although trauma patients may bleed more during hypothermic arrest, some systems allow for blood to be recirculated back into the patient, said Dr. Alam of Massachusetts General Hospital and Harvard University, both in Boston.

The goal of the multicenter trial is to limit EPR to less than 60 minutes. The hypothesis is that aortic arch flush can be initiated within 5 minutes of pulselessness, decreasing the tympanic membrane temperature to less than 20°C in 15 minutes.

A meeting attendee commented that death isn't the worst or most expensive outcome in these patients, noting the trial's potential for extremely poor outcomes. Data have shown that encephalopathy can begin 4 minutes after the cessation of blood flow in normothermic patients.

“The cheapest thing is a quick death,” Dr. Alam replied. “It's expensive if the heart comes back but the brain does not. But if we don't do this, we won't push ahead.”

The primary end point of the EPR-CAT trial is survival to hospital discharge without major disability, with the secondary outcome being neurologic function at 6 months.

Despite many medical and ethical questions, the trial is moving ahead; medical protocols have been submitted at two of the eight participating centers. Researchers expect to treat the first patient sometime in the second half of 2010, Dr. Tisherman said. The Food and Drug Administration will keep a close eye on the trial.

Disclosures: The trial is sponsored by the University of Pittsburgh. Dr. Tisherman disclosed no financial conflicts of interest.

CHANDLER, ARIZ. — The idea of using suspended animation in trauma care was unthinkable just 5 years ago, but surgeons now stand at the cusp of the first clinical trial in humans.

The nonrandomized, phase II trial will use emergency preservation and resuscitation (EPR), as it is now called, to buy surgeons time for victims of blunt or penetrating trauma who have exsanguinated to the point of cardiac arrest.

Hypothermia is achieved via a flush of ice-cold saline pumped into the aorta until the brain is cooled to a tympanic membrane temperature of less than 10°C. Patients can then undergo surgical interventions to control bleeding, followed by rewarming and resuscitation with cardiopulmonary bypass, principal investigator Dr. Samuel Tisherman explained at the annual meeting of the Eastern Association for the Surgery of Trauma.

Patients in the Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) trial must have at least one sign of life present within the 5-minute period prior to ED arrival or in the ED, and have no response to open-chest cardiopulmonary resuscitation with clamping the aorta or remain pulseless for 5 minutes despite aggressive resuscitative efforts.

Informed consent is impossible, said Dr. Tisherman, professor of critical care medicine and surgery and associate director of the Safar Center for Resuscitation Research at the University of Pittsburgh. “Why do it? Because we know our outcomes are so bad. These patients have almost no chance of survival with current therapy,” he said.

Standard resuscitation for patients in cardiac arrest from blunt or penetrating injuries includes emergency department thoracotomy (EDT), open cardiac massage, and fluid resuscitation. A recent analysis of 283 consecutive penetrating injury cases showed that patients with multiple cardiac or great-vessel gunshot wounds, regardless of ED signs of life, were “nearly unsalvageable”; only 1 patient survived EDT (J. Trauma 2009;67:1250–7).

Hypothermia is commonly used in elective pediatric and neurologic surgery, and is effective for cardiac arrest. In trauma care, however, hypothermia has been considered unfeasible because of three hurdles, coinvestigator Dr. Hasan B. Alam said at the meeting. The procedure is performed in a chaotic environment on patients who are typically in shock; it is technically challenging to cool the patient in less than 5 minutes, as opposed to the slow hypothermia induced in elective cases; and hypothermia has long been thought to exacerbate bleeding and coagulopathy in trauma patients.

Active rewarming can actually reverse coagulopathy, and although trauma patients may bleed more during hypothermic arrest, some systems allow for blood to be recirculated back into the patient, said Dr. Alam of Massachusetts General Hospital and Harvard University, both in Boston.

The goal of the multicenter trial is to limit EPR to less than 60 minutes. The hypothesis is that aortic arch flush can be initiated within 5 minutes of pulselessness, decreasing the tympanic membrane temperature to less than 20°C in 15 minutes.

A meeting attendee commented that death isn't the worst or most expensive outcome in these patients, noting the trial's potential for extremely poor outcomes. Data have shown that encephalopathy can begin 4 minutes after the cessation of blood flow in normothermic patients.

“The cheapest thing is a quick death,” Dr. Alam replied. “It's expensive if the heart comes back but the brain does not. But if we don't do this, we won't push ahead.”

The primary end point of the EPR-CAT trial is survival to hospital discharge without major disability, with the secondary outcome being neurologic function at 6 months.

Despite many medical and ethical questions, the trial is moving ahead; medical protocols have been submitted at two of the eight participating centers. Researchers expect to treat the first patient sometime in the second half of 2010, Dr. Tisherman said. The Food and Drug Administration will keep a close eye on the trial.

Disclosures: The trial is sponsored by the University of Pittsburgh. Dr. Tisherman disclosed no financial conflicts of interest.

Tomorrow's approach to the aging face is all about restoring volume and moving away from filling in lines and wrinkles, according to Dr. W. Philip Werschler.

Advances in nonsurgical options such as fillers, toxins, lasers, peels, and topical products make it possible to address the volume loss and change in facial shape that comes with aging. Volume loss is cumulative through the decades and consists of several components including dermal and muscle atrophy, shifts in fat deposits, and skeletal thinning and remodeling including flattening of the maxilla, expansion of the occipital orbit, and shrinking of the mandible, he said at the seminar.

The heart shaped or trianglular appearance of a youthful face, which peaks in the mid-twenties, inverts to the pyramid of age with volumetric loss and alteration, said Dr. Werschler, an assistant clinical professor of dermatology at the University of Washington in Seattle. In women, this occurs earlier, typically in the late 40s and 50s, than in men, in the 60s and 70s. The bottom of the face appears heavier, often jowly, there is loss of the mandibular sweep, and the nose, instead of the chin, serves as the apex of the inverted triangle. Ultimately, as we age, we take on facial proportions that make us look more like infants than adults, he said.

To address wrinkles only is to address only half of the problem, Dr. Werschler said. For example, laser resurfacing can produce smooth skin in an aging patient, but they will still have a flat face, lacking in contour and dimension. If, however, nasolabial folds are tackled by volumizing the cheeks, it will lift the face and fill in the nasolabial folds, resulting in a more youthful, balanced, and natural appearance. Similarly, botulinum toxin A can be used to change the shape of the orbital opening, thus affecting crow's feet and softening eyebrows.

It is helpful to divide the face into three facial treatment zones when planning a nonsurgical total facial rejuvenation (NSYFR)--upper, mid and lower. Facial treatment zones are useful terms in patient education because they are easy to remember and easy to comprehend.

When analyzing the treatment zones, look for changes in balance, proportion, and symmetry, and consider what the patient hopes to achieve. There are many approaches to NSTFR. However, they don't exsist in isolation, and frequently the combination of NSTFR and surgery is best, according to Dr. Werschler. A good example of this is a brow lift along with laser or filler on the lips or lower part of the face. That may mean referring or collaborating with a surgeon in your practice, but the patient will thank you for the result, he said.

^{Photo Courtesy Dr. W. Philip Werschler}

Dr. Werschler is a speaker, consultant, and clinical investigator for Allergan and Medicis, and has relationships with numerous other pharmaceutical companies. SDEF and this news organization are owned by Elsevier.

Tomorrow's approach to the aging face is all about restoring volume and moving away from filling in lines and wrinkles, according to Dr. W. Philip Werschler.

Advances in nonsurgical options such as fillers, toxins, lasers, peels, and topical products make it possible to address the volume loss and change in facial shape that comes with aging. Volume loss is cumulative through the decades and consists of several components including dermal and muscle atrophy, shifts in fat deposits, and skeletal thinning and remodeling including flattening of the maxilla, expansion of the occipital orbit, and shrinking of the mandible, he said at the seminar.

The heart shaped or trianglular appearance of a youthful face, which peaks in the mid-twenties, inverts to the pyramid of age with volumetric loss and alteration, said Dr. Werschler, an assistant clinical professor of dermatology at the University of Washington in Seattle. In women, this occurs earlier, typically in the late 40s and 50s, than in men, in the 60s and 70s. The bottom of the face appears heavier, often jowly, there is loss of the mandibular sweep, and the nose, instead of the chin, serves as the apex of the inverted triangle. Ultimately, as we age, we take on facial proportions that make us look more like infants than adults, he said.

To address wrinkles only is to address only half of the problem, Dr. Werschler said. For example, laser resurfacing can produce smooth skin in an aging patient, but they will still have a flat face, lacking in contour and dimension. If, however, nasolabial folds are tackled by volumizing the cheeks, it will lift the face and fill in the nasolabial folds, resulting in a more youthful, balanced, and natural appearance. Similarly, botulinum toxin A can be used to change the shape of the orbital opening, thus affecting crow's feet and softening eyebrows.

It is helpful to divide the face into three facial treatment zones when planning a nonsurgical total facial rejuvenation (NSYFR)--upper, mid and lower. Facial treatment zones are useful terms in patient education because they are easy to remember and easy to comprehend.

When analyzing the treatment zones, look for changes in balance, proportion, and symmetry, and consider what the patient hopes to achieve. There are many approaches to NSTFR. However, they don't exsist in isolation, and frequently the combination of NSTFR and surgery is best, according to Dr. Werschler. A good example of this is a brow lift along with laser or filler on the lips or lower part of the face. That may mean referring or collaborating with a surgeon in your practice, but the patient will thank you for the result, he said.

^{Photo Courtesy Dr. W. Philip Werschler}

Dr. Werschler is a speaker, consultant, and clinical investigator for Allergan and Medicis, and has relationships with numerous other pharmaceutical companies. SDEF and this news organization are owned by Elsevier.

Tomorrow's approach to the aging face is all about restoring volume and moving away from filling in lines and wrinkles, according to Dr. W. Philip Werschler.

Advances in nonsurgical options such as fillers, toxins, lasers, peels, and topical products make it possible to address the volume loss and change in facial shape that comes with aging. Volume loss is cumulative through the decades and consists of several components including dermal and muscle atrophy, shifts in fat deposits, and skeletal thinning and remodeling including flattening of the maxilla, expansion of the occipital orbit, and shrinking of the mandible, he said at the seminar.

The heart shaped or trianglular appearance of a youthful face, which peaks in the mid-twenties, inverts to the pyramid of age with volumetric loss and alteration, said Dr. Werschler, an assistant clinical professor of dermatology at the University of Washington in Seattle. In women, this occurs earlier, typically in the late 40s and 50s, than in men, in the 60s and 70s. The bottom of the face appears heavier, often jowly, there is loss of the mandibular sweep, and the nose, instead of the chin, serves as the apex of the inverted triangle. Ultimately, as we age, we take on facial proportions that make us look more like infants than adults, he said.

To address wrinkles only is to address only half of the problem, Dr. Werschler said. For example, laser resurfacing can produce smooth skin in an aging patient, but they will still have a flat face, lacking in contour and dimension. If, however, nasolabial folds are tackled by volumizing the cheeks, it will lift the face and fill in the nasolabial folds, resulting in a more youthful, balanced, and natural appearance. Similarly, botulinum toxin A can be used to change the shape of the orbital opening, thus affecting crow's feet and softening eyebrows.

It is helpful to divide the face into three facial treatment zones when planning a nonsurgical total facial rejuvenation (NSYFR)--upper, mid and lower. Facial treatment zones are useful terms in patient education because they are easy to remember and easy to comprehend.

