ORCID Profile
0000-0002-3685-3553
Current Organisations
The University of Auckland
,
Royal College of Obstetricians and Gynaecologists
,
Royal Australian and New Zealand College of Obstetricians and Gynaecologists
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Publications
Medical and surgical management of adenomyosis
Publisher: Elsevier BV
Date: 08-2006
DOI: 10.1016/J.BPOBGYN.2006.01.012
Abstract: Adenomyosis of the uterus is a common condition amongst women in their reproductive years. It is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The common presenting symptoms are painful and heavy periods and infertility, although many women are asymptomatic. Adenomyosis is thought to affect 1% of women and is typically diagnosed in the 4th and 5th decades of life. The aetiology is unclear, and until recently a diagnosis was made only after invasive and destructive surgery. With the advent of improved imaging of the pelvic organs, and in particular magnetic resonance imaging, the diagnosis of adenomyosis is being made more frequently. Unfortunately, because the disease has been infrequently diagnosed prior to hysterectomy, there are few well-designed studies of medical or surgical management. Management with hormonal treatment that aims to reduce the proliferation of endometrial cells is promising, but there is a paucity of well-designed studies to guide treatment. Hysterectomy or use of the levonorgestrel intrauterine system (LNG-IUS) remains the mainstay of treatment.
Ectopic pregnancy
Publisher: Elsevier BV
Date: 08-2005
Early detection of severe maternal morbidity: A retrospective assessment of the role of an Early Warning Score System
Publisher: Wiley
Date: 23-12-2014
DOI: 10.1111/AJO.12160
Abstract: The Early Warning Scoring (EWS) surveillance system is used to identify deteriorating patients and enable appropriate staff to be called promptly. However, there is a lack of evidence that EWS surveillance systems lead to a reduction in severe morbidity. To determine whether as EWS may have improved the detection of severe maternal morbidity or lessened the severity of illness among women with severe morbidity at a large tertiary maternity unit at Auckland City Hospital (ACH), New Zealand. Admissions to intensive care, cardiothoracic and vascular intensive care, or an obstetric high-dependency unit (HDU) were identified from clinical and hospital administrative databases. Case reviews and transcribed observation charts were presented to a multidisciplinary review group who, through group consensus, determined whether an EWS might have hastened recognition and/or escalation and effective treatment. The multidisciplinary review team determined that an EWS might have reduced the seriousness of maternal morbidity in five cases (7.6%), including three admissions for obstetric sepsis to intensive care unit and two to obstetric HDU for post-partum haemorrhage. No patient had a complete set of respiratory rate, heart rate, blood pressure and temperature recordings at every time period. These findings have been used to support introduction of an EWS to the maternity unit at ACH.
An Open Letter to the Food and Drug Administration Regarding the Use of Morcellation Procedures in Women Having Surgery for Presumed Uterine Myomas
Publisher: Elsevier BV
Date: 03-2016
High-dose chemotherapy and autologous bone marrow or stem cell transplantation versus conventional chemotherapy for women with early poor prognosis breast cancer
Publisher: Wiley
Date: 20-05-2016
Patient and professional perspectives about using in vitro fertilisation add-ons in the UK and Australia: a qualitative study
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2022-069146
Abstract: In vitro fertilisation (IVF) add-ons are additional procedures offered alongside an IVF cycle with the aim of improving live birth rates. They are controversial because of the paucity of evidence to support their efficacy and safety, alongside the additional financial cost they often pose to patients. Despite this, they are popular. However, there is limited qualitative research regarding their use. The aims of the VALUE Study were to understand the decision-making process surrounding using or recommending add-ons report sources of information for add-ons and explore concerns for safety and effectiveness when considering their use. ‘VALUE’ is a qualitative semistructured interview study using inductive thematic analysis of anonymised transcriptions. Participants were recruited from a broad geographical spread across the UK and Australia from public and private clinical settings. Patients (n=25) and health professionals (embryologists (n=25) and clinicians (n=24)) were interviewed. A purposive s ling strategy was undertaken. The s ling framework included people having state-subsidised and private cycles, professionals working in public and private sectors, geographical location and professionals of all grades. Patients often made decisions about add-ons based on hope, minimising considerations of safety, efficacy or cost, whereas professionals sought the best outcomes for their patients and wanted to avoid them wasting their money. The driving forces behind add-on use differed: for patients, a professional opinion was the most influential reason, whereas for professionals, it was seen as patient driven. For both groups, applying the available evidence to in idual circumstances was very challenging, especially in the sphere of IVF medicine, where the stakes are high. There is scope to build on the quality of the discourse between patients and professionals. Patients describe valuing their autonomy with add-ons, but for professionals, undertaking informed consent will be critical, no matter where they sit on the spectrum regarding add-ons. osf.io/vnyb9.
Surgery versus medical therapy for heavy menstrual bleeding
Publisher: Wiley
Date: 29-01-2016
Prioritising for fertility treatments—should a high BMI exclude treatment?
Publisher: Wiley
Date: 10-08-2006
Assisted hatching on assisted conception (IVF and ICSI)
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Timed intercourse for couples trying to conceive
Publisher: Wiley
Date: 17-03-2015
Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement†‡
Publisher: Oxford University Press (OUP)
Date: 10-10-2014
Effective treatment of subfertility: introducing the Cochrane Menstrual Disorders and Subfertility Group
Publisher: Oxford University Press (OUP)
Date: 07-1999
Abstract: The last two decades have seen a rapid explosion in research surrounding subfertility treatments. This ever-increasing volume of research has made it a difficult task for health professionals involved in the management of the subfertility to be able to assimilate the information easily. There is an urgent need for the findings from research to be synthesized into simple easy to read reviews that are both of a high quality and are based on the best evidence available. The Menstrual Disorders and Subfertility Group of the Cochrane Collaboration is attempting to address these issues by collecting a register of all the randomized controlled trials in the field of reproductive medicine and preparing systematic reviews on topics that will be of interest to healthcare workers and consumers. Readers are invited to participate in this process by identifying published and unpublished data and by helping in the process of preparing protocols and systematic reviews for inclusion in the Cochrane Library.
An Overview of Treatments for Endometriosis
Publisher: American Medical Association (AMA)
Date: 20-01-2015
Abstract: What treatments are associated with improved outcomes for women with endometriosis? The levonorgestrel-releasing intrauterine system (LNG-IUD), gonadotropin-releasing hormone analogues (GnRHa nafarelin, leuprolide, buserelin, goserelin, triptorelin), laparoscopic ablation, and excision are associated with relief of pain due to endometriosis. Gonadotropin-releasing hormone analogues and laparoscopic ablation or excision are associated with increased clinical pregnancy rates in women with endometriosis. Gonadotropin-releasing hormone analogues, danazol, and depot progestagens are associated with a higher incidence of adverse events.
Reporting assisted reproductive technology success rates on Australian and New Zealand fertility clinic websites
Publisher: Wiley
Date: 02-2020
DOI: 10.1111/AJO.13126
Long-acting follicle-stimulating hormone versus daily follicle-stimulating hormone for women undergoing assisted reproduction
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.FERTNSTERT.2016.01.041
Abstract: Follicle-stimulating hormone (FSH) given as a weekly injection in a medium dose is as safe and effective as a daily FSH injection for women undergoing assisted reproduction.
Ovarian reserve tests for predicting fertility outcomes for assisted reproductive technology: the International Systematic Collaboration of Ovarian Reserve Evaluation protocol for a systematic review
Publisher: Wiley
Date: 10-11-2006
DOI: 10.1111/J.1471-0528.2006.01068.X
Abstract: The presence of a wide range of tests of ovarian reserve suggests that no single test provides a sufficiently accurate result. Many tests are used without reference to an evidence base. So far, in idual studies conducted on these tests are too small to give precise estimates of prognostic accuracy. To systematically assess the accuracy of the available tests of ovarian reserve in terms of prediction of fertility outcomes. The search will be conducted using the name of the respective index test being studied (as listed on the MESH database), if more than 2000 citations are listed, 'ovary' and or 'ovarian', 'fertility' and or 'reserve' will be combined with the original search term as required. Studies of the accuracy of tests of ovarian reserve will be obtained without language restrictions from 1980 to 2005 using the following electronic databases and Ovid software: MEDLINE, EMBASE, PUBmed, Biological extracts, Pascal, Cochrane Library (CDSR, DARE, CCTR, HTA), Best Evidence databases, SCISEARCH, Conference Proceedings (ISI Proceedings, Healthstar, Current Contents, Science Citation Index, Cancerlit and Econlit and NHS Economic Evaluation database. The National Research Register, the Medical Research Council's Clinical Trials Register, MEDION, DARE, and the US Clinical Trials register. Studies will be selected if accuracy of tests are compared with a reference standard and include data that can be abstracted into a two-by-two table to calculate sensitivity and specificity. The studies to be included in this review will examine one of the following index 'tests' within a study population of women undergoing assisted reproductive technology: * Clinical variables--age, history of cancelled cycles. * Basal blood tests--follicle-stimulating hormone (FSH), lutenising hormone (LH), FSH:LH ratios, estradiol (E(2)), inhibin A and B, progesterone (P(4)), P(4):E(2) ratios, antimullerian hormone, testosterone, vascular endothelial growth factor, insulin-like growth factor-1:insulin-like growth factor binding protein-1 ratios. * Dynamic tests--clomiphene citrate challenge test, gonadotropin analogue stimulating test, exogenous FSH ovarian reserve test. * Ultrasound tests-antral follicle count, ovarian volume, ovarian stromal peak systolic velocity, including waveform and pulsatility index, ovarian follicular vascularity. * Histology--ovarian biopsy. Data collection and analysis Two independent reviewers will perform quality assessment and data extraction. Prognostic accuracy will be determined by calculating positive and negative likelihood ratios for the following outcomes or reference standards: live birth, ongoing pregnancy, clinical pregnancy, biochemical pregnancy, embryos available for transfer, eggs obtained at oocyte retrieval, cycles cancelled prior to oocyte retrieval. Main results and conclusions N/A.
Cost‐effectiveness analysis of levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding
Publisher: Wiley
Date: 22-06-2006
DOI: 10.1111/J.1471-0528.2006.00944.X
Abstract: To compare the cost-effectiveness of levonorgestrel intrauterine system (LNG-IUS) (Mirena Schering Co., Turku, Finland) and thermal balloon ablation (Thermachoicetrade mark Gynecare Inc., Menlo Park, CA, USA) for the treatment of heavy menstrual bleeding. An open, pragmatic, prospective randomised trial. A menstrual disorders clinic at National Women's Hospital, Auckland, New Zealand. Seventy-nine women with self-defined heavy menstrual bleeding randomised to the LNG-IUS (40 women) or the thermal balloon ablation (39 women). Decision tree modelling using primary source data was used to identify the incremental cost-effectiveness of the two treatments. Direct and indirect costs of medical treatment, including treatment costs, subsequent medical procedures, lost income and medical treatment for failed procedures. The change in quality of life as assessed by the Short Form-36 (SF-36) measured between time of treatment and 24 months was the primary outcome measure. Economic modelling examined the expected cost and outcome for a woman entering each treatment. Sensitivity analysis explored the robustness of the results. The expected cost of treatment was $NZ1241 ($US869) for the LNG-IUS and $NZ2418 ($US1693) for the thermal balloon ablation. The LNG-IUS was associated with an increase of 15 points on the SF-36 scale, compared with 12 points for the thermal balloon ablation. Sensitivity analysis indicates that the results are robust to a 25% decrease in the price of the primary cost drivers and to variations in the rates of failed treatment between the conditions. The LNG-IUS would appear to be cost-effective when compared with the thermal balloon ablation for treatment of heavy menstrual bleeding.
Oral contraceptive pill for heavy menstrual bleeding
Publisher: Wiley
Date: 07-10-2009
Measuring outcomes in fertility trials: Can we rely on clinical pregnancy rates?
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.FERTNSTERT.2009.11.018
Abstract: To assess whether the estimates of treatment effect in randomized clinical trials (RCTs) in reproductive medicine differ when either clinical pregnancy or live birth is used as the outcome measure. Metaanalysis. We analyzed RCTs in reproductive medicine found in systematic reviews published in the Cochrane Library that reported on both clinical pregnancy and live birth. Subfertile couples. For each in idual RCT, data on clinical pregnancy and live birth were extracted. We compared the outcome of each study by calculating a kappa-statistic (statistically significant treatment effective or not) and by comparing the odds ratio by calculating the ratio of the odds ratios (ROR). We found 67 systematic reviews, of which 42 reported on pregnancy and live birth. These 42 reviews included 654 RCTs, of which 143 (22%) reported both on pregnancy and live birth. The pregnancy loss rates in the treatment and control groups were comparable. Of the 143 RCTs, the conclusion based on pregnancy rate and live birth rate was comparable (kappa value of 0.81 95% confidence interval [CI], 0.68-0.94). The odds ratios estimating treatment effect from pregnancy and live birth were also comparable (ROR, 1.01, 95% CI 0.9 to 1.12). Only a minority of randomized clinical trials in reproductive medicine report on live birth. Conclusions on the effectiveness of a treatment based on either clinical pregnancy or live birth as endpoints are comparable.
