There is no evidence that aspirin therapy during in vitro fertilization (IVF) increases a woman's chances of becoming pregnant, according to an updated systematic review published August 10 in The Cochrane Library.

Aspirin is often prescribed to improve the outcome of women undergoing IVF "despite inconsistent evidence of its efficacy," Charalambos Siristatidis, MD, of the Assisted Reproduction Unit at the University of Athens in Greece, and colleagues note in their review.

They say use of aspirin for this purpose "cannot be recommended due to lack of evidence from the current trial data" and note that "[a]dequately powered trials are needed."

In an interview with Medscape Medical News, Roger Lobo, MD, professor of obstetrics and gynecology at Columbia University in New York City and current president of the American Society of Reproductive Medicine, said it's unlikely such trials would ever be conducted. "There's really no incentive.

"Empirically using aspirin in IVF has been batted around for a long time," Dr. Lobo said. "This meta-analysis combines the existing evidence and confirms that aspirin isn't likely to be of any major benefit in women undergoing IVF." Dr. Lobo did not participate in the Cochrane Review.

More Data; Same Conclusion

Research on the use of aspirin during IVF and other assisted reproduction techniques has yielded mixed results. Some studies suggest that aspirin therapy improves pregnancy rates; others suggest it may increase the risk for miscarriage.

A 2007 Cochrane Review examined data from 9 randomized controlled trials involving a total of 1449 women undergoing IVF or intracytoplasmic sperm injection (ICSI). Participants were treated with low-dose aspirin (≤150 mg once daily) or placebo or no treatment.

The reviewers found that women taking aspirin during IVF or ICSI were not significantly more likely to become pregnant than women in the controls groups. In addition, no significant difference in live birth rates existed between the aspirin and the control groups.

The findings of the updated 2011 Cochrane review mirror those of the 2007 review.

"Based on the available evidence, we reached the same conclusion as the initial version of the review. No single outcome measure demonstrated a benefit with the use of aspirin," the authors report.

The latest review of aspirin therapy with IVF included 13 randomized controlled trials in a total of 2653 women undergoing IVF of ICSI.

The trials compared aspirin (≤150 mg once daily) vs placebo or no treatment, taken either preconceptually or at different stages of the treatment cycle (eg, during down-regulation, during stimulation of ovulation, after egg collection, or after confirmation of pregnancy by a pregnancy test or ultrasonography).

"Aspirin treatment given for varying lengths of time was considered (for example up to different points in the treatment cycle; until confirmation of pregnancy; up to 12 weeks, 34 weeks gestation or delivery)," the authors note.

In the pooled analysis, there was no evidence of an improvement in live birth rate with aspirin (relative risk [RR], 0.91; 95% confidence interval [CI], 0.72 - 1.15) or in the clinical pregnancy rate (RR, 1.03; 95% CI, 0.91 - 1.17).

There was also no evidence of an effect of aspirin on multiple pregnancy rates (RR, 0.74; 95% CI, 0.38 - 1.46), ectopic rates (RR, 1.86; 95% CI, 0.75 - 4.63), and miscarriage rates (RR, 1.10; 95% CI, 0.68 - 1.77), although these findings are based on data from a limited number of studies, the authors note.

Embryo Quality Major Factor in Success

The authors note that one of the largest studies included in the updated review reported on 298 women and showed some benefit in clinical pregnancy rate; 45% of the population using aspirin became pregnant compared with 28% of the control population, yielding a 17% improvement with aspirin.

Nonetheless, they conclude that aspirin for the purpose of improving IVF outcomes cannot be recommended.

Dr. Lobo made the point that "the major factor influencing pregnancy is embryo quality; if you've got a good embryo, aspirin is not going to improve upon that. The theory is that aspirin improves blood flow and the [uterine] lining and so forth, but those aren't major factors in someone with routine infertility," he added.

Despite a lack of evidence of benefit, aspirin is commonly used in women undergoing IVF, Dr. Lobo told Medscape Medical News.

"Many people are grasping at straws, trying everything, so it is used empirically, but this new report pretty much tells us that it is not of value. And there are some downside risks, such as bleeding, even though the doses are low. I think there are more risks than benefits at this point," he concluded.

Cancer patients can reduce the risks of side effects and cancer recurrence by exercising regularly, a new report shows.

The report, "Move More: Physical activity the underrated 'wonder drug,'"from Macmillan Cancer Support in the U.K., says that 150 minutes of moderate intensity activity per week, the amount recommended by the U.K.'s four chief medical officers, is the minimum amount required to see the benefits.

Moderate intensity activity includes exercise such as cycling and very brisk walking, but also household tasks such as heavy cleaning and mowing the lawn.

