If both partners were merely overweight, the likelihood of waiting more than a year was 1.4 times higher, according to a study reported online in the March issue of Human Reproduction.

Earlier research had shown that weight can affect fertility in both men and women individually. However, fecundity is a couple concept, and this is the first study to look at the effect on fertility of overweight and obesity in couples, said Cecilia Ramlau-Hansen, a doctoral student at Aarhus University Hospital here, now on a visiting scholarship at UCLA, and colleagues in Denmark.

The data came from interviews, including weight measures and socioeconomic factors, with more than 64,000 pregnant women enrolled in the Danish National Birth Cohort from 1996 to 2000. After eliminating couples with incomplete information or where other factors warranted exclusion, the researchers were left with data on 47,835 couples.

In this cohort 6.8% of the men were obese, 8.2% of the women were obese, and both were obese in 1.4% couples.

Normal weight was defined as BMI 18.50 to 24.99 kg/m2; overweight as BMI 25 to 29.99 kg/m2; obesity as BMI 30 kg/ m2. Underweight was BMI < 18.50 kg/ m2.

Among men and women with a BMI of 18.5 kg/ m2 or more, there was a dose-response relationship between increasing BMI group and subfecundity (time to pregnancy of more than 12 months) as:

* Odds ratio (OR) = 1.32 (95% CI: 1.26-1.37) for women;
* OR = 1.19 (95% CI: 1.14-1.24) for men.

This higher risk of subfertility found in these men and women, was particularly true for couples, the researchers reported.

Among couples where both were either overweight or obese, the adjusted ORs for subfecundity were 1.41 (CI: 1.28 to 1.56) and 2.74 (CI: 2.27 to 3.30), respectively, compared with couples where both members were of normal weight.

Repeating the analysis using a six month time to pregnancy as the cutoff, gave similar results, as did restricting the analysis to first pregnancies only.

An underweight person, especially an underweight man, combined with an obese partner, seemed to cause additional pregnancy delays, the researchers noted.

The combination of an underweight man and an obese woman compared with a normal-weight couple, was associated with a risk of subfertility nearly four times higher (3.79) compared with a normal-weight couple. However, these findings must be treated with caution, the researchers said, as there were only 22 couples fitting this description, and the reasons for weight loss could be confounded by disease.

The researchers also analyzed 2, 374 couples where the women had more than one pregnancy and where the woman’s initial BMI was 18.5 kg/ m2 or more. Converting the women’s waiting times to days, they found that each kilogram increase in weight between the two pregnancies was associated with an extra 2.84 days to pregnancy (95% CI: 1.33-4.35).

A further analysis of these groups found that among 365 couples where the woman was overweight or obese before her first pregnancy and either lost weight or maintained the same weight in the time till the next pregnancy, for every 1 kg of weight lost, the waiting time to pregnancy was reduced by an average of 5.5 days.

These findings indicate a causal association between BMI and fertility, the researchers said. For the underweight women in the group, there was a tendency for the time to pregnancy to decrease if the women gained weight, a finding in line with earlier studies showing that being underweight has an adverse effect on a woman’s fertility.

Because this study included only couples who became pregnant, an association between high BMI and sterility was not detectable. “We believe, however, that the effect of BMI is quantitative rather than qualitative, if it is a cause of subfecundity, and this is supported by all existing studies,” the researchers said. A high BMI probably leads to sterility only in people in people with additional fertility problems, they added.

Previous studies have shown that men’s BMI is associated with semen quality and levels of reproductive hormones and that in women, obesity can affect ovulation, conception, implantation, and early fetal development.

“Since reliable information on the frequency and timing of sexual intercourse was not available, we cannot know whether infrequent intercourse delayed conception in overweight and obese couples,” the investigators said.

In addition, they said, that although these results indicate that overweight and obesity are a cause of subfertility, this study cannot confirm that. There might be unknown underlying factors, such as disease or genetic factors, that cause these results. Only a randomized trial can establish this, they wrote.

Whether losing weight restores fecundity is also best studied in a randomized trial, although this study indicates that this may be the case, the researchers concluded.

During a heart attack, the heart is deprived of oxygen, which can result in significant damage to heart muscle and tissue. After the attack, most patients require treatment to reduce and repair the damage and improve their chances of survival. With the exception of early reperfusion, there are no available therapies that are truly effective in protecting or repairing such damage clinically.