Review: transvaginal ultrasonography, sonohysterography, and hysteroscopy have moderate accuracy in abnormal uterine bleeding
Publisher: BMJ
Date: 2004
DOI: 10.1136/EBM.9.1.26
Cervical insemination versus intra-uterine insemination of donor sperm for subfertility
Publisher: John Wiley & Sons, Ltd
Date: 18-07-2007
Luteal phase support in assisted reproduction cycles
Publisher: Oxford University Press (OUP)
Date: 23-05-2012
Reply: Time-lapse in the IVF lab: How should we assess potential benefit?
Publisher: Oxford University Press (OUP)
Date: 09-03-2015
Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectiveness
Publisher: Wiley
Date: 2007
DOI: 10.1080/00016340600753117
Abstract: To assess the effectiveness of surgical interruption of pelvic nerve pathways in primary and secondary dysmenorrhea. Data sources. The Cochrane Menstrual Disorders and Subfertility Group Trials Register (9 June 2004), CENTRAL (The Cochrane Library, Issue 2, 2004), MEDLINE (1966 to Nov. 2003), EMBASE (1980 to Nov. 2003), CINAHL (1982 to Oct. 2003), MetaRegister of Controlled Trials, the citation lists of review articles and included trials, and contact with the corresponding author of each included trial. The inclusion criteria were randomized controlled trials of uterosacral nerve ablation or presacral neurectomy (both open and laparoscopic procedures) for the treatment of dysmenorrhea. The main outcome measures were pain relief and adverse effects. Two reviewers extracted data on characteristics of the study quality and the population, intervention, and outcome independently. Nine randomized controlled trials were included in the systematic review. There were two trials with open presacral neurectomy all other trials used laparoscopic techniques. For the treatment of primary dysmenorrhea, laparoscopic uterosacral nerve ablation at 12 months was better when compared to a control or no treatment (OR 6.12 95% CI 1.78-21.03). The comparison of laparoscopic uterosacral nerve ablation with presacral neurectomy for primary dysmenorrhea showed that at 12 months follow-up, presacral neurectomy was more effective (OR 0.10 95% CI 0.03-0.32). In secondary dysmenorrhea, along with laparoscopic surgical treatment of endometriosis, the addition of laparoscopic uterosacral nerve ablation did not improve the pain relief (OR 0.77 95% CI 0.43-1.39), while presacral neurectomy did (OR 3.14 95% CI 1.59-6.21). Adverse events were more common for presacral neurectomy than procedures without presacral neurectomy (OR 14.6 95% CI 5-42.5). The evidence for nerve interruption in the management of dysmenorrhea is limited. Methodologically sound and sufficiently powered randomized controlled trials are needed.
An economic evaluation of laparoscopic ovarian diathermy versus gonadotrophin therapy for women with clomiphene citrate resistant polycystic ovary syndrome
Publisher: Oxford University Press (OUP)
Date: 25-03-2004
IVF and IUI in couples with unexplained infertility (FIIX study): study protocol of a non-inferiority randomized controlled trial
Publisher: Oxford University Press (OUP)
Date: 2020
Abstract: In couples with unexplained infertility and a poor prognosis of natural conception, are four cycles of IUI with ovarian stimulation (IUI-OS) non-inferior to one completed cycle of IVF for the outcome of cumulative live birth? Are four cycles of IUI-OS associated with a lower cost per live birth compared to one completed cycle of IVF? Will four cycles of IUI-OS followed by one complete cycle of IVF result in as many live births at lower cost per live birth, than two complete cycles of IVF? Will four cycles of IUI-OS followed by two complete cycles of IVF result in more live births at lower cost per live birth, than two complete cycles of IVF alone? IUI is widely used in the USA, the UK and Europe as a low cost, less invasive alternative to IVF for couples with unexplained infertility. Although three to six cycles of IUI were comparable to IVF in the three major studies carried out to date, gonadotrophin ovarian stimulation was used in the majority of cases, and this also resulted in a high multiple pregnancy rate in some studies. Ovarian stimulation with clomiphene citrate is known to have lower multiple pregnancy rates. The FIIX study is a multicentre, open label, parallel, pragmatic non-inferiority randomized controlled trial of 580 couples with unexplained infertility comparing four cycles of IUI-OS with clomiphene citrate and one completed cycle of IVF. Variable block randomization stratified by age and clinic with electronic allocation will be used. Couples with poor prognosis for natural conception and who are eligible for publicly funded fertility treatment in six fertility clinics in New Zealand. Auckland Medical Research Fund (3718892/1119003), A+ Trust, Auckland District Health Board (A + 8479), Maurice and Phyllis Paykel Trust (3718514). No competing interests. ACTRN12619001003167. 15 July 2019 02/08/2019
Elective oophorectomy for benign gynecological disorders
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2007
Gynaecologists and industry: ain't no sunshine
Publisher: Oxford University Press (OUP)
Date: 03-07-2017
Abstract: The field of reproductive medicine is known for its innovations, and where there is innovation there is marketing and engagement with the doctors who are potential prescribers and users of those innovations. Financial connections between drug and device manufacturers with doctors have been extensively debated over the past decade. On one hand, relationships between doctors and industry could be considered synergistic by allowing the development of improved treatments. On the other hand, payment (and other benefits) from industry to doctors may subtly shift the main objective of the collaboration from patients' health to mutual benefits for both doctors and industry. Fertility patients can be considered 'vulnerable' as they face the multiple challenges of seeking to be parents, understanding complex and expensive fertility treatments that are by no means universally successful, and at the same time are under pressure because of their ever-increasing age. They are entitled to receive the most cost-effective treatments. We suggest that specialists in the field of reproductive medicine should be transparent about the receipt of financial benefits, including funding from industry, as it may be influencing both research outcomes and treatments that patients are offered. We also recommend that payments arising from industry-sponsored research should be centralized in institutional funds and not paid directly to researchers. And there should be transparency about the source and the purpose of the payment. Industry sponsorship of medical societies and their educational events should be kept to a minimum and declared quantitatively in societies' websites and scientific programme brochures. Industry sponsorship of scientific meetings should not include the right to host educational symposia or speakers within the programme. All speakers should declare their conflicts of interest (COIs) at their meetings. Guideline groups should require all members to declare their financial COIs before meeting and exclude or limit those members with COI. Governmental authorities should not allow continuing medical education credits to those educational events not complying with the above policies. The crucial role of medical journals as 'gatekeepers' for identifying 'science' must be reaffirmed.
Prioritising for fertility treatments—the effect of excluding women with a high body mass index
Publisher: Wiley
Date: 10-08-2006
DOI: 10.1111/J.1471-0528.2006.00995.X
Abstract: The effect of clinical priority access criteria for access to infertility treatment was examined for women outside the body mass index (BMI) range of 18-32 kg/m2. Treatments and outcomes were analysed from 1280 cases referred from 1998 to May 2005. Sixteen percent of women had a BMI of >32 kg/m2. Overall, 38% of these women had a birth from conceiving a treatment-related pregnancy or spontaneous pregnancy, compared with 52% of women with BMI 32<35 kg/m2 to access treatment, but women in higher BMI groups were less successful.
Under-reporting of maternal and perinatal adverse events in New Zealand
Publisher: BMJ
Date: 07-2015
Reply: Time-lapse in the IVF lab: how should we assess potential benefit?
Publisher: Oxford University Press (OUP)
Date: 06-03-2015
Randomized Clinical Trials, Clinical Use, and Hope: What Relationship?
Publisher: American Society of Clinical Oncology (ASCO)
Date: 05-2008
Chronic pelvic pain: Aetiology and therapy
Publisher: Elsevier BV
Date: 09-2006
Time-lapse systems for embryo incubation and assessment in assisted reproduction
Publisher: Wiley
Date: 27-02-2015
Cochrane review on HPV vaccination is not misleading
Publisher: BMJ
Date: 15-10-2019
An evaluation of the objective quality and perceived usefulness of maternity clinical practice guidelines at a tertiary maternity unit.
Publisher: Wiley
Date: 05-03-2018
DOI: 10.1111/AJO.12789
Abstract: Compliance with maternity clinical practice guidelines developed by National Women's Health has been found to be low at audit. To explore the reasons for poor compliance with maternity guidelines by evaluating the quality of a s le of National Women's Health guidelines using a validated instrument and assessing local guideline users' perceptions of and attitudes toward guidelines. Five independent reviewers evaluated the quality of 10 purposively selected guidelines for adherence to the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument standards. A self-administered questionnaire for staff was undertaken regarding views of and barriers to guideline use. None of the guidelines attained a score over 50% for the following domains: stakeholder involvement, rigour of development, applicability, editorial independence. The highest scoring domain was clarity of presentation (mean 69%). All guidelines scored the minimum possible for editorial independence. Survey respondents had positive attitudes toward guidelines, believed that their use could improve quality of care within the service, and felt that encouragement from senior staff members and peers would encourage their use. Accessibility was the most commonly cited of many barriers identified. The National Women's Health guidelines evaluated in this study cannot be considered to be high quality, and could be improved by reporting on methodology of the development process. Although poor guideline development may contribute to failure of the local maternity guidelines, it appears that accessibility is a major barrier to their use and implementation.
Interventions for the prevention of OHSS in ART cycles: An overview of Cochrane reviews
Publisher: John Wiley & Sons, Ltd
Date: 26-02-2016
Temperature of embryo culture for assisted reproduction
Publisher: Wiley
Date: 20-05-2016
Pharmaceutical industry payments and assisted reproduction in Australia: a retrospective observational study
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-049710
Abstract: To investigate the extent and nature of pharmaceutical industry payments related to fertility and assisted reproduction in Australia. This retrospective observational study employed four databases compiled from publicly available pharmaceutical industry transparency reports on educational event sponsorship (October 2011–April 2018), payments to healthcare professionals (October 2015–April 2018) and patient group support (January 2013–December 2017). Analyses were restricted to fertility-related payments by two major manufacturers of fertility medicines in Australia: Merck Serono and Merck, Sharp and Dohme (MSD). Descriptive statistics on fertility-related payments and other transfers of value (counts, total and median costs in Australian dollars) for educational events and to healthcare professionals and patient groups. Between October 2011 and April 2018, Merck Serono and MSD spent $A4 522 263 on 970 fertility-related events for healthcare professionals, including doctors, nurses and fertility scientists. 56.8% (551/970) events were held by fertility clinics and 29.3% (284/970) by professional medical associations. Between October 2015 and April 2018, Merck Serono spent $A403 800 across 177 payments to 118 fertility healthcare professionals, predominantly for educational event attendance. Recipients included obstetricians and gynaecologists (76.3% of payments, 135/177), nurses (11.3%, 20/177) and embryologists/fertility scientists (9.6%, 17/117). The highest paid healthcare professionals held leadership positions in major fertility clinics. Merck Serono provided $A662 850 to fertility-related patient groups for advocacy and education (January 2013–December 2017). The pharmaceutical industry sponsored a broad range of fertility clinicians and organisations, including doctors, nurses, embryologists, professional medical organisations, fertility clinics and patient groups. This sponsorship may contribute to the overuse of fertility services.
Alternative Treatments for Chronic Pelvic Pain
Publisher: Wiley
Date: 21-03-2011
Is another meta-analysis on the effects of intramural fibroids on reproductive outcomes needed?
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.RBMO.2010.08.006
Abstract: Intramural fibroids when encountered in women undergoing fertility treatment present a clinical dilemma. Despite recent studies that have suggested a negative outcome for intramural fibroids on fertility outcomes, the evidence remains far from conclusive. The current study presents a systematic review and meta-analysis of the currently available evidence. Relevant articles were identified in MEDLINE and EMBASE. Ten studies reported the effects of intramural fibroids on assisted conception treatment including one study reporting the effect of myomectomy for these fibroids. Combined analysis of the included studies, after taking into account possible confounding factors, showed no evidence of a significant effect for intramural fibroids on clinical pregnancy rate (odds ratio (OR) 0.74, 95% confidence intervals (CI) 0.50-1.09), live birth rate (OR 1.17, 95% CI 0.62-2.22) or miscarriage rate (OR 1.61, 95% CI 0.61-4.20). There was also no evidence for a significant effect for myomectomy on the clinical pregnancy rate (OR 1.88, 95% CI 0.57-6.14) or the miscarriage rate (OR 0.89, 95% CI 0.14-5.48). These findings highlight the current deficiency in the literature and suggest that evidence is insufficient to draw any conclusions regarding the effect of intramural fibroids on reproductive outcomes.
Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses' Health Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2013
Imaging modalities for the non-invasive diagnosis of endometriosis
Publisher: Wiley
Date: 26-02-2016
Short-term effects of high dose oral medroxyprogesterone acetate on bone density in premenopausal women
Publisher: The Endocrine Society
Date: 03-1996
DOI: 10.1210/JC.81.3.1014
Semen preparation techniques for intrauterine insemination
Publisher: Wiley
Date: 17-10-2007
Assisted reproductive technology: an overview of Cochrane Reviews
Publisher: Wiley
Date: 15-07-2015
Assisted reproductive technology: an overview of Cochrane Reviews
Publisher: John Wiley & Sons, Ltd
Date: 23-12-2014
A randomized controlled trial of laparoscopic ovarian diathermy versus gonadotropin therapy for women with clomiphene citrate-resistant polycystic ovary syndrome
Publisher: Elsevier BV
Date: 08-2002
DOI: 10.1016/S0015-0282(02)03225-9
Abstract: To compare the effectiveness of laparoscopic ovarian diathermy with gonadotropin ovulation induction for women with clomiphene citrate-resistant polycystic ovary syndrome. Randomized controlled trial. A tertiary referral fertility clinic. Women with anovulatory infertility secondary to clomiphene-resistant polycystic ovary syndrome. Inclusion criteria were age of <39 years, body mass index of 12 months of infertility, and no other causes of infertility. Laparoscopic ovarian diathermy versus three cycles of urinary or recombinant gonadotropins. Cumulative pregnancy and miscarriage rates. Cumulative pregnancy rates were 28% at 6 months for laparoscopic ovarian diathermy and 33% for three cycles of ovulation induction with gonadotropins. There were three miscarriages in each group. Women in the laparoscopic ovarian diathermy arm of the study had four additional spontaneous pregnancies 6 to 12 months after surgery. There was no statistically significant difference in pregnancy or miscarriage rates during the 6-month follow-up period or the three cycles. Laparoscopic ovarian diathermy is a safe and effective alternative to ovulation induction with gonadotropins.
