Role of complementary and alternative medicine to achieve fertility in uninsured patients.

UNLABELLED: Among those facing infertility in the United States, underinsured and uninsured women are at the greatest disadvantage. Women who receive medical care under Medicaid are rarely covered for infertility testing; only 4 states will cover infertility treatment as an element of family planning and preconception care. Studies exploring the use of complementary and alternative medicine (CAM) in infertility patients have focused on patients who have insurance. We conducted a review of the literature via MEDLINE. Articles were limited to English-language, human studies published between 1990 and 2011. Significant disparities exist in access to infertility treatment based on race and ethnicity, household income, and level of education, even in states with mandated insurance coverage. Given the steep costs of assisted reproductive technologies, many infertility patients augment traditional medical treatment with CAM. Acupuncture and herbal supplements are the most studied therapies. Although dietary supplementsmay enhance fertility, the use of othermore expensive forms of CAM such as acupuncture has had mixed results. Complementary and alternative medicine may be a viable option for infertility care for uninsured patients who cannot otherwise afford treatment. TARGET AUDIENCE: Obstetricians and gynecologists, family physicians LEARNING OBJECTIVES: After completing this CME activity, physicians should be better able to analyze the effects that health care disparities have on fertility treatments for uninsured and underinsured women and evaluate the literature to determine which complementary and alternative treatments for infertility can improve fertility.

Bone marrow-derived cells do not repair endothelium in a mouse model of chronic endothelial cell dysfunction.

AIMS: Bone marrow (BM)-derived endothelial progenitor cells (EPCs) in the circulation replace damaged vascular endothelium. We assessed the hypothesis that a BM transplant from healthy animals would restore normal arterial endothelium and prevent hypertension in young endothelial nitric oxide synthase-deficient (eNOS(-/-)) mice. METHODS AND RESULTS: Radiation or busulfan-induced BM ablation in eNOS(-/-) mice on day 6, day 14, or day 28 was followed by a BM transplant consisting of enhanced green fluorescent protein positive (EGFP(+)) cells from C57BL/6J mice. Peripheral blood cell chimerism was always greater than 85% at 4 months after BM transplant. Molecular assays of heart, kidney, and liver revealed low-level chimerism in all treatment groups, consistent with residual circulating EGFP(+) blood cells. When aorta, coronary, renal, hepatic, and splenic arteries in BM-transplanted eNOS(-/-) mice were examined by confocal microscopy, there were no EGFP- or eNOS-positive endothelial cells detected in these vessels in any of the treatment groups. Likewise, telemetry did not detect any reduction in blood pressure. Thus, no differences were observed in our measurements using several different treatment protocols. CONCLUSION: We found no evidence for BM-derived EPC renewal of endothelium in this eNOS-deficient mouse model of a chronic vascular disease or in wild-type mice during postnatal growth. Hence, renewal of chronic dysfunctional endothelium and endothelial homeostasis may be dependent on resident vascular progenitor cells.