Rakesh C. Kukreja, Ph.D., professor of medicine and Eric Lipman Chair of Cardiology at VCU, and colleagues compared nitroglycerin with two erectile dysfunction drugs — Viagra®, generically known as sildenafil, and Levitra®, generically known as vardenafil — to determine the effectiveness of each for heart protection following a heart attack. Nitroglycerin is a drug used to treat angina, or chest pain. It is a vasodilator and opens blood vessels in order to improve the flow of blood to a patient’s heart.

The research team reported that in an animal model, sildenafil and vardenafil reduce damage in the heart muscle when given after a severe heart attack. In contrast, nitroglycerin failed to reduce the damage in the heart when administered under similar conditions. The findings were published in the Journal of Molecular and Cellular Cardiology, the official publication of the International Society for Heart Research.

“Erectile dysfunction drugs can prevent damage in the heart not only when given before a heart attack, as we discovered previously, but also lessen the injury after the heart attack,” said Kukreja, who is the lead author of the study.

According to Kukreja, the protective effects on the heart produced by these erectile dysfunction drugs may be potentially useful as adjunct therapy in patients undergoing elective procedures, including coronary artery bypass graft, coronary angioplasty or heart transplantation. In addition, he said another potential application could be to prevent the multiple organ damage that occurs following cardiac arrest, resuscitation or shock.

“Preserving heart function is critical to optimal cardiac outcomes,” said George W. Vetrovec, M.D., chair of cardiology at the VCU Pauley Heart Center. “These agents have significant potential to enhance patient outcomes, particularly in high risk circumstances, such as acute heart attacks.”

For several years, Kukreja and his colleagues have studied a class of erectile dysfunction drugs known as phosphodiesterase-5 inhibitors as part of ongoing research into heart protection. The team first investigated sildenafil, and then vardenafil, and found that both compounds were protective when given before a heart attack under experimental conditions.

Taking the recommended dose of supplements after surgery can prevent the brain illness, called Wernicke encephalopathy, which is caused by a deficiency of thiamine, a B vitamin.

The syndrome is “a problem everyone needs to be aware of,” said Dr. Neil Hutcher, immediate past president of the American Society for Bariatric Surgery and director of the bariatric surgical service at Bon Secours St. Mary’s Hospital in Richmond, Va.

Hutcher was not involved in the study, which is published in the March 13 issue ofNeurology.

Wernicke encephalopathy can include vomiting, confusion, lack of coordination and visual changes such as nystagmus, an involuntary eye movement that can limit vision.

Doctors who perform weight-loss surgeries have known for years about this post-op complication, said study author Dr. Sonal Singh, an instructor in internal medicine at Wake Forest University School of Medicine, in Winston-Salem, N.C.

Singh is an internist and does not perform the gastric bypass surgeries. But he got interested in studying Wernicke encephalopathy after he treated a case a few years ago and then began noticing other patients with the problem.

“Absorption of vitamins is decreased after most gastric bypass surgery, so supplements are prescribed to make sure they get enough,” Singh said. Still, some patients may fail to take the supplements as prescribed, boosting risks for low thiamine and Wernicke encephalopathy.

Taking a closer look at the issue, Singh and co-researcher Dr. Abhay Kumar of the University of Iowa combed the medical literature and uncovered 32 cases of Wernicke encephalopathy after obesity surgery.

The 32 patients had various types of obesity surgery, but the most common type was Roux-en-Y gastric bypass, in which some of the stomach and small intestine is bypassed.

Singh found that most instances of Wernicke encephalopathy occurred from 4 to 12 weeks after the surgery, and that one case came on 18 months later. Most of the patients, 27, were women.

When the researchers evaluated the cases, they found some patterns. The complication “usually occurs in younger women, under age 55,” Singh said. “It usually occurs between one to three months after surgery.”

“Vomiting is a risk factor,” he said. “If you [frequently] vomit, you are more likely to get it.”

Of the 32 patients, 13 made full recoveries after treatment with vitamin B1, but others continued to have problems. One patient died while hospitalized from septic shock, Singh wrote.

“Some got the problem despite taking the supplement,” he said. But, in many of the cases, the patients were not taking the supplements as prescribed.

One thing is clear: Wernicke encephalopathy affects only a very small proportion of the 170,000 people who undergo obesity surgery in the United States each year, Singh said.

Still, because the condition can be permanent and is preventable and treatable, it’s important for physicians and patients to be aware of it, Singh said.

