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A Templeton

Publications and source records attributed to A Templeton.

At least 37 records · Page 2Linked to original sources
PubMed2002

In vitro fertilisation for unexplained subfertility.

BACKGROUND: In vitro fertilisation (IVF) is now a widely accepted treatment for unexplained infertility (RCOG 1998). However, with estimated livebirth rates per cycle varying between 13% and 28%, it's effectiveness has not been rigorously evaluated in comparison with other treatments. With increasing awareness of the role of expectant management and less invasive procedures such as intrauterine insemination, concerns about multiple complications and costs associated with IVF, it is extremely important to evaluate the effectiveness of IVF against other treatment options in couples with unexplained infertility. OBJECTIVES: The aim of this review is to determine, in the context of unexplained infertility, whether IVF improves the probability of livebirth compared with 1. expectant management 2. clomiphene citrate (CC) 3. intra uterine insemination (IUI) alone 4. IUI with controlled ovarian stimulation and 5. Gamete IntraFallopian Transfer (GIFT). SEARCH STRATEGY: RCTs were identified using the search strategies developed for the Menstrual Disorders and Subfertility Group. See Review group for more information. SELECTION CRITERIA: Only randomised controlled trials were included. Livebirth rate per woman was the primary outcome of interest. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed eligibility and quality of trials. MAIN RESULTS: Nine randomised controlled trials were identified. In two we could not extract data separately for unexplained infertility cases, two were non-randomised, one reported no valid rates (included in the review and not in the meta-analysis), leaving four trials for analysis. One trial compared two different interventions (IVF versus IUI with or without ovarian stimulation) and one study compared three interventions (IVF versus IUI with ovarian stimulation and GIFT). The number of trials assessing the effectiveness of IVF with the other treatments were as follows: IVF versus expectant management (one), IVF versus IUI (one), IVF versus IUI with ovarian stimulation (two) and IVF versus GIFT (three). Livebirth rate per woman was reported in two studies and three studies determined clinical pregnancy rate per woman. Multiple pregnancy rate was reported in three trials. Two studies reported ovarian hyperstimulation syndrome (OHSS) as an outcome measure. There were no comparative data for clomiphene citrate, and no comparative data on livebirth rates for expectant management or GIFT. There was no evidence of a difference in livebirth rates between IVF and IUI either without (OR 0.51, 95% CI 0.23 to 1.1) or with (OR 0.87, 95% CI 0.42 to 1.8) ovarian stimulation. There was no evidence of a difference in clinical pregnancy rates between IVF and expectant management. There was no significant difference in the clinical pregnancy rates between IVF and GIFT (OR 0.47, 95% CI 0.24 to 0.92). There was no evidence of a difference in the multiple pregnancy rates between IVF and either IUI with ovarian stimulation (OR 1.59, 95% CI 0.68 to 3.70) or GIFT (OR 0.47, 95% CI 0.08 to 0.58). Clinical heterogeneity was present among the studies included. However, there was no evidence of statistical heterogeneity, which allowed the studies to be combined for statistical analysis. REVIEWER'S CONCLUSIONS: Any effect of IVF relative to expectant management, clomiphene citrate, IUI with or without ovarian stimulation and GIFT in terms of livebirth rates for couples with unexplained subfertility remains unknown. The studies included are limited by their small sample size, so that even large differences might be hidden. Livebirth rates are seldom reported. Adverse effects such as multiple pregnancies and ovarian hyperstimulation syndrome have also not been reported in most studies. Larger trials with adequate power are warranted to establish the effectiveness of IVF in these women. Future trials should not only report rates per woman /couple but also include adverse effects and costs of the treatments compared as outcomes. Factors that have a major effect on these outcomes such as fertility treatment, female partner's age, duration of infertility and previous pregnancy history should also be considered.

Female↗
PubMed2002

New considerations for the pathogenesis of endometriosis.

