San Antonio Express-News (Sunday)
Do IVF-born babies have more health issues?
Q: My husband suffers from trigeminal neuralgia. This is often very painful for months at a time, then the pain will stop for a few months before it begins again. He does not want to begin taking an antiseizure medication. Are there any natural remedies?
A: Trigeminal neuralgia is a pain syndrome involving the trigeminal nerve, which provides the sensation to the face in three bands, called divisions of the nerve: the eye and scalp, upper jaw and nose, and lower jaw and ear.
The pain of trigeminal neuralgia tends to be intermittent, coming in spasms, which can occur infrequently or many times daily. The pain is often described as being like an electric shock or stabbing sensation. However, some people have continuous pain, and the quality may be described as burning. Touching specific areas of the face may trigger a spasm of pain. The diagnosis of trigeminal neuralgia is frequently delayed, as physicians and dentists may not recognize the pain as coming from the nerve.
Your husband’s experience — episodes lasting for weeks to months followed by a pain-free interval, lasting months to years — is also very common.
First-line treatment are medications that slow down the firing of nerve cells by blocking the sodium channel. Although these medicines can be used to treat of seizures and are approved by the Food and Drug Administration for this purpose, they have a well-established role in pain management, too. Carbamazepine, oxcarbazepine and gabapentin all are medications that have been studied for treatment of trigeminal neuralgia. I am unaware of any herbs or other materials found in nature that are effective, with the possible exception of injected purified botulinum toxin (Botox and others), made by bacteria, with some evidence to support its use in people who do not respond to first-line therapies.
The cause of trigeminal neuralgia in many people is compression of the nerve deep in the brain. People who do not respond to medication sometimes are offered surgery if a compression is found by MRI scan. Surgery is not a guarantee of cure. It may have only temporary benefits, and can be complicated by hearing loss or numbness.
I’d recommend you and your husband take a look at some websites that offer further information and support groups: livingwithtn.org, fpa-support.org, and tnnme.com, all sites I recommend.
Q: Is there any research that people born via in-vitro fertilization have increased longterm health issues? My 30year-old daughter was born via in-vitro and was healthy until she reached puberty. Then her hormones went haywire and she started having benign breast tumors, then asthma, then appendicitis, now thyroid problems. She went from being small for her age to overweight. I just wonder if the drugs her mother took to make in-vitro possible had some long-term effect?
A: There are some health issues associated with assisted reproductive technologies such as IVF. However, the best known of these are related to early development, including a small increase in congenital abnormalities, low birth weight and pregnancy loss. The neurological and developmental outcomes of children conceived by IVF and other technologies appears to be no different from children from spontaneous pregnancies.
I did read one report of children from IVF having early puberty, but it is not clear that the risk of early puberty is higher overall. Asthma, appendicitis, breast tumors and thyroid issues are very common in teens and young women, as are weight problems. Based on my reading, I doubt the IVF had anything to do with it.
Q: Please explain the difference between probiotics and prebiotics? I know they are both helpful for the digestive system, but I’m not sure why.
A: Prebiotics are nondigestible food ingredients, such as fiber, that promote the growth of beneficial micro-organisms in the intestines. Probiotics are the healthy organisms themselves, such as Lactobacillus and others. The proposed benefits include treatment and prevention of allergic disease, treatment of several intestinal diseases, such as inflammatory bowel disease and infectious diarrhea, and alleviating symptoms of depression. However, the purported benefits of prebiotics and probiotics have not been proven to the point of consensus among experts.
Our understanding of the microflora of the gut is really in its infancy. While I believe there are potential benefits in people with particular medical conditions, it is not yet clear which conditions they should be used for nor which specific products to use. More importantly, many people use both prebiotics and probiotics in absence of any disease or symptoms. I do not recommend this, as there is no convincing evidence that they are effective at preventing disease.
A healthy diet contains foods that contain prebiotics, and may contain probiotics as well, in the case of yogurt and other foods with active healthy bacteria.
Q: I am a 75-year-old male in decent health. I have osteoporosis of the spine and three fractured vertebrae. I have on and off back pain but consider myself fortunate to be able to walk and move as much as I do. Exercise is a regular daily thing in my life. One year ago, I was unable to walk at all because my pain was unceasing.
I have studied all the types of osteoporosis treatments. There is quite a range but no cure for the problem. The side effects of treatment force a huge number of people to stop taking them. No one will recommend a particular treatment for me. I take the recommended dose of vitamin D and calcium supplement, but I am reluctant to start any chemical treatment. Am I being foolish to wait?
A: With a history of three fractures, it’s not wise to refuse therapy beyond vitamin D and calcium. The next fracture could be even worse than the three you have had before. Vertebral fractures are usually painful and can lead to compression of the nerves to the body, with complications of worse pain, weakness and numbness. Worse yet, a hip fracture is a devastating injury, usually necessitating major surgery and always with significant risks.
I don’t have enough information about you to recommend a particular therapy. I will say that men with osteoporosis should always have a check of the testosterone level, since low testosterone frequently is associated with osteoporosis, and testosterone treatment increases bone density (although it is unproven to reduce fracture risk). Most men with osteoporosis are treated with anti-resorptive therapy, such as alendronate or risendronate.
You are right that many people stop treatment. In randomized trials, about 30 percent of people will stop their treatment, although that number was about the same in those assigned to placebo. Most people can tolerate the side effects well with the help of a provider who has experience managing this condition.
Especially in someone like you, with a history of multiple fractures, the benefits of treatment greatly outweigh the potential harms.