News, Events & Firsts
This section is devoted to the latest news which may be important to our patients. We will also post upcoming events and general items of interest. Check here often as we update this page.
In response to recent developments pertaining to the use of hormone replacement therapies, we have been innundated with inquiries from our patients regarding their use.
The Scoop on Hormone Replacement Therapy
Lately there has been a lot of information in the news on hormone replacement therapy (HRT); we would like to summarize this in more detail for you and provide you with a brief review of the research on HRT.
The HRT information that was recently in the news was based on The Women's Health Initiative (WHI). WHI is a group of clinical studies to investigate the prevention and control of common causes of postmenopausal morbidity (number of cases of a specific disease in relationship to a specific population) and mortality (the death rate). The studies include three major interventions that target specific outcomes.
Overview of the WHI targeted outcomes:
• Hormone Therapy to reduce the risk of heart disease, hip fracture and with breast cancer designated as an adverse outcome
• A low-fat diet to prevent breast and colorectal cancer and heart disease
• Supplementation with calcium and vitamin D to reduce osteoporotic fractures of the hip, other fractures and colorectal cancer
The Background on Hormone Replacement Therapy
An 8-year research study was designed to take an overall look at the benefits and risks of women using estrogen plus progesterone or no hormone replacement therapy.
After approximately 5 years (July 9, 2002), it was recommended by a study monitoring board to stop the estrogen plus progesterone portion of the study because the risks of hormone therapy outweighed the benefits.
Therefore before going further into this study, it is important to understand that there are many different types of estrogen and progesterone.
Here is an in-depth look at why the estrogen plus progesterone that were studied by the Women's Health Initiative (WHI) portion of the study was stopped; study participants showed the following:
- 26% increase in breast cancer
- 41% increase in stroke
- 29% increase in heart disease
- 110% increase in blood clots (thromboembolic events)
- 37% reduction in the development of colorectal cancer (37%)
- 34% reduction in the occurrence of hip fractures (34%)
Let us now take a look at the above results in another way, if we were to compare a group of 10,000 women (per year), those women using estrogen plus progesterone versus nonusers, the results were:
- 8 more cases of breast cancer (usually less aggressive types and more responsive to treatment)
- 8 more strokes (sudden loss of consciousness followed by paralysis caused by hemmorage in the brain)
- 8 more incidents of pulmonary embolism (lung obstruction of an artery or one or more of its branches)
- 7 more heart attacks
At this point it is important to note ....
The WHI study looked at only one specific type of estrogen plus progesterone combination
These results were not seen in women taking estrogen alone.
Did you know?
There is also another portion of the WHI study that is investigating the use of estrogen alone. This portion of the study is still in progress and it started at the same time as the estrogen plus progesterone study. Also the results (as listed above) have not been seen in women taking Prempro. (Prempro is made up of conjugated estrogens plus progesterone)
Short vs. Long Term Considerations
The ability of estrogen with or without progestin to relieve vasomotor symptoms remains unquestioned.
What are vasomotor symptoms?
• Hot flashes
• Perspiration
• Palpitations (of the heart)
The WHI did not assess vasomotor symptom relief with hormone therapy.
The WHI did demonstrate that the risk for cardiovascular events, blood clots (thromboembolic events) and stroke were increased with in year 1 and 2 of combined hormone therapy.
The benefits and risks of estrogen and progesterone for the relief of vasomotor symptoms should be carefully discussed to weigh the benefits and risks with the patient.
Estrogen (low doses of topical and oral) has been found to be helpful for women with postmenopausal vaginal atrophy (thinning of the vagina walls).
The study concluded that estrogen and progesterone should not be used as preventive therapy for cardiovascular disease. Again, note that studies of women taking just estrogen alone are still under way and therefore the risks and benefits are unknown at this time.
If you have more questions & would like to contact a health care provider from Binghamton Gynecology & Fertility, please click here.
The New Infertility Law – What Does It Actually Mean?
Of course your insurance company is trying to wiggle their way out of paying for fertility medications. Each insurance company will set their own guidelines as to how the new law applies to them. Only time will tell whether or not this will be challenged.
The good thing is that now at least some portions of the medications are covered.
Excluded are those insurance policies that originate from self-funded companies. For example large hospitals and businesses only use the insurance policy as a go between but they actually pay for total medical care. This is in contrast to small companies and individually purchased policies that pay a fixed quarterly rate, no matter what the claims are against policy. Also even though the new law took effect January 1, 2003 it may not be applicable to your policy until the renewable date this year. For example, if you renew your policy March 1st of every year, the new policy will not affect you until March 1st 2003.