OBJECTIVES: To review the available evidence regarding the immunological, epidemiological and other factors involved in the pathogenesis of endometriosis. METHODS: Literature review. RESULTS: Endometriosis remains a poorly-understood disease of unknown etiology and pathogenesis. CONCLUSIONS: There is evidence to suggest that alterations in the immune response, whether genetically transmitted or environmentally induced, predispose women to the ectopic implantation of endometrial cells transported into the peritoneal cavity by way of retrograde menstruation. This predisposition may exist because of an impaired peritoneal clearing of endometrial cells and fragments or because of pathological angiogenesis.

Choristoma↗
PubMed2002

Prevention of pelvic inflammatory disease by the control of C. trachomatis infection.

OBJECTIVES: To determine if there is evidence to indicate that screening for Chlamydia trachomatis (chlamydia) is an effective intervention in the prevention of pelvic inflammatory disease (PID). METHODS: A systematic review was made of the literature to assess the effectiveness of screening asymptomatic young women for lower genital tract infection with C. trachomatis in the prevention of PID and its major sequelae tubal infertility and ectopic pregnancy. RESULTS: There is considerable literature describing screening for lower genital tract infection with C. trachomatis, but only two randomized controlled trials, two ecological studies and one case-controlled trial were identified. These studies were graded and the evidence pooled. The suggestion that screening for chlamydia is an effective intervention in the prevention of PID is supported by Grade 2 evidence (level B recommendation). However, there are large gaps in the literature. Only small numbers of women have been studied and the follow-up periods are short. The studies have been conducted using mainly culture of cervical swabs to diagnose chlamydial infection and not the more recent nucleic acid based tests. The risk of a woman developing PID following detection of lower tract infection with C. trachomatis is still uncertain. CONCLUSIONS: There is evidence to support a level B recommendation that screening for chlamydia using culture is effective in preventing PID in the short term. Further randomized controlled trials are required to assess screening using nucleic acid based tests and involving longer follow-up periods.

Adult↗
PubMed2002

Active management of term prelabour rupture of membranes with oral misoprostol.

OBJECTIVE: To compare the active management of term prelabour rupture of membranes with oral misoprostol with conservative management for 24 hours followed by induction with oxytocin or prostaglandin E(2) (PGE(2)) gel. DESIGN: A non-blinded randomised controlled trial. SETTING: Induction and labour wards, Aberdeen Maternity Hospital. POPULATION: Sixty-one women with confirmed prelabour rupture of the membranes at > or =36 weeks of gestation. METHODS: The women were randomised to 50 microg of oral misoprostol repeated every 4 hours, if required, to a maximum of five doses (active group), or to induction of labour with PGE(2) gel or oxytocin only if not in spontaneous labour 24 hours after prelabour rupture of membranes (conservative group). MAIN OUTCOME MEASURES: Number of women in active labour within 24 hours of the prelabour rupture of membranes, preference of women for any one particular method of management in any subsequent pregnancy with prelabour rupture of membranes. RESULTS: 93.3% of the active group and 54.8% of the conservative group were in spontaneous labour within 24 hours of the prelabour rupture of membranes (RR 1.7, 95% CI 1.2 to 2.4). Of those achieving a vaginal delivery, 72% of the active group did so within 24 hours of the prelabour rupture of membranes as compared with 26.9% of the conservative group (RR 2.7, 95% CI 1.4 to 5.3, P = 0.002). There were no significant differences in the neonatal or maternal outcomes. In the active group, 78% felt they would have the same method of induction as compared with 40% in the conservative group (RR 1.9, 95% CI 1.1 to 3.3, P = 0.03). CONCLUSIONS: Active management with oral misoprostol resulted in more women going into labour and delivering within 24 hours of the prelabour rupture of membranes with no increase in maternal or neonatal complications. Women tended to view active management of prelabour rupture of membranes more positively. Oral misoprostol might be an option to consider in those wishing active management.

Administration, Oral↗
PubMed2002

Aspirin dilemma. Remodelling the hypothesis from a fertility perspective.