When analyzing the treatment zones, look for changes in balance, proportion, and symmetry, and consider what the patient hopes to achieve. There are many approaches to NSTFR. However, they don't exsist in isolation, and frequently the combination of NSTFR and surgery is best, according to Dr. Werschler. A good example of this is a brow lift along with laser or filler on the lips or lower part of the face. That may mean referring or collaborating with a surgeon in your practice, but the patient will thank you for the result, he said.

^{Photo Courtesy Dr. W. Philip Werschler}

Dr. Werschler is a speaker, consultant, and clinical investigator for Allergan and Medicis, and has relationships with numerous other pharmaceutical companies. SDEF and this news organization are owned by Elsevier.

CHANDLER, ARIZ. — A great disconnect exists between attitudes held by young adults about texting while driving and their willingness to engage in this risky behavior, new research shows.

Among 426 university freshman surveyed, 53% felt they cannot safely text and drive, yet 73% admit they text while behind the wheel.

Moreover, 84% of these young adults ride with drivers who text.

Overall, 92% of students felt that texting while driving affects their concentration “somewhat” or “a lot,” and is less safe than talking on a cell phone, Dr. Laura Buchanan said at the annual meeting of the Eastern Association for the Surgery of Trauma. Of all respondents to the anonymous Web-based survey, 60% said it should be illegal to text and drive.

This disconnect between attitudes and behavior is attributable in part to the use of rationalization by young adults, said Dr. Buchanan, a general surgery resident at West Virginia University in Morgantown.

“A fear-provoking situation can lead to one of two behaviors: fear control—or explaining away the danger in your mind—or danger control—actually changing your behavior,” she said. “Young adults and teenagers overwhelmingly will respond with fear control rather than danger control.”

Young adults are not the only ones engaged in rationalization. Safety officials cited texting by the train engineer as the primary cause of the September 2008 commuter train crash that killed 25 people and injured 135 in California. Even police officers have been found texting prior to being involved in fatal crashes.

Comprehensive data on texting while driving is not available, but the U.S. Department of Transportation estimates that 20% of motor vehicle collisions involve a driver who was talking or texting on a cell phone. Because texting relies on touch and sight, the cognitive load of the communication is far greater than a conversation with a passenger, Dr. Buchanan said.

In the survey, 67% of students said texting was more useful than speaking on the phone. More than half (52%) said they text more than 50 times per day, and 72% said they text during class.

The study was limited by a 10% response rate and lack of individual demographic data on the respondents, but it raises important questions about injury prevention, she said. Legislation may play an important role in reducing texting while driving; however, only 63% of drivers in a recent insurance survey said they plan to abide by such laws.

Last year, legislators called for a national texting ban, but the idea failed to gain enough momentum for approval. As of late January 2010, 19 states and the District of Columbia ban texting while driving, but the laws vary widely, Dr. Buchanan said. In four states, texting is a secondary offense, meaning that a driver must commit some other infraction before an officer can act. In other states, the prohibition only goes into effect in construction or school zones or for drivers under 18 years of age.

“Education and awareness are obviously needed, but just as legislation has not stopped drunk driving it's not likely to stop texting while driving,” she said. “Shock tactics such as graphic videos tend to reinforce the 'this-could-never-happen-to-me' thinking of young adults.”

Part of the solution may be to target youths at an early age, as is done with bicycle helmet campaigns, Dr. Buchanan said in an interview. Study participants averaged just 14 years of age when they received their first cell phone, and they began texting at age 15.

A related video is at www.youtube.com/InternalMedicineNews

CHANDLER, ARIZ. — A great disconnect exists between attitudes held by young adults about texting while driving and their willingness to engage in this risky behavior, new research shows.

Among 426 university freshman surveyed, 53% felt they cannot safely text and drive, yet 73% admit they text while behind the wheel.

Moreover, 84% of these young adults ride with drivers who text.

Overall, 92% of students felt that texting while driving affects their concentration “somewhat” or “a lot,” and is less safe than talking on a cell phone, Dr. Laura Buchanan said at the annual meeting of the Eastern Association for the Surgery of Trauma. Of all respondents to the anonymous Web-based survey, 60% said it should be illegal to text and drive.

This disconnect between attitudes and behavior is attributable in part to the use of rationalization by young adults, said Dr. Buchanan, a general surgery resident at West Virginia University in Morgantown.

“A fear-provoking situation can lead to one of two behaviors: fear control—or explaining away the danger in your mind—or danger control—actually changing your behavior,” she said. “Young adults and teenagers overwhelmingly will respond with fear control rather than danger control.”

Young adults are not the only ones engaged in rationalization. Safety officials cited texting by the train engineer as the primary cause of the September 2008 commuter train crash that killed 25 people and injured 135 in California. Even police officers have been found texting prior to being involved in fatal crashes.

Comprehensive data on texting while driving is not available, but the U.S. Department of Transportation estimates that 20% of motor vehicle collisions involve a driver who was talking or texting on a cell phone. Because texting relies on touch and sight, the cognitive load of the communication is far greater than a conversation with a passenger, Dr. Buchanan said.

In the survey, 67% of students said texting was more useful than speaking on the phone. More than half (52%) said they text more than 50 times per day, and 72% said they text during class.

The study was limited by a 10% response rate and lack of individual demographic data on the respondents, but it raises important questions about injury prevention, she said. Legislation may play an important role in reducing texting while driving; however, only 63% of drivers in a recent insurance survey said they plan to abide by such laws.

Last year, legislators called for a national texting ban, but the idea failed to gain enough momentum for approval. As of late January 2010, 19 states and the District of Columbia ban texting while driving, but the laws vary widely, Dr. Buchanan said. In four states, texting is a secondary offense, meaning that a driver must commit some other infraction before an officer can act. In other states, the prohibition only goes into effect in construction or school zones or for drivers under 18 years of age.

“Education and awareness are obviously needed, but just as legislation has not stopped drunk driving it's not likely to stop texting while driving,” she said. “Shock tactics such as graphic videos tend to reinforce the 'this-could-never-happen-to-me' thinking of young adults.”

Part of the solution may be to target youths at an early age, as is done with bicycle helmet campaigns, Dr. Buchanan said in an interview. Study participants averaged just 14 years of age when they received their first cell phone, and they began texting at age 15.

A related video is at www.youtube.com/InternalMedicineNews

CHANDLER, ARIZ. — A great disconnect exists between attitudes held by young adults about texting while driving and their willingness to engage in this risky behavior, new research shows.

Among 426 university freshman surveyed, 53% felt they cannot safely text and drive, yet 73% admit they text while behind the wheel.

Moreover, 84% of these young adults ride with drivers who text.

Overall, 92% of students felt that texting while driving affects their concentration “somewhat” or “a lot,” and is less safe than talking on a cell phone, Dr. Laura Buchanan said at the annual meeting of the Eastern Association for the Surgery of Trauma. Of all respondents to the anonymous Web-based survey, 60% said it should be illegal to text and drive.

This disconnect between attitudes and behavior is attributable in part to the use of rationalization by young adults, said Dr. Buchanan, a general surgery resident at West Virginia University in Morgantown.

“A fear-provoking situation can lead to one of two behaviors: fear control—or explaining away the danger in your mind—or danger control—actually changing your behavior,” she said. “Young adults and teenagers overwhelmingly will respond with fear control rather than danger control.”

Young adults are not the only ones engaged in rationalization. Safety officials cited texting by the train engineer as the primary cause of the September 2008 commuter train crash that killed 25 people and injured 135 in California. Even police officers have been found texting prior to being involved in fatal crashes.

Comprehensive data on texting while driving is not available, but the U.S. Department of Transportation estimates that 20% of motor vehicle collisions involve a driver who was talking or texting on a cell phone. Because texting relies on touch and sight, the cognitive load of the communication is far greater than a conversation with a passenger, Dr. Buchanan said.

In the survey, 67% of students said texting was more useful than speaking on the phone. More than half (52%) said they text more than 50 times per day, and 72% said they text during class.

The study was limited by a 10% response rate and lack of individual demographic data on the respondents, but it raises important questions about injury prevention, she said. Legislation may play an important role in reducing texting while driving; however, only 63% of drivers in a recent insurance survey said they plan to abide by such laws.

Last year, legislators called for a national texting ban, but the idea failed to gain enough momentum for approval. As of late January 2010, 19 states and the District of Columbia ban texting while driving, but the laws vary widely, Dr. Buchanan said. In four states, texting is a secondary offense, meaning that a driver must commit some other infraction before an officer can act. In other states, the prohibition only goes into effect in construction or school zones or for drivers under 18 years of age.

“Education and awareness are obviously needed, but just as legislation has not stopped drunk driving it's not likely to stop texting while driving,” she said. “Shock tactics such as graphic videos tend to reinforce the 'this-could-never-happen-to-me' thinking of young adults.”

Part of the solution may be to target youths at an early age, as is done with bicycle helmet campaigns, Dr. Buchanan said in an interview. Study participants averaged just 14 years of age when they received their first cell phone, and they began texting at age 15.

A related video is at www.youtube.com/InternalMedicineNews

Major Finding: Abdominal aortic intima media thickness was significantly greater in infants with IUGR than in controls, as was blood pressure, in one small study. In a second study of 59 IUGR fetuses, fetal ultrasonographic cardiovascular indices were significantly worse in the fetuses that died compared with survivors.

Data Source: The first study involved 25 infants with IUGR and 25 controls, while the second included 59 IUGR fetuses, in which the 8 fetuses that died were compared with survivors.

Disclosures: None reported.

HAMBURG, GERMANY — The environment experienced in utero was found in two small studies to influence the development of later cardiovascular disease and even perinatal death.

“We found that in fetuses and neonates with intrauterine growth restriction, aortic intima media wall thickness is increased with respect to controls, suggesting that it may represent an in utero marker of potential atherosclerosis development,” lead author Dr. Erich Cosmi said at the World Congress on Ultrasound in Obstetrics and Gynecology.

Doppler ultrasound revealed that maximum abdominal aortic intima media thickness (aIMT) was significantly increased in 25 infants with intrauterine growth restriction (IUGR), compared with 25 controls, at a mean gestational age of 32 weeks (2.05 mm vs. 1.05 mm) and at a mean of 18 months after birth (2.3 mm vs. 1.06 mm).

Blood pressure values were also significantly correlated with prenatal and postnatal aIMT values, reported Dr. Cosmi of the department of obstetrics and gynecology, University of Padua (Italy). Systolic blood pressure was 123 mm Hg in IUGR infants and 104 mm Hg in controls, which was significantly different at a P value of .0004.

When asked by the audience if any of the infants were on hypertension medication at the time of evaluation, Dr. Cosmi responded, “No, but they are now. We didn't know they would have hypertension. It was surprising for us.”

The researchers also assessed renal function after birth, as previous research in animal models suggests a renal contribution to developmentally programmed hypertension.

Compared with controls, IUGR infants had significantly higher urinary microalbumin (4.4 mg/L vs. 10.7 mg/L) and sodium (56 mmol/L vs. 122 mmol/L) levels and albumin/creatinine ratios (14.7 mg/g vs. 26.9 mg/g). All are markers of glomerular function.

Kidney length and volume were similar, as were levels of lysozyme, a marker of tubular function.

“The clinical implications of this study are that fetuses that were IUGR necessitate follow-up after birth, as they are at risk for cardiovascular disease,” Dr. Cosmi said in an interview.