Hutcher agreed that the risk to any one patient is small. Wernicke encephalopathy is “not at epidemic proportions,” he said, noting that 32 patients with the syndrome were identified “out of hundreds of thousands of bariatric surgeries.” Hutcher estimated that, overall, there must be “close to a half million bariatric surgery patients in the U.S.”

For patients who have undergone the surgery or plan to, Singh has this advice: “After the surgery, make sure you take your vitamin supplements, including the thiamine, and if you have vomiting or other symptoms [such as confusion, lack of coordination, visual changes], seek help immediately.”

While potentially serious when it does occur, Wernicke encephalopathy is “totally preventable and either completely or partially reversible,” Hutcher said.

Reputable physicians who do bariatric surgery will emphasize that supplements are crucial after surgery, he added.

The town’s health bosses are so impressed with the results of prescribing Varenicline tartrate, also known as champix, they have decided to started prescribing it to quitters even though at £50 it is more expensive than current treatments like nicotine replacement therapy – and they are not yet required to by the Department of Health.

The drug has already been granted safety licenses but it will only become widely available on the NHS if it is approved by the cost effectiveness watchdog NICE.

Bury PCT bosses, thought to be the only trust in Greater Manchester routinely offering champix, say although it costs £50 more than current treatments it is on average one and a half times more effective than other therapies (4 x more than willpower alone) and although it costs £200 for the 12 week course – £50 more than current treatments – it is good value for money.

The PCT’s director of public health Dr Peter Elton said: “I am delighted that this product is now available in Bury and I feel sure that together with the extended 12 week support available from the Stop Smoking Service that this will help people to avoid going back to smoking.

‘Breakthrough’

“Champix is a breakthrough in smoking cessation and will contribute towards the prevention of many early deaths. It is an effective way to help smokers quit when combined with advice and support.

“This is just one of a range of measure we are taking in Bury to help people quit, weighing the extra expense against the impact of smoking we believe it offers good value.”

Quitters using Champix take increasing doses of the tablets twice a day for 12 weeks.

Champix works by reducing the smoker’s craving for nicotine by influencing the nicotine receptors in the brain to reduce withdrawal symptoms.

It also reduces the satisfaction a smoker receives when smoking a cigarette.

It has been available on the NHS in Scotland since January and NICE is expected to make a decision about its use in England this summer.

The report, issued by Decision Resources, predicts Acomplia’s success will stem from its positive effects beyond weight loss and the dearth of competing agents in the pipeline.

“It has an intriguing mechanism of action and there’s nothing in the pipeline that really compares,” Nancy Li, an analyst with Decision Resources and author of the report, told United Press International.

The beneficial effects include improving insulin sensitivity, increasing HDL and lowering LDL cholesterol levels, greater reduction in waist circumference and reducing triglycerides.

Although Xenical is an effective drug, its side effects, which include oily stools and fecal urgency, are enough to keep patients looking for an alternative.

“Acomplia doesn’t have those side effects,” Li said. “Xenical patients don’t like the side effects and are very excited to try out Acomplia.”

However, the Food and Drug Administration’s approval of Acomplia remains uncertain. The agency previously issued an approvable letter for Acomplia, and Sanofi said last month the FDA pushed back its timeframe for making a decision on the drug from April 26 to July 27.

Sanofi has not divulged details about the FDA’s delay, but Li said based on the available data about Acomplia, she anticipates it will win approval.

“Judging from the positive data from the SERENADE trial, I think it has a really good chance of launching,” she said.

The drug is projected to be a blockbuster, generating more than $1 billion by 2015 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan.

However, the bulk of this will come from the United States, so if the drug doesn’t get approved by the FDA, expectations would have to be dialed back.

“If it doesn’t get approved in the United States, it will not reach blockbuster status,” Li said. She projects the drug will generate $350 million from other nations by 2015.

Sanofi has already launched Acomplia in 12 countries; it generated 31 million euros in sales last year.

Pfizer and Merck are developing two drugs that could compete with Acomplia, but the manufacturers have revealed few details about them so their potential remains an uncertainty.

Both drugs are in phase 3 trials, “but they’re keeping it hush-hush,” Li said. “If they’re able to launch successfully, they’ll be able to cut into Acomplia,” Li said.

The agents — Pfizer’s CP-945598 and Merck’s MK-0364 — are both cannabinoid-1 receptor antagonists, the same mechanism as Acomplia.

Bank of America analyst Chris Schott likes both Acomplia’s chances of approval and the rest of Sanofi’s pipeline.

