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EDITORIAL COMMENT: This paper provides important data concerning the contribution of the different infertility treatments (clomiphene plus gonadotropin versus GIFT plus IVF) to the community incidence of twin pregnancy. It seems to us that sampling only 0.6% of singleton pregnancies and 50% of twin pregnancies (table 3) may have underestimated the contribution to singleton pregnancy of both CC/GT and GIFT/IVF. Ideally, what we require is documentation on all the perinatal data forms of whether the index pregnancy resulted from treatment with CC/GT or GIFT/IVF -the multiple pregnancies rates (twin and higher order multiples) associated with these different treatment regimens could then be evaluated for the total population. This would give a new dimension to informed decision by the doctor and the infertile couple in selection of the method of treatment of infertility in those women who have patent tubes and are thus suitable candidates for either regimen. Knowledge of the twin and higher order multiple pregnancy rate, not to mention the rate of singleton pregnancy, associated with these 2 different regimens would also indicate if present drug regimens require further refinement to be competitive with GIFT and IVF, if. in terms of the community incidence of twin delivery but exclusive of other cost considerations. Summary: A cross-sectional sample of 150 singleton and 159 twin confinements delivered in Western Australia in 1991 were randomly sampled in 1993; 63% of the women responded to a postal questionnaire. Thirteen percent of respondents with singletons and 26% of those with twins reported having problems conceiving at some stage in their life. Six percent of those who had singleton confinements and 22% of those women who had twin confinements sought fertility advice prior to the conception of the index pregnancy. One percent (95%CI 0.03%, 5.5%) of women with singletons received infertility treatment compared with 17% (95%CI 10.4%, 26.3%) of those with twins. Overall 82.7% (95%CI 75.2%, 90.1%) of twin confinements followed spontaneous conception, 11.2% (95%CI 5.7%, 19.2%) followed ovarian stimulation treatment alone and 6.1% (95%CI 2.3%, 12.9%) followed IVF or GIFT procedures. The probability of a spontaneous twin confinement was 1 in 95. It was concluded that nearly twice as many twin pregnancies were associated with ovarian stimulation treatment given alone than with IVF and GIFT combined. The routinely collected data about assisted twin conceptions provide an incomplete picture with regard to the role of different infertility treatment modalities.

OBJECTIVE To review a 10-year experience of medical treatment for idiopathic retroperitoneal fibrosis (RPF), a rare condition of unknown causes, which may obstruct the ureter and for which treatment includes ureterolysis and relief of obstruction, and medical treatment with steroids with or without immunosuppressive medication. PATIENTS AND METHODS Of 31 patients with RPF treated between 1996 and 2004, 28 had idiopathic disease. Ureteric stents were used to relieve the obstruction in all patients, 12 had previous nephrostomies, 16 were given steroids and only one was treated with ureterolysis. RESULTS In all, 28 patients were followed for a mean of 51.17 months; the symptoms were relieved in all cases. Renal function, where impaired, improved dramatically in all patients. Fifteen patients (54%) are free of stents and medication after a mean (range) follow-up of 60.9 (24–110) months. CONCLUSION Idiopathic RPF responds well to conservative management consisting of relief of urinary tract obstruction and steroids.