Clinical implications of developments in in vitro fertilisation

During February 1979 to December 1983, 831 infertile couples were treated by in vitro fertilisation and embryo transfer. The problems they faced included deciding on the number of oocytes to be collected at laparoscopy, the numbers to be donated or fertilised, the numbers of embryos to be transferred and frozen, and whether abnormal embryos should be used for research or discarded. The 831 patients received a total of 1530 treatment cycles. Of the 763 patients for whom complete data were available, 136 (17.8%) became pregnant. The rate of pregnancy, however, increased dramatically from 7.4% when only one embryo was transferred to 21.1% and 28.1% when two and three embryos were transferred, respectively. The chance of multiple pregnancy also increased with the number of embryos transferred, but the risk (2% for twins) was far outweighed by the relatively poor result after transferring a single embryo. Out of 40 embryos freeze-thawed, 23 survived thawing and were transferred; of these, 4 (17%) resulted in pregnancy. Thirty four transfers of donor oocyte embryos also resulted in four pregnancies (12%), but two of these ended in abortion. Neither microscopy nor any other available test can determine the potential of an oocyte to result in pregnancy, so that discarding oocytes that may look abnormal simply reduces the chances of conception--both for the patient and for any prospective recipient of donor oocyte embryos. In any case, abnormal embryos tend to die when growth is allowed to continue in vitro. Probably all oocytes harvested from a patient should be inseminated and the utilisation of the embryos decided once the number developed is known.     

Report on in vitro fertilisation and embryo replacement

A report on in vitro fertilization and embryo transfer, prepared by the ethics committee of the Royal College of Obstetricians and Gynaecologists, is briefly summarized. The report finds the use of these techniques acceptable in overcoming infertility, and approves of ovum donation and embryo freezing while rejecting the use of surrogate mothers. Recommendations are made for careful record keeping, for follow-up of children born after in vitro fertilization, and on legal issues relating to in vitro fertilization and artificial insemination by a donor. The Medical Research Council's advice on research in this area is endorsed.     

In vitro fertilisation in a small unit in the NHS

In vitro fertilisation is one of the most effective new treatments for infertility, but financial restrictions have made it impossible for it to be widely carried out in the National Health Service. We report on the establishment of a small, largely self funded, unit that was set up with the help of the local health service management. All cycles are programmed so that most work is carried out during the working week; oocyte recoveries are performed as outpatient procedures without general anaesthesia and guided by ultrasound. Roughly a tenth of treatment cycles and roughly a fifth of embryo transfers resulted in a clinical pregnancy.     

In vitro fertilisation: the major issues--a comment

Mitchell, a sociologist, comments on a companion paper on in vitro fertilization by Peter Singer and Deane Wells. He criticizes the failure of Singer and Wells to consider the deleterious effects on society and on the children of artificial reproduction involving donated sperm or ova and accuses them of placing the desire of the individual to have a child above the good of society and of future generations. Singer, in a brief response, defends his utilitarian argument that reproductive technologies should be available to all. He does not consider knowledge of one's genetic identity to be a crucial issue, pointing out that the child's alternative is no existence at all.     

Essential pre-conceptual measures for the female partner before commencing an in vitro fertilisation programme

Summary  Two hundred and eighty-one women were checked for the presence of specific pre-conceptual data and their medico-legal implications prior to commencing an in vitro fertilisation (IVF) programme. In only 9.6 per cent were the results of a recent rubella test available in the patients referral notes. Fifty-four per cent were then tested in the unit. Two per cent were found to be not immune. Thirty-six per cent of women needed a cervical smear prior to commencing therapy. No such test had been undertaken previously in 6.7 per cent and 12.7 per cent had abnormal test results. Pre-conceptual intake of folic acid is considered an important preventative measure. The patient uptake rose from 15 per cent to 97 per cent following specific advice.     

Ovarian biomarkers predict controlled ovarian stimulation for in vitro fertilisation treatment in Singapore

INTRODUCTIONOvarian biomarkers have been shown to predict responses to controlled ovarian hyperstimulation (COH) during in vitro fertilisation (IVF) in predominantly Caucasian populations, with limited studies performed in Southeast Asian women in Singapore.METHODSWe evaluated the performance of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone and oestradiol levels, antral follicle count (AFC), body mass index, ovarian volume, and age to establish thresholds for the prediction of poor (< 4 oocytes retrieved) and excessive responses (> 19 oocytes retrieved) in 263 women undergoing COH. Univariate and multivariate logistic regression analysis and receiver operating characteristic curves were used to calculate probabilities for poor and excessive responders to COH.RESULTS36 (13.7%) and 50 (19.0%) women had poor and excessive response to COH, respectively. An AMH value of 0.69 ng/mL predicted poor ovarian response with positive likelihood ratio (LR) of 2.94, compared to an AFC of ≤ 5 when the positive LR is 2.36. Conversely, an AMH value of ≥ 3.06 ng/mL predicted excessive ovarian response with positive LR of 2.24, compared to an AFC cut-off of ≥ 12 with positive LR of 1.93.CONCLUSIONAMH levels and AFC are equivalent in the prediction of both poor and excessive ovarian response in women undergoing IVF. Our study highlights the importance of establishing population-specific cut-off biomarker values so that protocols can be tailored to optimise IVF treatment.     