Fetuses were classified as IUGR if their estimated fetal weight was below the 10th percentile with Doppler velocimetry greater than 2 standard deviations.

In a separate study presented during the same session, Dr. Elisenda Eixarchof the University of Barcelona reported that perinatal death in preterm IUGR fetuses is associated with the presence of markedly abnormal myocardial function before delivery and biomarkers of myocardial cell damage in cord blood.

Among 59 IUGR fetuses, the 8 fetuses who died as compared with survivors had significantly worse myocardial performance index z scores (2.5 vs. 1.7), left E/A (ratio of peak velocity during early diastolic filling to peak velocity during atrial contraction) z scores (2.4 vs. 0.8), and right E/A z scores (2.3 vs. 1). Only cardiac output was not significantly different at 816 mL/min per kilogram in those who died and 750 mL/min per kilogram in survivors.

Significant increases were also observed in fetuses who died versus survivors in B-type natriuretic peptide (350 pg/mL vs. 64 pg/mL), heart-type fatty acid–binding protein (23 mcg/L vs. 11 mcg/L), and troponin I levels (0.07 ng/mL vs. 0.02 ng/mL).

Major Finding: Abdominal aortic intima media thickness was significantly greater in infants with IUGR than in controls, as was blood pressure, in one small study. In a second study of 59 IUGR fetuses, fetal ultrasonographic cardiovascular indices were significantly worse in the fetuses that died compared with survivors.

Data Source: The first study involved 25 infants with IUGR and 25 controls, while the second included 59 IUGR fetuses, in which the 8 fetuses that died were compared with survivors.

Disclosures: None reported.

HAMBURG, GERMANY — The environment experienced in utero was found in two small studies to influence the development of later cardiovascular disease and even perinatal death.

“We found that in fetuses and neonates with intrauterine growth restriction, aortic intima media wall thickness is increased with respect to controls, suggesting that it may represent an in utero marker of potential atherosclerosis development,” lead author Dr. Erich Cosmi said at the World Congress on Ultrasound in Obstetrics and Gynecology.

Doppler ultrasound revealed that maximum abdominal aortic intima media thickness (aIMT) was significantly increased in 25 infants with intrauterine growth restriction (IUGR), compared with 25 controls, at a mean gestational age of 32 weeks (2.05 mm vs. 1.05 mm) and at a mean of 18 months after birth (2.3 mm vs. 1.06 mm).

Blood pressure values were also significantly correlated with prenatal and postnatal aIMT values, reported Dr. Cosmi of the department of obstetrics and gynecology, University of Padua (Italy). Systolic blood pressure was 123 mm Hg in IUGR infants and 104 mm Hg in controls, which was significantly different at a P value of .0004.

When asked by the audience if any of the infants were on hypertension medication at the time of evaluation, Dr. Cosmi responded, “No, but they are now. We didn't know they would have hypertension. It was surprising for us.”

The researchers also assessed renal function after birth, as previous research in animal models suggests a renal contribution to developmentally programmed hypertension.

Compared with controls, IUGR infants had significantly higher urinary microalbumin (4.4 mg/L vs. 10.7 mg/L) and sodium (56 mmol/L vs. 122 mmol/L) levels and albumin/creatinine ratios (14.7 mg/g vs. 26.9 mg/g). All are markers of glomerular function.

Kidney length and volume were similar, as were levels of lysozyme, a marker of tubular function.

“The clinical implications of this study are that fetuses that were IUGR necessitate follow-up after birth, as they are at risk for cardiovascular disease,” Dr. Cosmi said in an interview.

Fetuses were classified as IUGR if their estimated fetal weight was below the 10th percentile with Doppler velocimetry greater than 2 standard deviations.

In a separate study presented during the same session, Dr. Elisenda Eixarchof the University of Barcelona reported that perinatal death in preterm IUGR fetuses is associated with the presence of markedly abnormal myocardial function before delivery and biomarkers of myocardial cell damage in cord blood.

Among 59 IUGR fetuses, the 8 fetuses who died as compared with survivors had significantly worse myocardial performance index z scores (2.5 vs. 1.7), left E/A (ratio of peak velocity during early diastolic filling to peak velocity during atrial contraction) z scores (2.4 vs. 0.8), and right E/A z scores (2.3 vs. 1). Only cardiac output was not significantly different at 816 mL/min per kilogram in those who died and 750 mL/min per kilogram in survivors.

Significant increases were also observed in fetuses who died versus survivors in B-type natriuretic peptide (350 pg/mL vs. 64 pg/mL), heart-type fatty acid–binding protein (23 mcg/L vs. 11 mcg/L), and troponin I levels (0.07 ng/mL vs. 0.02 ng/mL).

Major Finding: Abdominal aortic intima media thickness was significantly greater in infants with IUGR than in controls, as was blood pressure, in one small study. In a second study of 59 IUGR fetuses, fetal ultrasonographic cardiovascular indices were significantly worse in the fetuses that died compared with survivors.

Data Source: The first study involved 25 infants with IUGR and 25 controls, while the second included 59 IUGR fetuses, in which the 8 fetuses that died were compared with survivors.

Disclosures: None reported.

HAMBURG, GERMANY — The environment experienced in utero was found in two small studies to influence the development of later cardiovascular disease and even perinatal death.

“We found that in fetuses and neonates with intrauterine growth restriction, aortic intima media wall thickness is increased with respect to controls, suggesting that it may represent an in utero marker of potential atherosclerosis development,” lead author Dr. Erich Cosmi said at the World Congress on Ultrasound in Obstetrics and Gynecology.

Doppler ultrasound revealed that maximum abdominal aortic intima media thickness (aIMT) was significantly increased in 25 infants with intrauterine growth restriction (IUGR), compared with 25 controls, at a mean gestational age of 32 weeks (2.05 mm vs. 1.05 mm) and at a mean of 18 months after birth (2.3 mm vs. 1.06 mm).

Blood pressure values were also significantly correlated with prenatal and postnatal aIMT values, reported Dr. Cosmi of the department of obstetrics and gynecology, University of Padua (Italy). Systolic blood pressure was 123 mm Hg in IUGR infants and 104 mm Hg in controls, which was significantly different at a P value of .0004.

When asked by the audience if any of the infants were on hypertension medication at the time of evaluation, Dr. Cosmi responded, “No, but they are now. We didn't know they would have hypertension. It was surprising for us.”

The researchers also assessed renal function after birth, as previous research in animal models suggests a renal contribution to developmentally programmed hypertension.

Compared with controls, IUGR infants had significantly higher urinary microalbumin (4.4 mg/L vs. 10.7 mg/L) and sodium (56 mmol/L vs. 122 mmol/L) levels and albumin/creatinine ratios (14.7 mg/g vs. 26.9 mg/g). All are markers of glomerular function.

Kidney length and volume were similar, as were levels of lysozyme, a marker of tubular function.

“The clinical implications of this study are that fetuses that were IUGR necessitate follow-up after birth, as they are at risk for cardiovascular disease,” Dr. Cosmi said in an interview.

Fetuses were classified as IUGR if their estimated fetal weight was below the 10th percentile with Doppler velocimetry greater than 2 standard deviations.

In a separate study presented during the same session, Dr. Elisenda Eixarchof the University of Barcelona reported that perinatal death in preterm IUGR fetuses is associated with the presence of markedly abnormal myocardial function before delivery and biomarkers of myocardial cell damage in cord blood.

Among 59 IUGR fetuses, the 8 fetuses who died as compared with survivors had significantly worse myocardial performance index z scores (2.5 vs. 1.7), left E/A (ratio of peak velocity during early diastolic filling to peak velocity during atrial contraction) z scores (2.4 vs. 0.8), and right E/A z scores (2.3 vs. 1). Only cardiac output was not significantly different at 816 mL/min per kilogram in those who died and 750 mL/min per kilogram in survivors.

Significant increases were also observed in fetuses who died versus survivors in B-type natriuretic peptide (350 pg/mL vs. 64 pg/mL), heart-type fatty acid–binding protein (23 mcg/L vs. 11 mcg/L), and troponin I levels (0.07 ng/mL vs. 0.02 ng/mL).

Major Finding: Obese and overweight women undergoing infertility treatment were less likely to become pregnant and more likely to have a stillbirth or premature birth.

Data Source: A retrospective analysis involving 610 women.

Disclosures: The study was supported by the Society for Assisted Reproductive Technology. The authors disclosed no conflicts of interest.

ATLANTA — Increasing weight among overweight and obese women undergoing infertility treatment dramatically decreases their chance of pregnancy and live birth, and increases the odds of stillbirth or premature birth, according to a retrospective analysis.

Young women under the age of 30 years—an age group that traditionally has the best success rates from infertility treatment—were at greatest risk of being obese and thus having poor outcomes.

“It's quite distressing that among the obese women [seeking infertility treatment], the youngest women represented the largest group—19.6%,” lead author Dr. Barbara Luke said at the annual meeting of the American Society for Reproductive Medicine.

Among 610 women, 41% of normal-weight women became pregnant as a result of assisted reproductive technology (ART) treatment, compared with 40.8% of underweight women, 39.6% of overweight women, and 36.5% of obese women.

Compared with normal-weight women, the odds of a live birth were reduced 14% for overweight women and 22% for obese women, Dr. Luke reported. The difference was significant for overweight and obese women, even after adjustment for maternal age, race and ethnicity, number of embryos transferred, and infertility diagnosis.

Stillbirth was twice as likely for underweight women as normal-weight women, and more than three times as likely for obese women. The odds of stillbirth, however, were significant only for obese women (odds ratio, 2.50) compared with underweight (OR, 1.93); normal-weight (OR, 1.00); and overweight (OR, 1.48) women.

This confirms earlier data that with increasing obesity there is an increased chance of stillbirth, regardless of fertility status, Dr. Luke said.

Increasing weight upped the odds of delivering early, even after the analysis was also adjusted for plurality.

Compared with normal-weight women, the risk of a very early preterm birth, before 29 weeks, was cut by almost one-half in underweight women (OR, 0.52) and by 6% in overweight women (OR, 0.94), but significantly increased by almost 60% in women who were obese (OR, 1.59).

The odds of a preterm birth before 32 weeks were also significantly increased among obese women, while both overweight and obese women had significantly higher odds of delivering before 37 weeks, said Dr. Luke of the obstetrics, gynecology, and reproductive biology department at Michigan State University in East Lansing.

The odds of a term birth at 37 weeks or more were significantly reduced by 13% for overweight women (OR, 0.87) and by 25% for obese women (OR, 0.75), compared with normal-weight (OR, 1.0) and underweight women (OR, 1.1).

“It was a very consistent and dose-dependent response,” Dr. Luke said.

The mechanism driving the poor outcomes may be metabolic, adding that “obesity is a state of inflammation, not a state of health. A 30-pound weight loss would move you to another category and improve outcomes,” she said.

Patients were categorized by body mass index, with 110 women being underweight (BMI less than 18.5 kg/m

Obesity was recorded in 19.6% of women aged less than 30 years, 17% aged 30-34 years, 17.5% aged 35-39 years, 17.9% aged 40-44 years, and 14.1 aged 45 years and older.

Major Finding: Obese and overweight women undergoing infertility treatment were less likely to become pregnant and more likely to have a stillbirth or premature birth.

Data Source: A retrospective analysis involving 610 women.

Disclosures: The study was supported by the Society for Assisted Reproductive Technology. The authors disclosed no conflicts of interest.

