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Background Multiple births after assisted reproduction techniques are associated with adverse outcome. Transferring one blastocyst is the best way to reduce the rate of multiple births but it may also decrease the clinical pregnancy rate if not used wisely. Methods In this study we reviewed the records of 170 women who undergone transfer of 1–3 blastocysts on day 5 or day 6 after in vitro fertilization from 2008 to 2010 to explore the outcome of elective single blastocyst transfer (SBT) compared with multiple blastocyst embryo transfer (MBT) and determine how this affects multiple pregnancy rates. Results The result suggested increasing the number of blastocysts transferred based on advanced age or poor blastocyst quality did not result in any significant increase in CPR while there was significant increase in multiple pregnancy rate (MPR). On the other hand, using the time of transfer as main criteria to decide the number of blastocysts transferred increased the CPR significantly, without significant increase in MPR. Conclusion Our study identified blastocyst transfer time (in hours) could be the best criteria to transfer single blastocyst (SBT) versus double blastocyst (DBT), as that showed to maximize the clinical pregnancy rate with no increase in multiple pregnancy rate. The likelihood of pregnancy is significantly higher in the group of women who had 2 blastocysts transferred after 140 h compared to SBT, with no increase in the multiple pregnancy rate.

Purpose: To evaluate age related ovarian response to controlled ovarian hyperstimulation, clinical pregnancy and ongoing pregnancy rates beyond 20 weeks in women undergoing assisted reproduction treatment (ART) with antimullerian hormone (AMH) levels of 38 years of age. Non parametric variables were expressed as median (Interquartile range) and compared by Kruskal-Wallis test. Categorical variables were expressed as numbers with proportions (%) and compared by Fisher’s exact test. Results: There was no statistical difference in body max index, level of antimullerian hormone (AMH), follicle stimulating hormone (FSH), dose of gonadotrophins used and cycles cancellation rate in two groups. Although number of oocytes retrieved (median 5), clinical pregnancy (18.4%) and ongoing pregnancy rate beyond 20 weeks (18.4%) was higher in group 1, there was no statistical difference between the two groups. There was one miscarriage in group 2. Conclusion: Women with extremely low-serum AMH levels can still have clinical pregnancy and ongoing pregnancies beyond 20 weeks after ART, though chances will be lower than women with normal ovarian reserve.

To determine knowledge retention 1 year after training for intrapartum emergencies.Training was undertaken in 6 hospitals and the Bristol Medical Simulation Centre, UK, between November 2004 and March 2005. Participants (22 junior and 23 senior doctors, 47 junior and 48 senior midwives) were randomly recruited from participating hospitals and underwent practical training at their local hospital or simulation center with or without additional teamwork training. The primary outcome was change in factual knowledge over time, as assessed by a 185-question multiple-choice questionnaire before and after training.Mean scores at 6 (97.6 ± 23.0; n = 107) and 12 (98.2 ± 21.6; n = 98) months remained higher than those before training (79.6 ± 21.9, n = 140; both P0.001), but were slightly lower than those immediately after training (101.0 ± 21.3, n = 133; P0.001 and P = 0.007, respectively). The type of training had no effect on retention of knowledge.Training was associated with sustained retention of factual knowledge of obstetric emergencies care for at least 1 year. The decay in knowledge was small compared with the original gain in knowledge. Neither training location nor inclusion of teamwork training affected knowledge retention. Annual training seemed to be satisfactory for all staff groups.

Chlamydia trachomatis infection of the genital tract is the most common sexually transmitted infection and has a world-wide distribution. The consequences of infection have an adverse effect on the reproductive health of women and are a common cause of infertility. Recent evidence also suggests an adverse effect on male reproduction. There is a need to standardise the approach in managing the impact of C. trachomatis infection on reproductive health. We have surveyed current UK practice towards screening and management of Chlamydia infections in the fertility setting. We found that at least 90% of clinicians surveyed offered screening. The literature on this topic was examined and revealed a paucity of solid evidence for estimating the risks of long-term reproductive sequelae following lower genital tract infection with C. trachomatis. The mechanism for the damage that occurs after Chlamydial infections is uncertain. However, instrumentation of the uterus in women with C. trachomatis infection is associated with a high risk of pelvic inflammatory disease, which can be prevented by appropriate antibiotic treatment and may prevent infected women from being at increased risk of the adverse sequelae, such as ectopic pregnancy and tubal factor infertility. Recommendations for practice have been proposed and the need for further studies is identified.