Right ectopic gestation following in vitro fertilisation: case report

The management of ectopic gestation has in recent years transformed from the normally accepted laparotomy to the laparoscopic approach. The objective of this case report is to describe a rare occurrence of an ectopic gestation following in vitro fertilisation procedure. A 35-year-old para 0 + 0, presented with lower abdominal pain and per vaginal bleeding six weeks after an in vitro fertilisation was done in South Africa. The patient was admitted with severe lower abdominal pain and per vaginal bleeding at six weeks gestation following an in vitro fertilisation procedure. She had undergone an "evacuation" one-week prior to this episode due to an initial diagnosis of an incomplete abortion. No chorionic villi were reported on histology. The repeat serum BhCG was 777 mimicro/l and at laparoscopy a right unruptured ampullary ectopic gestation (4 cms in size) was evident. A right linear salpingostomy was subsequently performed laparoscopically. Histology confirmed the presence of tubal chorionic villi. The laparoscopic management of ectopic pregnancies is now regarded as the gold standard in many centres in the world. In this patient the ectopic pregnancy resulted following an intra-uterine zygote transfer, and was managed successfully.     

In vitro fertilisation and allied techniques the initial experiences of the first Irish service

Since 1986 in vitro fertilisation and allied techniques have formed a part of the fertility service at St. James’s Hospital. By June 1988 using routine methodology, IVF or GIFT has been attempted at least once in 94 women with a further 17 having one repeat procedure and 4 two repeat procedures performed. Although embryos were cultured from 54% of oocytes in which fertilisation was attempted, no pregnancies were achieved during that period with IVF. Ten pregnancies had occurred during a GIFT cycle (9 at first attempt, 16%) 60% of these are on-going. Also continuing were pregnancies where ovulation induction was abandoned on day 8(1) and where conception occurred spontaneously whilst on the waiting list for the procedure (8) and in untreated cycles following the procedure (4) (16%). Seventy percent of patients who failed the first time expressed a wish to try again.     

医师量化考核择优晋升的方案设计与实践

目的：遵循公平、客观、透明的原则,探讨医师量化考核择优晋升的方案,为其晋升提供参考依据,并促进医师自身全面发展。方法：在广泛征求管理者和临床譬家的基础上,设立基本素质、工作作风、工作业绩、业务水平4个一级评价指标,通过基础分和附加分对医师实行综合评价。结果：医师评价坚持以医疗为中心,注重工作业绩和业务水平。结论：通过综合评价和量化排序,实现择优晋升,效果显著,并对医师发展起到引导和激励的作用。     

发展低碳卫生 促进医疗卫生事业发展

医疗卫生行业应增强低碳意识,紧跟低碳潮流,实施医院间检查、检验结果共享、互认,建立医疗设备共享中心,借助电子信息技术发展远程医学,建立电子病历,完善双向转诊制度,实施精细化管理,推进医疗卫生事业发展。构建适应低碳经济要求的卫生服务体系、管理机制和运行机制,是当前医疗卫生事业发展的必然要求。     

我国中医药健康服务现状及提升路径研究

目的:分析《中医药法》实施背景下中医药健康服务基本情况。方法:利用2017-2018年《中国卫生统计年鉴》《全国中医药统计摘编》及2018年5月底《中医药法》调研评估数据,对中医药医疗卫生资源与服务、中医预防和养生保健、政策和经费支持等方面进行分析与研究。结果:2017年末,全国中医类医院、每千人口中医执业(助理)医师、每千人口公立中医类医院床位分别达4566所、0.38人、0.59张;截至2018年5月底,全国开办备案制中医诊所2894所;2017年全国中医类医疗卫生机构诊疗人次、出院人数分别达10.2亿人次、0.33亿人次;全国中医类医院提供中医治未病服务1983万人次;各省均已将中医药发展经费纳入本级财政预算。结论:《中医药法》实施后,中医药健康服务能力提升显著,但与居民多层次多样化健康需求仍有较大差距。建议优先补充和提高中医药健康服务人才队伍,围绕中医药健康服务特色,筑牢基层中医服务阵地,强化中医药法配套政策落实监管,建立中医药事业经费投入长效机制,完善中医药健康服务体系。     

公共图书馆健康信息服务现状及提升策略

“健康中国”战略对健康信息服务提出新的要求，公共图书馆有必要开展健康信息服务。对31个省级公共图书馆的官网和微信公众号进行调研，了解其健康信息服务的形式、内容等，以此提出公共图书馆开展健康信息服务的策略：应将健康信息纳入常规性服务范畴，在现有服务基础上进一步拓宽服务内容、细分用户人群，并与医院等官方机构积极开展合作，以全面提升健康信息服务质量。     

三级医院在推进社区卫生服务中的作用和模式

根据目前北京市公共卫生体系和群众就医的现状,探讨了三级医院在构建新型城市社区卫生服务体系中,如何配合政府办事,如何在社区卫生服务机构中发挥作用,解决群众"看病难和看病贵"的问题.通过凋研和共建,明确了三级医院在提高社Ⅸ卫生服务机构医疗水平,建立社区健康档案,加强社区健康宣传教育、改善群众的生活质量和提高防病能力、配合社区卫生服务机构初步实现"双向转诊"流程和医院开设绿色通道、建立社区应对突发公共卫生事件有效应急救治及防控体系和使社区低保特困人群能及时得到政府关爱等方面均能充分发挥作用,指出三级医院托管社区卫生服务机构是目前北京市社区医疗卫生服务发展的最佳模式.