On the benefit of assisted reproduction techniques, a comparison of the USA and Europe

Sir, We were interested in the letter by the European IVF monitoring(EIM) group (Nygren et al., 2006) in response to our recentarticle (Gleicher et al., 2006). Nygren et al. ‘did not necessarily agree’ with ouropinion that significantly (in non-medical lingo dramatically)lower pregnancy and delivery rates in Europe ‘do not appearto benefit the European population’. Instead, they concludethat although ‘efficacy is higher in the USA, the benefit(to the population) may not be’. We believe that theirarguments are not supported by facts. EIM, indeed, uses selected data and statements from our articlein support of their arguments: For example, we had noted, andEIM emphasizes in their letter, that the costs [of assistedreproduction techniques (ARTs)] in Europe are lower (as allmedical costs are), insurance coverage is broader, utilizationof     

The choice of gender: is elective gender selection, indeed, sexist?

BACKGROUND: Like a number of international organizations before them, the American College of Obstetricians and Gynecologists (ACOG) recently issued an ethics opinion, which condemned all indications of elective gender selection as devaluatory to women and sexist and, therefore, given the choice, assumed automatic preference for male gender selection in all populations. This study intended to investigate this notion for accuracy. METHODS: We investigated the desired gender in 92 couples who had undergone between January 2004 and December 2006 first in vitro fertilization (IVF) cycles in attempts at gender selection for family balancing purposes. Their choices were then also investigated stratified for the ethnicity of the couple. RESULTS: Among 92 cycles, 36 cycles were selected for female and 56 for male (P = 0.037). An analysis based on the couples' ethnicities revealed, however, considerable differences in gender selection patterns. Especially Chinese (21 out of 22), Arab/Muslim (5 out of 6) and Asian-Indian (5 out of 5) couples primarily selected for males. Other ethnicities, however, actually preferentially selected for female gender (34 female, 25 male selections in 59 cycles). Gender choices thus varied in a statistically significant way between ethnicities (P < 0.001). CONCLUSIONS: In an ethnically mixed patient population, elective gender selection for family balancing purposes in most ethnic groups does not represent a discriminatory procedure against female equality. However, cultural biases against females are, indeed, still maintained in some minority populations. Ethics opinions should be considerate of minority opinions, but should be based on prevalent sentiments in a majority of the population.     

Association of Bullous Pemphigoid with Malignancy: A Myth or Reality?

Bullous pemphigoid (BP) is an autoimmune sub-epidermal blistering disorder of the skin. The association of BP with internal malignancy has always been a matter of debate with no consensus reached despite many published case reports and clinical trials. However, we report a hitherto unreported association of BP with squamous cell carcinoma of the tongue, wherein the patient had a recalcitrant downhill course despite adequate treatment measures with control of skin lesions being achieved only following excision of the tumor, and relapse coinciding with detection of metastasis. Hence, given the clinical behavior, it is reasonable to speculate that the association of malignancy was more than co-incidental.     

Improvement in diminished ovarian reserve after dehydroepiandrosterone supplementation

Dehydroepiandrosterone (DHEA) has been reported to improve oocyte/embryo yields and oocyte/embryo quality in women with diminished ovarian reserve. Whether DHEA objectively improves ovarian reserve is, however, unknown. This study investigated 120 consecutive patients with diminished ovarian reserve, supplemented for 30–120 days (mean 73 ± 27) with DHEA (25 mg three times daily). Anti-Müllerian hormone (AMH) concentrations were determined in relationship to DHEA supplementation using linear regression and, longitudinally, by examining interaction between days of DHEA treatment and pregnancy success in respect to changes in AMH. AMH concentrations significantly improved after DHEA supplementation over time (P = 0.002). Women under age 38 years demonstrated higher AMH concentrations and improved AMH concentrations more than older females. AMH improved longitudinally by approximately 60% (P < 0.0002). Women reaching IVF experienced a 23.64% clinical pregnancy rate and conceiving women showed significantly improved AMH concentrations compared with those who did not (P = 0.001). DHEA supplementation, thus, significantly improved ovarian reserve in parallel with longer DHEA use and was more pronounced in younger women.