Oregon Public Broadcasting

As In Vitro Fertilization Methods Improve, Abortion Rates Drop

Mardi Palan is a 30-year-old hair dresser from Portland. She has a partner and a one-year-old son. She hopes to carry twins for a gay couple from Israel.

If successful, she’ll get about $30,000 — money she hopes to use to buy a home.

In August, she had two embryos transferred and just found out via a blood test, that she’s pregnant. Does she feel different?

“Not really. I mean, like there were a couple of songs on the radio that I started crying to and that’s like how I knew," said Palan. "I was like, 'Oh yeah. Something's up.'"

As part of her contract with the intended parents, Palan has agreed to what people in the industry call "selective reduction" — that is, if an embryo develops a serious medical problem, or if it divides and she ends up carrying triplets.

"They have the right to abort the child if they don't want to go with it," she said. "They do a lot of testing when I'm carrying the baby to see if it has Down syndrome or things like that ... but I talked to them and they said if it was disabled they'd still have it."

In some countries like India or Nepal, it’s not unusual for three, four or more embryos to be transferred at a time — and to improve the odds, some companies will transfer that many eggs into multiple surrogates.

That can lead to a lot of "selective reduction" terminations.

But Palan is working with Oregon Reproductive Medicine in Portland.

Dr. Brandon Bankowski, who’s a partner at ORM, said the company focuses on reducing its rate of "selective reduction" by improving the science.

"Our goal is to get to the point where we transfer one embryo and we have one baby," said Bankowski. "The only options that we offer to our patients now are transferring one or two embryos. We would never transfer more than that."

On average, ORM transfers 1.7 embryos. Ten years ago, that average stood at about three embryos.  Still, said Bankowski, they do perform "selective reductions."

"This used to be something that we would talk about much more commonly," he said. "But because we only transfer one or two, it’s an incredibly rare thing for us to have to talk about. It’s essentially a needle procedure where you terminate one of the pregnancies. You can lose the entire pregnancy by doing that.”

Terminations are carried out well within legal time limits for abortion.

So, what is ORM’s success rate?

For women who use donated eggs, about 70 percent of transfers result in live births  — that’s according to the Society for Assisted Reproductive Technology (SART).

The national success rate is 56 percent.

SART is the in vitro fertilization industry's trade group and governing body. It audits success rates and makes them publicly available.

Bankowski said ORM has a high success rate for several reasons. It does an extensive medical check of egg donors, turning away 93 percent of applicants.

It also freezes and thaws eggs in a very specific way.

“That is sort of the secret sauce of the embryologist," he said. "Sometimes they’re keeping an embryo in a bath for five seconds longer.”

And the lab where eggs are collected? It’s essentially a clean room.

“It’s not just, 'Oh, well. Here’s a room and we’ll put in a little filter and here’s some incubators.' It was designed as this special box within a box after we consulted with the clean-room engineers at Intel,” said Bankowski.

People who go into the lab are asked not to wear perfume, because the volatile organic compounds they contain may harm developing eggs. Even new machines are left to air-out before being installed.

But Bankowski said their latest scientific improvement involves taking a tiny slice off the outside of a developing embryo and putting it on a microchip.

That chip contains a series of sensors that can tell whether or not a certain gene is corrupted.

“Four or five years ago, if we were to test an embryo, we would attach about 10 genetic probes to it," he said. "Now we attach about 500,000.”

Craig Reisser, a former banker who lives in London, chose to use Oregon Reproductive Medicine after putting together a spreadsheet comparing clinics across the world on their success rates and costs.

“We felt that where we had the best chance of success the first time round, was also the most financially cost effective place to go,” Reisser said.

Meanwhile, Palan is enthusiastic about the next nine months.  She’ll find out in about six weeks — via ultrasound — whether she’s carrying twins.

She gets an extra $5,000 for twins.

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Study: Working On Children Rattles EMS Staff

Emergency medical staff sometimes get rattled and make mistakes when dealing with children, according to a new study out of Oregon Health & Science University.

