What Should You Do About the Zika Virus?

There's a new "dread disease" to worry about; it's called the zika virus. From its start in Brazil, the zika virus has spread quickly throughout areas of Central and South America. It is transmitted by a strain of mosquitos not currently endemic in the United States. At the moment there is no vaccine to prevent zika infection and no medicine to treat it.

In adults, a zika viral infection causes only mild symptoms such as fever, rash, joint pain, and red eyes. The symptoms typically last for only 4-5 days. If that was all there was to a zika viral infection there wouldn't be much to worry about. But that's NOT all; health officials think that the zika virus is responsible for a substantial uptick in cases of microcephaly (a small head and brain) among infants born to zika-infected mothers. And infant microcephaly is a permanent condition that can lead to serious developmental consequences.

So how worried should you be? It depends. If you don't ever travel to Central or South America where the zika-transmitting mosquito is found, you can probably forget about the zika virus; you won't become infected. Even if you do travel to an infected area, it's probably no big deal as long as you don't plan on becoming pregnant.

On the other hand, the U.S. Centers for Disease Control and Prevention (the CDC) recommends that pregnant women postpone any travel to zika-infected areas. This may seem extreme, but there are no medications or vaccines to prevent zika infection, and the consequences to the fetus can be severe.

For more on this subject, visit the zika virus page of the CDC's website.

Hormonal Contraceptives Without a Physician's Prescription

Oregon is the first state to make hormonal contraceptives available without a prescription from a medical doctor (see an article in The New York Times.) Under a new law that took effect January 1, prescriptions for hormonal contraceptives may be written by pharmacists who have completed a state training course. The patient will only need to complete a questionnaire at a participating pharmacy, have it reviewed by the pharmacist, and pay a one-time fee of about $25. It is hoped that increased availability of contraceptives will reduce the rate of unintended pregnancies.

Oregon teenagers under 18 will still have to receive their first prescription from a doctor; after that, they can renew it at a pharmacy. After five years the legislature will review the law and decide whether the age restriction should be lifted.

Hormonal contraceptives have been around for a long time. They are considered so safe that The American Congress of Obstetricians and Gynecologists would like to see them available over-the-counter. However, over-the-counter availability would require approval from the U.S. Food and Drug Administration; not an easy task. To make contraceptives more readily available in their state right away, states are taking the approach of simply licensing their pharmacists to write prescriptions. A similar law will take effect this year in California, with no age restriction. Other states are watching Oregon and California closely as they consider whether to follow suit.

The FDA Proposes New Rules for Tanning Beds

Responding to the latest information that tanning in indoor tanning beds increases the risk of melanoma (the deadliest form of skin cancer), the Food and Drug Administration (FDA) is proposing new rules for the use of indoor tanning beds. Under the new rules, persons younger than 18 would not be allowed to use tanning beds, and adults would have to sign a waiver every 6 months documenting that they understood and accepted the risks.

Eleven states already ban minors from using tanning beds. The logic is that although adults can choose to do what they wish (they're allowed to smoke, for example), children need to be protected because they are not mature enough to make such decisions.

The FDA's proposed rule is open for public comment until mid-March, after which a final decision will be made. The FDA press announcement includes instructions on how to comment on the proposed rule if you wish.

Risks/Benefits of Home vs. Hospital Childbirth

Having a baby at home instead of in a hospital has become increasingly popular in recent years. Why do some women choose to have their baby at home, and what are the risks associated with that decision?

A recent study conducted in Oregon, one of states with highest rate of home (out-of-hospital) childbirth, provides some interesting answers (unfortunately, you'll need to pay for access to the full article). The study examined the outcomes of nearly 80,000 births in Oregon during 2012 and 2013. The individual data were placed in the home vs. hospital statistical group based on where the woman had initially planned to have the delivery, because some planned home deliveries ultimately are conducted in a hospital because of complications early on.

In terms of risks, the study found that although the risk of death is low for both groups, home deliveries were more likely to result in infant death during birth or within the first month after birth (0.39% for home deliveries, vs. 0.19% for hospital deliveries.) Home delivery also increased the risk that the infant would need a ventilator or have a seizure. For the mother, home births also increased the chance that a blood transfusion would be needed. None of these risks was very large, however.

On the other hand, there were also some benefits to out-of-hospital deliveries, which is precisely why some women choose them. Only 5.4% of out-of-hospital deliveries were by cesarean section, compared to 24.7% in a hospital. Home deliveries also resulted in fewer lacerations and fewer measures to stimulate labor.

The authors do not take a stand on the issue of whether home or hospital deliveries are best, and advocates of both options agree that better information such as this study provides will allow women to make the best choices for themselves.

In Vitro Fertilization (IVF) Success Rates With Multiple Attempts

Couples who are infertile (defined as not becoming pregnant after a year of normal, unprotected sex) sometimes turn to in vitro fertilization (IVF) to try to have a baby, depending on what the fertility problem is. But IVF is not a sure thing. Couples contemplating IVF might reasonably ask how often does the first IVF attempt result in a live birth? And if the first attempt isn't successful, what are the success rates with each additional attempt? Couples are usually advised that if they haven't had a baby by the fourth attempt they should probably give up. But that advice is based on 20-year-old data, and success rates could have gotten much better in the past two decades.

To answer these questions, British researchers examined the outcomes of multiple IVF attempts in nearly 157,000 women in the UK who underwent IVF procedures between 2003 and 2010. In a nutshell, they found that although the first attempt was the most successful, the success rate for subsequent attempts declined more slowly than was previously thought. Specifically, the success rate was 29.5% on the first attempt, still greater than 20% on the fourth attempt, and above 15% even on the ninth attempt (only 83 women actually tried nine times.)

So the answer to the first question - How often is IVF successful the first time around? - is about 30% of the time. The success rate for each additional attempt does decline, but not to zero. More than four attempts should not be ruled out if the couple really wants to continue trying and can afford it.

FDA Lifts Lifetime Ban on Gay Men Donating Blood

Since 1983 the Food and Drug Administration (FDA) has had a policy of not allowing gay men to donate blood, ever. That policy (of a lifetime ban) has been rescinded. Under the new policy, men who have had sex with other men within the past year will still not be allowed to donate blood, potentially eliminating most gay men anyway. But at least the ban is not permanent.

Empirically, gay men are at higher risk of contracting HIV infections than heterosexuals. So back in 1983, when HIV testing was not as accurate as it is today, it was considered prudent to ban gay men from donating blood. Today a lifetime ban is not considered necessary. However, the 1-year ban remains because a newly infected person may not test positive for HIV for up to six months.

The one-year ban also applies to women who know that their male partners have had sex with a man within the past year.