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Women who drank five or more cups of coffee a day were about 50% less likely to get pregnant through in-vitro fertilization (IVF) than non-drinkers, according to a recent Danish study.

“Although we were not surprised that coffee consumption appears to affect pregnancy rates in IVF, we were surprised at the magnitude of the effect,” said lead researcher Dr. Ulrik Schiøler Kesmodel of the Fertility Clinic of Aarhus University Hospital, in Denmark, in a statement.

For the study, presented at the annual meeting of the European Society of Human Reproduction and Embryology in Istanbul, Kesmodel and his colleagues followed nearly 4,000 women receiving IVF or intracytoplasmic sperm injection (ICSI) treatments in a large Danish fertility clinic. The women reported their coffee consumption at the start of treatment and at the start of each cycle. The researchers controlled for a variety of factors: the women’s age, smoking and alcohol consumption, the cause of their infertility, weight, ovarian stimulation and number of retrieved embryos.

Their findings showed that the relative chances of pregnancy were cut in half for women who drank more than five cups of coffee per day — “comparable to the detrimental effect of smoking” the authors noted — but there was no effect in women who drank less coffee.

(MORE: Coffee: Drink More Live Longer?)

“There is limited evidence about coffee in the literature, so we would not wish to worry IVF patients unnecessarily,” said Kesmodel in a statement. ”But it does seem reasonable, based on our results and the evidence we have about coffee consumption during pregnancy, that women should not drink more than five cups of coffee a day when having IVF.”

The assumption is that it’s the caffeine in coffee that may interfere with IVF success, but as Kesmodel told the BBC, there are so many substances in coffee, it’s hard to know for sure. However, researchers have long sought to understand whether caffeine affects fertility, and previous studies have found mixed results. Some data suggest that coffee drinkers are more likely to miscarry, while others have found the opposite. Some studies have also linked high caffeine consumption with lower odds of pregnancy, low birthweight and preterm birth, but a 2009 Cochrane review of gold-standard trials couldn’t confirm any benefits of avoiding caffeine during pregnancy.

Women who enjoy a cup-o-joe in the morning shouldn’t fret. “The fact that we found no harmful effects of coffee at lower levels of intake is well in line with previous studies on time-to-pregnancy and miscarriage, which also suggest that, if coffee does have a clinically relevant effect, it is likely to be upwards from a level of four-to-six cups a day,” said Dr. Kesmodel.

Long-lasting contraceptives such as the intrauterine device (IUD) and implants are better at preventing pregnancy than more popular birth control methods, including the pill, patch and vaginal rings, a new study concludes.

The study involved 7,486 women participating in the Contraceptive Choice Project, run by researchers at Washington University School of Medicine in St. Louis. The women, aged 14 to 45, were given their choice of contraception for free and then tracked for up to three years for unintended pregnancy. The results, published in the New England Journal of Medicine, found that longer-lasting contraceptives were up to 20 times more effective — that is, women using IUDs, implants or hormone injections were up to 20 times less likely to get pregnant — after three years than the shorter-acting methods of birth control.

(MORE: Plan B: 1 in 5 Pharmacists May Deny Eligible Teens Access to Emergency Contraception)

Among the 1,500 women who chose to use birth control pills, patches or vaginal rings, 4.8% became pregnant after one year, compared with only 0.3% of the nearly 5,800 women who chose IUDs or implantable contraceptives. After three years, 9.4% of women using short-acting contraceptives got pregnant, compared with 0.9% of those using longer-acting methods.

Women using hormone injections (a minority at 176) had even better success, with 0.1% becoming pregnant after one year and 0.7% becoming pregnant after three years.

The results, while striking, aren’t all that surprising, considering that shorter term options depend on consistent compliance to work most effectively: pills must be take daily and patches and rings must be replaced within days or weeks.

In contrast, IUDs, which are fitted into the uterus, last five or 10 years, depending on the device. Hormonal implants, which are surgically placed under the skin of the upper arm, are effective for three years. And injections last three months.

(MORE: The Pill at 50: Sex, Freedom and Paradox)

How well a birth-control method worked depended also on the age of the user: younger women, under 21, using pills, patches or vaginal rings were nearly twice as likely to become pregnant as older women who used the same contraceptives. Why? Because they were more likely to forget to take their pills or to change their patch or ring. There were no age-related differences in pregnancy rates among women using IUDs, implants or injections.

Overall, poorer women with less education were also more likely to experience contraceptive failures.