ATLANTA — Increasing weight among overweight and obese women undergoing infertility treatment dramatically decreases their chance of pregnancy and live birth, and increases the odds of stillbirth or premature birth, according to a retrospective analysis.

Young women under the age of 30 years—an age group that traditionally has the best success rates from infertility treatment—were at greatest risk of being obese and thus having poor outcomes.

“It's quite distressing that among the obese women [seeking infertility treatment], the youngest women represented the largest group—19.6%,” lead author Dr. Barbara Luke said at the annual meeting of the American Society for Reproductive Medicine.

Among 610 women, 41% of normal-weight women became pregnant as a result of assisted reproductive technology (ART) treatment, compared with 40.8% of underweight women, 39.6% of overweight women, and 36.5% of obese women.

Compared with normal-weight women, the odds of a live birth were reduced 14% for overweight women and 22% for obese women, Dr. Luke reported. The difference was significant for overweight and obese women, even after adjustment for maternal age, race and ethnicity, number of embryos transferred, and infertility diagnosis.

Stillbirth was twice as likely for underweight women as normal-weight women, and more than three times as likely for obese women. The odds of stillbirth, however, were significant only for obese women (odds ratio, 2.50) compared with underweight (OR, 1.93); normal-weight (OR, 1.00); and overweight (OR, 1.48) women.

This confirms earlier data that with increasing obesity there is an increased chance of stillbirth, regardless of fertility status, Dr. Luke said.

Increasing weight upped the odds of delivering early, even after the analysis was also adjusted for plurality.

Compared with normal-weight women, the risk of a very early preterm birth, before 29 weeks, was cut by almost one-half in underweight women (OR, 0.52) and by 6% in overweight women (OR, 0.94), but significantly increased by almost 60% in women who were obese (OR, 1.59).

The odds of a preterm birth before 32 weeks were also significantly increased among obese women, while both overweight and obese women had significantly higher odds of delivering before 37 weeks, said Dr. Luke of the obstetrics, gynecology, and reproductive biology department at Michigan State University in East Lansing.

The odds of a term birth at 37 weeks or more were significantly reduced by 13% for overweight women (OR, 0.87) and by 25% for obese women (OR, 0.75), compared with normal-weight (OR, 1.0) and underweight women (OR, 1.1).

“It was a very consistent and dose-dependent response,” Dr. Luke said.

The mechanism driving the poor outcomes may be metabolic, adding that “obesity is a state of inflammation, not a state of health. A 30-pound weight loss would move you to another category and improve outcomes,” she said.

Patients were categorized by body mass index, with 110 women being underweight (BMI less than 18.5 kg/m

Obesity was recorded in 19.6% of women aged less than 30 years, 17% aged 30-34 years, 17.5% aged 35-39 years, 17.9% aged 40-44 years, and 14.1 aged 45 years and older.

Major Finding: Obese and overweight women undergoing infertility treatment were less likely to become pregnant and more likely to have a stillbirth or premature birth.

Data Source: A retrospective analysis involving 610 women.

Disclosures: The study was supported by the Society for Assisted Reproductive Technology. The authors disclosed no conflicts of interest.

ATLANTA — Increasing weight among overweight and obese women undergoing infertility treatment dramatically decreases their chance of pregnancy and live birth, and increases the odds of stillbirth or premature birth, according to a retrospective analysis.

Young women under the age of 30 years—an age group that traditionally has the best success rates from infertility treatment—were at greatest risk of being obese and thus having poor outcomes.

“It's quite distressing that among the obese women [seeking infertility treatment], the youngest women represented the largest group—19.6%,” lead author Dr. Barbara Luke said at the annual meeting of the American Society for Reproductive Medicine.

Among 610 women, 41% of normal-weight women became pregnant as a result of assisted reproductive technology (ART) treatment, compared with 40.8% of underweight women, 39.6% of overweight women, and 36.5% of obese women.

Compared with normal-weight women, the odds of a live birth were reduced 14% for overweight women and 22% for obese women, Dr. Luke reported. The difference was significant for overweight and obese women, even after adjustment for maternal age, race and ethnicity, number of embryos transferred, and infertility diagnosis.

Stillbirth was twice as likely for underweight women as normal-weight women, and more than three times as likely for obese women. The odds of stillbirth, however, were significant only for obese women (odds ratio, 2.50) compared with underweight (OR, 1.93); normal-weight (OR, 1.00); and overweight (OR, 1.48) women.

This confirms earlier data that with increasing obesity there is an increased chance of stillbirth, regardless of fertility status, Dr. Luke said.

Increasing weight upped the odds of delivering early, even after the analysis was also adjusted for plurality.

Compared with normal-weight women, the risk of a very early preterm birth, before 29 weeks, was cut by almost one-half in underweight women (OR, 0.52) and by 6% in overweight women (OR, 0.94), but significantly increased by almost 60% in women who were obese (OR, 1.59).

The odds of a preterm birth before 32 weeks were also significantly increased among obese women, while both overweight and obese women had significantly higher odds of delivering before 37 weeks, said Dr. Luke of the obstetrics, gynecology, and reproductive biology department at Michigan State University in East Lansing.

The odds of a term birth at 37 weeks or more were significantly reduced by 13% for overweight women (OR, 0.87) and by 25% for obese women (OR, 0.75), compared with normal-weight (OR, 1.0) and underweight women (OR, 1.1).

“It was a very consistent and dose-dependent response,” Dr. Luke said.

The mechanism driving the poor outcomes may be metabolic, adding that “obesity is a state of inflammation, not a state of health. A 30-pound weight loss would move you to another category and improve outcomes,” she said.

Patients were categorized by body mass index, with 110 women being underweight (BMI less than 18.5 kg/m

Obesity was recorded in 19.6% of women aged less than 30 years, 17% aged 30-34 years, 17.5% aged 35-39 years, 17.9% aged 40-44 years, and 14.1 aged 45 years and older.

Major Finding: Oocyte cryopreservation is being offered in more than half of assisted reproductive technology (ART) clinics responding to a national survey, even though the practice is still considered experimental.

Data Source: A prospective survey of 282 ART programs in the Centers for Disease Control and Prevention database across 48 states.

Disclosures: None reported.

ATLANTA — Egg freezing is being offered in more than half of assisted reproductive technology clinics responding to a national survey, even though the practice is still considered experimental.

Moreover, the majority of programs that perform oocyte cryopreservation for cancer indications offer it for elective purposes as well.

Investigators prospectively surveyed 442 assisted reproductive technology programs in the Centers for Disease Control and Prevention database, with 282 (64%) programs across 48 states responding to the survey.

Of these, 143, or 51%, currently offer oocyte cryopreservation. Of those that do not, another 55% said they plan to in the near future, Dr. Briana Rudick and her colleagues reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM). The majority of programs (73%) are community based, while 27% are academic.

In all, 64% of the clinics offering egg freezing do so for elective and/or any indications, 18% for cancer-related purposes, and 18% for any indication, except elective. Independent of whether a clinic currently offers cryopreservation, 66% of all programs felt it could be offered electively.

Almost all (99%) clinics accept patients under the age of 35 for elective indications, 87% accept those aged 35-37 years, 49% consider age 38-40 years acceptable, while only 26% cryopreserve oocytes beyond age 40 years.

“Although oocyte cryopreservation is still considered to be experimental, these data suggest a growing acceptance for this technology within our field,” Dr. Rudick and her colleagues in the division of reproductive endocrinology at the University of Southern California in Los Angeles wrote.

Notably, a willingness to offer egg freezing for elective reasons was significantly associated with location. Clinics in the East are most likely to offer it for nonelective reasons (45.2%), while those in the West are most likely to do so for elective reasons (81.4%), the investigators reported.

According to ASRM, egg and ovarian tissue freezing should not be marketed or offered to healthy women as a means to defer reproductive aging. Because data relating to clinical outcomes are limited, egg and ovarian tissue freezing should be considered experimental techniques only to be performed under investigational protocol under the auspices of an Institutional Review Board (Fertil. Steril. 2006;86[suppl. 1]:S142-7).

More recently however, the group issued a report by its practice committee detailing the “essential elements” of informed consent for elective oocyte cryopreservation (Fertil. Steril. 2008;90[suppl. 1]:S134-5). The document is an effort to ensure patients are adequately informed about the experimental nature of egg freezing, Sean Tipton, ASRM director of public affairs, said in an interview. “We want them to have realistic expectations about the potential use of these oocytes in the future and know the statistics regarding chances for these to result in a child.”

“It still assumes that the clinic has IRB approval or a waiver from the IRB to freeze eggs,” he added.

Outcomes reported for 140 clinics in the current study show that there have been 337 live births resulting from 857 thawed cycles.

The mean fertilization rate was 63% (range, 0%-100%), and the mean pregnancy rate was 37% (range, 0%-100%). The clinics have been offering the procedure for as short as 3 months and as long as 10 years (mean, 2.4 years).

Major Finding: Oocyte cryopreservation is being offered in more than half of assisted reproductive technology (ART) clinics responding to a national survey, even though the practice is still considered experimental.

Data Source: A prospective survey of 282 ART programs in the Centers for Disease Control and Prevention database across 48 states.

Disclosures: None reported.

ATLANTA — Egg freezing is being offered in more than half of assisted reproductive technology clinics responding to a national survey, even though the practice is still considered experimental.

Moreover, the majority of programs that perform oocyte cryopreservation for cancer indications offer it for elective purposes as well.

Investigators prospectively surveyed 442 assisted reproductive technology programs in the Centers for Disease Control and Prevention database, with 282 (64%) programs across 48 states responding to the survey.

Of these, 143, or 51%, currently offer oocyte cryopreservation. Of those that do not, another 55% said they plan to in the near future, Dr. Briana Rudick and her colleagues reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM). The majority of programs (73%) are community based, while 27% are academic.

In all, 64% of the clinics offering egg freezing do so for elective and/or any indications, 18% for cancer-related purposes, and 18% for any indication, except elective. Independent of whether a clinic currently offers cryopreservation, 66% of all programs felt it could be offered electively.

Almost all (99%) clinics accept patients under the age of 35 for elective indications, 87% accept those aged 35-37 years, 49% consider age 38-40 years acceptable, while only 26% cryopreserve oocytes beyond age 40 years.

“Although oocyte cryopreservation is still considered to be experimental, these data suggest a growing acceptance for this technology within our field,” Dr. Rudick and her colleagues in the division of reproductive endocrinology at the University of Southern California in Los Angeles wrote.

Notably, a willingness to offer egg freezing for elective reasons was significantly associated with location. Clinics in the East are most likely to offer it for nonelective reasons (45.2%), while those in the West are most likely to do so for elective reasons (81.4%), the investigators reported.

According to ASRM, egg and ovarian tissue freezing should not be marketed or offered to healthy women as a means to defer reproductive aging. Because data relating to clinical outcomes are limited, egg and ovarian tissue freezing should be considered experimental techniques only to be performed under investigational protocol under the auspices of an Institutional Review Board (Fertil. Steril. 2006;86[suppl. 1]:S142-7).

More recently however, the group issued a report by its practice committee detailing the “essential elements” of informed consent for elective oocyte cryopreservation (Fertil. Steril. 2008;90[suppl. 1]:S134-5). The document is an effort to ensure patients are adequately informed about the experimental nature of egg freezing, Sean Tipton, ASRM director of public affairs, said in an interview. “We want them to have realistic expectations about the potential use of these oocytes in the future and know the statistics regarding chances for these to result in a child.”

