Monday, July 1, 2013 C5
HEALTH Dr Milton Leong says that Hong Kong lacks a uniform training system for embryologists. Photo: Felix Wong
66% of patients conceived after being treated with acupuncture and IUI in a study in Tel Aviv
T
here’s a lot of mystery and guesswork surrounding infertility, but one thing is for certain: Hong Kong needs more scientists and training in this medical field. One in six couples in the territory is infertile, compared to one in 10 two decades ago. Demand for infertility treatments is therefore high, but there’s a lack of embryologists – scientists who study the development of embryos – to carry out the work. There are 50 embryologists in Hong Kong, spread across 11 assisted reproductive technology centres. That’s 30 scientists short of the ideal figure. To plug the gap, Tung Wah College will launch a programme on embryology and reproductive medicine this September. It will cover basic reproductive biology, embryology, quality control and ethics, and assisted reproductive technologies. Dr Tony Chiu Tak-yu, visiting professor of embryology and assisted reproductive technology with the college’s Department of Medical Science, says there should be on average one embryologist for every 150 laboratory cycles, according to the American Society of Reproductive Medicine’s guidelines for human embryology and andrology laboratories. There were 11,631 reproductive technology procedures performed here in 2010, which means about 78 embryologists were needed. Dr Joseph Chan Woon-tong, deputy medical superintendent and head of the Department of Women’s Health and Obstetrics at the Hong Kong Sanatorium and Hospital, says the role of embryologists in infertility treatments are often overlooked. “While egg collection is done by doctors, the rest of work is done by embryologists. They
THE EGGS FACTOR Infertility is on the rise in the city but embryologists are in short supply, writes Elaine Yau have to ensure the embryos grow properly in a controlled environment,” Chan says. The Sanatorium, which has six embryologists, emphasises continual education to constantly improve their embryologists’ knowledge. Foreign consultants are flown in to train the scientists, who get opportunities to train abroad. However, Hong Kong lacks a uniform training system for embryologists, according to Dr Milton Leong Ka-hong, former president of the Hong Kong Society for Reproductive Medicine. “Training is done mostly on a mentor basis, where a mentor takes on a trainee who gets on-the-job training at a reproductive technology centre,” he says.
LAB REPORT ................................................ Jeanette Wang jeanette.wang@scmp.com
Lack of iron has long-term impact A long-term study has found that infants who lack iron have poorer cognitive, motor and socio-emotional outcomes as adults. In the study in The Journal of Paediatrics, researchers tracked 191 infants (12 to 23 months old) from an urban community near San José, Costa Rica. The adult follow-up 25 years later involved 122 of these subjects. The 33 subjects who had chronic iron deficiency as infants completed one less year of schooling on average and were less likely to complete secondary school or pursue further education, or get married. They also rated their emotional health as worse and reported more negative emotions and detachment/dissociation. Good sources of iron include red meat, egg yolks, dark leafy greens and fortified breakfast cereal.
Gene and not heard Children from Southeast Asia who are late-talkers could be missing a portion of a gene, finds an international research team led by Baylor College of Medicine. The team found this trait in children from 15 unrelated families of Vietnamese, Burmese Thai, Indonesian, Filipino and Micronesian origin. The children had a chromosomal deletion that is linked with bright white spots that show up in an MRI in the white matter of the brain. Late-talkers speak only two or three words at age two, compared to 75 to 100 words for most children. But many such children overcome early speech and language difficulties as they grow. The report is in The American Journal of Human Genetics. Tobacco control ‘will save lives’ Tobacco control measures put in place in 41 countries between 2007 and 2010 will prevent some 7.4 million premature deaths by 2050, according to a study published in the Bulletin of the World Health Organisation yesterday. The study looks at the effects of six measures identified by the WHO’s Framework Convention on Tobacco Control as most effective. They include monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning about tobacco’s dangers, enforcing bans on tobacco advertising, promotion and sponsorship and raising taxes on tobacco.