OHSU Dr. Jeanne-Marie Guise interviewed more than 750 emergency workers across the nation. Those are the workers who help out after a car accident or similar emergency.

She asked them when were they most likely to make mistakes.

“The EMS workers identified that airway management, their own personal heightened anxiety when caring for children, interference with the family members. That those are the factors that they were listing as commonly contributing to patient safety events,” she said.A ‘patient safety event’ is essentially a mistake that may cause a patient harm.

Guise said medical equipment that isn’t properly sized for children can also be a problem.

She said more training that simulates pediatric emergencies could help improve care.

Her report is published in the latest issue of The Journal of Pediatrics.

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Feds Propose Paying Doctors To Have End-Of-Life Conversations

After years of debate about whether the government should encourage end-of-life plans, the feds have proposed reimbursing doctors to have those conversations.

Medicare, which insures 55 million older and disabled people, is taking another look at paying doctors to talk to patients about how they’d like to be kept alive if they become too sick to speak.

The idea was lambasted by former Alaska Gov. Sarah Palin, as a "death panel."

But Oregon doctors have been squeezing in such conversations during scheduled appointments for years. They just haven’t been able to bill for them.

Dr. Susan Tolle with the Center for Ethics in Health Care at Oregon Health & Science University welcomes the idea.

"What it does is it gives this really important conversation dignity and standing," she said.

Patients in Oregon make their end-of-life directions clear on what’s known as a POLST form. Over the last five years, a quarter of a million forms have been submitted to the state POLST registry.

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New Report Says Oregon Health Reform Is Working

Oregon’s health care reform efforts appear to be working, according to a new report on outcomes and finances.

The report looks at how Oregon’s system of Coordinated Care Organizations are doing under the Oregon Health Plan.

That population ballooned last year by more than 400,000 people as part of the Affordable Care Act. Nobody was quite sure whether they’d swamp the system.

Lori Coyner of the Oregon Health Authority said most of the CCOs got incentive money for meeting their goals.

“Thirteen of the 16 CCOs were awarded over 100 percent of their quality pool funds, which was very exciting to us," she said. 

"Especially given the large increase in the Oregon Health Plan, we were not certain what it was going to look like at the end of this first year, but the Coordinated Care Organizations have done lots of work to make it happen," Coyner added.

The report shows a decrease in emergency room visits and that costs are being held down.

The state said some of the challenges include fewer cervical cancer screenings for women and more people asking for alcohol and drug treatment.

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OHSU Achieves $500 Million Goal For Cancer Research, Phil Knight To Match

Oregon Health & Science University has reached its $500 million fundraising goal for the school's cancer research campaign.

Nike co-founder Phil Knight and his wife, Penny, pledged in September 2013 to match the raised funds for a total of $1 billion for the OHSU Knight Cancer Institute.

"These last 22 months have shown what is possible when people of vision focus on a single goal," said Knight in a statement. "We are more convinced than ever that cancer will meet its match at OHSU, and we are proud to play a role in this history in the making."

OHSU says that more than 10,000 donors contributed, including Columbia's "Tough Mother," Gert Boyle who donated the largest gift from an individual — $100 million — to the campaign last summer. The largest gift came from the state of Oregon, which invested $200 million.

"This is an amazing accomplishment and a testament to the great science happening at OHSU." said Gov. Kate Brown in a statement. "I'm proud of Oregonians for coming together to support the Knight Cancer Challenge. This bodes well for our state's future, not just for cancer research and care, but also our ability to take on the big challenges of our time."

The school will use the money to hire 25 researchers and an additional 225 to 275 scientists and physicians dedicated to early cancer detection.

Achieving the fundraising goal is touted as the largest documented challenge pledge to succeed, according to researchers at the Indiana University Lilly Family School of Philanthropy.

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VA To Give Benefits To Vets Exposed To Agent Orange

The Department of Veterans Affairs announced Thursday it will expand benefits to reservists who were exposed to the herbicide Agent Orange.