Many clinical trials in obstetrics have failed to demonstrate improved outcomes with low-dose aspirin. This is not entirely surprising as prescribing aspirin for compromised tissue perfusion without insight into underlying pathology inevitably leads to suboptimal outcomes. We argue that a mismatch between the aspirin dose and the underlying pathology of altered tissue perfusion is the key factor to this failure. Based on this groundwork, we address the question of how best to optimize the dose of aspirin for use in fertility management, by providing examples from the assisted conception and recurrent miscarriage settings.

Abortion, Habitual↗
PubMed2002

Cost effectiveness of screening for Chlamydia trachomatis: a review of published studies.

OBJECTIVE: Screening for Chlamydia trachomatis in the lower genital tract may contribute to the prevention of pelvic inflammatory disease in women. The purpose of this review was to critically appraise, and summarise studies of the cost effectiveness of screening for C trachomatis. METHODS: A literature search was conducted on Medline and in Health Star from 1990-2000. Keywords were C trachomatis, screening, cost effectiveness. Bibliographies of reviewed articles were also searched. The population studied was asymptomatic sexually active women under 30 years of age in a primary care setting. The intervention assessed was screening for lower genital tract infection with C trachomatis and the outcomes studied were cases of C trachomatis detected, cases of PID prevented, and associated costs. Studies were assessed using the Drummond criteria for economic evaluations. They were assessed qualitatively as they were too heterogeneous to allow quantitative analysis. RESULTS: 10 studies were included. All were modelled scenarios and all found screening to be more cost effective than simply testing symptomatic women, although all were based on probabilities that were assumed. Six of the studies focused on DNA based testing, three of them using urine. The models showed screening to be cost effective at prevalences of 3.1-10.0%, and cost saving (overtesting symptomatic women) at a prevalence as low as 1.1%, if age was used as a selection factor and DNA based tests were used in urine samples. CONCLUSIONS: At the prevalence of infection expected in the target population, all studies suggest screening is cost effective. However, the assumptions used in the models have been difficult to confirm and there is a need for more data, particularly on the risk of complications in women with asymptomatic lower tract infection.

Chlamydia Infections↗
PubMed2001

Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: a randomised controlled trial.

BACKGROUND: Intracytoplasmic sperm injection (ICSI) is a more invasive option than conventional in-vitro fertilisation (IVF), which can be successful even when semen characteristics are poor. Reports of higher fertilisation rates after ICSI suggest that this technique may be better than the conventional method for all couples seeking IVF. We undertook a multicentre randomised controlled trial comparing clinical outcome after ICSI or traditional IVF in couples with non-male-factor infertility. METHODS: 415 eligible and consenting couples at four UK centres were randomly assigned IVF or ICSI (total 435 treatment cycles: IVF 224; ICSI 211). Usual clinical and laboratory protocols for the two treatment procedures were followed in each of four participating centres. The primary outcome was the implantation rate (number of gestation sacs per embryo replaced expressed as a percentage). Secondary outcomes were pregnancy and fertilisation rates associated with each treatment. Analyses were by intention to treat. FINDINGS: The implantation rate was higher in the IVF group than in the ICSI group (95/318 [30%] vs 72/325 [22%]; relative risk 1.35 [95% CI 1.04-1.76]). The pregnancy rate per cycle was also higher after IVF (72 [33%] vs 53 [26%]; 1.17 [0.97-1.35]). Mean associated laboratory time was significantly shorter with IVF than with ICSI (22.9 [SD 12.1] vs 74.0 [38.1] min; 95% CI for difference 45.6-56.6). INTERPRETATION: ICSI offers no advantage over IVF in terms of clinical outcome in cases of non-male-factor infertility. Our results support the current practice of reserving ICSI only for severe male-factor problems.

Adult↗
PubMed2001

High omega-3:omega-6 fatty acid ratios in culture medium reduce endometrial-cell survival in combined endometrial gland and stromal cell cultures from women with and without endometriosis.