The advent of a 1-stop approach to managing women with early pregnancy problems led to the development of early pregnancy clinics. Such clinics progressed to providing a patient centered approach, minimising inpatient admissions while providing women with an early diagnosis of miscarriage or extrauterine pregnancy by a multiprofessional group of individuals with expertise in this area. The clinic structure, referral process, and ongoing challenges are discussed.

Opinion remains divided as to whether finding endometriotic lesions in the absence of adhesions has an adverse effect on the likelihood of conception.This was a retrospective study of 192 fully investigated infertile couples, followed up for up to 3 years following laparoscopy. Women studied were ovulating,40 old years and their partners had normal sperm parameters. All 117 women with unexplained infertility and 75 with minimal/mild endometriosis without adhesive disease were managed conservatively.Women with endometriosis were found to have a lower probability of pregnancy compared with women with unexplained infertility (36% versus 55%; P0.05). Other factors adversely associated with pregnancy were primary infertility, smoking and longer duration (3 years) of infertility. However, the effects of duration of infertility and primary infertility were not observed to be statistically significant for women with endometriosis.The findings, although undertaken in a select population undergoing laparoscopy, suggest the likelihood of pregnancy is reduced in infertile women with minimal/mild endometriosis compared with those infertile women with a normal pelvis. Duration of infertility and a previous history of pregnancy are important in predicting the likelihood of pregnancy in women with no obvious cause for their infertility (unexplained), whilst the relationship may be more complex in women with minor endometriosis

Obesity and excessive weight gain during pregnancy are associated with poor outcomes for mother and baby. These include gestational diabetes, raised blood pressure (hypertension) in pregnancy, maternal venous blood clots (thromboembolism), delivery by caesarean section, high birthweight, stillbirth, maternal infection (sepsis), heavy maternal bleeding (haemorrhage) after delivery, and maternal death. As the number of women of childbearing age who are obese has increased so too has the number of women of childbearing age undergoing bariatric (weight-loss) surgery. This has resulted in an increased number of pregnant women with a history of weight-loss surgery. The most common bariatric procedure is gastric banding (laparoscopic adjustable gastric banding) in which a band containing a fluid-filled balloon is placed around the upper portion of the stomach creating a small upper pouch which limits transport of food into the lower pouch. This reduces a person's capacity to ingest food and so reduces nutritional intake. The volume of the balloon can be adjusted by addition to or removal of fluid from the balloon. At present there is no guidance on the best management of a gastric band during pregnancy and there is variation in care. Some clinicians advocate leaving the balloon filled (inflated) to limit food intake and limit weight gain during pregnancy. This strategy might reduce the likelihood of maternal high blood pressure or gestational diabetes and so improve the outcomes for mother and baby. There are concerns, however, that leaving the balloon inflated might reduce the intake of essential nutrients needed for normal fetal development and growth. In addition, it is possible that band complications, including nausea and vomiting, slippage or migration of the band because of the increased intra-abdominal pressure with pregnancy, might occur more frequently if the balloon is left inflated. As a result, some clinicians prefer to remove fluid to deflate the balloon when the woman becomes pregnant. This review aimed to compare outcomes for mothers and babies according to whether the balloon is deflated at the beginning of pregnancy compared to maintaining balloon inflation in pregnancy. No studies met the criteria for inclusion in the review. No conclusions can be drawn from randomised controlled trials regarding the best management of the gastric band in pregnancy. Further research is needed to define optimum management of the gastric band balloon during pregnancy.

To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option.Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results.Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1% live birth per cycle. However, IVF offers a success rate of around 13.7% per cycle.An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily.

