From:    Kirsten Emmott
Subject: fertility docs


 From an international news column in a recent Journal of the Soceity
of Obstetricians and Gynecologists of Canada:

	"We remain convinced that the vast majority of physicians are
honest.  But not all are.  The integrity of some fertility surgeons has
been challenged (Fertility News 1990: 24:10). One charged a fee of $8000
US and an assistant's fee of $1600.  The patient was told the fee was
increased because a laser was used and the patient was assured that she
had a 90 per cent chance of pregnancy, rather better than that for the
general  population.  Koko (in The Mikado by Gilbert and Sullivan) felt the
punishment should fit the crime.  One of the James Bond villians might
usefully be employed to strap the particular surgeon down in the path of a
steadily advancing carbon dioxide laser!"

	 comment; the take-home baby rate for most in vitro fertilization
clinics is around 1-5%.

  From a recent og/gyn journal:

	 "Particularly stupid action is often referred to as "the height
of folly".  The disproportionate attention paid by the media to side
effects rather than the benefits of medications may just fit this
definition.  The total column length in the British press sugesting a link
between breast cancer and the pill was 13,700 cm.  When a scientific
publication appeared suggesting a protective effect against breast cancer,
the single mention in the national press was 38 cm."

	comment:  and yet that was just one study.  The truth about breast
cancer and pill isn't in yet.  There are  a lot of studies showing no
relationship, and a few that do.


from a recent ob/gyn journal:

	 "The oral contraceptive probably has been more thoroughly
investigated than any other medication."
	 (comment; and not before time, too.  The original Enovid was
put on the market back in the sixties after shockingly inadeqate studies on
a few Puerto Rican women)
	 "A massive 16 year follow up of 17,032 women has been reported
(Br Med J 1989: 299:1487-1491_. The findings showed no significant
overall effect of oral contraceptive use on mortality."

(comment: okay, now how about a 60-year follow up?)


	From a recent ob/gyn journal:

	There has been a marked increase in cancer of the endometrium
(the lining/body of the uterus, not the cervix) between 1969 and
1975.   This increase exceeded 10% per year, and was highest in women
between 45 and 75.  The increase coincided with an increase in estrogen
use for menopause.  The relative risk of endometrial uterine cancer in
uses of estrogen seems to be about sixfold.  Generally the women were on
1.25 mg of Premarin daily and a trend to increased risk was seen after 2
or 3 years.
	 Now the good news; the cancers were a particularly superficial,
early sort with a 95% ten year survival rate, usually caused abnormal
bleeding and were usually noticed early.  "As a result, the majority of
the 3,000 deaths due to endometrial cancer in 1988 in the USA and the 317
deaths in 1988 in Canada do not occur in estrogen users."
	the risk of endometrial hyperplasia (pre-cancer) shrinks to almost
nothing if the woman takes progestins too.
	 Anybody you know on post-menopausal estrogens who still has her
uterus should be taking progestin for part of each month as well.
	 If you take estrogen alone, you should have a sampling (endometrial
biopsy) done every year or two.  Warning; this is painful.