Most embryologists in Hong Kong are science or medical science graduates who have not undergone proper embryology training in their undergraduate courses, Chiu says. The upcoming three-unit course at Tung Wah College will be offered to students in nursing and medical science. Those who complete it will have the chance to train for one year at a reproductive medicine centre. As a further contribution to infertility treatment, the college is going to conduct a study on combining Chinese and Western medicine to treat infertility. Two hundred infertile women will be recruited, says Professor Louis Chan Yik-si, honorary professor with the college’s Department of Medical
Science. Half the women will get Chinese medicine treatment for two months before Western artificial insemination treatment is offered; half will get only Western treatment. According to figures by the Council on Human Reproductive Technology, the overall on-going pregnancy rate for all IVF cycles is around 25.2 per cent. The low success rate often prompts people to try alternative therapy, such as traditional Chinese medicine. In a study published last year in the Journal of Integrative Medicine, researchers from Tel Aviv University’s Sackler Faculty of Medicine found a significant increase in fertility when both herbal preparations and acupuncture, in combination
[TCM] can help restore normal blood flow and strengthen the uterus KAM YUEN-CHING, TCM PRACTITIONER
with intrauterine insemination (IUI) infertility treatment were administered side-by-side. About 66 per cent of study participants who received combined treatments were able to conceive, compared with 39 per cent of the control group, who received no traditional Chinese medicine.
Kam Yuen-ching, registered Chinese medicine practitioner with the college, says two months of taking Chinese medicine can help strengthen a woman’s body. “In Chinese medicine theory, weak kidney and unsmooth flow of blood caused by stress and anxiety will affect implantation of embryos into the uterus, which is the most difficult part in infertility treatment,” she says. “Chinese medicine can help them restore normal blood flow and strengthen the uterus.” As couples are marrying later, infertility is a growing problem due to poorer ovulation in older women or low sperm quality in men. The success rate of artificial insemination decreases with a woman’s age, says Louis
Chan. For women above 30, the success rate is 30 per cent. For those aged over 40, the rate drops to 15 to 20 per cent. To boost the rate of conception, Hong Kong Sanatorium’s IVF Centre has acquired a new embryo incubator that monitors embryo development round-the-clock. It is said to boast a 45 per cent success rate compared to 39 per cent for normal IVF. Called the EmbryoScope, the device provides the controlled environment of an incubator, but also features a time-lapse camera that captures embryo development every 20 minutes. This feature does away with the conventional incubation method in which embryos are taken out every other day for observation to track developmental progress during the three to five days they are in the lab, before being transferred back to the woman. This creates disturbances to the process. “With the new device, we can observe the embryo almost continuously without the need to take it out,” says Chan. Continuous monitoring means scientists are able to identify optimal patterns of development or abnormalities in an embryo’s growth that may be indicative of the embryo’s future development. The reduced handling of the embryos may also contribute to improved embryo viability. One of the challenges for IVF scientists is predicting which embryo has the best chance of resulting in a pregnancy. “An average of 15 eggs can be retrieved from each patient,” says Xia Ping, senior embryologist and scientific director at Sanatorium’s IVF Centre lab. “The device allows us to know which embryos derive from the eggs with better quality and morphology.” elaine.yau@scmp.com
When cracks appear in your diet ................................................ Jeanette Wang jeanette.wang@scmp.com Hongkongers are sorely lacking calcium in their diet, according to a recent poll of more than 1,300 people. The average intake of the vital mineral is only 574mg, a far cry from the recommended 1,000mg, found the street survey conducted in May by milk powder brand Anlene. The results are consistent with previous studies, indicating that more education about the importance of calcium is urgently needed to prevent potentially dire consequences. The body needs calcium not only to maintain strong bones, but also for muscles to move and for nerves to carry messages between the brain and every body part. Calcium also helps blood vessels move blood throughout the body, and helps release hormones and enzymes that affect almost every function in the body. A lack of calcium over the long term can cause low bone mass (osteopenia) and increase the risks of osteoporosis and bone fractures. Orthopaedic surgeon Dr Cheung Kai-yin says there’s been an increase in bone issues in Hong Kong for the past several years, mainly affecting people older than 50. The recommended daily