The best way to ascertain if you have coverage for fertility treatment is to contact your insurance provider directly. When doing so always note:
- The complete name of person you spoke to
- The date and time you spoke to the person
- Attempt to get what is said in writing
Furthermore it is routine for us to contact insurance companies concerning fertility coverage. We do this routinely to ensure that the maximum benefits are utilized.
If you would like to determine your infertility needs and insurance coverage, please contact us at 607.797.7070 for more information and to schedule an appointment.
For more details about the infertility law and a summary, see below and review the attached information.
Follow the following steps for a detailed description of the law:
Go to www.senate.state.ny.us
Click on laws of New York
Click on ISC
Click on Article 43
Go to section 4303(s)
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Summary - Insurance Coverage of Fertility Treatment
Fourteen states have passed laws that require either mandating coverage or offering coverage for infertility diagnosis and treatment. Nine states have laws that require insurance companies to cover infertility treatment. Five states have laws that require insurance companies to offer coverage for infertility treatment. While most states with laws requiring insurance companies to offer or provide coverage for infertility treatment include coverage for in vitro fertilization, California and New York have laws that specifically exclude coverage for the procedure. New York’s expanded law does not mandate that health maintenance organizations (HMOs) and group health insurance policies cover certain procedures, including in vitro fertilization, gamete intra-fallopian tube transfers, and zygote intra-fallopian tube transfers. The law further asserts that procedures not necessarily considered assisted reproductive techniques, or procedures that otherwise may not be considered as aids to conception, are excluded from mandated coverage, e.g. reversal of elective sterilizations, sex-change procedures, cloning, and medical or surgical services or procedures that are deemed to be experimental in accordance with referenced clinical guidelines.
In 1990, lawmakers approved a simple measure that requires HMOs and group health insurance policies to cover surgical, medical, and hospital care for the diagnosis and treatment of correctable medical conditions which result in infertility (Chapter 897, L.1990). In 2002, after 2 years of legislative impasse, lawmakers approved a proposal, which expands this coverage with more specific mandates (Chapter 82, L.2002). The expanded coverage benefits persons 21 to 40 years of age (but the law does not preclude coverage for persons outside this age range).
This SRS Issues in Focus discusses the evolution of infertility coverage in New York State, including the controversy over coverage of in vitro fertilization, and summarizes other states’ activities in this area.
Summary provided by Senator Libous’s office.
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Transvaginal Sonography (TVS)/ Ultrasound
What does it mean?
Sonography or ultrasound is the use of sound waves to produce an image or photograph of an organ or tissue. The ultrasound has different velocities in tissues, which differ in density and elasticity from others. This property permits the use of ultrasound in outlining the shape of various tissues and organs in the body. Ultrasound is used for the diagnosing and other therapeutic purposes.
Binghamton Gynecology & Fertility has always provided in-office ultrasound scanning by certified ultrasonagraphers. We still remain the only office in our region certified by the American Institute of Ultrasound in Medicine (AIUM).
Transvaginal sonography/ ultrasound is considered the gold standard in evaluation and assessing gynecological disorders, infertility and more. TVS allows for an image to be viewed through or across the vagina. Rather than conventional ultrasounds (transabdominal sonography) that view images through or across the abdomen.
In our office we utilize TVS to evaluate the following:
- Irregular and/or postmenopausal bleeding
- Irregularities in the uterus, fallopian tubes
- Fibroids - A fibroid is a change in the membranous tissue of the uterus or cervix into a fibrous nature.
- Endometrial fluid
- Ovary and fallopian tubes
- Cysts
- Follicular monitoring for infertility treatment cycles and In-Vitro Fertilization (IVF)
- Screening for ovarian cancer
- Cervical incompetence and dilation
- Abscesses and other masses
- Bladder and rectal lesions
- Urinary bladder incontinence
Please contact an experienced health care provider at Binghamton Gynecology and Fertility & The Endometriosis Center for more details regarding Transvaginal Sonography (TVS).
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The Endometriosis Center at Binghamton Gynecology and Fertility has a long history of introducing "treatment firsts" into our region, including:
- First to introduce monitored injections for fertility treatments
- First pregnancy and delivery using super ovulation techniques
- First to introduce a satellite IVF program (and the third in the country!)
- First laparoscopic assisted hysterectomy performed in our region
- First laparoscopic appendectomy
- First and only practice offering supra cervical and total laparoscopic hysterectomy
- First laparoscopic bladder suspension
- First and only office to become certified in ultrasound by the American Institute of Ultrasound in medicine
- First to offer nutritional service for multiple medical disorders - such as diabetes, high cholesterol, Polycystic Ovarian Syndrome (PCOS) and obesity
The Endometriosis Center at Binghamton Gynecology and Fertility is dedicated not only to compassionate care but to providing the latest and most effective medical techniques.
