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In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.

BACKGROUND IVF and IUI with ovarian stimulation (IUI-OS) are widely used in managing unexplained infertility. IUI-OS is generally considered first-line therapy, followed by IVF only if IUI-OS is unsuccessful after several attempts. However, there is a growing interest in using IVF for immediate treatment because it is believed to lead to higher live birth rates and shorter time to pregnancy. OBJECTIVE AND RATIONALE Randomized controlled trials (RCTs) comparing IVF versus IUI-OS had varied study designs and findings. Some RCTs used complex algorithms to combine IVF and IUI-OS, while others had unequal follow-up time between arms or compared treatments on a per-cycle basis, which introduced biases. Comparing cumulative live birth rates of IVF and IUI-OS within a consistent time frame is necessary for a fair head-to-head comparison. Previous meta-analyses of RCTs did not consider the time it takes to achieve pregnancy, which is not possible using aggregate data. Individual participant data meta-analysis (IPD-MA) allows standardization of follow-up time in different trials and time-to-event analysis methods. We performed this IPD-MA to investigate if IVF increases cumulative live birth rate considering the time leading to pregnancy and reduces multiple pregnancy rate compared to IUI-OS in couples with unexplained infertility. SEARCH METHODS We searched MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, and the Cochrane Gynaecology and Fertility Group Specialised Register to identify RCTs that completed data collection before June 2021. A search update was carried out in January 2023. RCTs that compared IVF/ICSI to IUI-OS in couples with unexplained infertility were eligible. We invited author groups of eligible studies to join the IPD-MA and share the deidentified IPD of their RCTs. IPD were checked and standardized before synthesis. The quality of evidence was assessed using the Risk of Bias 2 tool. OUTCOMES Of eight potentially eligible RCTs, two were considered awaiting classification. In the other six trials, four shared IPD of 934 women, of which 550 were allocated to IVF and 383 to IUI-OS. Because the interventions were unable to blind, two RCTs had a high risk of bias, one had some concerns, and one had a low risk of bias. Considering the time to pregnancy leading to live birth, the cumulative live birth rate was not significantly higher in IVF compared to that in IUI-OS (4 RCTs, 908 women, 50.3% versus 43.2%, hazard ratio 1.19, 95% CI 0.81–1.74, I 2 = 42.4%). For the safety primary outcome, the rate of multiple pregnancy was not significantly lower in IVF than IUI-OS (3 RCTs, 890 women, 3.8% versus 5.2% of all couples randomized, odds ratio 0.78, 95% CI 0.41–1.50, I 2 = 0.0%). WIDER IMPLICATIONS There is no robust evidence that in couples with unexplained infertility IVF achieves pregnancy leading to live birth faster than IUI-OS. IVF and IUI-OS are both viable options in terms of effectiveness and safety for managing unexplained infertility. The associated costs of interventions and the preference of couples need to be weighed in clinical decision-making. [ABSTRACT FROM AUTHOR]

Abstract Background To gain more insight in whether failure of intrauterine insemination (IUI) treatment in patients with idiopathic subfertility could be related to diminished fertilization, the aim of this study is to compare the fertilization of an initial IVF procedure after six cycles of IUI and the fertilization of an initial IVF procedure without preceding IUI cycles in couples with idiopathic subfertility. Methods We performed a complimentary analysis of a randomized controlled trial, in which the number of total fertilization failure (TFF) in the first IVF procedure after unsuccessful IUI was compared to those of IVF without preceding IUI in patients with idiopathic subfertility. These patients participated in a previous study that assessed the cost effectiveness of IUI versus IVF in idiopathic subfertility and were randomized to either IUI or IVF treatment. Results 45 patients underwent IVF after 6 cycles of unsuccessful IUI and 58 patients underwent IVF immediately without preceding IUI. In 7 patients the IVF treatment was cancelled before ovum pick. In the IVF after unsuccessful IUI group TFF was seen in 2 of the 39 patients (5%) versus 7 of the 56 patients (13%) in the immediate IVF group. After correction for confounding factors the TFF rate was not significantly different between the two groups (p = 0.08, OR 7.4; 95% CI: 0.5–14.9). Conclusion Our data showed that TFF and the fertilization rate in the first IVF treatment were not significantly different between couples with idiopathic subfertility undergoing IVF after failure of IUI versus those couples undergoing IVF immediately without prior IUI treatment. Apparently, impaired fertilization does not play a significant role in the success rate of IUI in patients with idiopathic subfertility.