“Despite a conservative and increasingly unpredictable FDA (as seen with the recent Galvus delay), we continue to anticipate a U.S. approval for Acomplia in late July,” Schott stated in a research report released Friday.

“Based on the side profile (including suicide rate) seen in the 300,000 European patients prescribed Acomplia since its (third quarter 2006) European launch, we remain comfortable with Acomplia’s safety profile,” he added.

However, the drug may have to get by an FDA advisory committee in June before the FDA gives it the green light, he said.

Regarding the rest of Sanofi’s pipeline, Schott said his confidence was bolstered by a meeting with company officials.

“Following recent meetings with Sanofi-aventis management, we remain encouraged by the breadth of Sanofi’s pipeline,” he stated. “As we gain clarity on these opportunities over the next 6-12 months, we see room for multiple expansion in Sanofi shares, particularly with the stock trading at a 20 percent discount to the overall pharmaceutical group.”

The pipeline compounds Schott favors include the anti-thrombin agent idraparinux, a cholesterol-lowering agent in phase 2b, the cancer drug VEGF Trap AVE 005 and two anti-depression agents in phase 3 — saredutant and amibegron.

Sanofi’s Lovenox and Plavix are both facing generic competition, but Schott said he’s seeing signs Plavix is rebounding from the hit it took from the now suspended launch of Apotex’s generic version and could eventually recover some of the price reductions next year.

“Branded Plavix pricing could be impacted by 10-20 percent as (Sanofi/Bristol-Myers Squibb) seeks to regain lost formulary status as generic volumes dwindle,” he stated. “We believe that strong underlying demand (low-double-digit volume growth) will offset some of this price impact. In addition, we believe Sanofi/Bristol could recapture some of these price reductions in ’08.”

A few minutes after you smoke a cigarette, nicotine levels rise and then fall in your bloodstream. A smoker’s brain cells have receptors that are stimulated by nicotine. This generates a subsequent release of dopamine that results in the pleasurable sensation that smokers crave. A smoker who has repeated exposure to nicotine over long periods of time will actually have more of these receptors present in the brain, due to a process called upregulation.

Nicotine patches and nicotine gum, like GlaxoSmithKline’s (NYSE: GSK) Nicorette, are old treatment options for smoking cessation. But the low concentration of nicotine provided by the patch cannot compete with the higher nicotine dose that intermittent puffing provides. So these treatments work, but not all that well.

Glaxo’s Zyban, an antidepressant drug found to be helpful in getting some smokers to quit, was approved by the FDA for use as a smoking cessation medication in 1997. A 1999 study in the New England Journal of Medicine found that that abstinence rates were 15.6% in a placebo group, 16.4% in the nicotine-patch group, 30.3% in Zyban group, and 35.5% in the Zyban plus nicotine-patch group. So there is evidence of improved therapy, but newer treatment options would be welcomed. (Moreover, Zyban was not designed to help smokers stop smoking, and many smokers understandably do not want to be on an antidepressant. Additionally, some people are already on an antidepressant, so that complicates its use somewhat.)

On May 11, 2006, the FDA approved Pfizer’s (NYSE: PFE) new smoking cessation drug, Chantix. Chantix binds to the same receptors that are stimulated by nicotine, and thus prevents nicotine from binding to those receptor. Hence, when two friends of mine, both lifelong smokers, lit up after a week, their receptors were already full and they didn’t receive any pleasurable sensation — they were merely blowing smoke. Since those pesky receptors were full, the craving symptoms were dramatically lessened as well.

In the July 5, 2006 edition of the Journal of the American Medical Association, Douglas Jorenby and others published the results of a trial comparing Chantix to Zyban. They found that at one year, 23% taking Chantix had stopped compared with 10.3% in the placebo group and 14.6% in the Zyban group.

Chantix is far from a miracle drug, but it is still a significant improvement. Apparently, most folks won’t have the success that my friends did, but for those who do have long-term success — for potentially those millions that want to stop smoking but can’t — the drug can nearly be called a miracle drug. The CDC lists smoking as the single most preventable cause of premature death in the U.S., where one in every five deaths are smoking-related.

In my opinion, Pfizer has been slow to market this drug, but this is about to change. Last week Pfizer announced that it had hired McCann HumanCare of the Interpublic Group (NYSE: IPG) to market Chantix; the estimated media spending would be $75 million. Previously Pfizer had hoped that sales would eventually reach $1 billion annually; it is possible that Chantix could become Pfizer’s next blockbuster drug.