“It still assumes that the clinic has IRB approval or a waiver from the IRB to freeze eggs,” he added.

Outcomes reported for 140 clinics in the current study show that there have been 337 live births resulting from 857 thawed cycles.

The mean fertilization rate was 63% (range, 0%-100%), and the mean pregnancy rate was 37% (range, 0%-100%). The clinics have been offering the procedure for as short as 3 months and as long as 10 years (mean, 2.4 years).

Major Finding: Oocyte cryopreservation is being offered in more than half of assisted reproductive technology (ART) clinics responding to a national survey, even though the practice is still considered experimental.

Data Source: A prospective survey of 282 ART programs in the Centers for Disease Control and Prevention database across 48 states.

Disclosures: None reported.

ATLANTA — Egg freezing is being offered in more than half of assisted reproductive technology clinics responding to a national survey, even though the practice is still considered experimental.

Moreover, the majority of programs that perform oocyte cryopreservation for cancer indications offer it for elective purposes as well.

Investigators prospectively surveyed 442 assisted reproductive technology programs in the Centers for Disease Control and Prevention database, with 282 (64%) programs across 48 states responding to the survey.

Of these, 143, or 51%, currently offer oocyte cryopreservation. Of those that do not, another 55% said they plan to in the near future, Dr. Briana Rudick and her colleagues reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM). The majority of programs (73%) are community based, while 27% are academic.

In all, 64% of the clinics offering egg freezing do so for elective and/or any indications, 18% for cancer-related purposes, and 18% for any indication, except elective. Independent of whether a clinic currently offers cryopreservation, 66% of all programs felt it could be offered electively.

Almost all (99%) clinics accept patients under the age of 35 for elective indications, 87% accept those aged 35-37 years, 49% consider age 38-40 years acceptable, while only 26% cryopreserve oocytes beyond age 40 years.

“Although oocyte cryopreservation is still considered to be experimental, these data suggest a growing acceptance for this technology within our field,” Dr. Rudick and her colleagues in the division of reproductive endocrinology at the University of Southern California in Los Angeles wrote.

Notably, a willingness to offer egg freezing for elective reasons was significantly associated with location. Clinics in the East are most likely to offer it for nonelective reasons (45.2%), while those in the West are most likely to do so for elective reasons (81.4%), the investigators reported.

According to ASRM, egg and ovarian tissue freezing should not be marketed or offered to healthy women as a means to defer reproductive aging. Because data relating to clinical outcomes are limited, egg and ovarian tissue freezing should be considered experimental techniques only to be performed under investigational protocol under the auspices of an Institutional Review Board (Fertil. Steril. 2006;86[suppl. 1]:S142-7).

More recently however, the group issued a report by its practice committee detailing the “essential elements” of informed consent for elective oocyte cryopreservation (Fertil. Steril. 2008;90[suppl. 1]:S134-5). The document is an effort to ensure patients are adequately informed about the experimental nature of egg freezing, Sean Tipton, ASRM director of public affairs, said in an interview. “We want them to have realistic expectations about the potential use of these oocytes in the future and know the statistics regarding chances for these to result in a child.”

“It still assumes that the clinic has IRB approval or a waiver from the IRB to freeze eggs,” he added.

Outcomes reported for 140 clinics in the current study show that there have been 337 live births resulting from 857 thawed cycles.

The mean fertilization rate was 63% (range, 0%-100%), and the mean pregnancy rate was 37% (range, 0%-100%). The clinics have been offering the procedure for as short as 3 months and as long as 10 years (mean, 2.4 years).

ATLANTA — A new embryo morphology grading system could revolutionize the way in which patients and physicians compare infertility clinics, investigators reported.

Until now, data from national reporting of in vitro fertilization (IVF) success rates have been used to compare clinics. However, that data can be imprecise, because the severity of patient infertility varies between IVF clinics. Centers that are required to accept all comers inherently have lower success rates than those that can cherry-pick their clientele.

In 2004, several clinics approached the Society for Assisted Reproductive Technology (SART) to consider having clinics report morphologic grades for their embryos, because embryo quality is thought to reflect fertility potential. Some clinics have been collecting these data, but the quality measurements differed between laboratories.

SART developed its own system that grades embryos according to visual characteristics into one of three categories: good, fair, or poor. The society also introduced the morphologic characteristics of cellular symmetry and percentage fragmentation as potential hallmarks of embryonic well-being.

From June 2006 to January 2008, SART asked clinics to voluntarily report their morphology data. Those data have been obtained for 70,293 embryos from 28,186 transfers, representing 19% of all the fresh autologous embryo transfers reported to SART's Clinical Outcomes Reporting System in 2006 and in 32% of all transfers in 2007.

Analyses showed significant differences between good, fair, and poor embryos and live birth rates. Furthermore, the relationship between live births and embryo grade was negatively correlated with increasing maternal age, according to Michael Vernon, Ph.D., who helped develop the system with seven other embryologists led by Catherine Racowsky, Ph.D.

Embryo transfers were performed from 1 to more than 7 days post insemination, with 62% of transfers performed on day 3 and 29% on day 5. The majority of embryos transferred were classified as good on day 3 (70%) and day 5 (78%). Few fair and even fewer poor embryos were transferred on day 3 (24% and 5.5%, respectively) and day 5 (18.6% and 3.6%).

Among women who received two embryos of the same grade, the live birth rate for good embryos was 45% on day 3 and 56% on day 5, compared with 35% and 42% for fair embryos, and just 21% and 30% for poor embryos, Dr. Vernon, chair and professor of obstetrics and gynecology, West Virginia University in Morgantown, and his associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM).

The data are so encouraging that SART is considering mandating that clinics report their embryo morphology information. If that mandate does come to be, clinics will have critical information to aid their quality control and quality assurance activities.

In the current data set, more than 670 embryo transfers contained more than 6 embryos, which is not within SART guidelines of acceptability. In some cases, more than 10 embryos were transferred. In all, 48% of labs transferred only one to two embryos on day 3, and 79% did so on day 5.

That falls within the recently revised SART/ASRM embryo transfer guidelines recommending that only one more embryo be transferred than called for in four age-based prognostic categories.

Related data reported at the same meeting by Dr. Racowsky associate professor of obstetrics and gynecology at Brigham and Women's Hospital, Boston, showed a strong positive correlation for cellular symmetry and percentage fragmentation.

The analysis she presented showed that live birth rate increased from from 2.9% for embryos with less than six cells on day 3, to 24.3% for those with eight cells, but decreased to 16.2% for those with with more than eight cells. The live birth rate decreased from 23% for embryos with perfect symmetry to 11.3% with moderate asymmetry and 4.5% for severe asymmetry. The live birth rate was 21% for embryos with no fragmentation, 11% for those with 10%-25% fragmentation, and just 2.5% for those with greater than 25% fragmentation.

The regression equation derived from this analysis revealed that with a cut-off of 0.3, 76.4% of embryos were classified correctly as either not resulting in a live birth, or giving rise to a live birth.

The authors noted that future analysis of a larger SART data set could increase the accuracy of the morphologic classification system and lead to a Web-based regression equation enabling ranking of embryo viability.

Such an equation would enhance the selection of fewer embryos at embryo transfer and reduce the potential for multiple births.

Moreover, standardization of a national embryo morphology system should assist clinics with quality control and quality assurance activities, thereby improving overall care of infertility patients.

Disclosures: Dr. Racowsky disclosed having served as an adviser to Medicult/Humagen/MidAtlantic Diagnostics and EMD Serono, and as a consultant for Schering-Plough. Dr. Vernon said that he had no disclosures. Data were collected by SART in accordance with requirements for reporting of assisted reproductive technology data to the Centers for Disease Control and Prevention.

ATLANTA — A new embryo morphology grading system could revolutionize the way in which patients and physicians compare infertility clinics, investigators reported.

Until now, data from national reporting of in vitro fertilization (IVF) success rates have been used to compare clinics. However, that data can be imprecise, because the severity of patient infertility varies between IVF clinics. Centers that are required to accept all comers inherently have lower success rates than those that can cherry-pick their clientele.

In 2004, several clinics approached the Society for Assisted Reproductive Technology (SART) to consider having clinics report morphologic grades for their embryos, because embryo quality is thought to reflect fertility potential. Some clinics have been collecting these data, but the quality measurements differed between laboratories.

SART developed its own system that grades embryos according to visual characteristics into one of three categories: good, fair, or poor. The society also introduced the morphologic characteristics of cellular symmetry and percentage fragmentation as potential hallmarks of embryonic well-being.

From June 2006 to January 2008, SART asked clinics to voluntarily report their morphology data. Those data have been obtained for 70,293 embryos from 28,186 transfers, representing 19% of all the fresh autologous embryo transfers reported to SART's Clinical Outcomes Reporting System in 2006 and in 32% of all transfers in 2007.

Analyses showed significant differences between good, fair, and poor embryos and live birth rates. Furthermore, the relationship between live births and embryo grade was negatively correlated with increasing maternal age, according to Michael Vernon, Ph.D., who helped develop the system with seven other embryologists led by Catherine Racowsky, Ph.D.

Embryo transfers were performed from 1 to more than 7 days post insemination, with 62% of transfers performed on day 3 and 29% on day 5. The majority of embryos transferred were classified as good on day 3 (70%) and day 5 (78%). Few fair and even fewer poor embryos were transferred on day 3 (24% and 5.5%, respectively) and day 5 (18.6% and 3.6%).

Among women who received two embryos of the same grade, the live birth rate for good embryos was 45% on day 3 and 56% on day 5, compared with 35% and 42% for fair embryos, and just 21% and 30% for poor embryos, Dr. Vernon, chair and professor of obstetrics and gynecology, West Virginia University in Morgantown, and his associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM).

The data are so encouraging that SART is considering mandating that clinics report their embryo morphology information. If that mandate does come to be, clinics will have critical information to aid their quality control and quality assurance activities.

In the current data set, more than 670 embryo transfers contained more than 6 embryos, which is not within SART guidelines of acceptability. In some cases, more than 10 embryos were transferred. In all, 48% of labs transferred only one to two embryos on day 3, and 79% did so on day 5.

That falls within the recently revised SART/ASRM embryo transfer guidelines recommending that only one more embryo be transferred than called for in four age-based prognostic categories.

Related data reported at the same meeting by Dr. Racowsky associate professor of obstetrics and gynecology at Brigham and Women's Hospital, Boston, showed a strong positive correlation for cellular symmetry and percentage fragmentation.

The analysis she presented showed that live birth rate increased from from 2.9% for embryos with less than six cells on day 3, to 24.3% for those with eight cells, but decreased to 16.2% for those with with more than eight cells. The live birth rate decreased from 23% for embryos with perfect symmetry to 11.3% with moderate asymmetry and 4.5% for severe asymmetry. The live birth rate was 21% for embryos with no fragmentation, 11% for those with 10%-25% fragmentation, and just 2.5% for those with greater than 25% fragmentation.

The regression equation derived from this analysis revealed that with a cut-off of 0.3, 76.4% of embryos were classified correctly as either not resulting in a live birth, or giving rise to a live birth.

The authors noted that future analysis of a larger SART data set could increase the accuracy of the morphologic classification system and lead to a Web-based regression equation enabling ranking of embryo viability.

Such an equation would enhance the selection of fewer embryos at embryo transfer and reduce the potential for multiple births.

