Monday, September 19, 2005

Study: Men's Tobacco Chewing May Harm Sperm

Study: Men's Tobacco Chewing May Harm Sperm

Sept. 16 (WEBMD) - A new study notes a possible link between tobacco chewing and sperm problems.

Infertile men "should be counseled about the adverse effects of tobacco chewing on sperm," write the researchers in Fertility and Sterility.

Chewing Tobacco and Sperm

The study included 638 men at an infertility clinic in Mumbai, India. All of the men had been tobacco chewers for four to 10 years.

"A large population of Indian men is addicted to tobacco chewing," write the researchers.

The men were split into three groups based on their tobacco chewing habits:

  • Mild: Chewing tobacco less than three times daily.
  • Moderate: Chewing tobacco three to six times daily.
  • Severe: Chewing tobacco more than six times daily.

Men in the "severe" tobacco chewing group had the fewest, worst quality sperm. The more tobacco the men chewed, the poorer their sperm were, the study shows.

The study didn't include any men who weren't tobacco chewers. Thus, the researchers can't say that it's actually the chewing tobacco for sure that caused the sperm problems.

The scientists who worked on the study included Ashok Agarwal, PhD, HCLD. Agarwal works at the Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function at The Cleveland Clinic's Glickman Urological Institute.

Other Factors?

The study didn't pinpoint why the men were infertile. In India, tobacco chewing is more common among disadvantaged people, the researchers note.

Hardship can affect health in many ways; tobacco chewing probably doesn't paint the whole picture.

"Men addicted to tobacco chewing also have the least access to infertility medical services," write the researchers.

Efforts should be made to "direct the attention of the general public towards the possible relationship between tobacco chewing and the incidence of male infertility," write Agarwal and colleagues.

They note that an earlier study by other researchers didn't find a link between male infertility and tobacco chewing. That study was smaller and was designed differently, Agarwal's team writes.

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More First-Time Moms Opting For C-Sections

More First-Time Moms Opting For C-Sections
Patient-choice cesareans up nearly 40 percent, report finds

MONDAY, Sept. 12 (HealthDay News) -- More and more first-time mothers are choosing to deliver their babies by Cesarean section, even when there's no medical need for the procedure, researchers report.

A new report from HealthGrades found that patient-choice C-sections for first-time mothers with no medical need for a cesarean increased 36.6 percent from 2001 to 2003. While the absolute numbers are still low, accounting for only about 2.5 percent of U.S. births, the decision still remains a controversial one.

Some doctors support the idea of patient choice, while others feel it's nearly impossible for women without medical training to truly comprehend the risks involved with Cesarean births.

"I think women understand more now than they ever did, but do they understand the real risk? Probably not," said Dr. Samantha Collier, author of the report and vice president of medical affairs for HealthGrades, in Golden, Colo.

"The bottom line is that patient-choice C-section is an unnecessary surgery. And, there's an alternative to it, which women have been doing since the beginning of time. Plus, it may or may not be covered by insurance since it's not necessary," said Collier.

Collier said she wasn't against patient-choice C-sections -- just that women need to be as informed as possible. And, she added, women need to understand that their physicians will likely have a bias either for or against a patient-choice C-section, and it's important for women to know how their doctor feels about the issue.

Having a C-section is considered major abdominal surgery, according to Collier. The risks for the mother include hemorrhage, pain, infection and placenta-implantation problems in subsequent pregnancies. For the baby, risks include respiratory problems, accidental surgical cuts and an increased risk of breastfeeding problems and asthma, according to the report.

The risk of complications from a C-section has decreased dramatically, even in the last 10 to 20 years, said Collier. "While C-section complications are higher than for vaginal delivery, they're still so, so low," she said.

That reduction in complication rates may be one of the driving forces in the increase. Collier said women are also more educated on the issue and are demanding patient-choice C-sections. Plus, they're getting support from medical groups such as the American College of Obstetrics and Gynecology, she said.

In 2001, the rate of patient-choice Cesareans was 1.87 percent. That number rose to 2.55 percent in 2003, according to the HealthGrades report. These figures come from 1,500 hospitals in 17 states. Over the three years the report encompasses, 267,340 patient-choice C-sections were performed, according to the report.

There was significant variability in the patient-choice C-section rate from state to state. Nevada had the largest increase (56.7 percent), followed by Washington (53.6 percent) and Florida (47.6 percent) in elective first-time C-sections.

The states with the lowest change in the percentage of elective C-sections performed were Iowa (28.2 percent), New York (26.3 percent) and Arizona (15.7 percent).

Florida, New Jersey, New York and Nevada had the highest rates of patient-choice C-section, with each state having slightly more than 3 percent of births performed by elective cesarean.

Collier said she's not sure why there's such a difference from state to state, but said it may have something to do with physician training, or it could be more culturally accepted in some areas.

Dr. Kim Warner, an obstetrician/gynecologist for Kaiser Permanente in Denver, said, "The numbers of patient-choice C-sections probably are increasing, but I haven't seen it much here in Denver."

"We're very stringent in our indications for patient choice C-section and convenience is never one of them," she said.

Warner, incidentally, had an elective C-section for her first birth, and said that as many as one in three obstetricians chooses this option, hoping to prevent later problems, such as urinary or fecal incontinence. She is quick to point out, however, that there's no solid proof that vaginal delivery can cause such problems.

"For the majority of women, vaginal delivery is still the standard of care and is usually indicated, but you can definitely have a discussion about how you want to deliver your child with your doctor," said Warner.

Collier advised that, "if you decide that patient-choice C-section is something you're very, very interested in, collect information and talk to your doctor. Make sure you really understand the risks. It's often a tradeoff -- do you want pain now or later?"

"While you might get out of labor pain, later, when you're caring for your baby, you'll have a harder time picking up and caring for the baby because you're recovering from major abdominal surgery, which can impact bonding with the baby during the perinatal period," she said.

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More Research Needed Into Preemie Births

More Research Needed Into Preemie Births
March of Dimes experts say premature delivery up 30 percent since the 1980s

FRIDAY, Sept. 15 (HealthDay News) -- Targeted research to prevent premature birth is needed in order to save the lives of thousands of babies each year, according to a March of Dimes expert panel report released Friday.

"Preterm birth is a complex disorder, like heart disease or diabetes, with no single cause, and it requires a multifaceted approach," report lead author Dr. Nancy S. Green, March of Dimes medical director, said in a prepared statement.

"We need to stimulate more funding for research in six promising areas that may lead to new clinical strategies for identifying who is at greatest risk for premature birth and how to prevent it," Green said.

The six priority areas are:

  • Epidemiological studies that examine the risk of extremely preterm births to spot factors that predispose women to very early labor and delivery.
  • Genes and their interaction with the environment that, combined, result in preterm birth.
  • Racial and ethnic differences that may explain why non-Hispanic black American women have the highest rate of premature babies in the U.S.
  • The impact of infection and immune response to infection.
  • The effects of stress on the mother and fetus.
  • Clinical trials to assess the effectiveness of potential treatments.

More than 12 percent (about 500,000) of babies born each year in the United States are born prematurely and the rate of premature births in the country has increased by more than 30 percent since 1981. Premature birth is the leading cause of death among U.S. newborns, and preterm babies who survive often suffer lifelong health problems.

The recommendations appear in the current issue of the American Journal of Obstetrics and Gynecology.

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