UK HealthCare looks to improve research and help infertility heartbreak.

Knowing risks, options can aid those with infertility

Written by Patrick Hannon, post-doctoral researcher in the UK Department of Obstetrics and Gynecology.

About 15 percent of couples in the United States experience infertility, which is when a couple has tried to become pregnant for a year without success. Infertility comes as a shock to many couples who have spent years preventing pregnancy.

The inability to become pregnant leads to long-lasting and detrimental effects on a woman’s physical and emotional wellbeing. These detrimental effects include a decreased quality of life as indicated by increased levels of stress, impairments in physical and mental health, and diminished social functioning when compared to fertile women. Research has shown that being diagnosed with infertility has similar emotional and life-altering impacts as being diagnosed with cancer or a heart attack.

Infertility is a major public health concern as the diagnosis and treatment of infertility is estimated to cost society over $5 billion annually. For many couples, equally devastating is the realization that their health insurance does not cover infertility treatment, and all their medical costs must be paid out-of-pocket. It is critically important for UK infertility research to understand the causes of infertility in order to refine treatments, decrease the costs associated with infertility, and benefit the overall wellbeing of those suffering from infertility

Risk factors

The most prominent underlying causes of female infertility are defects in ovulation, or release of the egg from the ovary. The exact cause for defects in the woman’s reproductive tract is not entirely understood, but several risk factors are associated with infertility, including:

  • Untreated sexually transmitted infections
  • Pelvic inflammatory disease
  • Certain cancer treatment regimens
  • Endometriosis
  • Polycystic ovarian syndrome
  • Exposure to environmental toxicants
  • Lifestyle factors such as smoking, drug use, excessive alcohol use, abnormally high levels of stress, and extreme weight gain or loss

Age and female infertility

However, the single most significant contributing factor to female infertility is age. Fertility greatly declines with age due to the natural depletion of eggs within the ovary and decreased quality of the remaining eggs, leading to increased chances of miscarriage. Further, the potential health of the child can be impacted by a woman’s age due to genetic abnormalities in the eggs of older women. As women in today’s society are delaying child birth for personal, professional and financial reasons, age becomes an important factor contributing to infertility.

Combating infertility

To combat infertility, women can undergo treatment from a trained infertility specialist, which includes infertility testing, drug treatment to aid in ovulation, surgery to repair abnormalities in the reproductive tract and assisted reproductive technologies (ART), which includes the commonly used in vitro fertilization (IVF) procedure. In ART, the egg is fertilized outside the body before being placed back into the woman’s uterus. Unfortunately, the challenges of infertility treatments, specifically ART, are that success rates are low (approximately 56 percent) and decline with age.

UK infertility research

Scientists are continuing to refine and improve ART methods, such as working to optimize dosing regimens of the drugs that aid in ovulation, refining the conditions in which fertilization takes place outside the body, enhancing the procedures used to evaluate embryo quality prior to placing the embryo back into the woman, and investigating ways to preserve the fertility of cancer patients by using ovarian cryopreservation.

In our laboratories here at the University of Kentucky, we are determining precisely how ovulation is controlled in women and are identifying novel factors that drive ovulation. Each of these advancements aims to improve effectiveness, while decreasing the time and cost of infertility treatments.

 

Prevent Zika virus in Kentucky with repellent.

What you should know about Zika virus this summer

Talk of the Zika virus is everywhere these days, and it has many people understandably worried. On Tuesday, UK HealthCare experts held a news conference to answer questions about Zika. The bottom line? If you’re here in Kentucky and aren’t planning to travel this summer, your risk of catching Zika is very low. But there are things you can do to be prepared in case that risk increases this summer.

“At the present time, the risk for infection is low for Kentuckians not traveling to areas with active Zika,” said Dr. Phillip Chang, UK HealthCare chief medical officer. “However, the Centers for Disease Control and Prevention (CDC) continue to provide updates and if locally transmitted cases are found in the U.S., the risk could increase.”

What is Zika virus?