An Overview of Treatments for Endometriosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2015
Ovulation suppression for endometriosis for women with subfertility
Publisher: Wiley
Date: 18-07-2007
Cost-effectiveness of the New Zealand diabetes in pregnancy guideline screening recommendations
Publisher: BMJ
Date: 22-06-2015
Techniques for preparation prior to embryo transfer
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Laparoscopy for the management of acute lower abdominal pain in women of childbearing age
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Intrauterine insemination: A UK survey on the adherence to NICE clinical guidelines by fertility clinics
Publisher: BMJ
Date: 15-05-2015
Surgical pelvic neuroablation for chronic pelvic pain: a systematic review
Publisher: Wiley
Date: 12-2000
High dose chemotherapy for poor prognosis breast cancer: Systematic review and meta-analysis
Publisher: Elsevier BV
Date: 06-2007
DOI: 10.1016/J.CTRV.2007.01.007
Abstract: High dose chemotherapy with autologous transplantation of bone marrow or peripheral stem cells (autograft) has been considered promising for treating poor prognosis breast cancer. We reviewed the relevant evidence. We included randomised controlled trials comparing high dose chemotherapy and autograft with conventional chemotherapy for women with early poor prognosis breast cancer. We searched medical databases (Cochrane Library, MEDLINE, EMBASE), websites (co-operative cancer research groups, American Society of Clinical Oncologists) and citations of articles found, to September 2006. Where appropriate, data were pooled to obtain a relative risk, using a fixed effects model. Clinical, methodological and statistical heterogeneity were examined with sensitivity analyses. Thirteen trials with 5064 women were included. There was a significant benefit in event-free survival for the high dose group at three years (RR 1.19 (95% CI 1.06, 1.19)) and four years (RR 1.24 (95% CI 1.03, 1.50)) and at five years this benefit approached statistical significance (RR 1.06 (95% CI 1.00, 1.13)). Overall survival rates were not significantly different at any stage of follow up. There were significantly more treatment-related deaths on the high dose arm (RR 8.58 (95% CI 4.13, 17.80)). Morbidity was higher in the high dose group but there was no significant difference in the incidence of second cancers. The high dose group reported significantly worse quality of life immediately after treatment, but there were few differences by one year. There is insufficient evidence supporting routine use of high dose chemotherapy with autograft for treating early poor prognosis breast cancer.
Laparoscopic ovarian diathermy and gonadotropin therapy resulted in similar pregnancy rates in women with PCOS
Publisher: Elsevier BV
Date: 09-2003
Don’t abandon RCTs in IVF. We don’t even understand them
Publisher: Oxford University Press (OUP)
Date: 11-2019
Abstract: The conclusion of the Human Fertilisation and Embryology Authority that ‘add-on’ therapies in IVF are not supported by high-quality evidence has prompted new questions regarding the role of the randomized controlled trial (RCT) in evaluating infertility treatments. Critics argue that trials are cumbersome tools that provide irrelevant answers. Instead, they argue that greater emphasis should be placed on large observational databases, which can be analysed using powerful algorithms to determine which treatments work and for whom. Although the validity of these arguments rests upon the sciences of statistics and epidemiology, the discussion to date has largely been conducted without reference to these fields. We aim to remedy this omission, by evaluating the arguments against RCTs in IVF from a primarily methodological perspective. We suggest that, while criticism of the status quo is warranted, a retreat from RCTs is more likely to make things worse for patients and clinicians.
The use of oil‐soluble contrast media for tubal flushing in infertility: A consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence)
Publisher: Wiley
Date: 09-08-2020
DOI: 10.1111/AJO.13222
Medroxyprogesteronazetat und Psychotherapie in der Behandlung der pelvinen Kongestion: eine randomisierte kontrollierte Studie
Publisher: S. Karger AG
Date: 1990
DOI: 10.1159/000271307
Cochrane reviews in perspective: the importance of appropriate conclusions and timing of publication
Publisher: Oxford University Press (OUP)
Date: 24-10-2011
Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses' Health Study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2013
Blood biomarkers for the non-invasive diagnosis of endometriosis
Publisher: Wiley
Date: 05-2016
A prospective study of outcomes five years after hysterectomy in premenopausal women
Publisher: Wiley
Date: 10-2008
Ovarian conservation at the time of hysterectomy for benign disease
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2007
Lipiodol tubal flushing increased pregnancy rate in women with endometriosis, but otherwise unexplained infertility
Publisher: Elsevier BV
Date: 09-2005
Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology
Publisher: Wiley
Date: 30-06-2016
ICSI versus conventional techniques for oocyte insemination during IVF in patients with non-male factor subfertility: a Cochrane review
Publisher: Oxford University Press (OUP)
Date: 02-2004
Abstract: This paper is based on a Cochrane review of the same title by the same authors published in The Cochrane Library, issue 3, 2003 (see www.CochraneLibrary.net for information) with permission from the Cochrane Collaboration-John Wiley and Sons. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review. The objective of this review was to investigate whether ICSI improves live-birth rate in comparison with IVF in couples with non-male factor subfertility. We searched the Cochrane Menstrual Disorders and Subfertility Group trials register (searched 30 May 2002), the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2002), PubMed (January 1992 to September 2003) and reference lists of articles. Trials were included if they compared the effects of ICSI and IVF on live births, pregnancy and fertilization outcomes. Only randomized studies were included in this review. Two reviewers extracted data independently. There were no randomized data comparing live-birth rates. The single identified study did not find a difference in pregnancy rates (OR 1.4, 95% CI 0.95-2.2). There were no randomized data on miscarriage rates, or on other adverse events such as congenital malformations that may be of concern (415 couples randomized). Two studies used alternation to assign their couples and did have live birth as an outcome. These studies showed a significantly higher fertilization rate in the IVF group, but no difference in pregnancy, miscarriage or live-birth rate. Whether ICSI should be preferred to IVF for cases of non-male factor subfertility remains an open question. Further research should focus on live-birth rates and adverse events.
Laparoscopic drilling by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome
Publisher: John Wiley & Sons, Ltd
Date: 18-07-2007
Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
Low dose aspirin treatment in late pregnancy differentially inhibits cyclo-oxygenase in maternal platelets
Publisher: Elsevier BV
Date: 11-1987
DOI: 10.1016/0090-6980(87)90294-2
Abstract: Eighteen pregnant women were treated with aspirin, 37.5 mg once daily by mouth. Treatment was started two weeks before the expected date of delivery, and continued until delivery. Seventeen untreated women were studied concurrently. Platelet thromboxane (TX) production was determined by radioimmunoassay of TXB2 in serum from blood incubated for one hour with thrombin at 37 degrees C. Maternal blood was studied before treatment and at delivery. Fetal blood, from the cord, was studied at delivery. Prostacyclin (PGI2) production by rings of umbilical artery incubated in Hanks' solution at 37 degrees C for one hour was determined by radio-immunoassay of its hydrolysis product, 6-oxo-prostaglandin (PG) F1 alpha. Maternal and fetal blood from untreated women produced similar amounts of TXB2. Aspirin, in the dose regimen used, significantly inhibited TXB2 production in maternal but not in fetal blood, and did not impair PGI2 synthesis by umbilical artery rings. This differential effect on the cyclo-oxygenase of maternal platelets is probably due to the unusual kinetic properties of aspirin, and may prove therapeutically useful.
Beyond the numbers: Classifying contributory factors and potentially avoidable maternal deaths in New Zealand, 2006-2009
Publisher: Elsevier BV
Date: 10-2011
DOI: 10.1016/J.AJOG.2011.07.044
Abstract: We sought to describe a new classification system for contributory factors in, and potential avoidability of, maternal deaths and to determine the contributory factors and potential avoidability among 4 years of maternal deaths in New Zealand. A new classification system for reporting contributory factors in all maternal deaths was developed from previous tools and applied to all maternal deaths in New Zealand from 2006 through 2009. There were 49 deaths and the maternal mortality ratio was 19.2/100,000 maternities. Contributory factors were identified in 55% of cases. An expert panel identified 35% of maternal deaths as potentially avoidable. In cases where potential avoidability was determined, there were nearly always 2 or 3 domains where contributory factors were identified. Almost one third of maternal deaths in New Zealand can be considered to be potentially avoidable. This methodology has the potential to identify areas for improvement in the quality of maternity care.
Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
The management of menorrhagia - SMART study (Satisfaction with Mirena and Ablation: a Randomised Trial)
Publisher: Elsevier BV
Date: 07-2001
Laparoscopic ovarian diathermy versus metformin for women with polycystic ovarian syndrome
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Methodological Quality of Systematic Reviews in Subfertility: A Comparison of Two Different Approaches
Publisher: Public Library of Science (PLoS)
Date: 28-12-2012
Blastocyst or cleavage-stage embryo transfer?
Publisher: Elsevier BV
Date: 02-2007
Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
Time-lapse in the IVF-lab: how should we assess potential benefit?
Publisher: Oxford University Press (OUP)
Date: 14-10-2014
Abstract: Time-lapse imaging of embryos has been widely introduced to fertility laboratories worldwide with the aim of identifying the best quality embryos to transfer that will ultimately improve IVF success rates. In this opinion paper, we explore the lack of evidence of benefit of this novel intervention, analyse the methodological flaws of current studies, offer ideal study designs that assess the various features of time-lapse imaging, and discuss forthcoming studies. In particular, we emphasize the ethical aspects of hastily adopting a costly technology without current high level evidence of improved live birth rates, safety and cost effectiveness.
Do uterine fibroids cause infertility and should they be removed to increase fertility?
Publisher: BMJ
Date: 16-01-2009
DOI: 10.1136/BMJ.B126
The sexually transmitted infections and HIV/AIDS Cochrane review groups
Publisher: BMJ
Date: 29-04-2014
Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery
Publisher: John Wiley & Sons, Ltd
Date: 18-10-2006
Pipelle for Pregnancy (PIP): study protocols for three randomised controlled trials
Publisher: Springer Science and Business Media LLC
Date: 27-04-2016
3 The Cochrane Library
Publisher: Elsevier BV
Date: 12-1996
Barrier agents for adhesion prevention after gynaecological surgery
Publisher: John Wiley & Sons, Ltd
Date: 23-04-2008
Trial does not change the conclusions of Cochrane review of long term hormone therapy for perimenopausal and postmenopausal women
Publisher: BMJ
Date: 03-12-2012
DOI: 10.1136/BMJ.E8141
A pilot survey of the impact of menstrual cycles on adolescent health
Publisher: Wiley
Date: 24-09-2009
A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy
Publisher: Elsevier BV
Date: 02-2001
A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic pain
Publisher: Wiley
Date: 23-08-2004
Electrocautery strategy and ovulation induction with FSH had similar 12-month pregnancy rates in women with PCOS
Publisher: Elsevier BV
Date: 03-2005
Clinicians report high satisfaction with clinical guidelines, but question their practicality
Publisher: Elsevier BV
Date: 2003
Pinch skin grafting or porcine dermis in venous ulcers.
Publisher: BMJ
Date: 09-05-1987
DOI: 10.1136/BMJ.294.6581.1228-B
Abstract: The small and large delta antigens (S-HDAg and L-HDAg, respectively) represent two forms of the only protein encoded by the hepatitis delta virus (HDV) RNA genome. Consequently, HDV relies, at a large extent, on the host cell machinery for replication and transcription. Until now, only a limited number of cellular proteins were identified as S-HDAg or L-HDAg partners being involved in the modulation of the virus life cycle. In an attempt to identify cellular S-HDAg-binding proteins we made use of a yeast two-hybrid approach to screen a human liver cDNA library. We were able to identify HuR, a ubiquitously expressed protein involved in RNA stabilization, as an S-HDAg partner both in vitro and in vivo. HuR was found to be overexpressed and colocalize with HDAg in human hepatoma cells. siRNA knockdown of HuR mRNA resulted in inhibition of S-HDAg and L-HDAg expression.