Moreover, standardization of a national embryo morphology system should assist clinics with quality control and quality assurance activities, thereby improving overall care of infertility patients.

Disclosures: Dr. Racowsky disclosed having served as an adviser to Medicult/Humagen/MidAtlantic Diagnostics and EMD Serono, and as a consultant for Schering-Plough. Dr. Vernon said that he had no disclosures. Data were collected by SART in accordance with requirements for reporting of assisted reproductive technology data to the Centers for Disease Control and Prevention.

ATLANTA — A new embryo morphology grading system could revolutionize the way in which patients and physicians compare infertility clinics, investigators reported.

Until now, data from national reporting of in vitro fertilization (IVF) success rates have been used to compare clinics. However, that data can be imprecise, because the severity of patient infertility varies between IVF clinics. Centers that are required to accept all comers inherently have lower success rates than those that can cherry-pick their clientele.

In 2004, several clinics approached the Society for Assisted Reproductive Technology (SART) to consider having clinics report morphologic grades for their embryos, because embryo quality is thought to reflect fertility potential. Some clinics have been collecting these data, but the quality measurements differed between laboratories.

SART developed its own system that grades embryos according to visual characteristics into one of three categories: good, fair, or poor. The society also introduced the morphologic characteristics of cellular symmetry and percentage fragmentation as potential hallmarks of embryonic well-being.

From June 2006 to January 2008, SART asked clinics to voluntarily report their morphology data. Those data have been obtained for 70,293 embryos from 28,186 transfers, representing 19% of all the fresh autologous embryo transfers reported to SART's Clinical Outcomes Reporting System in 2006 and in 32% of all transfers in 2007.

Analyses showed significant differences between good, fair, and poor embryos and live birth rates. Furthermore, the relationship between live births and embryo grade was negatively correlated with increasing maternal age, according to Michael Vernon, Ph.D., who helped develop the system with seven other embryologists led by Catherine Racowsky, Ph.D.

Embryo transfers were performed from 1 to more than 7 days post insemination, with 62% of transfers performed on day 3 and 29% on day 5. The majority of embryos transferred were classified as good on day 3 (70%) and day 5 (78%). Few fair and even fewer poor embryos were transferred on day 3 (24% and 5.5%, respectively) and day 5 (18.6% and 3.6%).

Among women who received two embryos of the same grade, the live birth rate for good embryos was 45% on day 3 and 56% on day 5, compared with 35% and 42% for fair embryos, and just 21% and 30% for poor embryos, Dr. Vernon, chair and professor of obstetrics and gynecology, West Virginia University in Morgantown, and his associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine (ASRM).

The data are so encouraging that SART is considering mandating that clinics report their embryo morphology information. If that mandate does come to be, clinics will have critical information to aid their quality control and quality assurance activities.

In the current data set, more than 670 embryo transfers contained more than 6 embryos, which is not within SART guidelines of acceptability. In some cases, more than 10 embryos were transferred. In all, 48% of labs transferred only one to two embryos on day 3, and 79% did so on day 5.

That falls within the recently revised SART/ASRM embryo transfer guidelines recommending that only one more embryo be transferred than called for in four age-based prognostic categories.

Related data reported at the same meeting by Dr. Racowsky associate professor of obstetrics and gynecology at Brigham and Women's Hospital, Boston, showed a strong positive correlation for cellular symmetry and percentage fragmentation.

The analysis she presented showed that live birth rate increased from from 2.9% for embryos with less than six cells on day 3, to 24.3% for those with eight cells, but decreased to 16.2% for those with with more than eight cells. The live birth rate decreased from 23% for embryos with perfect symmetry to 11.3% with moderate asymmetry and 4.5% for severe asymmetry. The live birth rate was 21% for embryos with no fragmentation, 11% for those with 10%-25% fragmentation, and just 2.5% for those with greater than 25% fragmentation.

The regression equation derived from this analysis revealed that with a cut-off of 0.3, 76.4% of embryos were classified correctly as either not resulting in a live birth, or giving rise to a live birth.

The authors noted that future analysis of a larger SART data set could increase the accuracy of the morphologic classification system and lead to a Web-based regression equation enabling ranking of embryo viability.

Such an equation would enhance the selection of fewer embryos at embryo transfer and reduce the potential for multiple births.

Moreover, standardization of a national embryo morphology system should assist clinics with quality control and quality assurance activities, thereby improving overall care of infertility patients.

Disclosures: Dr. Racowsky disclosed having served as an adviser to Medicult/Humagen/MidAtlantic Diagnostics and EMD Serono, and as a consultant for Schering-Plough. Dr. Vernon said that he had no disclosures. Data were collected by SART in accordance with requirements for reporting of assisted reproductive technology data to the Centers for Disease Control and Prevention.

Major Finding: Many oncologists are not likely to mention fertility preservation to cancer patients who have a poor prognosis, contrary to guidelines.

Data Source: A national 53-item survey of 513 U.S. oncologists.

Disclosures: The study was sponsored by the American Cancer Society. Dr. Quinn and her associates stated that they have no conflicts of interest.

ATLANTA — Physicians' attitudes may conflict with recommended guidelines for fertility preservation and reduce the likelihood that cancer patients will receive information about this reproductive option.

That conclusion was drawn from a national 53-item survey of 513 U.S. oncologists, specifically examining physicians' attitudes toward fertility preservation referral among cancer patients with a poor prognosis.

Sixty percent of respondents agreed with the statement that “fertility preservation is a high priority for me to discuss with newly diagnosed cancer patients,” while 26% were unsure and 14% disagreed, Gwendolyn Quinn, Ph.D., and her associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

Overall, 68% of oncologists agreed that “some patients with certain cancers, e.g., hereditary breast and ovarian cancer, should be informed about preimplantation genetic diagnosis,” also known as embryo screening, the investigators said.

When these oncologists were asked, however, if they support posthumous parenting, or the parenting of a child born from assisted reproduction subsequent to the patient's death, only 16.2% agreed, 51.5% were unsure, and 32.3% disagreed.

The statement, “Patients with a poor prognosis should not pursue fertility preservation,” evoked similar responses, with 45% of oncologists being unsure, 23% agreeing, and 32% disagreeing.

In a logistic regression analysis, only support of posthumous reproduction was a significant predictor of support for fertility preservation in patients with a poor prognosis, wrote Dr. Quinn of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, and her associates.

Guidelines by the American Society for Reproductive Medicine recommend that physicians inform cancer patients about options for fertility preservation and future reproduction prior to treatment, and that “concerns about the welfare of resulting offspring should not be cause for denying cancer patients assistance in reproducing.”

Fertility, as an issue of quality survivorship, is also part of the agenda of most national advocacy groups, including the American Cancer Society, the Lance Armstrong Foundation, and the Young Survivors Coalition.

Many physicians assume a patient with late-stage disease or a poor prognosis is not a candidate for fertility preservation, Dr. Quinn said in an interview.

“There are multiple cases of couples/families using stored sperm or embryos to expand families after the death of the loved one,” she said.

“However, people may not go public with this because it can be perceived as 'strange' or odd. As a consequence, physicians may not be aware of what patients and families are doing,” she said.

The bottom line, however, is that all of the national guidelines that address fertility preservation specify that “all” patients should receive information on the matter. “It is not for the physician to pick and choose who gets the information,” Dr. Quinn said.

The majority of respondents were male (70%), white (76%), and Catholic (30%) and had children (85%). Most physicians had graduated from medical school in 1991 or earlier, and practiced primarily at a teaching hospital, university-affiliated cancer center, National Cancer Institute–designated center, or location other than a private oncology practice.

Dr. Quinn said that national guidelines are a slow and ineffective way to create behavior change, noting that the American Society of Clinical Oncology and American Academy of Pediatrics also have existing recommendations on fertility preservation.

One aspect of awareness raising that seems to work well is testimonials by patients about why fertility preservation is important to them, the regret and remorse they feel when they did not receive it, and the types of family-building options patients have pursued, she said.

'It is not for the physician to pick and choose who gets the information.'

Source DR. QUINN

Major Finding: Many oncologists are not likely to mention fertility preservation to cancer patients who have a poor prognosis, contrary to guidelines.

Data Source: A national 53-item survey of 513 U.S. oncologists.

Disclosures: The study was sponsored by the American Cancer Society. Dr. Quinn and her associates stated that they have no conflicts of interest.

ATLANTA — Physicians' attitudes may conflict with recommended guidelines for fertility preservation and reduce the likelihood that cancer patients will receive information about this reproductive option.

That conclusion was drawn from a national 53-item survey of 513 U.S. oncologists, specifically examining physicians' attitudes toward fertility preservation referral among cancer patients with a poor prognosis.

Sixty percent of respondents agreed with the statement that “fertility preservation is a high priority for me to discuss with newly diagnosed cancer patients,” while 26% were unsure and 14% disagreed, Gwendolyn Quinn, Ph.D., and her associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

Overall, 68% of oncologists agreed that “some patients with certain cancers, e.g., hereditary breast and ovarian cancer, should be informed about preimplantation genetic diagnosis,” also known as embryo screening, the investigators said.

When these oncologists were asked, however, if they support posthumous parenting, or the parenting of a child born from assisted reproduction subsequent to the patient's death, only 16.2% agreed, 51.5% were unsure, and 32.3% disagreed.

The statement, “Patients with a poor prognosis should not pursue fertility preservation,” evoked similar responses, with 45% of oncologists being unsure, 23% agreeing, and 32% disagreeing.

In a logistic regression analysis, only support of posthumous reproduction was a significant predictor of support for fertility preservation in patients with a poor prognosis, wrote Dr. Quinn of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, and her associates.

Guidelines by the American Society for Reproductive Medicine recommend that physicians inform cancer patients about options for fertility preservation and future reproduction prior to treatment, and that “concerns about the welfare of resulting offspring should not be cause for denying cancer patients assistance in reproducing.”

Fertility, as an issue of quality survivorship, is also part of the agenda of most national advocacy groups, including the American Cancer Society, the Lance Armstrong Foundation, and the Young Survivors Coalition.

Many physicians assume a patient with late-stage disease or a poor prognosis is not a candidate for fertility preservation, Dr. Quinn said in an interview.

“There are multiple cases of couples/families using stored sperm or embryos to expand families after the death of the loved one,” she said.

“However, people may not go public with this because it can be perceived as 'strange' or odd. As a consequence, physicians may not be aware of what patients and families are doing,” she said.

The bottom line, however, is that all of the national guidelines that address fertility preservation specify that “all” patients should receive information on the matter. “It is not for the physician to pick and choose who gets the information,” Dr. Quinn said.

The majority of respondents were male (70%), white (76%), and Catholic (30%) and had children (85%). Most physicians had graduated from medical school in 1991 or earlier, and practiced primarily at a teaching hospital, university-affiliated cancer center, National Cancer Institute–designated center, or location other than a private oncology practice.

Dr. Quinn said that national guidelines are a slow and ineffective way to create behavior change, noting that the American Society of Clinical Oncology and American Academy of Pediatrics also have existing recommendations on fertility preservation.

One aspect of awareness raising that seems to work well is testimonials by patients about why fertility preservation is important to them, the regret and remorse they feel when they did not receive it, and the types of family-building options patients have pursued, she said.

'It is not for the physician to pick and choose who gets the information.'

Source DR. QUINN

Major Finding: Many oncologists are not likely to mention fertility preservation to cancer patients who have a poor prognosis, contrary to guidelines.