Pfizer’s shareholders could use some good news, since the stock has performed so poorly over the last five years and the company’s future is murky, with flagship product Lipitor going off patent in a few short years. Now may be a good time for value investors to consider purchasing Pfizer shares.

Pfizer is an Inside Value recommendation. GlaxoSmithKline is an Income Investor selection.

That news comes from researchers including Leslie Jacobsen, M.D., of the departments of psychiatry and pediatrics at Yale University’s medical school.

Exposure to tobacco smoke before birth or during the teen years may interfere with the development of attention skills, Jacobsen and colleagues report. That’s one more reason to prevent smoking, especially among women of childbearing age, and to help people quit smoking, the researchers note.

Their study looked at 181 teens. The researchers asked the teens’ moms if they had smoked during pregnancy.

The researchers then split the teens into four groups:
# 67 teen smokers whose mothers had smoked during pregnancy
# 44 teen smokers whose mothers had not smoked during pregnancy
# 25 nonsmoking teens whose mothers had smoked during pregnancy
# 45 nonsmoking teens whose mothers had not smoked during pregnancy.

The teens took a series of computerized attention tests in which they saw a word on a computer screen or heard a recorded word played out loud. They were told to focus on the word shown on the computer screen (visual attention test) or the word played out loud (auditory attention test).

The tests got progressively harder as the researchers added visual or auditory distractions.

For instance, they played a recording of a word during a visual attention test. The teens had to ignore such distractions and focus on the test.

Here are the results of the attention tests:

# Best scores: Nonsmoking teens whose mothers had not smoked during
pregnancy
# Second-best scores: Teen smokers whose mothers had not smoked during
pregnancy
# Worst scores: Teen smokers whose mothers had smoked during pregnancy.

Smoking teenaged girls whose mothers had smoked during pregnancy scored worse than other girls on both the visual and auditory tests. Smoking teenaged boys whose mothers had smoked during pregnancy scored worse than other boys on the auditory attention test, but not the visual one.

The findings held when the researchers considered that teen smokers were more likely to report depression and drug use.

The study appears in the advance online edition of Neuropsychopharmacology.

The investigators looked at two genes related to ADHD risk and considered whether mothers smoked during pregnancy. In past studies, maternal smoking had been linked to a 1.2- to 1.3-fold increase in risk of ADHD. Genes associated with ADHD elevated risk between 1.2- and 1.4-fold.

“But when we looked at the effect of maternal smoking in children with one of our candidate genes, we saw a three-fold increase in risk, and in children with both genes whose mothers smoked during pregnancy, we saw a nine-fold increase,” says senior investigator Richard D. Todd, M.D., Ph.D., the Blanche F. Ittleson Professor and director of the Division of Child Psychiatry at Washington University. “Our findings begin to offer an explanation for the modest effects we’ve seen when looking at genes or environmental variables one at a time. It appears it’s really the interaction of genes and environmental factors that predisposes a child to problems with ADHD.”

Todd’s team reports its findings online in the journal Biological Psychiatry. The study also will appear in an upcoming print issue of the journal.

The researchers studied children from 782 Missouri families, gathering information on 1,540 twins between 7 and 18 years of age. A parent from each family, usually the mother, completed diagnostic interviews about both twins to determine whether either had ADHD symptoms or other behavioral problems. The researchers also studied DNA from twins in 557 of those families. The mothers were asked about smoking and complications during their pregnancy.

“Almost 25 percent of the mothers said they had smoked when they were pregnant,” says lead author Rosalind J. Neuman, Ph.D., research professor of mathematics in psychiatry. “We classified mothers as smokers if they reported smoking at all while pregnant, and we think that’s fairly representative because of those who reported smoking at all during pregnancy, 75 percent continued to smoke during all three trimesters, and another 10 percent smoked in two of the three trimesters.”

In this study, Neuman, Todd and their colleagues concentrated on two of the candidate genes linked to ADHD risk in past research. One was the DRD4 gene on chromosome 11 and the second was the DAT1 gene on chromosome 5. Both genes are part of the brain’s dopamine system, and animal studies have shown that dopamine activity is related to attention. Common variants in both genes have been linked to small increases in ADHD risk.

“We looked at these particular genes because stimulant medications used to treat ADHD are known to increase dopamine at synapses between brain cells, and that’s where the protein products of these genes are located,” Todd explains. “These same cells also possess the nicotinic receptors that smoking activates, which also increases dopamine.”