Advice has changed for hormone therapy in the WHI era
Publisher: Wiley
Date: 04-2006
Hysterectomy rates in the United States 1990–1997
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2002
DOI: 10.1016/S0029-7844(01)01723-9
Abstract: To assess hysterectomy rates, type of hysterectomy, and other factors associated within the United States from 1990-1997. A descriptive statistical analysis of national discharge data was undertaken. Data from the nationwide Inpatient S le of the Healthcare Cost and Utilization Project (from which national estimates are generated based on a 20% stratified s le of US community hospitals) were used for the years 1990-1997. All women who underwent hysterectomy were identified using International Classification of Diseases, 9th Revision, Clinical Modification, procedure codes. Outcome measures included rate, type of hysterectomy, age of patients, length of stay, total hospital charges, and diagnostic categories. Rates of hysterectomy have not changed significantly over the years from 1990-1997. Rates for hysterectomy in 1990 were 5.5 per 1000 women and increased slightly by 1997 to 5.6 per 1000 women. The type of hysterectomy has changed, with laparoscopic hysterectomy accounting for 9.9% of cases by 1997, with a concomitant decline in abdominal hysterectomy but no substantial change in vaginal hysterectomy rates. Length of stay decreased and total charges increased for all types of hysterectomy. Vaginal hysterectomy and laparoscopic hysterectomy are associated with shorter length of stay than abdominal hysterectomy. Abdominal hysterectomy is the most common procedure (63.0% in 1997). The majority of hysterectomies are abdominal, and the most common indication is uterine fibroids. The introduction of alternative techniques for controlling abnormal uterine bleeding such as endometrial ablation has not had an impact on hysterectomy rates, and there has only been a limited uptake of laparoscopic approaches.
A systematic review of transvaginal ultrasonography, sonohysterography and hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women
Publisher: Wiley
Date: 29-05-2003
DOI: 10.1034/J.1600-0412.2003.00191.X
Abstract: To determine the accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy for the investigation of abnormal uterine bleeding in premenopausal women. Systematic review of common diagnostic imaging tests. Relevant papers were identified through electronic searching of MEDLINE (1980 to July 2001) and EMBASE (1980 to July 2001) and manual searching of a bibliography of primary and review articles. Studies were selected if accuracy of transvaginal ultrasonography, sonohysterography and diagnostic hysteroscopy was compared with a reference standard and included data that could be abstracted into a two-by-two table in order to calculate sensitivity and specificity. Quality assessment and data extraction were performed by at least two independent reviewers. Diagnostic accuracy was determined by calculating positive and negative likelihood ratios for all intrauterine pathologies, submucous fibroids and endometrial hyperplasia. Nineteen studies met the inclusion criteria. Statistically significant heterogeneity was present between the likelihood ratios for studies of transvaginal ultrasound. A positive test result with sonohysterography diagnosed submucous fibroids with a pooled likelihood ratio of 29.7 (17.8, 49.6). A positive test result with hysteroscopy diagnosed submucous fibroids with a pooled likelihood ratio of 29.4 (13.4, 65.3), and any intrauterine pathology with a pooled likelihood ratio of 7.7 (4.3, 13.7). A negative test result with hysteroscopy for diagnosing any intrauterine pathology had a pooled likelihood ratio of 0.07 (0.04, 0.15). Although there was considerable variability present between the studies, all three diagnostic tests were moderately accurate in detecting intrauterine pathology. However, sonohysterography and hysteroscopy performed better than transvaginal ultrasound in detecting submucous fibroids.
The evidence for the management of endometriosis
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-1998
DOI: 10.1097/00001703-199808000-00007
Abstract: This review article has focussed on identifying the evidence from randomized controlled trials for the medical and surgical management of endometriosis. A critical summary of the medical management has shown that there is little difference in effectiveness of various medical treatments, but there are differences in the side-effect profiles. Few randomized controlled trials have been undertaken in surgery, but these have shown that surgical management is effective in the management of both painful symptoms and subfertility.
How to read a cochrane review
Publisher: Cambridge University Press
Date: 2011
BMI Trumps Age in Decision for Endometrial Biopsy: Cohort Study of Symptomatic Premenopausal Women
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
The association of hysterectomy and menopause: a prospective cohort study
Publisher: Wiley
Date: 23-05-2005
DOI: 10.1111/J.1471-0528.2005.00696.X
Abstract: To determine whether or not hysterectomy leads to an earlier onset of the menopause. A prospective cohort study. Gynaecology service of large urban hospital. Premenopausal women with and without hysterectomy. Multivariate survival analysis techniques were used to adjust for differences in initial follicle stimulating hormone (FSH) levels, body mass index, smoking and unilateral oophorectomy between the groups. FSH levels were measured for five years following hysterectomy and compared with the comparison group. Menopause was defined as a single FSH measurement of at least 40 IU/L. Two hundred and fifty-seven women undergoing hysterectomy were compared with 259 women who had not undergone a hysterectomy. Fifty-three women (20.6%) in the hysterectomy group and 19 women (7.3%) in the comparison group reached menopause over the five years of the study. Women in the hysterectomy group with a pre-operative FSH <10 IU/L reached menopause 3.7 years (95% CI 1.5-6.0 years) earlier than women in the comparison group independent of BMI, smoking and unilateral oophorectomy. Twenty-eight women in the hysterectomy group had unilateral oophorectomy and 10 (35.7%) of these women reached menopause over the five years of follow up. Women in the hysterectomy group with unilateral oophorectomy reached menopause 4.4 years (95% CI 0.6, 7.9 years) earlier than women with both ovaries in the hysterectomy group independent of baseline FSH, BMI and smoking. Hysterectomy is associated with an earlier onset of menopause. Hysterectomy with unilateral oophorectomy is associated with an even earlier onset of the menopause in this study.
Body mass index trumps age in decision for endometrial biopsy: cohort study of symptomatic premenopausal women
Publisher: Elsevier BV
Date: 11-2016
DOI: 10.1016/J.AJOG.2016.06.006
Abstract: Clinical guidelines recommend that women with abnormal uterine bleeding with risk factors have an endometrial biopsy to exclude hyperplasia or cancer. Given the majority of endometrial cancer occurs in postmenopausal women, it has not been widely recognized that obesity is a significant risk factor for endometrial hyperplasia and cancer in young, symptomatic, premenopausal women. We sought to evaluate the effect of body mass index on risk of endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding. This was a retrospective cohort study in a single large urban secondary women's health service. Participants were 916 premenopausal women referred for abnormal uterine bleeding of any cause and had an endometrial biopsy from 2008 through 2014. The primary outcome was complex endometrial hyperplasia (with or without atypia) or endometrial cancer. Almost 5% of participants had complex endometrial hyperplasia or cancer. After adjusting for clinical and demographic factors, women with a measured body mass index ≥30 kg/m Obesity is an important risk factor for complex endometrial hyperplasia or cancer in premenopausal women with abnormal uterine bleeding who had an endometrial biopsy in a secondary gynecology service. As over half of women with the outcome in this study were age <45 years, deciding to biopsy primarily based on age, as currently recommended in national guidelines, potentially misses many cases or delays diagnosis. Body mass index should be the first stratification in the decision to perform endometrial biopsy and/or to refer secondary gynecology services.
Accuracy of ultrasound measurements of female pelvic organs
Publisher: Wiley
Date: 08-1990
DOI: 10.1111/J.1471-0528.1990.TB16241.X
Abstract: Uterine size, endometrial thickness and ovarian volume were measured ultrasonically and the results compared with caliper measurements made shortly afterwards at the time of total hysterectomy and bilateral salpingo-oophorectomy. The results establish the validity of ultrasound measurements. Histological studies also confirmed the diagnosis made with ultrasound of polycystic ovaries in women complaining of pain due to pelvic congestion.
Gonadotrophins for idiopathic male factor subfertility
Publisher: John Wiley & Sons, Ltd
Date: 17-10-2007
Expression and regulation of DNA methyltransferases in human endometrium
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.FERTNSTERT.2010.09.030
Abstract: The messenger RNA of the DNA methyltransferases DNMT3a and DNMT3b are expressed temporally in the endometrium across the menstrual cycle, as is the steroid hormone regulation of DNMT1, DNMT3a, and DNMT3b. This suggests that DNA methylation in endometrium is changeable during the menstrual cycle and potentially alters gene expression.
Cost effectiveness of pre‐operative gonadotrophin releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy
Publisher: Wiley
Date: 11-2002
DOI: 10.1046/J.1471-0528.2002.01224.X
Abstract: To conduct a cost effectiveness analysis of pre-operative gonadotrophin releasing hormone agonists (GnRHa) in women with uterine fibroids undergoing hysterectomy or myomectomy. A cost effectiveness analysis using the effectiveness data from a systematic review of GnRHa. Secondary care. Women with uterine fibroids undergoing hysterectomy or myomectomy and women volunteers. Effectiveness data were used from a systematic review to construct a model and to calculate the cost per surgical outcome avoided. In order to evaluate the value women place on the outcome, a willingness to pay analysis of women volunteers was undertaken. (a) The cost of avoiding abdominal hysterectomy and the cost of avoiding a vertical incision at either hysterectomy or myomectomy (b) The value that women place on avoiding abdominal hysterectomy and on avoiding a vertical incision at either hysterectomy or myomectomy. All costs are in NZ dollars. For hysterectomy, the additional cost of treatment with GnRHa was NZ$1190 per case. The cost of avoiding one abdominal procedure was NZ$4577 per case and the cost of avoiding one vertical incision was NZ$6263. For a myomectomy, the additional cost of treatment with GnRHa was NZ$1535 per case. The cost of avoiding one vertical incision was NZ$4651 per case. These costs exceeded the benefit women placed on the outcomes. Although the pre-operative use of GnRHa results in benefits which include less frequent abdominal incisions in the case of hysterectomy and less frequent vertical incisions in the case of myomectomy, the benefits do not justify the costs. This study highlights the importance of considering both the benefits and costs in health care decisions.
Methodological quality of systematic reviews in subfertility: A comparison of Cochrane and non-Cochrane systematic reviews in assisted reproductive technologies
Publisher: Oxford University Press (OUP)
Date: 02-10-2012
Abstract: Are there differences in the methodological quality of Cochrane systematic reviews (CRs) and non-Cochrane systematic reviews (NCRs) of assisted reproductive technologies? CRs on assisted reproduction are of higher methodological quality than similar reviews published in other journals. The quality of systematic reviews varies. This was a cross-sectional study of 30 CR and 30 NCR systematic reviews that were randomly selected from the eligible reviews identified from a literature search for the years 2007-2011. We extracted data on the reporting and methodological characteristics of the included systematic reviews. We assessed the methodological quality of the reviews using the 11-domain Measurement Tool to Assess the Methodological Quality of Systematic Reviews (AMSTAR) tool and subsequently compared CR and NCR systematic reviews. The AMSTAR quality assessment found that CRs were superior to NCRs. For 10 of 11 AMSTAR domains, the requirements were met in >50% of CRs, but only 4 of 11 domains showed requirements being met in >50% of NCRs. The strengths of CRs are the a priori study design, comprehensive literature search, explicit lists of included and excluded studies and assessments of internal validity. Significant failings in the CRs were found in duplicate study selection and data extraction (67% meeting requirements), assessment for publication bias (53% meeting requirements) and reporting of conflicts of interest (47% meeting requirements). NCRs were more likely to contain methodological weaknesses as the majority of the domains showed <40% of reviews meeting requirements, e.g. a priori study design (17%), duplicate study selection and data extraction (17%), assessment of study quality (27%), study quality in the formulation of conclusions (23%) and reporting of conflict of interests (10%). The AMSTAR assessment can only judge what is reported by authors. Although two of the five authors are involved in the production of CRs, the risk of bias was reduced by not involving these authors in the assessment of the systematic review quality. Not all systematic reviews are equal. The reader needs to consider the quality of the systematic review when they consider the results and the conclusions of a systematic review. There are no conflicts with any commercial organization. Funding was provided for the students by the summer studentship programme of the Faculty of Medical and Health Sciences of the University of Auckland.
An evaluation of risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding
Publisher: Elsevier BV
Date: 09-1999
DOI: 10.1016/S0002-9378(99)70487-4
Abstract: We sought to determine the clinical risk factors for endometrial hyperplasia in premenopausal women with abnormal bleeding. A laboratory database was searched to identify all endometrial s les taken in 1033 premenopausal women over a 30-month period from January 1995 to July 1997. Clinical data were extracted from the patients' clinical records retrospectively, and univariate and multivariate analyses were performed. The setting was the gynecologic service of a large teaching hospital. There were 46 cases of endometrial hyperplasia and 5 cases of endometrial cancer diagnosed. The following factors were independently associated with increased risk of endometrial hyperplasia or the presence of carcinoma: age >/=45 years (odds ratio, 3.1 95% confidence interval, 1.5-6.1), weight >/=90 kg (odds ratio, 5.5 95% confidence interval, 2.9-10.6), history of infertility (odds ratio, 3.6 95% confidence interval, 1.3-9.9), family history of colonic carcinoma (odds ratio, 5.0 95% confidence interval, 1.3-19.1), and nulliparity (odds ratio, 2.8 95% confidence interval, 1.1-7.2). There was no increased association of endometrial hyperplasia on the basis of irregularity of menstrual cycle or duration of menstrual bleeding. The following are risk factors for endometrial hyperplasia in premenopausal women with abnormal menstrual bleeding: body weight >/=90 kg, age >/=45 years, infertility, family history of colonic carcinoma, and nulliparity. Current guidelines may need to be reconsidered.