The Zika virus is spread through mosquito bites or through sexual contact with an infected person. Currently, virus transmission is happening in many Caribbean and Central and South American countries. Although many people who become infected have mild or no symptoms, pregnant women who contract the disease are at high risk for complications. Zika has been linked to microcephaly, a potentially fatal neurological disorder characterized by an abnormally small head.

Currently, the only cases in the U.S. have been travel-associated. But concern is growing about the possibility of travelers spreading it to mosquitoes in the U.S., which can then infect people who have not traveled to countries with the active virus. The Aedes aegypti mosquito, which is the main carrier of the virus, can be found in the U.S. during the summer months, including Kentucky. This means that the Zika virus in Kentucky could be a real possibility.

“Currently, there is no anti-viral treatment and no vaccine for the Zika virus, so we are focusing on prevention and risk reduction and, if necessary, proper screening for our patients if Zika becomes a concern in the region,” said Dr. Derek Forster, UK HealthCare medical director for infection prevention and control.

Pregnant women and Zika

Since February, UK HealthCare’s obstetrics and gynecology clinics have been educating patients on the risks of Zika, particularly for pregnant patients or pregnant patients with partners who travel to these areas, said Dr. Wendy Hansen,chair of UK Obstetrics and Gynecology.

“We have been telling pregnant patients to postpone travel to areas with outbreaks of Zika virus, which currently is nearly all of Central America and much of the Caribbean and South America,” Hansen said. “We also are counseling and advising patients on what to do if they have partners that plan to or have traveled to these areas.”

According to current CDC guidelines, the following special precautions are recommended for pregnant women:

  • Pregnant women should not travel to any area with Zika.
  • If you must travel to one of these areas, talk to your doctor or other health care provider first and strictly follow steps to prevent mosquito bites during your trip.
  • Until more is known, pregnant women with male sex partners who have lived in or traveled to an area with Zika virus should either use a condom every time they have sex or abstain from sex throughout the pregnancy.

Precautions for everyone

While the Zika virus is most dangerous for pregnant women who risk complications, everyone is urged to take precautions to prevent mosquito bites during the summer months to prevent possible spread of the disease.

Precautions include:

  • Wearing protective clothes, including long-sleeved shirts and long pants. For extra protection, treat clothing with permethrin, a chemical that repels insects and kills mosquitoes and ticks when sprayed on clothing, tents and other gear.
  • Using an EPA-registered insect repellent every day containing one or more of the following active ingredients: DEET, PICARIDIN or IR3535.
  • Using screens on windows and doors, and using air conditioning when available.
  • Keeping mosquitoes from laying eggs in and near standing water near your home.

“Although these precautions are especially important for pregnant women and women of childbearing age who want to become pregnant, we want everyone to educate themselves on how to protect their family members and friends,” Hansen said.

Watch UK HealthCare experts discuss Zika virus below.

 


Next steps:

  • The CDC recommends that testing for the Zika virus be done for pregnant women who have recently traveled somewhere with active Zika or anyone who has traveled and has symptoms.
  • For the most up-to-date information, visit the CDC’s website.

Appalachian Research Day shows community-based health care efforts

For many UK researchers who study health in Appalachia, the Center of Excellence in Rural Health (CERH) is an indispensable partner in conducting community-based research. The Center, located in Hazard, connects researchers with the local community and provides necessary infrastructure, from conference rooms to a team of community health workers, called Kentucky Homeplace, who engage participants and gather data.

This week, researchers shared the findings from these community-based studies at the second annual Appalachian Research Day.

“Today is an opportunity for people who do research with the Center to report back about their findings, and see what we can come up with together to better our lives here in Appalachia,” said Fran Feltner, director of the CERH.

Addressing Appalachian health issues

Rural Appalachian communities in Eastern Kentucky experience some of the nation’s most concerning health disparities, including elevated rates of obesity, diabetes, stroke, heart disease, depression, and cancer incidence and death. Residents of Appalachia might also face challenges in accessing health care, such as distance from providers, lack of insurance, or socioeconomic barriers.