Parasitic infection as the only or concomitant cause of infertility in Caucasian women is rare. A parasitic infection may also present itself quite unexpectedly as a coincidental finding as shown with this case report. Moving microfilariae of Mansonella perstans were found in the aspirated follicular fluid of a patient who underwent in-vitro fertilization (IVF) with embryo transfer because of tubal pathology due to Chlamydia trachomatis. The patient also appeared to have a Schistosoma infection. To our knowledge, the presence of parasites in follicular fluid has never been reported before. We expect that infertility physicians may be confronted with parasitic infections more often, not only in patients originating from tropical countries but also in Western women as a result of a tendency to travel more frequently to exotic and (sub)tropical countries. [ABSTRACT FROM AUTHOR]

The 'Project for Achieving Consensus in Training' has been initiated by the European Board & College of Obstetrics and Gynaecology to harmonise training in Obstetrics and Gynaecology throughout Europe. In this project called the EBCOG-PACT, a state of the art pan-European training curriculum will be developed. Implementation of a pan-European curriculum will enhance harmonisation of both quality standards of women's healthcare practice and standards of postgraduate training. Secondly, it will assure equal quality of training of gynaecologists, promoting mobility throughout Europe. Thirdly, it will enhance cooperation and exchange of best practices between medical specialists and hospitals within Europe. The project is expecting to deliver (1) a description of the core and electives of the curriculum based on previously defined standards of care, (2) a societally responsive competency framework based on input from societal stakeholders and (3) strategies for education and assessment based on the current literature. Also, the project focuses on implementation and sustainability of the curriculum by delivering (4) a SWOT-analysis for the implementation based on insights into transcultural differences, (5) recommendations for implementation, change management and sustainability based on the SWOT analysis (6) and finally a handbook for other specialties initiating European curriculum development. The development and the implementation of this modern pan-European curriculum in Obstetrics and Gynaecology aims to serve as an example for the harmonisation of postgraduate training in Europe., (Copyright © 2016. Published by Elsevier Ireland Ltd.)

Objective: Premature ovarian failure (POF) is characterized by secondary amenorrhea before the age of 40 years, along with repeated increased follicle-stimulating hormone and low estrogen concentrations. POF is considered a complex genetic disease with a familial presentation in 12% to 50% of cases. POF may originate from different genes and various gene-environment interactions. The aim of this study was to identify possible differences in phenotype comparing women with familial and women with sporadic POF., Methods: A multicenter study was initiated in the Netherlands using standardized phenotyping. For each woman, medical history, menstrual cycle, and fertility and smoking status were assessed and a standardized examination was performed. Based on a detailed three-generation family history, women were identified as having either familial (defined as having at least one relative with POF) or sporadic POF., Results: A total of 58 familial cases and 142 sporadic cases of POF were identified. Maternal age at menopause was significantly lower in the women with familial compared with the women with sporadic POF (41.0 +/- 7.5 and 49.7 +/- 2.6 y, respectively; P < 0.001). Sex hormone-binding globulin concentration was significantly higher in the women with familial than in the women with sporadic POF (73.6 +/- 37.1 and 55.2 +/- 26.9 nmol/L, respectively; P = 0.002). All other characteristics, such as parity, bone mineral density, and serum follicle-stimulating hormone and lipid levels were similar, as was the incidence of autoimmunity and cytogenetic abnormalities., Conclusions: Familial and sporadic POF do not differ in phenotype except for maternal menopause age and sex hormone-binding globulin concentration. Future studies are needed to unravel the genotype-phenotype interactions in POF.