OBJECTIVE: To study the effects of omega-3 and omega-6 polyunsaturated fatty acid (PUFA) on in vitro proliferation of endometrial cells and their production of the cytokine interleukin-8 (IL-8). DESIGN: In vitro study. SETTING: Obstetrics and gynecology department, University of Aberdeen. PATIENT(S): Women attending an infertility clinic. INTERVENTION(S): In vitro cell cultures using culture mediums supplemented with normal and high ratios of omega-3 PUFA and omega-6 PUFA. MAIN OUTCOME MEASURE(S): In vitro survival and production of IL-8 by dispersed endometrial cells. RESULT(S): In vitro survival of endometrial cells from women with and without endometriosis was significantly reduced in the presence of high omega-3:omega-6 PUFA ratios compared with cells incubated in the absence of fatty acids, in balanced omega-3:omega-6 PUFA ratios, and in high omega-6:omega-3 PUFA ratios. Endometrial cells from women with endometriosis secreted higher concentrations of IL-8, especially in the presence of high omega-3:omega-6 PUFA ratios. CONCLUSION(S): omega-3 PUFA may have a suppressive effect on the in vitro survival of endometrial cells and omega-3 PUFA be useful in the management of endometriosis by reducing the inflammatory response and modulating cytokine function.

Cell Survival↗
PubMed2001

A randomized controlled trial of direct access for laparoscopic sterilization.

OBJECTIVES: The aim of this study was to establish and evaluate a direct access service for laparoscopic sterilization. METHODS: A pragmatic randomized controlled trial was carried out on a total of 232 women referred to Aberdeen Royal Infirmary for sterilization between 1 June 1996 and 31 March 1997, from 57 general practices around Aberdeen, Scotland, comprising 75 from general practices that had received criteria for direct access, and 157 from control practices. The main outcome measures were: patients' waiting times to appointments and operation, satisfaction, short-term regret, operative complications and costs; conjoint analysis of patient preferences; GPs' adherence to referral criteria; GP and gynaecologist satisfaction; and NHS costs. RESULTS: Analysis was by intention to treat. There were no inappropriate direct referrals. Waiting time was lower in the intervention group, but there were more visits post-operatively to the GP. Patient and doctor satisfaction was equally high in both groups. There was no difference in operative complication rate, nor in total cost to patients or to the NHS. GPs and gynaecologists strongly supported direct access, but women preferred to meet both a gynaecologist and a GP before sterilization (routine referral). Other attributes of care important to patients included written information, although waiting time was not important. Of all women referred for sterilization during the study period, only 31% were suitable for direct referral. CONCLUSIONS: Patients preferred routine referral, and there were no differences in patient costs or satisfaction. There was, however, strong medical support for direct referral. Restrictive direct referral criteria may limit the uptake. These findings are important for future planning of direct referral services. Important methodological lessons were also learnt about the conduct of trials involving the primary-secondary care interface.

Adult↗
PubMed2001

Mifepristone as a late post-coital contraceptive.

This study was undertaken to assess the efficacy of mifepristone as a post-coital contraceptive beyond 72 h and up to 5 days in women who found the intrauterine contraceptive device (IUCD) unacceptable. During a 2 year period 219 consecutive women fulfilling the inclusion criteria and presenting late for emergency contraception were approached and offered a choice of methods. Fifteen (6.8%) women wished to have the IUCD fitted, but 204 (93.2%) who found this unacceptable were offered and accepted mifepristone 200 mg. In one woman there was a technical problem fitting the IUCD and mifepristone was administered. Women who had mifepristone were younger (mean age 21.4 versus 26.9 years, P = 0.004) and more likely to be nulliparous (81 versus 25 %, P < 0.001) than the IUCD group. A total of 155 (75.6%) women who had mifepristone and all 14 who had the coil fitted were followed up. There were no true failures in either group. There was one user failure in the mifepristone group, where pregnancy occurred from an act of intercourse subsequent to treatment, giving a crude pregnancy rate of 0.65%. Mifepristone prevented 85% of expected pregnancies. Most women find the IUCD an unacceptable method of post-coital contraception. Mifepristone is an effective late post-coital contraceptive, which can be offered to women who decline the IUCD.

Adult↗
PubMed2001

Fetal antecedents of male factor sub-fertility: how important is birthweight?