Community-based research is essential in addressing disproportionate rates of poor health by collaboratively identifying problems and developing shared solutions that are a good fit for communities. For this type of research to succeed, it must begin at the local level, built upon the foundation of relationships with individuals, neighborhoods and groups who have common questions and concerns. In Eastern Kentucky, the CERH has enabled community-based studies since 1990, when it was founded to improve health through education, service, and research.

In 2015, the CERH launched Appalachian Research Day as an opportunity to share and discuss research findings with the communities that were involved in the studies. Feltner describes the day as an invitation for everyone involved in community health research to “come sit on the porch” of the Center and talk about their work and ongoing needs. More than 100 researchers, coordinators, community health workers, community advisory board members, students, and staff participated this year, with four podium presentations and 13 poster presentations.

“These research findings drive new and exciting health initiatives that are transforming lives across our rural Appalachian region,” Feltner said.

Researching change

The presen­tations focused on community research related to healthy lifestyles, depression, lung cancer screening, drug use and risk behaviors in Appalachia.

Mark Dignan, professor in the UK College of Medicine and director of the UK Prevention Research Center, discussed his work with faith-based communities to study energy balance, obesity and cancer in Appalachia.  According to the CDC, the national obesity rate in adults is about 29 percent, while in Appalachian states the rate is 31-35 percent. Dignan was particularly interested in how to help people re-engineer their lives to include more physical activity.

“When you do research in the community, hopefully you’ll make change that will be lasting,” he said.

Rates of depression are also higher in Appalachia than the rest of the country. For Appalachian women, the rate of depression is four times higher than the national rate. They are also less likely to receive adequate treatment, according to Claire Snell-Rood, PhD, who shared her research on adapting treatment options for rural settings where the traditional mental health system is both inappropriate and inadequate.

“This research focuses on how to adapt evidence-based programs to address not only limited treatment options in rural areas, but the substantial social and health challenges that impede Appalachian women from obtaining the care they need,” she said.

Snell-Rood worked with Kentucky Homeplace community health workers to conduct interviews with women, and she is currently adopting a collaborative, peer-based practice to support rural individuals in developing their own processes for wellbeing.

Roberto Cardarelli, DO, MPH, professor and chief of community medicine in the UK College of Medicine, also presented his research project, the Terminate Lung Cancer study, which aims to understand the knowledge and attitudes of lung cancer screening among high-risk rural populations. Kentucky’s lung cancer mortality rate dramatically exceeds the national lung cancer mortality rate, with 73.2 deaths per 100,000 in Kentucky versus 49.5 nationally. Cardarelli and his team conducted focus groups in order to develop an effective campaign to promote lung cancer screening in the region.

“We like to focus on research that’s important to communities, and we couldn’t find a more important topic than tobacco cessation and lung cancer screening,” he said.

The final presentation of the day addressed drug use and prescription opioid use in Eastern Kentucky. Michele Staton-Tindall, PhD, associate professor in the UK College of Social Work, conducted research in jails to learn about drug use and health-related risk behaviors among rural women in Appalachia. She said that rates of drug use are “alarmingly high” in this area of Appalachia, with many users injecting.

“Injection is the preferred route of administration, which is coupled with increased public health risks including HCV and HIV,” she said.

Solving problems together

The event was supported in part by the UK Center for Clinical and Translational Science, which aims to accelerate discoveries that improve human health, with particular focus on the Appalachian region.

For Feltner, a nurse who has worked in rural health for 35 years, Appalachian Research Day represents the best qualities of the place she calls home.

“What I love most about Appalachia is the fellowship we have together, as neighbors and friends, working together to solve problems.”

Celebrate International Women's Day with UK HealthCare's health tips.

Women, take charge of your health

In our society, women often care for everyone else – parents, spouses, children – first and neglect themselves. Looking after yourself isn’t selfish – it’s the best way to keep on doing what you do for those around you.