Oregon Democratic Sens. Ron Wyden and Jeff Merkley have lobbied the VA for years to get health care and disability benefits for these veterans.

Last week, the senators blocked the confirmation of a top VA official, arguing the agency needed to extend benefits to the C-123 veterans who were members of the Air National Guard and used C-123 aircraft stateside.

“These C-123 veterans deserve medical care and benefits for their exposure to the hazards of Agent Orange,” Wyden said. “I’m very pleased that the VA has decided that turning a cold shoulder to these veterans is the wrong thing to do and they have changed course.” Sen. Merkley says the VA was slow to act, but the outcome is a victory. “The health issues or injuries that come from Agent Orange don’t happen immediately, they happen years later,” he said. “When our citizen have served in the military and stood up for our nation we have to absolutely stand up for them.”

The planes the veterans used had been contaminated from carrying Agent Orange in Vietnam, and exposure largely took place after the Vietnam War ended.

The reservists were largely based in Ohio, Massachusetts and Pennsylvania between 1969 and 1986, according to the agency.

"Opening up eligibility for this deserving group of Air Force veterans and reservists is the right thing to do," said VA Secretary Robert McDonald in a statement. "We can now fully compensate any former crew member who develops an Agent Orange-related disability."

According to the VA, Agent Orange has been associated with various cancers, Parkinson’s disease and other health issues.

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Consumer Group Says Proposed Health Insurance Rate Hikes 'Unjustified'

Health insurance companies haven’t justified their proposed increases for next year, according to an analysis by Oregon Public Interest Research Group.

The insurance company with the largest enrollment, Moda, is asking for a 25 percent increase next year. LifeWise wants 37 percent and PacificSource is after 42 percent.

The companies say those numbers are justified. They point to all the previously uninsured people who signed up for insurance last year and used a lot of services.

OSPIRG receives a federal grant to look into these increases. The cost spike is likely temporary, said Jesse O’Brien, a health-care advocate with the consumer group.

“The cost of providing medical service to those individuals who’ve been blocked from coverage for many years is very likely to go down in future years as their conditions require fewer acute interventions and become more manageable,” he said.

The Oregon Insurance Division is holding public hearings on the proposed new rates this month. It’s expected to decide final rates by July 1.

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Oregon Senator Calls For Better E-Cigarette Tracking

Oregon Senator Ron Wyden has asked the US International Trade Commission to start tracking imports of electronic cigarettes.

Wyden says we know little about how many e-cigarettes are coming into the country, who is manufacturing them, or the ultimate public health implications.

He says it’s time to collect information and impose new regulations.

Stefen Stockwell of Rosecity Vapsters in Portland says he’s not against new regulations, especially for imported products, “The juice is of way poor quality," he said.

"We make our own juice in shop here using all medical grade materials, and food grade flavorings and concentrates. We have a clean-room environment and it’s a very strict process for making juice. We’ve been regulating this all within the industry ourselves for the last couple of years.”

Wyden says the e-cigarette market last year amounted to about $2.5 billion dollars, with 90 percent of products coming from China.

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Clark County’s E-Cig Law Goes Into Effect Monday

New rules that would regulate e-cigarettes like tobacco cigarettes go into effect Monday in Clark County, Washington.

The new ordinance prohibits smoking e-cigarettes in public places. One exception to the law is that e-cigs can be smoked in dedicated vaping shops.

Theresa Cross, health educator, with the Clark County Public Health Department, said one hope is to curb the rising use of e-cigs among young people.

“The second hand vapor that comes off of these devices is not just simply water vapor," she said. "It does contain toxic substances and those are harmful to human health. Not to the degree second hand smoke from a lit cigarette would be, but it is harmful and we’re wanting to protect the public’s health.”

Last week, Oregon Gov. Kate Brown signed a law that bans the sale of e-cigs to minors and prohibits use in indoor public places.

The portion of the law that prohibits selling e-cigs to minors went into effect immediately. The indoor vaping portion goes into effect January 1, 2016.

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