It’s healthier to concentrate on a pure form of calcium, such as milk PRISCILLA LAU, DIETICIAN
themselves.” cheese pretty calcium intake for this age group Communitywell, and full is 1,200mg. based nutrition cream milk Osteoporosis, which literally education can tends to be means porous bone, is a major help increase better tolerated. public health problem of those surveyed did not calcium intake, a Also, a tolerance worldwide, and this burden is take 30 minutes exercise, Vietnamese study to lactose can growing with increasing life three times a week, shows. be built up, expectancy and population as recommended Researchers from starting with a ageing, according to the the National Institute of third of a cup of Osteoporosis Society of Hong Nutrition in Hanoi carried milk, increasing Kong. It is forecast that, by 2050, out a controlled trial in the amount gradually over time. more than half of all hip Vietnam’s Red River Delta, People usually don’t know fractures in the world, a total of involving 140 women aged 55 they’re taking too little calcium, 3,250 million cases, will occur in who had less than 400mg because, in the short term, the Asia – and mostly in China. calcium per day. An body maintains calcium levels In their report, Guidelines intervention group was given in the blood by taking it from for Clinical Management of nutrition education counselling bone. There are no obvious Postmenopausal over 18 months to improve symptoms. Osteoporosis is Osteoporosis in Hong Kong, calcium intake. diagnosed usually only published in April, the After 18 months, these after a fracture. society notes that reports women had increased their Other lifestyle habits from the 1980s and ’90s also contribute to healthy calcium intake significantly and showed a traditional their bone mass had remained bones. Regular weightChinese diet contained a bearing exercise, such as stable. In comparison, the bone calcium content of mass of the control group weightlifting and around 400mg daily. (which had not received running for 30 minutes Publications from the counselling) had decreased by a day three times a 2000s showed an Plain low-fat yogurt (240ml) – 415mg 0.5 per cent. week, is a key factor, increase in daily dietary Supplements can help says Anthony Kwok, calcium content to Part-skim mozzarella (42 grams) – 333mg boost low dietary calcium vice-president of the 500mg to 600mg. Canned sardines with bones in oil (85 grams) – 325mg Hong Kong intake, but Lau says it’s Because dairy Non-fat milk (240ml) – 299mg preferable to obtain the Osteoporosis products are the major mineral from food sources. Foundation. food source of calcium, Calcium-fortified soy milk (240ml) – 299mg There have been suggestions The survey found the high incidence of Calcium-fortified orange juice (180ml) – 261mg of a possible link between that 74 per cent of lactose intolerance in Firm tofu (85 grams) – 130mg calcium supplements and a respondents did not Chinese people could potential increased risk of meet this requirement. explain the low intake. cardiovascular disease. A daily 15-minute However, dietitian But an expert panel from the dose of sunshine, Priscilla Lau notes that Council for Responsible Kwok adds, allows dark green leafy Nutrition in the US last year vitamin D synthesis, vegetables and hard tofu examined rigorous scientific which enhances are also calcium sources. studies and found they were calcium absorption. The Anlene survey “more confident than ever in Only 28 per cent of found that 28 per cent of both [calcium supplements’] respondents met this. Hongkongers preferred health benefits and safety”. “The effects of to consume milk by Panelist Dr Robert Heaney osteoporosis are having it in coffee. But said: “Consumers can feel incredibly serious and Lau says caffeine in confident about the safety of can include severe coffee leaches calcium their calcium supplements and fractures to the wrist, from bones. “It’s much should continue taking them hip or vertebrae, loss of healthier to focus on a with confidence. mobility, and stooping pure or concentrated “They should, however, be due to spinal curvature,” source of calcium, such aware of how much calcium says Kwok. “We urge as milk,” she says. their diets provide, and then people to make small Lau adds that the lactose supplement accordingly.” lifestyle changes to protect intolerant can take yogurt and
74%
Some sources of calcium