There are 18 diagnostic symptoms that can go into an ADHD diagnosis, nine involving attention and nine involving hyperactivity and impulsivity. Under the current criteria in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a child must have six or more symptoms to have a diagnosis of ADHD.

A child with at least six inattentive symptoms is classified as inattentive. Six or more of the hyperactive symptoms classifies a child as hyperactive. Six or more from both categories is known as the combined subtype of ADHD. Children with the DRD4 and DAT1 genes whose mothers smoked during pregnancy tended to be at risk for that severe, combined subtype.

Interestingly, even children who didn’t officially have ADHD did have more symptoms of the disorder if they had been exposed to cigarette use in utero or had the genetic variations related to risk.

“There were statistically significant differences just comparing the number of ADHD symptoms a child had when the mother smoked versus the number of symptoms in kids whose mothers didn’t smoke during pregnancy,” Neuman says. “We also found that whether or not they actually met diagnostic criteria for ADHD, kids prenatally exposed to cigarette smoke who had a risk variant in either their DRD4 or DAT1 gene also had more symptoms.”

Neuman and Todd say those children might be thought of as having sub-syndromal forms of ADHD, too mild to be diagnosed officially but probably related to both their genetic makeup and to prenatal exposure to cigarettes. In future studies, they hope to gather more data, such as whether either the mother or father have ADHD symptoms themselves or whether children are growing up in houses where both mother and father smoke, potentially affecting brain development. And as the studies continue, the investigators plan to focus on the interplay of genetic and environmental factors rather than considering them separately.

“The important thing we’ve learned is that the risks were not just cumulative, but they were interactive,” Todd says. “It’s the interplay of genetic and environmental effects that seems to determine which children develop ADHD, so in future studies we want to focus on that interaction.”

Neuman RJ, Lobos E, Reich W, Henderson CA, Sun LW, Todd RD. Prenatal smoking exposure and dopaminergic genotypes interact to cause severe ADHD subtype. Biological Psychiatry, DOI: 10.1016/j.biopsych.2006.08.049

This research was supported by grants from the National Institutes of Health.

Washington University School of Medicine’s full-time and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked fourth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

The doctors at the Liverpool School of Tropical Medicine say parents who are smokers at the time of conception are more likely to have a female child and the chances of having a male baby decreases by as much as 50 percent if both parents are smokers.

The researchers also suggests that smoking raises the chances of a miscarriage and say substances contained in cigarettes, such as nicotine, inhibit sperm carrying male chromosomes from fertilizing eggs.

An analysis of 9,000 pregnancies at the hospital between 1998 and 2003 showed that mothers who smoked during pregnancy were one-third less likely to have a boy child than non-smokers.

When the father also smoked the chance of having a boy were cut almost in half.

The results also suggest that pregnant women who are exposed to passive smoke are also more likely to have a girl.

The authors say the results raise serious questions about the impact of smoking on the population balance.

Fertility experts have also voiced concern that the study results could encourage parents to take up smoking in an effort to decide their baby’s sex.

It is already known that male embryos are less robust and more likely to miscarry than females but the smoking connection adds yet another factor.

However there remains a consensus that would be parents should avoid smoke and smoking altogether if they want a healthy child.

‘Sexuality in Midlife and Beyond’, a new report compiled by researchers at Harvard Medical School, suggest that the medications work only if the man is feeling sexual desire for his partner, but if emotional issues are impinging on libido, the pills will not help.

The 48-page report says that if a man struggling with ED is embarrassed that he is no longer willing to attempt sexual activity, his partner may mistakenly believe that he is no longer attracted to her. She may assume that her partner’s newfound erections are merely a chemical phenomenon, not the result of his interest in her.

Sex therapy may be more helpful in dealing with such cases, rather than dependence on erectile-dysfunction drugs, says the report.

It advises that couples should try to regard these drugs as an opportunity to renew their sexual relationship, while realising that ED drugs are neither a mandate to have intercourse nor a panacea for every problem in the bedroom.

Dr. Alan Altman, Assistant Professor at Harvard Medical School, and Suki Hanfling, a certified sex therapist, have edited ‘Sexuality in Midlife and Beyond’.

The report is available for 16 dollars from Harvard Health Publications, and order for it can also be placed online at http://www.health.harvard.edu/SMB.

It helps readers understand the following:

1. Sexuality and attitudes about sexuality and aging, including emotional and social issues

2. How health problems, including medications, affect sexuality

3 The pros and cons of treatments for common sexual problems

4. The role of sex therapy and what to expect

5. How to use self-help strategies and put the fun back into sex.