Human reproduction
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Justice and access are among the most urgent questions for medically assisted reproduction. This paper analyses this question not only for people suffering from infertility, but also for people who need assistance to prevent the birth of a child with a specific genetic disorder. Based on the impact of not being able to have a child on the quality of life of a person, the position is defended that infertility treatment should be at least partially reimbursed. Simultaneously, the medical professionals have an obligation towards their patients and the health care system to bring down the costs as far as reasonably possible.
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Randomized Controlled Trial Comparative Study
Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint.
BACKGROUND Conventional ovarian stimulation and the transfer of two embryos in IVF exhibits an inherent high probability of multiple pregnancies, resulting in high costs. We evaluated the cost-effectiveness of a mild compared with a conventional strategy for IVF. METHODS Four hundred and four patients were randomly assigned to undergo either mild ovarian stimulation/GnRH antagonist co-treatment combined with single embryo transfer, or standard stimulation/GnRH agonist long protocol and the transfer of two embryos. ⋯ The incremental cost-effectiveness ratio of the standard strategy compared with the mild strategy was euro185 000 per extra pregnancy leading to term live birth. CONCLUSIONS Despite an increased mean number of IVF cycles within 1 year, from an economic perspective, the mild treatment strategy is more advantageous per term live birth. It is unlikely, over a wide range of society's willingness-to-pay, that the standard treatment strategy is cost-effective, compared with the mild strategy.
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Clinical manifestations of androgen excess-hirsutism, acne and alopecia-are very common and distressing symptoms in women of reproductive age. These symptoms are frequently associated with polycystic ovary syndrome, in which condition menstrual disturbances are also common. The combination of the anti-androgen cyproterone acetate (2 mg) and ethinyl estradiol (35 microg) (co-cypridiol) is of proven efficacy in management of symptoms of both hyperandrogenism and menstrual abnormalities but its long-term use has been discouraged because of concern about increased risk of venous thromboembolism. In this article, we review the evidence for efficacy and adverse effects and conclude that its benefits are clear and that the risks of venous thromboembolism are no more common that with the use of third generation combined oral contraceptives.
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Review Meta Analysis
Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. A systematic review and meta-analysis.
Both cleavage-stage and blastocyst-stage embryo transfer policies have advantages and drawbacks. The number of embryos transferred, however, is a crucial parameter that needs to be considered before attempting any comparison. ⋯ The best available evidence suggests that the probability of live birth after fresh IVF is significantly higher after blastocyst-stage embryo transfer as compared to cleavage-stage embryo transfer when equal number of embryos are transferred in the two groups compared.
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To determine the effectiveness of an initial transvaginal ultrasound scan (TVS) in the detection of ectopic pregnancy in consecutive women attending an early pregnancy unit (EPU). ⋯ In unselected women attending an EPU, pregnancy location can be diagnosed accurately in over 90% of all pregnancies and in 73.9% of ectopic pregnancies with a single TVS.