Data Source: A national 53-item survey of 513 U.S. oncologists.

Disclosures: The study was sponsored by the American Cancer Society. Dr. Quinn and her associates stated that they have no conflicts of interest.

ATLANTA — Physicians' attitudes may conflict with recommended guidelines for fertility preservation and reduce the likelihood that cancer patients will receive information about this reproductive option.

That conclusion was drawn from a national 53-item survey of 513 U.S. oncologists, specifically examining physicians' attitudes toward fertility preservation referral among cancer patients with a poor prognosis.

Sixty percent of respondents agreed with the statement that “fertility preservation is a high priority for me to discuss with newly diagnosed cancer patients,” while 26% were unsure and 14% disagreed, Gwendolyn Quinn, Ph.D., and her associates reported in a poster at the annual meeting of the American Society for Reproductive Medicine.

Overall, 68% of oncologists agreed that “some patients with certain cancers, e.g., hereditary breast and ovarian cancer, should be informed about preimplantation genetic diagnosis,” also known as embryo screening, the investigators said.

When these oncologists were asked, however, if they support posthumous parenting, or the parenting of a child born from assisted reproduction subsequent to the patient's death, only 16.2% agreed, 51.5% were unsure, and 32.3% disagreed.

The statement, “Patients with a poor prognosis should not pursue fertility preservation,” evoked similar responses, with 45% of oncologists being unsure, 23% agreeing, and 32% disagreeing.

In a logistic regression analysis, only support of posthumous reproduction was a significant predictor of support for fertility preservation in patients with a poor prognosis, wrote Dr. Quinn of the H. Lee Moffitt Cancer Center and Research Institute, Tampa, and her associates.

Guidelines by the American Society for Reproductive Medicine recommend that physicians inform cancer patients about options for fertility preservation and future reproduction prior to treatment, and that “concerns about the welfare of resulting offspring should not be cause for denying cancer patients assistance in reproducing.”

Fertility, as an issue of quality survivorship, is also part of the agenda of most national advocacy groups, including the American Cancer Society, the Lance Armstrong Foundation, and the Young Survivors Coalition.

Many physicians assume a patient with late-stage disease or a poor prognosis is not a candidate for fertility preservation, Dr. Quinn said in an interview.

“There are multiple cases of couples/families using stored sperm or embryos to expand families after the death of the loved one,” she said.

“However, people may not go public with this because it can be perceived as 'strange' or odd. As a consequence, physicians may not be aware of what patients and families are doing,” she said.

The bottom line, however, is that all of the national guidelines that address fertility preservation specify that “all” patients should receive information on the matter. “It is not for the physician to pick and choose who gets the information,” Dr. Quinn said.

The majority of respondents were male (70%), white (76%), and Catholic (30%) and had children (85%). Most physicians had graduated from medical school in 1991 or earlier, and practiced primarily at a teaching hospital, university-affiliated cancer center, National Cancer Institute–designated center, or location other than a private oncology practice.

Dr. Quinn said that national guidelines are a slow and ineffective way to create behavior change, noting that the American Society of Clinical Oncology and American Academy of Pediatrics also have existing recommendations on fertility preservation.

One aspect of awareness raising that seems to work well is testimonials by patients about why fertility preservation is important to them, the regret and remorse they feel when they did not receive it, and the types of family-building options patients have pursued, she said.

'It is not for the physician to pick and choose who gets the information.'

Source DR. QUINN

Major Finding: Elastography correctly identified 98% of lesions shown on biopsy to be malignant, and 78% of lesions shown on biopsy to be benign.

Data Source: A study of 193 women.

Disclosures: Dr. Destounis disclosed being a consultant for Carestream Health Inc., an advisory board member for Siemens AG, and an investigator for Siemens, Fujifilm Holdings Corp., Hologic Inc., and U-Systems Inc.

CHICAGO — The use of elastography, or the ability to measure the stiffness of lesions during ultrasound, may help distinguish benign from malignant breast lesions, suggest results of a study of 193 women.

Elastography correctly identified 98% of lesions that were shown on biopsy to be malignant. With biopsied benign lesions, elastography properly identified 78% of the lesions, Dr. Stamatia V. Destounis, a diagnostic radiologist at a breast-imaging and diagnosis center in Rochester, N.Y., reported in a poster at the annual meeting of the Radiological Society of North America.

“The addition of elastography could potentially help decrease the need to perform a biopsy, or could reduce the need for additional imaging of benign lesions, thus reducing the associated patient anxiety,” she told reporters, noting that as many as 20% of young women have breast fibroadenomas.

Elastography software has been available for some time, but is having a resurgence in recent years, particularly in thyroid, prostate, and breast applications as the technology advances and the software is included on new imaging units. The technology can also be applied to a standard unit without an additional upgrade, with the images read side by side, she said at a press briefing.

Overall, elasticity imaging increases the specificity of ultrasound by measuring the compressibility and mechanical properties of a lesion. Tumors are typically stiffer than surrounding tissue, whereas cysts demonstrate a “bull's eye” appearance on elastography, Dr. Destounis said. Cancerous lesions also tend to be larger than benign findings on elastography.

The study was conducted in 2007-2009 and included 193 patients (average age, 54 years) who underwent elastography at the time of standard breast ultrasound utilizing a Siemens Sonoline Antares or Siemens S2000 ultrasound unit.

A total of 58 lesions did not undergo biopsy and were predetermined to be benign. Biopsies were performed in 140 lesions, of which 59 were cancers, 69 were benign, 1 was an atypical papillary neoplasm, and 11 were cyst aspirations in which fluid was drained and the abnormality resolved. Of the 140 biopsies, the elastogram image correlated with the standard B-mode ultrasound image in 58 of the 59 cancers (98%), said Dr. Destounis, also of the department of imaging sciences at the University of Rochester.

Of the 69 benign findings observed, the elastogram and B-mode ultrasound images correlated in 54 (78%) of cases. Four did not correlate and measured larger on elastography, and 11 cases were unclear, she said.

Although the data are early, elastography is a promising adjunct imaging tool, Dr. Destounis said.

“Women are becoming more and more concerned about unnecessary procedures and unnecessary needle biopsies and the anxiety that creates,” she said. “I think this may be an additional tool, specifically for some of the benign findings like the fibroadenomas in young women or some of the cystic structures that you can really identify with elastography. You have to use your clinical judgment. I'm not using elastography in a vacuum. I'm using it in correlation with everything else.”

For some women, the information gained through elastography will be enough to defer a biopsy, but others will not be comfortable until a biopsy has been performed, she said.

Although the data are early, elastography is a promising adjunct imaging tool.

Source DR. DESTOUNIS

This ultrasound (left) shows a solid mass. When elasticity software is applied, the mass is noticeably larger (right). Biopsy proved this to be invasive cancer.

The nodule on ultrasound (left) appears consistent with a known fibroadenoma. Elasticity imaging (right) shows the fibroadenoma as markedly smaller.

Source Images courtesy Radiological Society of North America

Major Finding: Elastography correctly identified 98% of lesions shown on biopsy to be malignant, and 78% of lesions shown on biopsy to be benign.

Data Source: A study of 193 women.

Disclosures: Dr. Destounis disclosed being a consultant for Carestream Health Inc., an advisory board member for Siemens AG, and an investigator for Siemens, Fujifilm Holdings Corp., Hologic Inc., and U-Systems Inc.

CHICAGO — The use of elastography, or the ability to measure the stiffness of lesions during ultrasound, may help distinguish benign from malignant breast lesions, suggest results of a study of 193 women.

Elastography correctly identified 98% of lesions that were shown on biopsy to be malignant. With biopsied benign lesions, elastography properly identified 78% of the lesions, Dr. Stamatia V. Destounis, a diagnostic radiologist at a breast-imaging and diagnosis center in Rochester, N.Y., reported in a poster at the annual meeting of the Radiological Society of North America.

“The addition of elastography could potentially help decrease the need to perform a biopsy, or could reduce the need for additional imaging of benign lesions, thus reducing the associated patient anxiety,” she told reporters, noting that as many as 20% of young women have breast fibroadenomas.

Elastography software has been available for some time, but is having a resurgence in recent years, particularly in thyroid, prostate, and breast applications as the technology advances and the software is included on new imaging units. The technology can also be applied to a standard unit without an additional upgrade, with the images read side by side, she said at a press briefing.

Overall, elasticity imaging increases the specificity of ultrasound by measuring the compressibility and mechanical properties of a lesion. Tumors are typically stiffer than surrounding tissue, whereas cysts demonstrate a “bull's eye” appearance on elastography, Dr. Destounis said. Cancerous lesions also tend to be larger than benign findings on elastography.

The study was conducted in 2007-2009 and included 193 patients (average age, 54 years) who underwent elastography at the time of standard breast ultrasound utilizing a Siemens Sonoline Antares or Siemens S2000 ultrasound unit.

A total of 58 lesions did not undergo biopsy and were predetermined to be benign. Biopsies were performed in 140 lesions, of which 59 were cancers, 69 were benign, 1 was an atypical papillary neoplasm, and 11 were cyst aspirations in which fluid was drained and the abnormality resolved. Of the 140 biopsies, the elastogram image correlated with the standard B-mode ultrasound image in 58 of the 59 cancers (98%), said Dr. Destounis, also of the department of imaging sciences at the University of Rochester.

Of the 69 benign findings observed, the elastogram and B-mode ultrasound images correlated in 54 (78%) of cases. Four did not correlate and measured larger on elastography, and 11 cases were unclear, she said.

Although the data are early, elastography is a promising adjunct imaging tool, Dr. Destounis said.

“Women are becoming more and more concerned about unnecessary procedures and unnecessary needle biopsies and the anxiety that creates,” she said. “I think this may be an additional tool, specifically for some of the benign findings like the fibroadenomas in young women or some of the cystic structures that you can really identify with elastography. You have to use your clinical judgment. I'm not using elastography in a vacuum. I'm using it in correlation with everything else.”

For some women, the information gained through elastography will be enough to defer a biopsy, but others will not be comfortable until a biopsy has been performed, she said.

Although the data are early, elastography is a promising adjunct imaging tool.

Source DR. DESTOUNIS

This ultrasound (left) shows a solid mass. When elasticity software is applied, the mass is noticeably larger (right). Biopsy proved this to be invasive cancer.

The nodule on ultrasound (left) appears consistent with a known fibroadenoma. Elasticity imaging (right) shows the fibroadenoma as markedly smaller.

Source Images courtesy Radiological Society of North America

Major Finding: Elastography correctly identified 98% of lesions shown on biopsy to be malignant, and 78% of lesions shown on biopsy to be benign.

Data Source: A study of 193 women.

Disclosures: Dr. Destounis disclosed being a consultant for Carestream Health Inc., an advisory board member for Siemens AG, and an investigator for Siemens, Fujifilm Holdings Corp., Hologic Inc., and U-Systems Inc.

CHICAGO — The use of elastography, or the ability to measure the stiffness of lesions during ultrasound, may help distinguish benign from malignant breast lesions, suggest results of a study of 193 women.

Elastography correctly identified 98% of lesions that were shown on biopsy to be malignant. With biopsied benign lesions, elastography properly identified 78% of the lesions, Dr. Stamatia V. Destounis, a diagnostic radiologist at a breast-imaging and diagnosis center in Rochester, N.Y., reported in a poster at the annual meeting of the Radiological Society of North America.