IVF add‐ons in Australia and New Zealand: A systematic assessment of IVF clinic websites
Publisher: Wiley
Date: 16-02-2021
DOI: 10.1111/AJO.13321
Abstract: In vitro fertilisation (IVF) ‘add‐ons’ are extra (non‐essential) procedures, techniques or medicines, which usually claim to increase the chance of a successful IVF outcome. Use of IVF add‐ons is believed to be widespread in many settings however, information about add‐on availability in Australasia is lacking. To understand which add‐ons are advertised on Australasian IVF clinic websites, and what is the evidence for their benefit. A systematic assessment of website content was undertaken between December 2019–April 2020, capturing IVF add‐ons advertised, including costs, claims of benefit, statements of risk or limitations, and evidence of effectiveness for improving live birth and pregnancy. A literature review assessed the strength and quality of evidence for each add‐on. Of the 40 included IVF clinics websites, 31 (78%) listed one or more IVF add‐ons. A total of 21 different add‐ons or add‐on groups were identified, the most common being preimplantation genetic testing for aneuploidies (offered by 63% of clinics), time‐lapse systems (33%) and assisted hatching (28%). In most cases (77%), descriptions of the IVF add‐ons were accompanied by claims of benefit. Most claims (90%) were not quantified and very few referenced scientific publications to support the claims (9.8%). None of the add‐ons were supported by high‐quality evidence of benefit for pregnancy or live birth rates. The cost of IVF add‐ons varied from $0 to $3700 (AUD/NZD). There is widespread advertising of add‐ons on IVF clinic websites, which report benefits for add‐ons that are not supported by high‐quality evidence.
Endometrial injury and reproductive outcomes: there's more to this story than meets the horse's blind eye
Publisher: Oxford University Press (OUP)
Date: 20-01-2015
Pitfalls in systematic reviews
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-0006
Non-publication and publication bias in reproductive medicine: a cohort analysis
Publisher: Oxford University Press (OUP)
Date: 29-06-2017
Abstract: Does publication bias or non-publication exist in fertility trials presented as conference abstracts? This study did not detect any publication bias however, it did identify a high level of non-publication, with only 49% of abstracts reaching full-text publication four or more years after abstract presentation. Systematic reviews of randomized controlled trials (RCTs) are the foundation of evidence based medicine. Non-publication or publication deficit refer to the failure to publish trial results. A publication bias exists when there is any tendency on the parts of the investigators or editors to fail to publish study results on the basis or strength of the study findings. Both present a serious problem for researchers, clinicians and policymakers alike, and ultimately impact on patient care. A retrospective cohort study identified 337 fertility RCTs presented as conference abstracts between 2007 and 2010, as captured by an electronic search of the Cochrane Gynaecology and Fertility Database. After excluding ineligible trials and duplicates, 224 abstracts remained. A search for the full-text papers of each abstract was undertaken in Pubmed, MEDLINE, Embase, CINAHL and Google in May 2015 using a probabilistic approach. Trial authors were contacted to query the publication status of abstracts when no full-text was identified. The association between in idual variables and the probability of publication, and time to publication, was assessed using logistic regression and Cox regression, respectively. Of the 224 included abstracts, only 110 (49% 95% CI: 42.6, 55.6) were found to be published as full-text articles. Publication bias was not identified in this cohort studies with positive results had a similar probability of reaching full-text publication 52/113 (46% 95% CI: 37.0, 55.3) as studies with non-positive (negative or null) results 58/111 (52% 95% CI: 17.8, 33.9) (adjusted odds ratio (AOR): 1.02 95% CI: 0.53, 1.97). Similarly, the time from abstract presentation to full-text publication was similar in studies with positive and non-positive results. Oral presentations were more likely to be published, and to be published sooner, than poster presentations (poster presentation AOR: 0.31 95% CI: 0.15, 0.61 and adjusted hazard ratio (AHR): 0.57 95% CI: 0.38, 0.86). Studies that were not registered were less likely to be published and to have delayed publication, than studies which were registered either prospectively or retrospectively (AOR: 0.14 95% CI: 0.04, 0.44 and AHR: 0.43 95% CI: 0.25, 0.72). Abstracts which were presented a longer time ago also had a higher probability of reaching full-text publication (P = 0.01). Commencing with a cohort of RCTs from ethics committee registers may provide a better picture of the extent of non-publication and publication bias, as not all trials reach the stage of abstract presentation. It is also possible that the search did not identify all published trials, as some may have been published after the follow-up period. This study did not identify any publication bias. However, only half of the abstracts in this cohort have been published as full-text articles, four or more years after their presentation at a conference. This is similar to publication rates reported previously for fertility trials, and is despite increasing awareness of the importance of publishing trial results, and subsequent requirements for all RCTs to be registered prior to trial initiation. A better understanding of the reasons for non-publication should assist in facilitating the prompt full-text publication of RCTs in the future. Funding provided from the University of Auckland. All authors declare they have no conflicts of interest in relation to this article. Not applicable.
No implementation without evaluation: the case of mesh in vaginal prolapse surgery
Publisher: John Wiley & Sons, Ltd
Date: 09-02-2016
Endometrial injury for pregnancy following sexual intercourse or intrauterine insemination
Publisher: Wiley
Date: 14-06-2016
VALUE study: a protocol for a qualitative semi-structured interview study of IVF add-ons use by patients, clinicians and embryologists in the UK and Australia
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-047307
Abstract: For couples undergoing assisted reproduction, a plethora of adjuncts are available these are known as ‘add-ons’. Most add-ons are not supported by good quality randomised trial evidence of efficacy, with some proven to be ineffective. However, estimates suggest that over 70% of fertility clinics provide at least one add-on, often at extra cost to the patient. This study has three aims. First, to undertake a survey of in vitro fertilisation (IVF) clinics in the UK to ascertain which add-ons are being offered and at what cost. Second, to undertake qualitative semi-structured interviews of patients, clinicians and embryologists, to explore their opinions and beliefs surrounding add-ons. Third, to review the interpretation of the Human Fertilisation and Embryology Authority traffic light system, to better understand the information required by IVF patients, clinicians and embryologists when making decisions about add-ons. All UK IVF clinics will be contacted by email and invited to complete an online survey. The survey will ask them which add-ons they offer, at what cost per cycle and how information is shared with patients. Semi-structured interviews will be conducted in the UK and Australia with three groups of participants: (i) fertility patients (ii) clinicians and (iii) embryologists. Participants for the interviews will be recruited via social media channels, website adverts, email and snowball s ling. Up to 20 participants will be recruited for each group in each country. Following an online consent process, interviews will be conducted via video-conferencing software, transcribed verbatim and data subjected to inductive thematic analysis. Ethical approval has been granted by the Universities of Sheffield, Bath Spa and Melbourne. Findings will be published in a peer-reviewed journal and disseminated to regulatory bodies in the UK and Australia. A lay summary of findings will be shared via Fertility Network, UK.
Combination of the non-invasive tests for the diagnosis of endometriosis
Publisher: Wiley
Date: 13-07-2016
Neonatal encephalopathy in New Zealand: Demographics and clinical outcome
Publisher: Wiley
Date: 05-05-2016
DOI: 10.1111/JPC.13165
Abstract: To establish the incidence of moderate to severe neonatal encephalopathy (NE) in term infants from New Zealand and to document demographic characteristics and neonatal outcomes. Cases were reported monthly via the New Zealand Paediatric Surveillance Unit (NZPSU). Data were collected from paediatricians for neonatal items and lead maternity carers for pregnancy and birth details. Term neonatal deaths in the Perinatal and Maternal Mortality Review Committee dataset that were because of hypoxia and/or neonatal deaths from hypoxic ischaemic encephalopathy were added to the cases identified via the NZPSU, if they had not previously been ascertained. For the period January 2010 to December 2012, there were 227 cases, equivalent to a rate of 1.30/1000 term births (95% CI 1.14-1.48). Rates of NE were high in babies of Pacific and Indian mothers but only reached statistical significance for the comparison between Pacific and NZ European. There was also a significant increase in NE rates with increasing deprivation. Resuscitation at birth was initiated for 209 (92.1%) infants with NE. Mechanical ventilation was required, following neonatal unit admission, in 171 (75.3%) infants. Anticonvulsants were used in 157 (69.2%) infants with phenobarbitone (65.6%), phenytoin (14.5%) and benzodiazapines (21.1%), the most common. Cooling was induced in 168 infants (74%) with 145 (86.3%) reported as commenced within a 6-h window. The rate of NE in New Zealand is consistent with reported international rates. Establishing antecedent factors for NE is an important part of improving care, which may inform strategic efforts to decrease rates of NE.
Gynaecologic cancer patients' needs and experiences of supportive health services in New Zealand
Publisher: Wiley
Date: 02-2010
DOI: 10.1002/PON.1553
Abstract: Psychosocial care across the cancer continuum is a core component of quality gynaecologic cancer services. The purpose of this qualitative study was to identify needs for supportive care in a s le of New Zealand women and to understand to what extent they feel their needs are being met by health services. Purposive s ling was used to recruit women (n=28) diagnosed with a gynaecologic cancer. Unstructured interviews were conducted and a thematic analysis was performed. Interviews revealed a range of shared and unique needs and support experiences. Three themes emerged reflecting participants' sense of control, need for validation of the cancer experience and organisation of their care. Findings suggest issues of continuity and coordination of care result in unmet support needs across the continuum of care, but primarily after treatment finishes. While broadly consistent with previous results, findings highlight the need for a patient-focused, comprehensive, integrated approach to supportive cancer care encompassing diagnosis, treatment and long-term recovery.
EDITORIAL: The evidence base for current infertility treatment
Publisher: Wiley
Date: 19-10-2004
Long‐term follow up of women with laparoscopic ovarian diathermy for women with clomiphene‐resistant polycystic ovarian syndrome
Publisher: Wiley
Date: 06-11-2007
Behavioural interventions for dysmenorrhoea
Publisher: Wiley
Date: 18-07-2007
Endometrial scratching for subfertility: Everyone's doing it
Publisher: Oxford University Press (OUP)
Date: 22-03-2016
Abstract: What proportion of clinicians across Australia, New Zealand and the UK are currently offering or recommending endometrial scratching for subfertility? Eighty-three percent of clinicians responding to this survey are recommending endometrial scratching to women undergoing IVF. Endometrial scratching is currently being proposed as a technique to increase the probability of implantation in women undergoing IVF. While trial results provide evidence in favour of this procedure, there remains some uncertainty about both the extent of any beneficial effect and the subgroups of women most likely to benefit. Cross-sectional survey with responses from a total of 143 public and private fertility care providers surveyed between August and October 2015. An online survey was distributed to all 189 fertility clinics across Australia, New Zealand and the UK. All clinicians, nurses and embryologists were eligible to take part. One hundred and forty-three of the 152 responses received were eligible for inclusion, with multiple responses per clinic in 33 cases. At least one response was received from 68 clinics (36% response rate per clinic). This survey found that 83% of clinicians commend endometrial scratching prior to IVF. Of these, 92% recommend endometrial scratching to women with recurrent implantation failure (RIF) and 6% recommend it to all women having IVF. Most respondents (73%) agreed that the procedure is beneficial in women with RIF undergoing IVF and disagreed (53%) that the procedure is beneficial for women undergoing their first IVF cycle. The most common timeframe for performing endometrial scratching is the luteal phase of the cycle prior to the IVF cycle. Additionally, only 4% of clinicians recommend endometrial scratching to women undergoing intrauterine insemination or trying to conceive naturally. Fertility care providers who recommend endometrial scratching may be more likely to respond to the survey and this could exaggerate the use of the procedure reported here. This study was conducted across three countries and may be generalizable to similar settings. While this procedure already appears to be offered by the majority of respondents, the results of further studies in this area may further refine or expand the context in which this procedure is beneficial. No funding or competing interests. N/A.
A randomized trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2006
Aromatase inhibitors for subfertile women with polycystic ovary syndrome: Summary of a Cochrane review
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.FERTNSTERT.2014.10.016
Abstract: Polycystic ovary syndrome (PCOS) is a common cause of anovulatory subfertility. We evaluated the effectiveness and safety of aromatase inhibitors compared with other methods of ovulation induction in women with anovulatory PCOS.
The FLUSH Trial--Flushing with Lipiodol for Unexplained (and endometriosis-related) Subfertility by Hysterosalpingography: a randomized trial
Publisher: Oxford University Press (OUP)
Date: 24-06-2004
Cervical insemination versus intra-uterine insemination of donor sperm for subfertility
Publisher: Wiley
Date: 23-04-2008
Obesity and endometrial hyperplasia and cancer in premenopausal women: A systematic review
Publisher: Elsevier BV
Date: 06-2016
DOI: 10.1016/J.AJOG.2016.01.175
Abstract: To systematically review the literature on the association between obesity and endometrial hyperplasia or cancer in premenopausal women. We searched the bibliographic databases MEDLINE, EMBASE, PubMed, and CINAHL (inception to May 5, 2015), and checked reference lists of included studies and systematic reviews. Studies of more than 50 women with endometrial pathology diagnosed during premenopause that reported on obesity as a risk factor were eligible. Study identification and data extraction were independently performed by 2 authors. Where possible, data were pooled in a generic inverse variance forest plot. Heterogeneity was reported using the I(2) statistic. Nine case-control studies of moderate quality were included. Quantitative analysis of 5 studies showed a dose-response relationship of body mass index and increased risk of endometrial cancer. For studies of women with body mass index of ≥25, the pooled odds ratio was 3.85 (95% confidence interval 2.53-5.84) body mass index of ≥30 was 5.25 (4.00-6.90) and body mass index of ≥40 was 19.79 (11.18-35.03). Body mass index is a consistent and leading risk factor for endometrial complex hyperplasia or cancer in premenopausal women. Body mass index should be considered when deciding to assess the endometrium in symptomatic premenopausal women.
Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.FERTNSTERT.2015.12.024
Abstract: To determine the association between assisted reproductive technology (ART) treatment and the rate of combined gestational hypertension (GH), preecl sia (PE). Retrospective population study. Not applicable. A total of 596,520 mothers (3.6% ART mothers) who gave birth between 2007 and 2011. Not applicable. Comparison of the rate of GH/PE for ART and non-ART mothers, with odds ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval (CI) used to assess the association between ART and GH/PE. The overall rate of GH/PE was 4.3%, with 6.4% for ART mothers and 4.3% for non-ART mothers. The rate of GH/PE was higher for mothers of twins than singletons (12.4% vs. 5.7% for ART mothers 8.6% vs. 4.2% for non-ART mothers). The ART mothers had a 17% increased odds of GH/PE compared with the non-ART mothers (AOR 1.17 95% CI, 1.10-1.24). After stratification by plurality, the difference in GH/PE rates between ART and non-ART mothers was not statistically significant, with AOR 1.05 (95% CI, 0.98-1.12) for mothers of singletons and AOR 1.10 (95% CI, 0.94-1.30) for mothers of twins. The changes in AOR after stratification indicated that multiple pregnancies after ART are the single most likely explanation for the increased rate of GH/PE among ART mothers. The lower rate of GH/PE among mothers of singletons compared with mothers of twins suggests that a policy to minimize multiple pregnancies after ART may reduce the excess risk of GH/PE due to ART treatment.
Consensus on infertility treatment related to polycystic ovary syndrome
Publisher: Oxford University Press (OUP)
Date: 03-2008
Abstract: The treatment of infertile women with polycystic ovary syndrome (PCOS) is surrounded by many controversies. This paper describes, on the basis of the currently available evidence, the consensus reached by a group of experts regarding the therapeutic challenges raised in these women. Before any intervention is initiated, preconceptional counselling should be provided emphasizing the importance of life style, especially weight reduction and exercise in overweight women, smoking and alcohol consumption. The recommended first-line treatment for ovulation induction remains the anti-estrogen clomiphene citrate (CC). Recommended second-line intervention, should CC fail to result in pregnancy, is either exogenous gonadotrophins or laparoscopic ovarian surgery (LOS). The use of exogenous gonadotrophins is associated with increased chances for multiple pregnancy and, therefore, intense monitoring of ovarian response is required. LOS alone is usually effective in <50% of women and additional ovulation induction medication is required under those circumstances. Overall, ovulation induction (representing the CC, gonadotrophin paradigm) is reported to be highly effective with a cumulative singleton live birth rate of 72%. Recommended third-line treatment is in vitro fertilization. More patient-tailored approaches should be developed for ovulation induction based on initial screening characteristics of women with PCOS. Such approaches may result in deviation from the above mentioned first-, second- or third-line ovulation strategies in well-defined subsets of patients. Metformin use in PCOS should be restricted to women with glucose intolerance. Based on recent data available in the literature, the routine use of this drug in ovulation induction is not recommended. Insufficient evidence is currently available to recommend the clinical use of aromatase inhibitors for routine ovulation induction. Even singleton pregnancies in PCOS are associated with increased health risk for both the mother and the fetus.
Laparoscopy for the management of acute lower abdominal pain in women of childbearing age
Publisher: Wiley
Date: 22-05-2014
An economic evaluation of single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured ectopic pregnancy
Publisher: Elsevier BV
Date: 02-2001
Protocol for developing a core outcome set for male infertility research: an international consensus development study
Publisher: Oxford University Press (OUP)
Date: 2022
Abstract: We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health’s consensus development conference. An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for in idual core outcomes. This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Gr ian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586. N/A. N/A.
A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.AJOG.2005.08.066
Abstract: This study was undertaken to determine the outcomes of hysterectomy with and without conservation of the ovaries. Data were collected prospectively for 3 years from 257 women undergoing hysterectomy (group 1) and 57 women undergoing hysterectomy with oophorectomy (group 2). Pelvic pain, abdominal pain, and depression scores were reduced in the 3 years after hysterectomy. Twenty-one percent of the women in group 1 and 43% in group 2 regretted the loss of fertility 3 years after hysterectomy. Satisfaction with the operation was greater than 90% after 3 years in both groups. New symptoms of pelvic pain were infrequent in groups 1 (3%) and 2 (5%). Three years after undergoing hysterectomy with and without oophorectomy, satisfaction is high although some women regret the loss of fertility.
Audit of short term outcomes of surgical and medical second trimester termination of pregnancy
Publisher: Springer Science and Business Media LLC
Date: 30-09-2009
Abstract: As comparisons of modern medical and surgical second trimester termination of pregnancy (TOP) are limited, and the optimum method of termination is still debated, an audit of second trimester TOP was undertaken, with the objective of comparing the outcomes of modern medical and surgical methods. All cases of medical and surgical TOP between the gestations of 13 and 20 weeks from 1st January 2007 to 30th June 2008, among women residing in the local health board district, a tertiary teaching hospital in an urban setting, were identified by a search of ICD-10 procedure codes (surgical terminations) and from a ward database (medical terminations). Retrospective review of case notes was undertaken. A total of 184 cases, 51 medical and 133 surgical TOP, were identified. Frequency data were compared using Chi-squared or Fischer's Exact tests as appropriate and continuous data are presented as mean and standard deviation if normally distributed or median and interquartile range if non-parametric. Eighty-one percent of surgical terminations occurred between 13 to 16 weeks gestation, while 74% of medical terminations were performed between 17 to 20 weeks gestation. The earlier surgical TOP occurred in younger women and were more often indicated for maternal mental health. Sixteen percent of medical TOP required surgical delivery of the placenta. Evacuation of retained products was required more often after medical TOP (10%) than after surgical TOP (1%). Other serious complications were rare. Both medical and surgical TOP are safe and effective for second trimester termination. Medical TOP tend to be performed at later gestations and are associated with a greater likelihood of manual removal of the placenta and delayed return to theatre for retained products. This case series does not address long term complications.
Oral contraceptive pill as treatment for primary dysmenorrhoea
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review
Publisher: Oxford University Press (OUP)
Date: 2022
Abstract: What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80–2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For ex le, semen quality was reported by 75 trials and was defined in 7 different ways, including the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. A.P.—chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the ‘Insights for Fertility Conference’, funded by MERK SERONO Limited. M.v.W.—holds a ZON-MW research grant. No external funding was obtained for this study.
Transabdominal versus transvaginal ultrasound in the diagnosis of polycystic ovaries in a population of randomly selected women
Publisher: Wiley
Date: 1994
DOI: 10.1046/J.1469-0705.1994.04010054.X
Abstract: A study was conducted which compared transvaginal and transabdominal ultrasound in determining the prevalence of polycystic ovaries in a population of women. Women, chosen randomly from electoral rolls, were sent a letter inviting them to take part in a study determining the presence of polycystic ovaries. A transvaginal and transabdominal ultrasound scan was performed on day 5-9 of their menstrual cycles. A total of 187 women (mean age 33 years) took part in the study. The prevalence of polycystic ovaries was 21% (40/187) by transabdominal ultrasound and 27% (36/134) by transvaginal ultrasound. No differences existed between women with polycystic and normal ovaries with respect to uterine size and endometrial thickness. Mean ovarian volume was larger in women with polycystic ovaries irrespective of the use of hormonal contraception or breast feeding. There was no difference in the prevalence of polycystic ovaries diagnosed by transabdominal or transvaginal ultrasound in the group of randomly selected women. However, almost 20% of the women declined a transvaginal ultrasound examination.
ICSI does not increase the cumulative live birth rate in non-male factor infertility
Publisher: Oxford University Press (OUP)
Date: 12-06-2018
Abstract: What is the cumulative live birth rate following ICSI cycles compared with IVF cycles for couples with non-male factor infertility? ICSI resulted in a similar cumulative live birth rate compared with IVF for couples with non-male factor infertility. The ICSI procedure was developed for couples with male factor infertility. There has been an increased use of ICSI regardless of the cause of infertility. Cycle-based statistics show that there is no difference in pregnancy rates between ICSI and IVF in couples with non-male factor infertility. However, evidence indicates that ICSI is associated with an increased risk of adverse perinatal outcomes. A population-based cohort of 14 693 women, who had their first ever stimulated cycle with fertilization performed for at least one oocyte by either IVF or ICSI between July 2009 and June 2014 in Victoria, Australia was evaluated retrospectively. The pregnancy and birth outcomes following IVF or ICSI were recorded for the first oocyte retrieval (fresh stimulated cycle and associated thaw cycles) until 30 June 2016, or until a live birth was achieved, or until all embryos from the first oocyte retrieval had been used. Demographic, treatment characteristics and resulting outcome data were obtained from the Victorian Assisted Reproductive Treatment Authority. Data items in the VARTA dataset were collected from all fertility clinics in Victoria. Women were grouped by whether they had undergone IVF or ICSI. The primary outcome was the cumulative live birth rate, which was defined as live deliveries (at least one live birth) per woman after the first oocyte retrieval. A discrete-time survival model was used to evaluate the cumulative live birth rate following IVF and ICSI. The adjustment was made for year of treatment in which fertilization occurred, the woman's and male partner's age at first stimulated cycle, parity and the number of oocytes retrieved in the first stimulated cycle. A total of 4993 women undergoing IVF and 8470 women undergoing ICSI had 7980 and 13 092 embryo transfers, resulting in 1848 and 3046 live deliveries, respectively. About one-fifth of the women (19.0% of the IVF group versus 17.9% of the ICSI group) had three or more cycles during the study period. For couples who achieved a live delivery, the median time from oocyte retrieval to live delivery was 8.9 months in both IVF (range: 4.2-66.5) and ICSI group (range: 4.5-71.3) (P = 0.474). Fertilization rate per oocyte retrieval was higher in the IVF than in the ICSI group (59.8 versus 56.2%, P < 0.001). The overall cumulative live birth rate was 37.0% for IVF and 36.0% for ICSI. The overall likelihood of a live birth for women undergoing ICSI was not significantly different to that for women undergoing IVF (adjusted hazard ratio (AHR): 0.99, 95% CI: 0.92-1.06). For couples with a known cause of infertility, non-male factor infertility (female factor only or unexplained infertility) was reported for 64.0% in the IVF group and 36.8% in the ICSI group (P < 0.001). Among couples with non-male factor infertility, ICSI resulted in a similar cumulative live birth rate compared with IVF (AHR: 0.96, 95% CI: 0.85-1.10). Data were not available on clinic-specific protocols and processes for IVF and ICSI and the potential impact of these technique aspects on clinical outcomes. The reported causes of infertility were based on the treating clinician's classification which may vary between clinicians. This population-based study found ICSI resulted in a lower fertilization rate per oocyte retrieved and a similar cumulative live birth rate compared to conventional IVF. These data suggest that ICSI offers no advantage over conventional IVF in terms of live birth rate for couples with non-male factor infertility. No specific funding was received to undertake this study. There is no conflict of interest, except that M.B. is a shareholder in Genea Ltd. N/A.
Consensus on infertility treatment related to polycystic ovary syndrome
Publisher: Oxford University Press (OUP)
Date: 11-04-2008
A randomized controlled trial of fallopian tube sperm perfusion compared with standard intrauterine insemination for women with non-tubal infertility
Publisher: Oxford University Press (OUP)
Date: 11-04-2013
Abstract: Does fallopian tube sperm perfusion (FSP) result in better pregnancy and live birth rates than standard intrauterine insemination (SIUI) for couples with non-tubal infertility with or without gonadotrophin or clomiphene stimulation? There was no evidence of an improvement in live birth rates with FSP compared with SIUI. Previous randomized controlled trials have suggested improved live birth rates with FSP but these trials were small. A systematic review published in 2004 suggested heterogeneity in results. This pragmatic, multicentre, randomized controlled trial compared SIUI and FSP in 417 women with non-tubal infertility. The patients were treated at fertility clinics in New Zealand, Australia and the United Arab Emirates. Four hundred and seventeen women were randomized to SIUI (n = 210) or FSP (n = 207). Data were available for analysis from 198 women in the SIUI group and 198 women in the FSP group. There were 19 women with incomplete data because of cycle cancellation or withdrawals and 2 women who conceived prior to commencing treatment. There were no significant differences in live birth rates between the two groups with 27 (12.9%) in the SIUI group and 21 in the FSP group (10.1%) [Odds Ratio (OR) 1.31 (0.71, 2.39), P = 0.48]. Two ectopic pregnancies were reported in the SIUI group and one was reported in the FSP group. Different ovulation protocols were used in the different clinics. Approximately 10% of the cycles involved donor sperm and ∼5% of the cycles did not complete the assigned intervention. There was no evidence of an improvement in live birth rates with FSP compared with SIUI. The study was funded in part by the A+ trust of the Auckland District Health Board. No commercial funding was received. ANZCTR Number ACTRN12612001303831.