In honor of International Women’s Day today, check out our list of tips that will help you be your healthiest:

  • Understand recommended cancer screenings for your age. Breast, skin, lung and gynecologic cancers are some of most common types affecting women, and regular screening can help catch the disease when it’s most treatable. Check out the American Cancer Society’s guidelines for early cancer screening.
  • Get the HPV vaccine. If you’re 26 or younger, ask your doctor about getting an HPV vaccine, which protects against the types of human papilloma virus that most typically cause cervical cancer.
  • Don’t smoke and avoid second-hand smoke. Smoking is a major risk factor for cancer and heart disease, the No. 1 killer of women in America.
  • Listen to your heart. Women’s hearts are different from men’s in certain ways, which can affect the way women develop heart disease and experience heart attacks. Check out the top 10 things to know about women’s heart health from Dr. Gretchen Wells, director of the UK Gill Heart Institute Women’s Heart Health Program.
  • Protect your skin by using sunscreen and avoiding indoor tanning. Exposure to ultraviolet rays from the sun and tanning beds can cause melanoma, the deadliest type of skin cancer.
  • Stay active. Regular exercise, along with a healthy diet, can lower your risk for several types of cancer and reduce your risk for heart disease. Being overweight can increase your risk of a heart attack and other heart complications.
  • Think about your mental health, too. Some mental illnesses are more common in women or affect women in different ways than men. Conditions such as anxiety, eating disorders and postpartum depression can significantly impact your life. The National Institute of Mental Health has more information specifically for women, but simple things like staying in touch with family and friends, exercising, and getting good sleep can boost your mental health. If you’re unable to shake your symptoms or they keep coming back, talk with your doctor.
  • Be a role model for health. Make sure you’re setting good examples for the girls and young women in your life. Practice healthy eating habits at home and encourage exercise. Encourage the teenage girls in your life to get the HPV vaccination. And for teenage girls especially, emotional support is important. Be available to talk with young women in your life who may be experiencing increased anxiety or depression as they undergo a time of physical and personal growth.

Next steps:

What you need to know about Zika virus

What you need to know about Zika virus

Chances are you’ve heard about the Zika virus outbreak and its potential to cause birth defects and other pregnancy issues. Should you be concerned about the risk of infection for you and your loved ones? Unless you’ve recently traveled to an area where the virus has spread, the answer is no.

While it is unlikely to become infected unless you’ve traveled to an area where Zika has been reported, here’s what you should know about Zika virus.

What is Zika virus?

Zika is a disease caused by Zika virus, which is spread to people when they are bitten by an infected mosquito. The current outbreak of Zika virus has spread through the Caribbean, Central America, South America, Mexico, Samoa and Cape Verde. The illness is usually mild, so people may not realize they have the disease. If infected, symptoms will normally last several days to a week. Human-to-human transmission is rare but sexual transmission has been reported.

Symptoms of Zika virus include fever, rash, joint pain and conjunctivitis (red eyes).

Women and Zika virus

Women who are pregnant or who are thinking about becoming pregnant should take special precautions. Zika virus has reportedly been linked in Brazil to microcephaly, a condition that causes a baby’s head to be much smaller at birth and can also lead to intellectual disability.

If you’re pregnant, it is recommended that you not travel to areas where Zika virus transmission is ongoing. If travel is unavoidable, speak with your health care provider about your travel plans and discuss mosquito bite prevention methods.

What can I do to protect myself?

When traveling to countries where Zika virus has been found, practice mosquito bite prevention. Wearing long-sleeved shirts and long pants and using Environmental Protection Agency-registered insect repellents is recommended. You should also stay in places that use air conditioners or window and door screens that keep out bugs.

Sexual transmission of Zika virus is of particular concern during pregnancy. Men who have traveled to an area of active Zika virus transmission who also have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.

If you have recently visited an area currently affected by the outbreak and have developed symptoms of Zika, please call UK HealthCare at 859-257-1000 or (toll-free) 800-333-8874.

For more information about Zika virus, watch a video featuring UK HealthCare experts.