BACKGROUND: Severely reduced fetal growth has been linked to gonadal dysfunction. The aim of this study was to explore the link between birthweight and subsequent male infertility using the Aberdeen Maternity and Neonatal Databank (AMND). METHODS AND RESULTS: Assuming 80% power at the 5% significance level, a minimum of 126 men (63 in each group) was required to show a mean difference of 0.5 (SD = 1) in the standardized birthweight scores between cases and controls. Men born locally with unexplained male factor infertility (n = 79) were identified from the infertility clinic database. Men with normal semen parameters, born in Aberdeen and attending the infertility clinic with their partners (n = 104), served as controls. The pregnancy records of these men's mothers were obtained from the AMND and a standard case-control analysis performed. In addition to standardized birthweight scores, the following variables were studied: crude birthweight, social class, maternal age, parity, obstetric history, antepartum and peripartum events. CONCLUSIONS: No differences were found between the two groups, suggesting that low birthweight is unlikely to affect male fertility in later life.

Birth Weight↗
PubMed2001

Review of unexplained infertility and obstetric outcome: a 10 year review.

BACKGROUND: Increased maternal and fetal risks have been reported in pregnancies following unexplained infertility. Our aims were to examine the obstetric and perinatal outcome of singleton pregnancies in couples with unexplained infertility and explore the impact of fertility treatment. METHODS: Women with unexplained infertility were identified from the Aberdeen Fertility Clinic Database. Their unit numbers were matched against the Aberdeen Maternity and Neonatal Databank (AMND) in order to extract obstetric records of those women with subsequent pregnancy outcomes. The general obstetric population served as a control group. RESULTS: Women with unexplained infertility were older [30.8 versus 27.9 years, 95% confidence interval (CI) for difference = +2.4 to +3.4] and more likely to be primiparous (59 versus 40%, 95% CI = +1.3 to +1.9). After adjusting for age and parity they had a higher incidence of pre-eclampsia, abruptio placentae, preterm labour, emergency Caesarean section and induction of labour in comparison with the general population (P < 0.05). Perinatal outcome did not differ between women with unexplained infertility and those of the general population. The multiple pregnancy rate was 5.4% higher following fertility treatment than in women who conceived spontaneously (95% CI = +2.8 to +9.7). CONCLUSIONS: Women with unexplained infertility are at higher risk of obstetric complications which persist even after adjusting for age, parity and fertility treatment. The reasons are however unclear and merit further study.

Abruptio Placentae↗
PubMed2001

Avoiding multiple pregnancies in ART: evaluation and implementation of new strategies.

Strategies for reducing the multiple pregnancies which increase perinatal mortality and morbidity in women undergoing IVF are discussed. Elective single embryo transfer with the promise of subsequent transfer of frozen-thawed embryos would achieve the goal of a single healthy child as a result of IVF treatment. The urgent establishment of a definitive trial comparing elective single versus double embryo transfer is advocated.

Cryopreservation↗
PubMed2001

Medical management of early fetal demise using a combination of mifepristone and misoprostol.

BACKGROUND: This study aims to assess the efficacy of a combination of mifepristone and misoprostol in the management of missed miscarriage and anembryonic pregnancy. METHODS: Data of 220 consecutive women with miscarriage, undergoing medical evacuation of the uterus were collected prospectively at an early pregnancy assessment unit in a tertiary referral hospital. Each woman received a single oral dose of mifepristone 200 mg and 36-48 h later vaginal misoprostol 800 microg. Three hours following the first dose, two further doses of misoprostol, 400 microg each, were administered vaginally or orally at 3 h intervals. Women who failed to pass products of conception were offered repeat medical regime with misoprostol. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation. RESULTS: The overall success rate of medical management was 84.1%. Mifepristone alone induced natural expulsion of products of conception in 18.1% of women. The median dose of misoprostol required was 1600 microg and the median induction miscarriage interval after first prostaglandin administration was 8.04 h (range: 0.58-50.54 h). Of the 142 women who were symptomatic at presentation the medical regime failed in 30 (21.1%), compared with five (6.4%) failures of the 78 who were asymptomatic (P = 0.007). Of the 35 women who had surgical evacuation, eight required an emergency curettage for bleeding. CONCLUSIONS: The combination of oral mifepristone 200 mg with vaginal or oral misoprostol is an alternative to surgical management of early fetal demise, although it is not as effective as surgery.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

The treatment of incomplete miscarriage with oral misoprostol.