We report the safe use of levonorgestrel hormone releasing intra uterine system (Mirena®) as a contraceptive in egg donors during a treatment cycle. In the first case report, a 29-year-old egg donor using the Mirena coil for contraception and two egg recipients, aged 41 years and 32 years respectively underwent standard IVF treatment, oocyte retrieval in the egg donor and in vitro fertilization followed by embryo transfer in the recipient. The outcome of IVF cycle using donor eggs was satisfactory with successful pregnancy in the egg recipient. The second case involved a 34-year-old egg donor using the Mirena coil and a 44-year-old recipient. Our findings suggest that egg donors can safely use the (Mirena®) as a contraceptive device during treatment, without compromising follicular development and oocyte quality.

Purpose: Chronological age, or biological age as indicated by elevated FSH levels, are related to ovarian reserve. This study addresses the likelihood of cancellation of IVF treatment due to a poor ovarian response utilising both basal serum FSH and woman's age. Methods: A prospective cohort of 536 infertile but ovulating women were studied in their first cycle of IVF treatment. Standardised methods of pituitary desensitisation and ovarian stimulation prior to IVF treatment were employed. Treatment cycles cancelled due to a poor ovarian response to gonadotrophins were studied. A series of logistic regression models were used to explore the probabilities of cancellation in relation to age and FSH. Results: Both age and basal serum FSH levels were independently associated with the risk of treatment cancellation. A low risk of treatment cancellation was observed in women under the age of 35 irrespective of serum FSH, however in older women the risk of treatment cancellation was most likely in women with a high FSH. Conclusions: In combination both age and FSH may serve as a valuable indicator of poor ovarian response leading to treatment cancellation. However, among older women FSH has particular importance, while less so in younger women with regular menstrual cycles.

Tubal pelvic damage is a common cause of infertility, and laparoscopy is the accepted gold standard for its diagnosis. However, laparoscopy is both costly and invasive. Chlamydia is now recognized as the most common cause of tubal pelvic damage. In contrast to laparoscopy, evidence of past chlamydial infection using serology is readily available, and the test is simple and quick to perform. As such, serology can be used as a screening test in infertile women. It is accepted that screening tests may have higher margins of error and may be less accurate than diagnostic tests. Screening is most valuable when detecting a disease for which the treatment is more effective when undertaken at the earliest opportunity. Because there are justified constraints to the indiscriminate use of laparoscopy, there is a need to minimize the number of patients who do not have disease (false positives) who are subjected to this diagnostic investigation. An appropriate Chlamydia antibody titre that would distinguish women at risk of tubal pelvic damage should be determined using diagnostic test analysis and clinical judgement. Identification by serology of women who are likely to have damage would enable these women to undergo a diagnostic test such as laparoscopy sooner, allowing treatment to be provided earlier. However, the severity of tubal pelvic damage varies, and the need to distinguish women with a favourable or unfavourable prognosis after treatment using a simple classification system is discussed.

Surveys in the United Kingdom have repeatedly discovered substandard care in significant proportions of maternal, fetal, and neonatal deaths. In the United Kingdom, training in obstetrical emergencies is carried out both nationally and locally in maternity units. This prospective, randomized controlled trial evaluated training in 6 hospitals in the United Kingdom. The 140 participants included 22 junior and 23 senior doctors as well as 47 junior and 48 senior midwives. They were randomized to one of 4 obstetrical emergency training interventions: a 1-day course at a local hospital, a 1-day course at a simulation center, a 2-day course with teamwork training at a local hospital, and a 2-day course with teamwork training at a simulation center. A 183-question multiple choice questionnaire (MCQ) was completed up to 3 weeks before the training intervention and again 3 weeks after the intervention. All but 7 of the 140 participants completed training and the posttraining assessment. Knowledge of obstetrical emergency management increased following training. The increase in the mean MCQ score was significant at the P < 0.001 level. All but 10 of 133 participants who completed both assessments had increased MCQ scores. Neither the location of training nor the inclusion of teamwork training significantly influenced posttraining scores. Changes in MCQ scores after training correlated negatively with pretraining scores. There were, however, no significant differences between staff groups in their relative responses to the 4 training interventions. With one exception-management of breech presentation-scores for individual components of the MCQ improved significantly. This is the first study demonstrating objective improvement in what doctors and midwives know following training in obstetrical emergency management. It remains to be determined whether this translates into lower maternal and neonatal morbidity and mortality rates. The investigators believe that all relevant staff should take part in this type of training on an annual basis.