The researchers hope their results will prompt more women to consider using long-acting contraceptives to prevent unwanted pregnancy. Each year in the U.S., there are an estimated 3 million unplanned pregnancies, about 1.2 million of which lead to abortion, according to the study. About half of unintended pregnancies occur because of because of incorrect or inconsistent use of contraception, including condoms and birth-control pills.

Still, the pill is the most commonly used contraceptive in the U.S. That may be because women don’t hear about long-acting methods as often as other contraceptives, or because women are more comfortable taking a pill or using a patch than having a device implanted in their body. Another factor: cost. IUDs and implants are expensive and aren’t typically covered by insurance.

(MORE: Teen Sex Ed: Instead of Promoting Promiscuity, It Delays First Sex)

“Nationally, only about 5 percent are using long-lasting methods like IUDs and implants. We know one of the barriers to why they’re not using them more frequently is up-front costs,” the study’s lead author, Dr. Brooke Winner of Washington University School of Medicine, told Reuters. “If [more] women were using these products nationally, there would be a very significant drop in unintended pregnancies, which would have far-reaching effects.”

While longer-lasting contraceptives can be more expensive up front, they may turn out to cost about the same as the pill when the expense is broken down by day, the researchers noted. IUDs and implants can be removed when women wish to become pregnant, and fertility typically returns immediately.

The researchers hope their study will also encourage doctors to consider IUDs and implants when discussing birth control with their patients. “If there were a drug for cancer, heart disease or diabetes that was 20 times more effective we would recommend it first,” another study author, Dr. Jeffrey Peipert, a professor of obstetrics and gynecology at Washington University, told the Wall Street Journal.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

Read more: http://healthland.time.com/2012/05/24/iuds-and-implants-beat-the-pill-in-preventing-pregnancy/?iid=hl-main-feature#ixzz1x5mUfmlM

The small fraction of women who choose intrauterine devices (IUDs) or under-skin implants as their preferred method of birth control may be on to something: According to a new study, these long-acting forms of contraception are 20 times better at preventing unintended pregnancies than the Pill and other short-term methods.

The study, published this week in the New England Journal of Medicine, compared the effectiveness of various types of birth control in a group of about 7,500 sexually active women in the St. Louis area. Over a period of three years, 9.4% of women using birth control pills, patches, or vaginal rings became pregnant accidentally, compared to just 0.9% of women who opted for IUDs or implants.

The difference in these so-called contraceptive failure rates was especially dramatic among teenagers and young women, a group at high risk for unintended pregnancies.

Women under age 21 who used short-term birth control were nearly twice as likely as their older counterparts to become pregnant, whereas the failure rate for IUDs and implants was less than 1% regardless of age.

“It’s not that birth control pills aren’t effective, because they are — when they’re used perfectly,” says Jeffery Peipert, M.D., a study author and professor of obstetrics and gynecology at Washington University Medical School, in St. Louis. “But humans aren’t perfect, and it’s normal to forget to take a pill every day or file for prescription refills every month.”

Health.com: What’s the best birth control for you?

Birth control pills, the method of choice for 28% of U.S. women, are the most commonly used form of reversible contraception, but their effectiveness depends on consistent daily use. Nationally representative surveys have reported failure rates with the Pill similar to those seen in the current study.

Patches and rings require less attentiveness than pills, but they still leave room for human error. The birth control patch (known by its brand name, Ortho Evra) needs to be changed weekly, while the vaginal ring (known as NuvaRing) needs to be changed once a month.

By contrast, IUDs and implants are designed to be foolproof. An IUD, a T-shaped piece of plastic inserted into the uterus by a gynecologist, can remain in place for five to 10 years. Implants such as Implanon and Nexplanon, matchstick-size devices inserted below the skin on the upper arm that release a slow trickle of hormones, can last up to three years.

Despite being far more effective than pills, IUDs and implants — collectively known as long-acting reversible contraception (LARC) — have proven to be less popular with women. According to the latest government data, just 5.5% of women on birth control use IUDs and less than 1% use implants.

Health.com: The worst birth control mistakes

“When a woman tells her ob-gyn that she wants to go on birth control, most doctors offer the Pill right off the bat,” Peipert says. “That needs to change. If there were a drug for cancer that was 20 times more effective, we would obviously recommend that first — and that’s what we should be doing for contraception, as well.”

A third type of birth control, the hormone injections sold under the brand name Depo-Provera, had a low failure rate comparable to those of IUDs and implants, the study found. That rate may not accurately reflect the real-world effectiveness of the shots, however, since the study included only women who received them every three months, as required, Peipert says.