Next steps:

Dr. Gretchen Wells talks about why awareness is so important to women’s heart health

Dr. Gretchen Wells

Dr. Gretchen Wells

Are you ready to support women’s heart health? The truth is that heart disease is a major killer of women, and some of the reason for that is women’s symptoms are different from men’s — and often go unrecognized until it’s too late, which is why raising awareness is so critical.

Dr. Gretchen Wells, director of the Gill Heart & Vascular Institute’s Women’s Heart Health Program, took time to answer some of our questions on women’s heart health.

Why is it important to raise awareness about women’s heart health?

People assume all heart attacks feel like a crushing in the chest, but often, and for women in particular, the symptoms of a heart attack can be quite different. More women are aware of this now than they were 20 years ago, but that’s still not good enough. So it’s important we take the opportunity to teach women what to look for and how to take the best care of your heart.

Why is it important for a place like Gill to have a specialized heart health program for women?

We’re the leaders in up-to-date diagnostic and therapeutic interventions. Each year, we have new technologies that expand our abilities to prevent and treat heart disease. We also offer leading-edge research and patients can participate in trials. All of us here come to work in the morning asking “How can I push the envelope and do better?”

What are the most common concerns you hear from patients in your program?

I just had this insight this week. Many women bring their daughters to clinic. I always thought that it was for the patient to have a support person, a ride, or maybe someone to take notes. But just yesterday, I had a patient with her daughter. After the visit, as we were closing, the patient said “I don’t want my daughter to have the heart problems that I did. I want her to know her risks and get treated early. All of this is preventable.” What great insight – and a sign of motherly love.

What led you to specialize in women’s heart health?

I didn’t start out doing this, but women gravitated towards me. Several trials evaluating women’s heart disease symptoms and prevention came out, and they raised some thought-provoking questions in my mind as to how to treat women. More importantly, I saw how these women presented differently from men. My first reaction was “we need to study this.” And then family members started having cardiac events, so it became personal.


Next steps:

What women need to know about stroke

Commonly thought of as a problem primarily affecting older men, stroke is a woman’s disease. Approximately 60 percent of deaths related to stroke in the United States occur in women, and the lifetime risk of stroke is higher in women (about one in five) compared to men (about one in six) for those aged 55 to 75 years.

The good news is that stroke can often be prevented.

Although men and women have several modifiable stroke risk factors in common such as high blood pressure (normal less than 120/80 mmHg), diabetes, cigarette smoking, overweight-obesity, atrial fibrillation (an irregular beating of the upper chambers of the heart), excessive alcohol consumption, poor diet or lack of regular exercise,  several risk factors are unique to women.

Stroke risk can be increased during pregnancy, in part leading to a higher stroke risk among women of childbearing age compared to similarly aged men. Migraine with aura (neurologic symptoms such as seeing sparkling or zigzag lights) is also associated with a higher stroke risk, particularly among women who smoke or use oral contraceptives. Women who have had eclampsia or pre-eclampsia associated with pregnancy (high blood pressure, protein in the urine, and in the case of eclampsia, seizures) are at increased risk of stroke up to 30 years later.

What can women do to reduce their stroke risk?

  • Follow a healthy diet such as the DASH or Mediterranean diet.
  • Get regular exercise such as walking at a brisk but comfortable pace for 20-30 minutes most days of the week.
  • No more than one alcoholic drink per day (no alcohol during pregnancy)
  • Don’t smoke and avoid exposure to tobacco smoke
  • Have your blood pressure checked regularly

In addition, talk to your health care provider about reducing your stroke risk if you:

  • Have migraine, particularly migraine with aura
  • Have ever had eclampsia or pre-eclampsia

Memorize some common stroke symptoms using the FAST acronym:

  • Facial droop
  • Arm weakness
  • Speech slurring
  • Time call 911 – Stroke is frequently preventable and treatable, but you need to get help quickly

Larry B. Goldstein, MD

 

Larry B. Goldstein, MD, FAAN, FANA, FAHA, is the Ruth L Works Professor and Chairman of the UK Department of Neurology and Co-Director, Kentucky Neuroscience Institute.

 

 

This column appeared in the Dec. 6, 2015 edition of the Lexington Herald-Leader.