Consecutive cycles in in vitro fertilization–embryo transfer

Background.?The decline of female fertility with advancing age is well documented. The aim of this study was to compare the ovarian performance after repeated ovarian stimulation cycles in women of different ages.

Methods.?Four hundred patients who started at least three in vitro fertilization (IVF) cycles during the 5-year period between 1998 and 2002 were identified. The patients were divided into four groups: the 25–30 age group (n?=?90), the 31–35 age group (n?=?150), the 36–40 age group (n?=?110) and the 41–45 age group (n?=?50).

Results.?Comparing subsequent cycles versus the first treatment cycle we found a statistically significantly increased number of ampules of recombinant follicle stimulating hormone (rFSH) needed to reach follicles maturation (p?<?0.001). The number of ampules of gonadotropin required was significantly higher (p?<?0.001) in the groups of advanced age compared with the groups of young women. For women in the 36–40 group and in the 41–45 group we found the number of follicles, the number of oocytes and the proportion of grade A embryos, in every cycle, were significantly lower than in the groups of young women. We compared the characteristics of ovarian stimulation and response of a single age group in different consecutive cycles. We found significant differences (p?<?0.05) only in the number of ampules required.

Conclusions.?Maternal age adversely affected ovarian performance. During repeated IVF cycles we also noted an age-independent decline of ovarian response.     

Trends in induced abortions between 1975 and 2000 in a cohort of women born in 1960–64 in four Scandinavian countries

Objectives?To study induced abortion rates, live birth rates, and proportions between the number of induced abortions and live births during a 25-year period in a cohort of Scandinavian women born 1960–1964.

Method?The numbers of abortions and live births in a cohort of women in Denmark, Finland, Norway and Sweden who were 15–19 years old in 1975 were retrieved from official statistics for 1975, 1980, 1985, 1990, 1995 and 2000, when these women had turned 40 to 44 years of age.

Results?Women in each country, who were 15–19 years old in 1975, maintained their original behaviour regarding induced abortion throughout their fertile period. Women in Denmark and Sweden, who had the highest rates of induced abortion in 1975, still had higher rates than women in Norway and Finland in 2000 when aged 40–44.

Conclusion?Behaviour and attitudes established at a young age seem to remain unchanged over time. This finding indicates that guidance and education of youths concerning reproductive matters may be decisive in shaping behaviour for most of the fertile period.     

Publication productivity in IVF in Europe, 1990–2006

The present investigation was conducted to determine how individual European states rank with respect to quantitative productivity in research and publication on IVF. A search in MEDLINE was performed in August 2007 and the number of entries under the MeSH ‘Reproductive Techniques, Assisted’ was registered for each individual year 1990–2006 for 19 European countries. Countries with a total number of >60 publications between 1990 and 2006 were further evaluated. Publication productivity was assessed by three measures: absolute numbers of scientific articles published in MEDLINE, mean number of publications published per year normalized to population size, and mean number of publications published per year normalized to gross domestic product (GDP). The Benelux and Scandinavian countries lead the field, with a median of 26 publications per year per 10⁷ population in Belgium, followed by Finland, The Netherlands, Denmark, and Sweden with 12, 11, 10, and nine publications respectively. This compares with a median of three and two entries from Italy and Germany respectively. After normalizing the publication number to GDP, Belgium leads the field with a median of 10 publications per year per 10¹¹€ GDP, followed by Greece, Sweden, UK and Finland with six, six, five and five publications respectively. The back markers are Switzerland and Germany (one publication each). In conclusion, drastic differences between individual European countries exist in terms of publication activity.     

Which factors play a role in clinical decision-making in subfertility?

Sixteen vignettes of subfertile couples were constructed by varying fertility history, post-coital test, sperm motility, FSH concentration and Chlamydia antibody titre (CAT). Thirty-five gynaecologists estimated probabilities of treatment-independent pregnancy, intrauterine insemination (IUI) and IVF. Thereafter, they chose IUI, IVF or no treatment. The relative contribution of each factor to probability estimates and to subsequent treatment decisions was calculated. Duration of subfertility and maternal age were the most important contributors for gynaecologists' estimates of treatment-independent pregnancy [relative contribution (RC) 41, 26%]. Maternal age and FSH concentration were the most important contributors in the estimates for IUI (RC: 51, 25%) and for IVF (RC: 64, 31%). The decision to start IVF was mainly determined by maternal age, duration of subfertility, FSH concentration and CAT. The relative contribution of maternal age and duration of subfertility was in concordance with existing prediction models, whereas previous pregnancy and FSH concentration were under- and overestimated respectively. In conclusion, maternal age, duration of subfertility and FSH concentration are the main factors in clinical decision-making in subfertility. Gynaecologists overestimate the importance of FSH concentration, but underestimate that of a previous pregnancy, as compared with their importance reported in prediction models and guidelines.     

current titles in china

current titles in china     

National Occupational Standards in clinical embryology: implementation in 2005?

In 2001 the UK Department of Health initiated the National Occupational Standards Project in Healthcare Science. This project incorporates the 43 disciplines of healthcare science with the aim of developing a framework for competent performance in all areas of healthcare science, thereby standardising the delivery of services in this area. The whole of the project relies on the concept of function, and using the process of functional analysis each discipline is broken down into key work areas. The standards are derived from a further breakdown of these key work areas. Each standard gives expected requirements for the competent performance of the function, along with the relevant knowledge required. It is envisaged that the implementation of National Occupational Standards will ensure that individuals performing healthcare science functions throughout the UK, whether they are healthcare scientists themselves or not, will be performing these functions to an adequate standard. Since work began on the project 63 standards, and associated assessment guidance, have been drafted the whole of healthcare science. The National Occupational Standards are due to be implemented in 2005 by Skills for Health, an organisation that defines and monitors skills in healthcare both in the NHS and the private sector.