In a retrospective study of 112 women, the effectiveness of three sequential oral doses of misoprostol was evaluated for the treatment of incomplete miscarriage. We report our experience with this regimen, which achieved a complete miscarriage rate of 85%. Surgical intervention was required in 17 women (15%). The regimen appears to be effective in terms of a high rate of complete miscarriage, and it is safe.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

A comparison of oral and vaginal misoprostol tablets in induction of labour at term.

OBJECTIVE: To compare the efficacy of equivalent doses of orally administered with vaginally administered misoprostol in induction of labour at term. DESIGN: A non-blinded randomised controlled trial. SETTING: Induction and labour wards of a UK teaching hospital. PARTICIPANTS: Two hundred and forty-five pregnant women at term, with medical or obstetric indications for labour induction and unfavourable cervices. METHODS: The women were randomly assigned to receive 50 microgm of misoprostol orally or vaginally four hourly to a maximum of five doses. MAIN OUTCOME MEASURES: Interval from induction to vaginal delivery, mode of delivery, oxytocic and analgesic requirements in labour, neonatal outcome, patient satisfaction and acceptability. RESULTS: The mean induction to vaginal delivery interval was significantly shorter in the vaginal group compared with the oral group (17.8h vs 27.9h: mean difference 10.1 hrs, 95% CI 5.8-14.4). More women were delivered within 24 hours (80% vs 46.3%; RR 1.7, 95% CI 1.3-2.1) and fewer women needed oxytocin augmentation (39% vs 58.2%; RR 0.67, 95% CI 0.5-0.9) in the vaginal group. There was no difference in the mode of delivery, analgesic requirements or neonatal outcomes in the two groups. There was a higher incidence of uterine hyperstimulation in the vaginal group (4.9% vs 0.8%, RR 6, 95% CI 0.07-48.7) and more caesarean sections were performed for fetal distress in this group (13% Vs 2.4%, RR 5.3, 95% CI 1.6-17.7), although the overall operative delivery rate was similar in the two groups. CONCLUSION: Misoprostol effectively induces labour, with the vaginal route of administration having a faster action than the oral route in equivalent doses. However, the more frequent occurrence of hyperstimulation and the higher intervention rate for fetal distress in the vaginal group could mean that the preferred route might be oral. More trials are needed to find the right oral dosage that combines efficacy with safety.

Administration, Intravaginal↗
PubMed2000

Effects of sparfloxacin, grepafloxacin, moxifloxacin, and ciprofloxacin on cardiac action potential duration.

Fluoroquinolone antibiotics have been associated with QT prolongation following administration to humans. This study compares the effects of four fluoroquinolones, sparfloxacin, grepafloxacin, moxifloxacin and ciprofloxacin on action potential duration recorded from canine isolated cardiac Purkinje fibres. Left and right ventricular Purkinje fibres were isolated from canine hearts and continuously superfused with physiological salt solution. Action potential duration at 90% repolarization was recorded via intracellular microelectrodes. Sparfloxacin, grepafloxacin, moxifloxacin and ciprofloxacin prolonged action potential duration in a concentration dependent manner. Mean concentrations causing a 15% prolongation of action potential duration recorded at a stimulation frequency of 1 Hz were: sparfloxacin 4.2+/-0.7 microg/ml; grepafloxacin 9.3+/-0.9 microg/ml; moxifloxacin 9.9+/-1.6 microg/ml and ciprofloxacin 72.8+/-26.4 microg/ml. Prolongation was inverse frequency dependent with larger increases in action potential duration occurring when the stimulation frequency was reduced to 0.5 Hz. These results indicate that effects on action potential duration vary within this class of compound. Rank order of potency was sparfloxacin > grepafloxacin = moxifloxacin > ciprofloxacin.

Action Potentials↗