Increased gonadotrophin stimulation does not improve IVF outcomes in patients with predicted poor ovarian reserve

Purpose

This retrospective study was carried out to evaluate whether increasing the starting dose of FSH stimulation above the standard dose of 150 IU/day in patients with low predicted ovarian reserve can improve IVF outcomes.

Method

A total of 122 women aged less than 36 years in their first cycle of IVF were identified as having likely low ovarian reserve based on a serum AMH measurement below 14 pmol/l. Thirty five women were administered the standard dose of 150 IU/day FSH, while the remaining 87 received a higher starting dose (200–300 IU/day FSH). There were no significant differences in age, BMI, antral follicle count, serum AMH, FSH or aetiology of infertility between the two dose groups.

Results

No significant improvement in oocyte and embryo yield or pregnancy rates was observed following an upward adjustment of FSH starting dose. While increasing the dose of FSH above 150 IU/day did not produce any adverse events such as OHSS, it did consume an extra 1,100 IU of FSH per IVF cycle.

Conclusion

The upward FSH dose adjustment in anticipation of low ovarian reserve can not be advocated as it is both expensive and of no proven clinical value.     

Implementing an oral health program in a group prenatal practice

The Rochester Adolescent Maternity Program (RAMP) has incorporated evidence-based oral health guidelines into its prenatal care. These guidelines focus on tracking oral health services, screening and triaging prenatal patients, and providing patient and staff with the education needed to decrease oral health risks to mother, fetus, and baby. The RAMP process serves as a model for promoting quality oral health practices in pregnant teenagers and their babies.     

Controversies in Sexual Medicine: Is Elective Vulvar Plastic Surgery Ever Warranted,and What Screening Should Be Conducted Preoperatively?

IntroductionElective vulvar plastic surgery was the topic of a heated discussion on the list-serve of the International Society for the Study of Women's Sexual Medicine. At the suggestion of a board member, it was determined that this discussion might of interest to journal readers in the form of a published controversy.MethodsSix people with expertise and/or strong opinions in the area of vulvar health, several of whom had been involved in the earlier online discussion, were invited to submit evidence-based opinions on the topic.Main Outcome MeasureTo provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine.ResultsGoodman believes that patients should make their own decisions. Bachmann further states that, while that is a woman's right, she should be counseled first, because variations in looks of the vulvar region are normal. Johnson furthers this thought, discussing the requirement for counseling before performing reinfibulation surgery on victims of female genital cutting. Fourcroy emphasizes the need to base surgical procedures on safety and efficacy in the long term, and not merely opportunity at the moment. Goldstein and Goldstein state that, based on the four principles of ethical practice of medicine, vulvar plastic surgery is not always ethical, but not always unethical. Sklar pursues this thought further, pointing out specific examples in regard to the principles of ethics.ConclusionVulvar plastic surgery may be warranted only after counseling if it is still the patient's preference, provided that it is conducted in a safe manner and not solely for the purpose of performing surgery. Goodman MP, Bachmann G, Johnson C, Fourcroy JL, Goldstein A, Goldstein G, and Sklar S. Is elective vulvar plastic surgery ever warranted, and what screening should be done preoperatively?     

Engaging Intergenerational Hispanics/Latinos to Examine Factors Influencing Childhood Obesity Using the PRECEDE–PROCEED Model

Maternal and Child Health Journal - Introduction Hispanics/Latinos are disproportionately affected by obesity in the U.S. Multiple factors place Hispanic/Latino children at risk for overweight,...     

The double triumph: sustained sobriety and successful cigarette smoking cessation

Conventional practice wisdom has long shielded alcohol treatment center clients from social and medical pressures to quit smoking. But, recent findings of increased cancer risk are forcing a re-examination of traditional practices. Detailed case histories of 14 recovering alcoholics who successfully quit smoking suggest the feasibility of cessation efforts even in the face of severe substance abuse histories.     

Randomized Nutrition Education Intervention to Improve Carbohydrate Counting in Adolescents with Type 1 Diabetes Study: Is More Intensive Education Needed?

BackgroundYouth with type 1 diabetes do not count carbohydrates accurately, yet it is an important strategy in blood glucose control.ObjectiveThe study objective was to determine whether a nutrition education intervention would improve carbohydrate counting accuracy and glycemic control.DesignWe conducted a randomized, controlled nutrition intervention trial that was recruited from February 2009 to February 2010.SubjectsYouth (12 to 18 years of age, n=101) with type 1 diabetes were screened to identify those with poor carbohydrate counting accuracy, using a previously developed carbohydrate counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n=66, age=15±3 years, 41 male, diabetes duration=6±4 years, hemoglobin A1c [HbA1c]=8.3%±1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90-minute class with a registered dietitian/certified diabetes educator and twice kept 3-day food records, which were used to review carbohydrate counting progress.Main outcome measuresCarbohydrate counting accuracy (measured as described) and HbA1c were evaluated at baseline and 3 months to determine the effectiveness of the intervention.Statistical analyses performedt Tests, Spearman correlations, and repeated measures models were used.ResultsAt baseline, carbohydrate content was over- and underestimated in 16 and 5 of 29 food items, respectively. When foods were presented as mixed meals, participants either significantly over- or underestimated 10 of the 9 meals and 4 snacks. After 3 months of follow-up, HbA1c decreased in both the intervention and control groups by ?0.19%±0.12% (P=0.12) and ?0.08%±0.11% (P=0.51), respectively; however, the overall intervention effect was not statistically significant for change in HbA1c or carbohydrate counting accuracy.ConclusionsMore intensive intervention might be required to improve adolescents' carbohydrate counting accuracy and nutrition management of type 1 diabetes. Additional research is needed to translate nutrition education into improved health outcomes.