Psychological and educational interventions for subfertile men and women
Publisher: Wiley
Date: 31-03-2016
Comment: 'A six-year audit of the management of ectopic pregnancy' (multiple letters) [1]
Publisher: Wiley
Date: 27-05-2003
A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding
Publisher: Wiley
Date: 16-02-2006
DOI: 10.1111/J.1471-0528.2006.00863.X
Abstract: To compare the levonorgestrel intrauterine system (LNG-IUS) (Mirena) Schering Co., Turku, Finland) and thermal balloon ablation (Thermachoice Gynecare Inc., Menlo Park, CA, USA) for the treatment of heavy menstrual bleeding. An open, pragmatic, prospective randomised trial. A menstrual disorders clinic at National Women's Hospital, Auckland, New Zealand. Seventy-nine women with heavy menstrual bleeding randomised to the LNG-IUS (40 women) or the thermal balloon ablation (39 women). Women were randomised to treatment with the LNG-IUS or thermal balloon ablation and followed up by a postal and telephone questionnaire. Menstrual loss measured by a pictorial bleeding assessment chart (PBAC) at 3, 6, 12 and 24 months. Patient satisfaction, quality of life and menstrual symptoms were assessed by questionnaire administered at 3, 6, 12 and 24 months. Treatment side effects and treatment failures were also recorded. Both the treatments resulted in a significant reduction in PBAC scores. At 12 and 24 months, median PBAC scores were significantly lower in women treated with the LNG-IUS compared with women treated by thermal balloon ablation (11.5 versus 60.0 at 12 months [P= 0.002] 12.0 versus 56.5 [P= 0.002] at 24 months). At 24 months, nine (35%) women still using the LNG-IUS had amenorrhoea compared with one (5%) woman successfully treated by thermal balloon ablation (P = 0.025). There were no significant differences in patient satisfaction between two treatments during follow up. Treatment failed in 11 (28%) women using the LNG-IUS and in 10 (26%) women treated with thermal balloon ablation. Overall, women in both groups showed an increased quality of life as a result of the treatment, with Short Form-36 scores increasing from 63.7 at randomisation to 76.1 at 24 months. At 12 and 24 months of follow up, women with heavy menstrual bleeding treated with the LNG-IUS have significantly lower PBAC scores than women treated with thermal balloon ablation. Both the treatments resulted in a significant increase in overall quality of life, but there were no significant differences between either treatment in quality of life, patient satisfaction or the number of women requesting an alternative treatment during 24 months of follow up.
Cleavage-stage or blastocyst transfer: what are the benefits and harms?
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.FERTNSTERT.2016.06.029
Abstract: ET is a critical step in an assisted reproduction cycle. Over the past decade there has been an increasing trend to extending culture from cleavage-stage to blastocyst transfer. There has also been a trend to single ET and reporting the success of an assisted reproductive cycle as a cumulative live-birth rate after using both fresh and frozen embryos. There is low evidence that fresh blastocyst transfer is associated with improved live-birth rates compared with fresh cleavage-stage embryos. However, in the few studies that report cumulative pregnancy rates after fresh and frozen transfers, no significant difference was found. Cleavage-stage transfer is associated with greater numbers of embryos available for freezing, and blastocyst transfer is associated with increased number of cycles with no embryos to transfer. Further well-designed studies are warranted to evaluate the outcomes for blastocyst transfer including cumulative live-birth rate after fresh and frozen transfers, time to live birth, costs of the different transfer strategies, and perinatal mortality and severe perinatal morbidity.
Management of Dysfunctional Uterine Bleeding
Publisher: Springer Science and Business Media LLC
Date: 10-1992
DOI: 10.2165/00003495-199244040-00005
Abstract: Dysfunctional uterine bleeding, although not usually life-threatening, can cause disruption and discomfort for many women. It has often been poorly researched in the past, possibly because of the difficulty in measuring menstrual blood loss. Several different therapies are available and in idual women can choose from a number of options. Nonsteroidal anti-inflammatory drugs such as mefenamic acid or indomethacin will be the first choice for many women as they have few side effects and it is only necessary to take them when menstrual bleeding occurs. When contraception is also required, combined oral contraceptives are helpful. Progestogen and danazol therapy are also effective, although side effects do occur. A new development has been the levonorgestrel-containing intrauterine contraceptive device which has been shown to result in large decreases in menstrual blood loss. For those women who would like a surgical approach but do not want to undergo hysterectomy, the relatively new technique of endometrial resection results either in amenorrhoea or reduced menstrual blood loss in the majority of women.
Hormone therapy in postmenopausal women and risk of endometrial hyperplasia
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Review of contributory factors in maternity admissions to intensive care at a New Zealand tertiary hospital
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.AJOG.2013.07.031
Abstract: The purpose of this study was to identify factors that contributed to severe maternal morbidity, defined by admission of pregnant women and women in the postpartum period to the intensive care unit (ICU) from 2010-2011 at Auckland City Hospital (ACH), a tertiary hospital that delivers 7500 women/year, and to determine potentially avoidable morbidity with the use of local multidisciplinary review. All admissions of pregnant women and women in the postpartum period (to 6 weeks) to the ICU at ACH from 2010-2011 were identified from hospital databases. Case notes were summarized and discussed by a multidisciplinary team. The presence of contributory factors and potentially avoidable morbidity were determined by consensus with a tool that was developed by the New Zealand Perinatal and Maternal Mortality Review Committee for the review of maternal and perinatal deaths. Specific recommendations for clinical management were identified by the multidisciplinary group. Nine pregnant women and 33 women in the postpartum period were admitted to the ICU from 2010-2011. Contributory factors were identified in 30 cases (71%) 20 cases (48%) were considered to be potentially avoidable personnel factors were the most commonly identified avoidable causes. Specific recommendations that resulted from the study included the need for the development of guidelines for puerperal sepsis, improved planning for women at known risk of postpartum hemorrhage, enhanced supervision of junior staff, and enhanced communication through multidisciplinary meetings. Forty-eight percent of severe maternal morbidity, which was defined as admission to the ICU at ACH from 2010-2011, was considered to be potentially avoidable by a local multidisciplinary review team priorities were identified for improvement of local maternity services.
The Prevalence of Polycystic Ovaries on Ultrasound Scanning in a Population of Randomly Selected Women
Publisher: Wiley
Date: 02-1994
DOI: 10.1111/J.1479-828X.1994.TB01041.X
Abstract: Polycystic ovaries (PCO) diagnosed by ultrasound have been commonly reported amongst healthy women. The study aimed to determine the prevalence of PCO in a population of women from the community, and to relate it to clinical and endocrinological data. Twelve hundred women chosen randomly from electoral rolls were invited to take part in the study. Two hundred and fifty five women (21%) who met eligibility criteria greed to participate and 183 women 916%) finally completed the study. Seventy two women did not attend. An ultrasound scan and blood tests were taken on day 5-9 of their menstrual cycles. Data about their menstrual periods and reproductive history was collected. The prevalence of PCO was 21% (39 of 183). No differences existed between women with PCO and normal ovaries with respect to uterine size, body mass index, luteinizing hormone levels, serum hormone binding globulin levels and fertility status. Hirsutism (Ferriman Gallwey score > 7), elevated testosterone levels and irregular menstrual cycles were significantly more frequent amongst women with PCO. Mean ovarian volume was larger in women with PCO irrespective of the use of hormonal contraception. Fifty nine per cent of women with PCO had irregular menstrual cycles or elevated Ferriman Gallwey scores or both. There was no detectable effect of PCO on parity or miscarriage although only 70% of women with PCO had evidence of an adequate ovulation compared to 95% of women with normal ovaries.
Contributory factors and potentially avoidable neonatal encephalopathy associated with perinatal asphyxia
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.AJOG.2015.12.037
Abstract: The recently published monograph, Neonatal encephalopathy and neurologic outcome, from the American College of Obstetricians and Gynecologists calls for a root cause analysis to identify components of care that contributed to cases of neonatal encephalopathy to design better practices, surveillance mechanisms, and systems. All cases of infants born in New Zealand with moderate and severe neonatal encephalopathy were reported to the New Zealand Perinatal and Maternal Mortality Review Committee from 2010. A national clinical review of these in idual cases has not previously been undertaken. The objective of the study was to undertake a multidisciplinary structured review of all cases of neonatal encephalopathy that arose following the onset of labor in the absence of acute peripartum events in 2010-2011 to determine the frequency of contributory factors, the proportion of potentially avoidable morbidity and mortality and to identify themes for quality improvement. National identification of, and collection of clinical records on, cases of moderate or severe neonatal encephalopathy occurring after the onset of labor in the absence of an acute peripartum event, excluding those with normal gases and Apgar scores at 1 minute, among all cases of moderate and severe neonatal encephalopathy at term in New Zealand in 2010-2011 was undertaken. Cases were included if they had abnormal gases as defined by any of pH of ≤ 7.2, base excess of ≤ -10, or lactate of ≥ 6 or if there were no cord gases, an Apgar score at 1 minute of ≤ 7. A clinical case review was undertaken by a multidisciplinary team using a structured tool to record contributory factors (organization and/or management, personnel, and barriers to access and/or engagement with care), potentially avoidable morbidity and mortality and to identify themes to guide quality improvement. Eighty-three babies fulfilled the inclusion criteria for the review, 56 moderate (67%) and 27 severe (33%), 21 (25%) of whom were deceased prior to hospital discharge. Eighty-four percent of 64 babies with cord gas results had one of pH of ≤ 7.0, base excess of ≤ -12, or lactate of ≥ 6 and 42% (8 of 19) without cord gases had 5 minute Apgar scores < 5. Excluding 5 babies who died within a day of birth, all but 1 baby were admitted to a neonatal unit within 1 day of birth. Contributory factors were identified in 84% of 83 cases, most commonly personnel factors (76%). Fifty-five percent of cases with morbidity or mortality were considered to be potentially avoidable, and 52% of cases were considered potentially avoidable because of personnel factors. The most frequently identified theme related to the use and interpretation of cardiotocography in labor. A multidisciplinary case review of neonatal encephalopathy following apparently uncomplicated labor identified a high rate of potentially avoidable morbidity and mortality and issues amenable to quality improvement such as multidisciplinary training of staff in fetal surveillance in labor.
Introduction and history of polycystic ovary syndrome
Publisher: Cambridge University Press
Date: 2007
Urinary biomarkers for the non-invasive diagnosis of endometriosis
Publisher: Wiley
Date: 23-12-2015
Clinical trial registration in fertility trials – a case for improvement?
Publisher: Oxford University Press (OUP)
Date: 28-07-2017
Abstract: What is the prevalence and source of prospectively and retrospectively registered and unregistered trials in fertility treatments? Trial registration is low and does not appear to be changing over the 5 years studied. Trial registration is associated with lower risk of bias than in unregistered trials. The Cochrane Gynaecology and Fertility Group's specialised register was searched on 5 November 2015 for randomised controlled trials (RCTs) published from January 2010 to December 2014. Eligible trials included randomised women or men for fertility treatments, were published in full text, and written in English. Two reviewers independently assessed trial registration status for each trial, by searching the publication, trial registries, and by contacting the original authors. Of 693 eligible RCTS, only 44% were registered trials. Of 309 registered trials, 21.7% were prospectively registered, 15.8% were registered within 6 months of first patient enrolment and 62.5% were retrospectively registered trials. Prospective trial registration by country varied from 0% to 100%. The highest frequency of prospective trial registration amongst the top 10 publishing countries was 31% in the Netherlands. Only English language trials were included in this review. Prospective trial registration is still low. Journals, funders and ethics committees could have a greater role to increase trial registration. University of Auckland. No competing interests.
Nonsteroidal anti-inflammatory drugs for dysmenorrhoea
Publisher: Wiley
Date: 30-07-2015
Long term hormone therapy for perimenopausal and postmenopausal women
Publisher: John Wiley & Sons, Ltd
Date: 15-04-2009
Effectiveness of social egg freezing: protocol for systematic review and meta-analyses
Publisher: BMJ
Date: 10-2019
DOI: 10.1136/BMJOPEN-2019-030700
Abstract: Social egg freezing is storing egg for the purpose of preserving fertility and delayed childbearing. Currently, little is known about the utilisation and effectiveness of this approach. This review aims to determine (1) the proportion of women who used their stored eggs, and (2) the egg survival rate through vitrification, and the clinical pregnancy rate and live birth rate per 100 women partaking in the procedure, and among women who stored their eggs for medical reasons. This systematic review will be done according to the items listed in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Embase, Scopus, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Library and Health Technology Assessment databases will be searched to identify eligible studies published since 2012. Two reviewers will independently appraise the eligibility and quality of the studies based on preset checklists and extract the data using a data extraction template. Outcomes of interest are proportion of women who used their stored eggs, egg survival rate, pregnancy rate and live birth rates. We will determine the presence heterogeneity among studies using the Cochrane’s Q test. The percentage of total variation across studies, which is due to statistical heterogeneity, will be calculated using the I 2 statistics. Outcomes of interest will be pooled together using metaprop programme STATA V.14. For this review, ethical committee approval is not required. We will use publically available data from previously published studies. The final report of the review will be disseminated through publication on national or international journal, and it will be presented on different scientific conferences. CRD42018114254.
Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne
Publisher: Wiley
Date: 15-04-2009
Epigenetic regulation of endometrium during the menstrual cycle
Publisher: Oxford University Press (OUP)
Date: 05-02-2010
Abstract: The endometrium undergoes morphological and functional changes during the menstrual cycle which are essential for uterine receptivity. These changes are driven by estrogen and progesterone and involve the fine control of many different genes-several of which have been identified as being epigenetically regulated. Epigenetic modification may therefore influence the functional changes in the endometrium required for successful implantation. There is, however, only limited information on epigenetic regulation in endometrium. We review the potential role of epigenetic regulation of key processes during the menstrual cycle and present our own findings following a preliminary study into global acetylation levels in the human endometrium. A changing epigenetic state is associated with the differentiation of stem cells into different lineages and thus may be involved in endometrial regeneration. Histone acetylation is implicated in the vascular endothelial growth factor pathway during angiogenesis, and studies using histone deacetylase inhibitors suggest an involvement in endometrial proliferation and differentiation. The processes of decidualization and implantation are also associated with epigenetic change and epigenetic modulators show variable expression across the menstrual cycle. Our own studies found that endometrial global histone acetylation, as determined by western blotting, changed throughout the menstrual cycle and correlated well with expected transcription activity during the different phases. This suggests that epigenetics may be involved in the regulation of endometrial gene expression during the menstrual cycle and that abnormal epigenetic modifications may therefore be associated with implantation failure and early pregnancy loss as well as with other endometrial pathologies.
Ectopic pregnancy: an update
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2004
DOI: 10.1097/01.GCO.0000136494.49334.6B
Abstract: This review discusses recent publications that investigate the epidemiology, diagnosis and treatment of ectopic pregnancy. Transvaginal ultrasound is being used with increasing confidence for the diagnosis of ectopic pregnancy, and methotrexate now has an established role in the treatment of ectopic pregnancy. No serum markers have been found that can reliably differentiate intrauterine from extrauterine pregnancy. As more experience has been gained with medical therapy, it is apparent that it is possible to identify a subgroup of women in whom it is unlikely to succeed. The use of adjunctive therapy such as mifepristone does not appear to increase the effectiveness of methotrexate. Screening for ectopic pregnancy in at-risk women has been suggested, but it may be of only limited value. In the surgical management of ectopic pregnancy the effect on fertility of salpingotomy and salpingectomy remains uncertain, although recent cohort studies suggest that salpingotomy may be associated with a better subsequent intrauterine pregnancy rate than salpingectomy. A number of case reports of pregnancies at unusual sites continue to be published, but in the last 2 years there has been a dramatic increase in the number of caesarean scar pregnancies reported. Medical therapy now has an established role in the treatment of ectopic pregnancy, but it is clear that careful patient selection is essential. In the surgical management of ectopic pregnancy the effects of salpingotomy and salpingectomy on subsequent fertility are uncertain and need further investigation.
Validation of local review for the identification of contributory factors and potentially avoidable perinatal deaths
Publisher: Wiley
Date: 07-03-2016
DOI: 10.1111/AJO.12454
Abstract: Reporting on perinatal mortality commenced 2006 in New Zealand through the Perinatal and Maternal Mortality Review Committee (PMMRC). Following review of international models, a process was developed for use in local review to identify contributory factors and potentially avoidable perinatal deaths. Local review of 720 perinatal deaths in 2009 found contributory factors in 24% of deaths and 14% to be potentially avoidable. To validate the process of local review for identification of contributory factors and potentially avoidable perinatal deaths. Records of 48 perinatal deaths were reviewed by an independent multidisciplinary panel using the same methodology as local review to determine agreement between local and independent review for identification of contributory factors and potentially avoidable perinatal death. Independent review found contributory factors in 54% of deaths compared to 40% by local review. Independent review identified eight deaths and local review identified one death with contributory factors not identified by the other review. Kappa statistic for agreement for identifying contributory factors was substantial [0.63 (0.42, 0.84)]. Independent review found 42% of deaths potentially avoidable compared to 23% by local review. Independent review identified 10 deaths and local review identified one death not identified by the other review. Kappa statistic for agreement for identifying potentially avoidable deaths was moderate [0.50 (0.26, 0.73)]. This study provides validation of local review for identification of contributory factors in perinatal death. The higher proportion of potentially avoidable perinatal deaths identified by independent review compared to local review requires further exploration.
Clomiphene and anti-oestrogens for ovulation induction in PCOS
Publisher: John Wiley & Sons, Ltd
Date: 07-10-2009
PCOSMIC: A multi-centre randomized trial in women with PolyCystic Ovary syndrome evaluating metformin for infertility with clomiphene
Publisher: Oxford University Press (OUP)
Date: 30-04-2010
Abstract: Ovulation induction treatment with metformin, either alone or in combination with clomiphene citrate (CC), remains controversial even though previous randomized trials have examined this. A double blinded multi-centre randomized trial was undertaken including 171 women with anovulatory or oligo-ovulatory polycystic ovary syndrome. Women with high body mass index (BMI) > 32 kg/m(2) received placebo ('standard care') or metformin women with BMI 32 kg/m(2), clinical pregnancy and live birth rates were 22% (7/32) and 16% (5/32) with metformin, 15% (5/33) and 6% (2/33) with placebo. For women with BMI 32 kg/m(2) whatever treatment is used, with no evidence of benefit of metformin over placebo. For women with BMI < or = 32 kg/m(2) there is no evidence of significant differences in outcomes whether treated with metformin, CC or both. ClinicalTrials.gov number NCT00795808 trial protocol accepted for publication November 2005: Johnson, Aust N Z Journal Obstet Gynaecol 2006 :141-145.
Twenty years of Cochrane reviews in menstrual disorders and subfertility
Publisher: Oxford University Press (OUP)
Date: 29-08-2013
Abstract: The past three decades have seen considerable change in the understanding of clinical research methods. There has been an acceptance that RCTs are the best way of establishing treatment effectiveness and a recognition that, while single studies are useful, pooling knowledge from a complete body of work is likely to provide the best evidence. Advances in methodology have been mirrored by the many advances in the field of reproductive medicine, such as assisted reproduction, assessment of male fertility, ovulation induction and laparoscopic surgery. Together, they have led to welcome improvements in the outcomes of fertility treatments. In particular, systematic reviews have become important tools enabling clinicians and patients to make health-care decisions based on evidence from all the available high-quality studies. The move towards identifying and aggregating the highest quality evidence has been led by the Cochrane Collaboration, which this year celebrates 20 years of preparing and publishing systematic reviews. This paper outlines the achievements, progress and challenges of this enterprise to date, with a particular focus on systematic reviews of reproductive medicine.
Inositol for subfertile women with polycystic ovary syndrome
Publisher: Wiley
Date: 30-09-2016
Accessing fertility treatment in New Zealand: A comparison of the clinical priority access criteria with a prediction model for couples with unexplained subfertility
Publisher: Oxford University Press (OUP)
Date: 06-09-2011
Abstract: In New Zealand, public funding for assisted reproductive technology (ART) is restricted to subfertile women who are unlikely to conceive spontaneously, based on clinical and social criteria known as the clinical priority access criteria (CPAC) score. The objective of this study was to compare this CPAC score with a prediction model for predicting spontaneous conception, developed in the Netherlands (the Hunault model). We performed a cohort study and included couples with unexplained subfertility and assessed the measure of agreement and the performance of the CPAC score and the Hunault prediction score. Of 663 couples referred, 249 (38%) couples had unexplained subfertility. Of 246 women with full follow-up data, there were 143 women (58%) who had a live birth during the follow-up period, 65 (26%) after fertility treatment and 78 (32%) after natural conception. There were 100 couples (41%) who had a Hunault prediction score of 65, which is the New Zealand threshold for publically funded treatment. There were 69 couples (28%) who meet the threshold for treatment in the Netherlands but did not meet the New Zealand threshold for public funding. The kappa coefficient as a measure of agreement of the two scores and their treatment thresholds was 0.30, suggesting a fair agreement. The area under the curve for the CPAC and Hunault scores were both 0.63, but the Hunault model performed better in calibration. The CPAC score correlates fairly with the Hunault prediction score, although using the Hunault prediction model 26% more couples would be recommended for ART. The discriminative capacities of both scores were comparable, but the Hunault prediction score performed better in calibration. Funding models in New Zealand should consider treating those women with unexplained subfertility who are least likely to conceive spontaneously.
Response to commentaries on retention of the ovaries and long-term survival after hysterectomy.
Publisher: Informa UK Limited
Date: 2006
Is our public research money well spent? Publication of research outputs from Health Research Council of New Zealand-funded studies: a cross-sectional study
Publisher: BMJ
Date: 05-2023
DOI: 10.1136/BMJOPEN-2023-072446
Abstract: To evaluate the reporting of results from the projects and programmes funded by the Health Research Council (HRC) New Zealand. A cross-sectional analysis. Research projects and programmes funded by the HRC New Zealand from 2006 to 2014. Publicly available data provided by the HRC. The number and proportion with evidence of publication and dissemination of a research output from HRC grants and the time taken to disseminate the results. Of the 374 HRC grants from 2006 to 2014, there was no evidence of publication or reporting of any research output for 48 studies (13%). Of the 326 (87%) grants with research outputs, there was a mean dissemination time of 4.73 years (SD 2.37). The total funding provided by the HRC was NZ$471 663 336, while the 48 grants with no evidence of dissemination represented NZ$47 095 727 (10%). Thirteen per cent of the HRC projects and programmes from 2006 to 2014 have not contributed to the healthcare evidence as their results remain unknown.
Beyond the numbers: reporting potentially avoidable perinatal deaths
Publisher: Wiley
Date: 12-01-2012
The impact of body mass index on semen parameters and reproductive hormones in human males: A systematic review with meta-analysis
Publisher: Oxford University Press (OUP)
Date: 04-11-2009
Abstract: It has been suggested that body mass index (BMI), especially obesity, is associated with subfertility in men. Semen parameters are central to male fertility and reproductive hormones also play a role in spermatogenesis. This review aimed to investigate the association of BMI with semen parameters and reproductive hormones in men of reproductive age. MEDLINE, EMBASE, Biological Abstracts, PsycINFO and CINAHL databases and references from relevant articles were searched in January and February 2009. Outcomes included for semen parameters were sperm concentration, total sperm count, semen volume, motility and morphology. Reproductive hormones included were testosterone, free testosterone, estradiol, FSH, LH, inhibin B and sex hormone binding globulin (SHBG). A meta-analysis was conducted to investigate sperm concentration and total sperm count. In total, 31 studies were included. Five studies were suitable for pooling and the meta-analysis found no evidence for a relationship between BMI and sperm concentration or total sperm count. Overall review of all studies similarly revealed little evidence for a relationship with semen parameters and increased BMI. There was strong evidence of a negative relationship for testosterone, SHBG and free testosterone with increased BMI. This systematic review with meta-analysis has not found evidence of an association between increased BMI and semen parameters. The main limitation of this review is that data from most studies could not be aggregated for meta-analysis. Population-based studies with larger s le sizes and longitudinal studies are required.
Elective oophorectomy in the gynecological patient: When is it desirable?
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2007
Pelvic pain — pelvic congestion or the irritable bowel syndrome?
Publisher: Elsevier BV
Date: 10-1990
DOI: 10.1016/0028-2243(90)90097-K
Abstract: Chronic unexplained pelvic pain in women may arise from either gynaecological or colonic causes. 35 women with pelvic congestion were interviewed with regard to their bowel habits and compared with a population with the irritable bowel syndrome. The results suggest that pelvic congestion and the irritable bowel syndrome are two distinctly different conditions, both of which may cause chronic lower abdominal pain in women.
Danazol for pelvic pain associated with endometriosis
Publisher: Wiley
Date: 17-10-2007
Role of fertility treatments in multiple pregnancy at National Women's Hospital from 1996 to 2001
Publisher: Wiley
Date: 10-2003
DOI: 10.1046/J.0004-8666.2003.00107.X
Abstract: Objective: To determine the influence of fertility treatments on multiple pregnancy rates. Study Design: A retrospective audit of women with multiple pregnancies from 1996 to 2001 at National Women's Hospital (NWH), Auckland, New Zealand was conducted. Information was collected regarding the demographics, fertility treatment, outcome of the pregnancy and complications experienced by women discharged with multiple births as an discharge diagnosis. Results: For the years 1996–2001 there were 1136 multiple births at NWH. Of these births, 201 (18%) were conceived following fertility treatment. Seventeen percent of twin births and 44% of triplet births were conceived following fertility treatment. There was a statistically significant increase in the number of births conceived following fertility treatment, from 9% in 1996 to 24% in 2001, although the proportion of births that were multiple overall did not change (2% in 1996 and 2.3% in 2001). Sixty‐three percent of all fertility conceived multiple births were following in vitro fertilization/intracytoplasmic sperm injection treatment. Sixty percent of these women had two embryos transferred and 31% had three embryos transferred. Ovulation induction with follicle‐stimulating hormone accounted for 19% of all fertility conceived multiple births. Nineteen percent of fertility conceived multiple births followed clomiphene treatment alone. Conclusions: The proportion of multiple pregnancies as a result of fertility treatments has increased over the 6 years studied.
Related Organisations
Royal College Of Obstetricians And Gynaecologists
Location: United Kingdom of Great Britain and Northern Ireland
Royal Australian And New Zealand College Of Obstetricians And Gynaecologists
Location: Australia
Related Funding Activities
No related grants have been discovered for Cynthia Farquhar.