“The addition of elastography could potentially help decrease the need to perform a biopsy, or could reduce the need for additional imaging of benign lesions, thus reducing the associated patient anxiety,” she told reporters, noting that as many as 20% of young women have breast fibroadenomas.

Elastography software has been available for some time, but is having a resurgence in recent years, particularly in thyroid, prostate, and breast applications as the technology advances and the software is included on new imaging units. The technology can also be applied to a standard unit without an additional upgrade, with the images read side by side, she said at a press briefing.

Overall, elasticity imaging increases the specificity of ultrasound by measuring the compressibility and mechanical properties of a lesion. Tumors are typically stiffer than surrounding tissue, whereas cysts demonstrate a “bull's eye” appearance on elastography, Dr. Destounis said. Cancerous lesions also tend to be larger than benign findings on elastography.

The study was conducted in 2007-2009 and included 193 patients (average age, 54 years) who underwent elastography at the time of standard breast ultrasound utilizing a Siemens Sonoline Antares or Siemens S2000 ultrasound unit.

A total of 58 lesions did not undergo biopsy and were predetermined to be benign. Biopsies were performed in 140 lesions, of which 59 were cancers, 69 were benign, 1 was an atypical papillary neoplasm, and 11 were cyst aspirations in which fluid was drained and the abnormality resolved. Of the 140 biopsies, the elastogram image correlated with the standard B-mode ultrasound image in 58 of the 59 cancers (98%), said Dr. Destounis, also of the department of imaging sciences at the University of Rochester.

Of the 69 benign findings observed, the elastogram and B-mode ultrasound images correlated in 54 (78%) of cases. Four did not correlate and measured larger on elastography, and 11 cases were unclear, she said.

Although the data are early, elastography is a promising adjunct imaging tool, Dr. Destounis said.

“Women are becoming more and more concerned about unnecessary procedures and unnecessary needle biopsies and the anxiety that creates,” she said. “I think this may be an additional tool, specifically for some of the benign findings like the fibroadenomas in young women or some of the cystic structures that you can really identify with elastography. You have to use your clinical judgment. I'm not using elastography in a vacuum. I'm using it in correlation with everything else.”

For some women, the information gained through elastography will be enough to defer a biopsy, but others will not be comfortable until a biopsy has been performed, she said.

Although the data are early, elastography is a promising adjunct imaging tool.

Source DR. DESTOUNIS

This ultrasound (left) shows a solid mass. When elasticity software is applied, the mass is noticeably larger (right). Biopsy proved this to be invasive cancer.

The nodule on ultrasound (left) appears consistent with a known fibroadenoma. Elasticity imaging (right) shows the fibroadenoma as markedly smaller.

Source Images courtesy Radiological Society of North America

Major Finding: Live 3-D volume imaging provided the “face-on” view of the fetal interventricular septum in all but 1 of 153 singleton pregnancies.

Data Source: Exams were performed on an iU-22 ultrasound scanner, with images taken between 20 and 30 weeks' gestation.

Disclosures: None reported.

HAMBURG, GERMANY — A novel technique that incorporates motion into 3-D ultrasonography allows clinicians to rapidly capture a view of the fetal heart that is difficult to obtain by standard sonography, according to Dr. Yi Xiong.

In a study of 153 singleton pregnancies, the en face, or “face-on,” view of the fetal interventricular septum was visualized using live 3-D imaging in all but 1 case, Dr. Xiong reported at the World Congress on Ultrasound in Obstetrics and Gynecology.

There were seven abnormal cases including one isolated ventricular septal defect, one atrioventricular septal defect, three truncus arteriosus with ventricular septal defects, and one case of tetralogy of Fallot.

Only one case—a transposition of the great arteries without a ventricular septal defect—could not be displayed with live 3-D imaging. It was subsequently diagnosed by 2-D ultrasound and confirmed by postnatal echocardiography and surgery.

Although further studies are required to evaluate the sensitivity and reproducibility of this technique in a large population, live 3-D imaging may be a useful tool for the rapid assessment and diagnosis of fetal ventricular septal defects, said Dr. Xiong of the Prince of Wales Hospital at the Chinese University of Hong Kong.

Defects in the crest of the interventricular septum, the atrioventricular valves, and outflow tracts make up the majority of congenital heart defects observed in infants.

Ultrasound is the modality of choice to assess the fetal heart, but even with 3-D ultrasound, the rapid beating of the fetal heart can result in motion artifact. Several methods have been used in an attempt to reduce this limitation.

“The 3-D images can be acquired in real time; therefore, the motion artifacts are no longer a problem,” coauthor Dr. Tze Kin Lau, also with the university, said in an interview.

In the current study, the exams were performed on an iU-22 ultrasound scanner (Philips Medical System) with a 7-2 MHz matrix-array transducer. All images were taken between 20 and 30 weeks' gestation, Dr. Xiong said.

With an apical four-chamber view as the starting point, the live 3-D imaging function is activated; the acquisition angle is adjusted to 72 degrees, and the volume is cropped along the z-axis to display the 3-D image of the four-chamber view.

When the fetus remains quiescent for 1-2 seconds, the “freeze” button is pressed, creating a cine sequence of real-time 3-D volumes, Dr. Xiong explained.

The best volume is chosen and then cropped along the x-axis by moving the red “render box” to the right side of the interventricular septum (IVS). The resultant volume is then turned 90 degrees along the y-axis to make the right side of the IVS face the operator. Finally, the green render box is scrolled back along the original z-axis for complete display of the en face view of the IVS.

Although live 3-D imaging was used in the study, Dr. Lau acknowledged that conventional 2-D ultrasound is usually used at their hospital to identify congenital heart defects.

Major Finding: Live 3-D volume imaging provided the “face-on” view of the fetal interventricular septum in all but 1 of 153 singleton pregnancies.

Data Source: Exams were performed on an iU-22 ultrasound scanner, with images taken between 20 and 30 weeks' gestation.

Disclosures: None reported.

HAMBURG, GERMANY — A novel technique that incorporates motion into 3-D ultrasonography allows clinicians to rapidly capture a view of the fetal heart that is difficult to obtain by standard sonography, according to Dr. Yi Xiong.

In a study of 153 singleton pregnancies, the en face, or “face-on,” view of the fetal interventricular septum was visualized using live 3-D imaging in all but 1 case, Dr. Xiong reported at the World Congress on Ultrasound in Obstetrics and Gynecology.

There were seven abnormal cases including one isolated ventricular septal defect, one atrioventricular septal defect, three truncus arteriosus with ventricular septal defects, and one case of tetralogy of Fallot.

Only one case—a transposition of the great arteries without a ventricular septal defect—could not be displayed with live 3-D imaging. It was subsequently diagnosed by 2-D ultrasound and confirmed by postnatal echocardiography and surgery.

Although further studies are required to evaluate the sensitivity and reproducibility of this technique in a large population, live 3-D imaging may be a useful tool for the rapid assessment and diagnosis of fetal ventricular septal defects, said Dr. Xiong of the Prince of Wales Hospital at the Chinese University of Hong Kong.

Defects in the crest of the interventricular septum, the atrioventricular valves, and outflow tracts make up the majority of congenital heart defects observed in infants.

Ultrasound is the modality of choice to assess the fetal heart, but even with 3-D ultrasound, the rapid beating of the fetal heart can result in motion artifact. Several methods have been used in an attempt to reduce this limitation.

“The 3-D images can be acquired in real time; therefore, the motion artifacts are no longer a problem,” coauthor Dr. Tze Kin Lau, also with the university, said in an interview.

In the current study, the exams were performed on an iU-22 ultrasound scanner (Philips Medical System) with a 7-2 MHz matrix-array transducer. All images were taken between 20 and 30 weeks' gestation, Dr. Xiong said.

With an apical four-chamber view as the starting point, the live 3-D imaging function is activated; the acquisition angle is adjusted to 72 degrees, and the volume is cropped along the z-axis to display the 3-D image of the four-chamber view.

When the fetus remains quiescent for 1-2 seconds, the “freeze” button is pressed, creating a cine sequence of real-time 3-D volumes, Dr. Xiong explained.

The best volume is chosen and then cropped along the x-axis by moving the red “render box” to the right side of the interventricular septum (IVS). The resultant volume is then turned 90 degrees along the y-axis to make the right side of the IVS face the operator. Finally, the green render box is scrolled back along the original z-axis for complete display of the en face view of the IVS.

Although live 3-D imaging was used in the study, Dr. Lau acknowledged that conventional 2-D ultrasound is usually used at their hospital to identify congenital heart defects.

Major Finding: Live 3-D volume imaging provided the “face-on” view of the fetal interventricular septum in all but 1 of 153 singleton pregnancies.

Data Source: Exams were performed on an iU-22 ultrasound scanner, with images taken between 20 and 30 weeks' gestation.

Disclosures: None reported.

HAMBURG, GERMANY — A novel technique that incorporates motion into 3-D ultrasonography allows clinicians to rapidly capture a view of the fetal heart that is difficult to obtain by standard sonography, according to Dr. Yi Xiong.

In a study of 153 singleton pregnancies, the en face, or “face-on,” view of the fetal interventricular septum was visualized using live 3-D imaging in all but 1 case, Dr. Xiong reported at the World Congress on Ultrasound in Obstetrics and Gynecology.

There were seven abnormal cases including one isolated ventricular septal defect, one atrioventricular septal defect, three truncus arteriosus with ventricular septal defects, and one case of tetralogy of Fallot.

Only one case—a transposition of the great arteries without a ventricular septal defect—could not be displayed with live 3-D imaging. It was subsequently diagnosed by 2-D ultrasound and confirmed by postnatal echocardiography and surgery.

Although further studies are required to evaluate the sensitivity and reproducibility of this technique in a large population, live 3-D imaging may be a useful tool for the rapid assessment and diagnosis of fetal ventricular septal defects, said Dr. Xiong of the Prince of Wales Hospital at the Chinese University of Hong Kong.

Defects in the crest of the interventricular septum, the atrioventricular valves, and outflow tracts make up the majority of congenital heart defects observed in infants.

Ultrasound is the modality of choice to assess the fetal heart, but even with 3-D ultrasound, the rapid beating of the fetal heart can result in motion artifact. Several methods have been used in an attempt to reduce this limitation.

“The 3-D images can be acquired in real time; therefore, the motion artifacts are no longer a problem,” coauthor Dr. Tze Kin Lau, also with the university, said in an interview.

In the current study, the exams were performed on an iU-22 ultrasound scanner (Philips Medical System) with a 7-2 MHz matrix-array transducer. All images were taken between 20 and 30 weeks' gestation, Dr. Xiong said.

With an apical four-chamber view as the starting point, the live 3-D imaging function is activated; the acquisition angle is adjusted to 72 degrees, and the volume is cropped along the z-axis to display the 3-D image of the four-chamber view.

When the fetus remains quiescent for 1-2 seconds, the “freeze” button is pressed, creating a cine sequence of real-time 3-D volumes, Dr. Xiong explained.

The best volume is chosen and then cropped along the x-axis by moving the red “render box” to the right side of the interventricular septum (IVS). The resultant volume is then turned 90 degrees along the y-axis to make the right side of the IVS face the operator. Finally, the green render box is scrolled back along the original z-axis for complete display of the en face view of the IVS.

Although live 3-D imaging was used in the study, Dr. Lau acknowledged that conventional 2-D ultrasound is usually used at their hospital to identify congenital heart defects.