Eve Espey, M.D., a professor of ob-gyn at the University of New Mexico, in Albuquerque, says doctors in her field have been anxiously awaiting the publication of these findings, which emerged from a broader ongoing study, known as the Contraceptive CHOICE Project, that was developed to promote LARC use in and around St. Louis.

“It definitely confirms what most people in family planning have expected, that the LARC methods are by far the most effective,” says Espey, who was not involved in the study. “We’ve been anticipating this CHOICE data for a while, because it’s such a great way to look at outcomes of different contraceptive methods in real life.”

Health.com: What’s healthier: the pill or an IUD?

The CHOICE project, however, differs from real life in key ways that may shed light on why IUDs aren’t more widely used. The project, which is funded in part by the Susan Thompson Buffett Foundation, was purposefully designed to remove all financial barriers to the use of IUDs and implants, which have a high upfront cost — $500 or more — and aren’t always covered by insurance.

All of the study participants, who ranged in age from 14 to 45, received a prescription for their preferred birth control method for two to three years, free of charge. With cost taken out of the equation, more than three-quarters of the participants opted for an IUD or implant — a proportion roughly 10 times higher than in the general population.

In addition, the participants talked with a doctor about the risks and benefits of each birth control method before making a selection. This counseling session also may have helped to encourage IUD and implant use by dispelling many of the misconceptions that surround long-term birth control, Peipert says.

Health.com: Common birth control side effects

IUDs, for instance, haven’t fully shaken the bad reputation they earned in the 1970s, when an early device known as the Dalkon Shield was pulled from the market after it was found to cause infection and injury. Decades later, some gynecologists still aren’t trained to insert IUDs, and others believe that many women — such as those who have never had children — are not good candidates for the method, Peipert says.

In fact, today’s IUDs and implants have been shown to be safe and effective for a wide range of women, including teenagers, Espey says. Women who are interested in trying one should talk to a gynecologist, or more than one, she adds.

“If you’re told that you’re not a good candidate, you shouldn’t necessarily take that at face value,” she says. “You might need to take an advocacy role for yourself if you really want the best options available to you.”

Maintaining good health during pregnancy is one of the surest ways mothers can protect their developing babies’ well-being. A new study suggests that adequate levels of vitamin D could be one such protective factor.

Some data have linked low vitamin D levels to weight gain and obesity in women and children, but in the new study researchers at the University of Southampton in the U.K. found that association may begin the womb: children born to mothers with low levels of the vitamin during pregnancy had more body fat at age 6 than those whose mothers weren’t vitamin deficient.

The study, published in the American Journal of Clinical Nutrition, looked at the vitamin D levels of 977 pregnant women and the body composition of their kids. All the women were part of the Southampton Women’s Survey — one of the largest women’s surveys in the U.K.

(MORE: Jessica Simpson’s Pregnancy Weight: Why Everyone Has an Opinion)

“In the context of current concerns about low vitamin D status in young women, and increasing rates of childhood obesity in the U.K., we need to understand more about the long-term health consequences for children who are born to mothers who have low vitamin D status,” lead researcher Dr. Siân Robinson said in a statement.

How vitamin D in mothers affects their children’s weight gain remains unknown, but the authors speculate that there are “programmed effects on the fetus that arise from maternal vitamin D insufficiency that remain with the [baby] and that may predispose him or her to gain excess body fat in later childhood.”

The researchers add that childhood weight gain can also be attributed to other issues associated with insufficient maternal nutrition like too much or too little weight gain by pregnant mothers.

(MORE: Is There an Obesity Tipping Point in Infancy?)

Previous research has shown low vitamin D levels can lead to other pregnancy complications. A 2010 study found that women who developed a severe form of pregnancy-related high blood pressure called early-onset severe preeclampsia had lower vitamin D levels than healthy pregnant women. The complication is more common among African American women, who are also more likely to be vitamin D deficient; vitamin D is naturally synthesized in the skin when exposed to sunlight, and the process is less efficient in people with darker skin.

A 2012 nutrition report from the Centers for Disease Control and Prevention (CDC) reported the highest rates of vitamin D deficiency are among non-Hispanic blacks.

The National Institutes of Health says everyone can get vitamin D from enhanced foods, sun exposure and dietary supplements. Vitamin D is present naturally in very few foods, including:

Swordfish
Salmon
Milk
Eggs (in yolks)

The new study is part of a larger project by the University of Southampton’s MRC Lifecourse Epidemiology Unit, which investigates how factors during pregnancy may influence childhood growth and development long-term.

Read more: http://healthland.time.com/2012/05/23/is-moms-lack-of-vitamin-d-linked-with-childs-weight/#ixzz1vllZlaJi

CNN conditions expert Dr. Otis Webb Brawley is the chief medical officer of the American Cancer Society, a world-renowned cancer expert and a practicing oncologist. He is also the author of the book, “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.”

