Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD
Infertility treatment can be physically uncomfortable, time-consuming, exhausting, and costly — all without a guarantee of success. The infertility experience for many can range from multiple diagnostic procedures through progressively more aggressive treatment options, all of which impose demands upon the emotional and physical self. It's no wonder that many women experience severe stress, depression, or anxiety during treatment for infertility.
It is possible although difficult to relieve some of the stress and pressure of infertility treatment. Some tried-and-true stress control suggestions from former infertility patients and counselors include the following:
Accept that you are experiencing a time of heightened stress and don't try to downplay or deny its effects. You may find that you need to cut back on some or all of your nonessential obligations or activities for a while. Give yourself permission to say 'no' to nonessential commitments and demands on your time.
Don't suffer alone. Confide in a trusted friend, loved one, or support group. Social support networks can tremendously reduce feelings of stress and emotional pain. Many infertility clinics also offer support groups and/or counseling services. If you're trying to conceive as a couple, accept that your partner may also feel stress, depression, or anxiety and may not be able to provide all the emotional support you require right now.
Join RESOLVE, the National Infertility Association. You should be able to find a local chapter in your area. Individual chapters sponsor support groups, newsletters, and seminars and lectures on treatment options. Both health care providers and patients make up the membership of this valuable organizational resource.
Empower yourself with knowledge about the procedures and treatments you may need. After researching on the Web, write down a list of questions to take with you to your next appointment if you feel there are issues you'd like to clarify.
Decide in advance with whom you want to share your experience, and plan some strategies for avoiding inappropriate questions and unwanted advice from colleagues and acquaintances.
Discuss the possibility of treatment breaks with your doctor, if you feel that you need "time off" from the experience. Some people prefer to be treated every other month or every few menstrual cycles, while others are stressed by the waiting periods. Work with your doctor to find a treatment schedule that is comfortable for you.
Know that it's common for women in the midst of treatment to experience feelings of depression or sadness, and sometimes these feelings are strongest when participating in baby or child centered functions. Don't feel guilty if you want to pass up the baby shower or child's birthday party you're invited to. Taking care of yourself and your emotional needs is the top priority now.
Ask a doctor for your medical problems free
Monday, July 13, 2009
Sunday, July 5, 2009
NIAID study finds higher dose of flu vaccine improves response in elderly
There may be a simple way to provide elderly Americans with extra protection against the annual flu virus: give them a higher dose of seasonal flu vaccine.
This idea is suggested by the results of a newly reported clinical trial supported by the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH).
The trial, described in the latest issue of the Archives of Internal Medicine, was conducted by a team of researchers from Baylor College of Medicine in Houston, TX, and sanofi pasteur, the vaccines business of the sanofi-aventis Group in Paris. Led by Dr. Wendy Keitel, M.D., the team conducted the trial at the Baylor Vaccine and Treatment Evaluation Unit, which is one of a network of NIAID-supported sites at university research hospitals across the United States that conduct Phase I and II clinical trials to test and evaluate candidate vaccines for infectious diseases.
NIH Director Elias A. Zerhouni, M.D., notes, "The study results reported by Dr. Keitel and her colleagues are important because they suggest that a higher dose of seasonal influenza vaccine can safely and significantly increase the immune responses of older people."
"Elderly Americans are among the most vulnerable to serious complications of influenza because they generally have more underlying diseases and weaker immune systems than younger people," says NIAID Director Anthony S. Fauci, M.D. "These findings are an important first step in developing new strategies to better protect the elderly against influenza-associated hospitalizations and mortality."
"If you look at people who are dying and going into the hospital during an outbreak of seasonal influenza," says Dr. Keitel, "the majority of those people are older individuals."
Influenza accounts for some 36,000 deaths and more than 200,000 hospitalizations every year in the United States. It is among America's most lethal killers simply because the virus infects so many people--some 5 to 20 percent of the U.S. population every year.
In other influenza vaccine studies, higher antibody levels resulted in better protection against infection. Conversely, decreased antibody production in the elderly can leave them more susceptible to infection and the severe complications of influenza. Helping elderly people increase antibody production should help them fight off influenza infections, and this is exactly what Dr. Keitel and her colleagues set out to test when they began the clinical trial. They hypothesized that elderly people could be given higher doses of vaccine safely and that these higher doses would increase the antibody response and confer increased protection without increasing side effects.
In the study, the investigators randomly assigned 202 adults 65 years of age or older into four equal-sized groups: those receiving the normal dose of vaccine (15 micrograms); twice the normal dose (30 micrograms); four times the normal dose (60 micrograms); or a placebo. The average age of the volunteers was 72.4 years. All study participants were followed for a month post-vaccination to look for any vaccine-related side effects and to collect blood to evaluate antibody responses.
Dr. Keitel and her colleagues found that participants in the high-dose group (60 micrograms) had 44 to 79 percent higher levels of antibody than did those who received the normal dose of vaccine. Higher doses also increased the number of elderly volunteers achieving levels of antibody that have been associated with protection against influenza. Moreover, the vaccine was well-tolerated at all dosage levels. Although the higher doses of vaccine caused more mild side effects at the injection site, there were no significant differences in systemic symptoms such as fever or body aches among the groups.
The successful achievement of higher levels of antibodies in this study suggests that larger doses of vaccine may be a safe and viable way of enhancing protection against influenza among elderly persons. These promising results provide a basis for further evaluation of enhanced potency vaccines in the elderly, says Dr. Keitel.