The report presents four key findings:

1. Breast cancer patients' risk of recurrence and of dying from the disease can be reduced by up to 40% by doing 150 minutes of moderate intensity activity per week.
2. Bowel cancer patients' risk of recurrence and dying from the disease can be reduced by up to 50% by doing significant amounts of physical activity; this means about six hours of moderate intensity physical activity per week.
3. Prostate cancer patients' risk of dying from the disease can be reduced by up to 30% by doing the recommended 150 minutes of moderate intensity physical activity.

After treatment, all cancer patients can reduce their risk of side effects from cancer and its treatment, including fatigue, depression, osteoporosis, and heart disease, by doing the recommended levels of physical activity.

Many Health Professionals Unaware of Benefits:

However, despite strong emerging evidence that being physically active could dramatically improve cancer patients' recovery and long-term health, a Macmillan online survey of 400 health professionals who deal with cancer patients found that many are not aware of this and most are not talking to their patients about it. Over half of the primary care doctors, nurses, and oncologists surveyed do not speak to their cancer patients about the benefits of physical activity, or at best they speak to just a few of them.

Ciaran Devane, chief executive of Macmillan Cancer Support, says, "Cancer patients would be shocked if they knew just how much benefit physical activity could have on their recovery and long-term health, in some cases reducing their chances of having to go through the grueling ordeal of treatment all over again."


Exercise Not Just an Add-on to Care:

According to Jane Maher, chief medical officer of Macmillan Cancer Support, "The advice I would previously have given to one of my patients would have been to 'take it easy.' This has now changed significantly because of the recognition that, if physical exercise were a drug, it would be hitting the headlines. There really needs to be a cultural change so that health professionals see physical activity as an integral part of cancer after-care, not just an optional add-on."

British scientists have developed an implanted sleeve that looks like a giant sausage skin, which they claim can cure diabetes.

A team, led by Dr. John Mason of the Trafford Healthcare National Health Service Trust U.K., says that the two-feet-long device can reverse diabetes within weeks - in fact, it acts as an incision-less alternative to a weight loss surgery known as duodenal switch.

The duodenum is the name for the first 10 to 12 inches of the small intestine, which attaches to the stomach.

The new device, called the EndoBarrier, is designed to have the same effects as the surgery but far safer. It is a plastic sleeve that lines the duodenum, meaning food can only be absorbed lower down the intestine.

The procedure is performed under anaesthetic in less than an hour. The sleeve - made from a thin plastic - is inserted via the mouth and passed into the digestive tract using a thin tube, the Daily Mail reported.

Once in place, a sprung titanium anchor prevents it slipping out. It is removed after a year. During trials researchers found that in obese patients who also suffered diabetes, the disease went into remission.

The discovery has led to clinical trials at three British hospitals, which found the implant also lowers cholesterol levels and blood pressure.

At a two-day consultation here, health ministers and senior officials from 11 SAARC nations emphasised on the need to improve routine immunisation services and WHO officials announced the formation of a regional committee to enhance and sustain the existing services among member countries.

Union Health Minister Ghulam Nabi Azad highlighted challenges of the programme in the country. "You can estimate the scale of India's immunisation programme from the fact that around 26 million children are born every year....We face challenges to cover this large birth cohort."

Under flak for watering down pictorial warnings on tobacco products, and for coming under pressure from the tobacco lobby, for the first time the government is focusing on beedi smokers.

It has planned a new ad campaign to start from Monday and wants to set up 5 labs to test beedi content.

The Health Ministry's latest initiative to spread awareness on the ills of beedi smoking is a new ad campaign called Campaign Heartbreak that changes the focus from cigarettes and gutka to beedis.

Health Secretary BK Prasad said, "In our country 8-10 lakh people die of tobacco related diseases."

"When we look at the consumption pattern, it is mainly the low socio eco group for cigarettes, they are informed consumers, but with beedi, people don't know what they are consuming," said Tobacco Control Program CMO Dr Jagdish Kaur.

In fact, according to the Global Adult Tobacco Survey beedi is the second most highly consumed tobacco product in India. 16 per cent Indian males smoke beedis compared to nearly 10 per cent who smoke cigarettes.

In fact, beedi smoke contains three times the carbon monoxide and nicotine and

five times the amount of tar that cigarette smoke does.

The NGO World Lung Foundation helped pre-test and develop this ad campaign.

Nandita Murukutla of the World lung foundation said, "The first problem is that there are no regulations, secondly the tobacco lobby is very strong in India. But we applaud this project by the government because we know from our studies that these mass media campaigns do work."

The government has now identified 5 labs across the country to test tobacco products and will set up one lab dedicated for tobacco research. In December, the long-awaited pictorial warnings on all beedi products will also come into effect.