(CNN) — Q: This week the U.S. Preventive Services Task Force issued preliminary guidelines for ovarian cancer screening. It recommends against routine screening saying that the risk of false positive diagnoses outweighs the benefits. How can this be and why is it so hard to find a good screening test for ovarian cancer?

A: The U,S. Preventive Services Task Force is a group of medical experts who assess the scientific literature on an issue, such as ovarian cancer screening, before making a recommendation. They do influence how doctors practice medicine.

The statement recommends against routine ovarian cancer screening because they find the evidence of harm associated with screening is greater than the evidence of benefit.

Unfortunately we do not have a good screening test for ovarian cancer, the fifth leading cause of cancer death in women. We need something as effective for ovarian cancer screening as pap smears are for cervix cancer screening.

It is a surprise to many that a screening test could be considered more harmful than helpful. The problem is routine ovarian cancer screening starts a cavalcade of medical procedures associated with harms that are greater than the ultimate benefits. Importantly, it is not that there is no benefit to ovarian cancer screening. The problem is there is not a “net benefit.”
Olympic gymnast battles cancer

The blood test CA 125 is elevated in about half of women who are known to have ovarian cancer. If effectively treated by surgery or chemotherapy, the CA 125 level in the blood goes down. It has been used for nearly three decades to follow progress in treatment.

This test was suggested for screening in the late 1980s. Screening is doing a test in asymptomatic patients who are not suspected of having the disease but are at risk because of age and gender. Very early on, many thought CA 125 would not work well as a screening test.

A teacher gave me this example more than 20 years ago and it still holds. It is dense in numbers, but I think it is followable. It illustrates how a public health physician thinks of a screening test and the trouble with CA 125.

A group of investigators tested the CA 125 blood test for screening in a group of 915 women average age 55, and a total of 36 or 3.9% were abnormal (a level greater than 35 U/ml). These women were evaluated for ovarian cancer and followed. Ultimately none had ovarian cancer.

What if one was to screen 100,000 women? That means 3.9% of the 100,000 or 3,900 women will have false positive findings. Using U.S. cancer incidence data, 13 women in the 100,000 would have ovarian cancer in a given year.

Given that most of the 13 women will be diagnosed with incurable advanced ovarian cancer, a fair assumption is six of the 3,900 will be diagnosed with a potentially curable ovarian cancer.

Given that CA 125 is positive in half of ovarian cancer patients, one would reasonably estimate that three of the six women with curable disease would be identified. That is three potential cures in the more than 3,900 women screened.

Of the 100,000 women, we expect 148 will die of cancer and nine of the 148 will be die because of ovarian cancer within a year of the screen.

That might sound worthwhile at face value, but lets look at the harms of screening. Most of the 3,900 women will get further testing. This consists mostly of ultrasounds and CAT scans. Several hundred will need to get laparoscopy or more invasive abdominal surgery for evaluation.

This is the area of greatest concern. One survey shows 14% of women over the age of 65 have complications after abdominal surgery. Surgical complications cause death in 1% to 2% of women over 65 and one-half of 1% of women over 50, Several hundred women will get abdominal surgery.

When done as a routine test it is quite easy to see that ovarian cancer screening could actually cause the death of more women than the number of women saved. Most of the women who have bad outcomes will not have ovarian cancer.

The gold standard for proving effectiveness of a screening test is a prospective randomized clinical trial comparing a screened group to a group that is not screened over time.

The U.S. National Cancer Institute began such a study in 1993 and published the result in 2011. The trial included 78,216 women aged 55 to 74. It randomly assigned 39,105 to screening and 39,111 to usual care. After an average of more than 12 years of follow-up, the groups had no difference in the ovarian cancer death rate. This means that the trial showed no evidence of routine screening saving lives.

CA 125 is not a good test for ovarian cancer screening, and ovarian cancer may not be a good cancer for screening. What we need is a test that flags fewer people who do not have the disease as suspicious of having the disease. It would be even better if the test found more than half of the women who have the disease. Screening also works better in cancers that tend to stay localized for longer periods of time. Many ovarian cancers spread throughout the abdomen very early in the life of the cancer when the tumor is still very small.

It is important to note that the task force addressed routine screening. The test can be appropriate for screening a woman known to be at high risk for ovarian cancer because of a family history. The test may also be appropriate in assessing a woman who has lower abdominal discomforts.

The opinions expressed in this article do not necessarily represent those of CNN, The American Cancer Society, or Emory University.