Ask a doctor for your medical problems free
This idea is suggested by the results of a newly reported clinical trial supported by the National Institute of Allergy and Infectious Diseases (NIAID), a component of the National Institutes of Health (NIH).
The trial, described in the latest issue of the Archives of Internal Medicine, was conducted by a team of researchers from Baylor College of Medicine in Houston, TX, and sanofi pasteur, the vaccines business of the sanofi-aventis Group in Paris. Led by Dr. Wendy Keitel, M.D., the team conducted the trial at the Baylor Vaccine and Treatment Evaluation Unit, which is one of a network of NIAID-supported sites at university research hospitals across the United States that conduct Phase I and II clinical trials to test and evaluate candidate vaccines for infectious diseases.
NIH Director Elias A. Zerhouni, M.D., notes, "The study results reported by Dr. Keitel and her colleagues are important because they suggest that a higher dose of seasonal influenza vaccine can safely and significantly increase the immune responses of older people."
"Elderly Americans are among the most vulnerable to serious complications of influenza because they generally have more underlying diseases and weaker immune systems than younger people," says NIAID Director Anthony S. Fauci, M.D. "These findings are an important first step in developing new strategies to better protect the elderly against influenza-associated hospitalizations and mortality."
"If you look at people who are dying and going into the hospital during an outbreak of seasonal influenza," says Dr. Keitel, "the majority of those people are older individuals."
Influenza accounts for some 36,000 deaths and more than 200,000 hospitalizations every year in the United States. It is among America's most lethal killers simply because the virus infects so many people--some 5 to 20 percent of the U.S. population every year.
In other influenza vaccine studies, higher antibody levels resulted in better protection against infection. Conversely, decreased antibody production in the elderly can leave them more susceptible to infection and the severe complications of influenza. Helping elderly people increase antibody production should help them fight off influenza infections, and this is exactly what Dr. Keitel and her colleagues set out to test when they began the clinical trial. They hypothesized that elderly people could be given higher doses of vaccine safely and that these higher doses would increase the antibody response and confer increased protection without increasing side effects.
In the study, the investigators randomly assigned 202 adults 65 years of age or older into four equal-sized groups: those receiving the normal dose of vaccine (15 micrograms); twice the normal dose (30 micrograms); four times the normal dose (60 micrograms); or a placebo. The average age of the volunteers was 72.4 years. All study participants were followed for a month post-vaccination to look for any vaccine-related side effects and to collect blood to evaluate antibody responses.
Dr. Keitel and her colleagues found that participants in the high-dose group (60 micrograms) had 44 to 79 percent higher levels of antibody than did those who received the normal dose of vaccine. Higher doses also increased the number of elderly volunteers achieving levels of antibody that have been associated with protection against influenza. Moreover, the vaccine was well-tolerated at all dosage levels. Although the higher doses of vaccine caused more mild side effects at the injection site, there were no significant differences in systemic symptoms such as fever or body aches among the groups.
The successful achievement of higher levels of antibodies in this study suggests that larger doses of vaccine may be a safe and viable way of enhancing protection against influenza among elderly persons. These promising results provide a basis for further evaluation of enhanced potency vaccines in the elderly, says Dr. Keitel.
Ask a doctor for your medical problems free
Thursday, July 2, 2009
New cause of sexual dysfunction in women revealed
Researchers at Yale School of Medicine and the Albert Einstein College of Medicine have found that female sexual dysfunction (FSD) affects 48.2 percent of women in a new study and that these women had decreased sensation in the clitoris, which increased the risk of sexual dysfunction.
"There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.
Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men.
"The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD."
The trial was conducted while Connell was at the Albert Einstein College of Medicine. The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region.
The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women.
###
Other authors on the study included Marsha K. Guess, M.D., Julie La Combe, M.D., Andrea Wang, M.D., Kenneth Powers, M.D., George Lazarou, M.D. and Magdy Mikhail, M.D.
"There is a paucity of data available on FSD and this study brings attention to the possibility of a neurological cause for the dysfunction," said lead author Kathleen Connell, M.D., assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine.
Connell said previous epidemiological studies have shown that about 10 million women between the ages of 50 and 74 report abnormal sexual complaints, including decreased desire, inability to reach orgasm and increased pain with intercourse. In contrast to data on men, Connell said clinical trials evaluating the physiologic mechanisms responsible for sexual function in women are few, despite reports of other investigators, which suggest that sexual dysfunctions may be more common in women than men.
"The sexual response is complex and involves interaction between the nervous system, the vascular system and the musculoskeletal system," said Connell. "Alterations in any of these systems could potentially cause FSD."
The trial was conducted while Connell was at the Albert Einstein College of Medicine. The team studied the pudenal nerve, which provides nerve fibers to the pelvic floor muscles and is also responsible for sensation in the genital region. They evaluated the role of genital neurological integrity and sexual function in 56 women. They used a validated screening questionnaire to identify women between ages 18 and 68 with FSD and tested vibratory and pressure sensation in the genital region.
The team found that almost half of the women studied reported sexual dysfunction. Of the women with FSD, 23.2 percent had more than one form of sexual dysfunction. Those with sexual dysfunction had decreased sensation in the clitoris compared to asymptomatic women.
###
Other authors on the study included Marsha K. Guess, M.D., Julie La Combe, M.D., Andrea Wang, M.D., Kenneth Powers, M.D., George Lazarou, M.D. and Magdy Mikhail, M.D.
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