Short description:

What is the global variability in misoprostol treatment for the management of early pregnancy loss (EPL)?.

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Abstract taken from PubMed

Research question:

What is the global variability in misoprostol treatment for the management of early pregnancy loss (EPL)?

Design:

An international web-based survey of fertility specialists and obstetrics and gynaecology clinicians was conducted between August and November 2020. The survey consisted of 16 questions addressing several aspects of misoprostol treatment for EPL.

Results:

Overall, 309 clinicians from 80 countries participated in the survey, of whom 67.3% were fertility specialists. Nearly one-half (47.9%) of the respondents let the patient choose the first line of treatment (expectant management, misoprostol treatment or surgical aspiration) according to her own preference. The 248 respondents who administer misoprostol in their daily practice were asked further questions; 59.7% of them advise patients to take the medication at home. The most common dose and route of administration is 800 µg administered vaginally. Only 28.6% of participants use mifepristone pretreatment. Variation in the timing of the first follow-up visit after misoprostol administration was wide, ranging from 24 h to 1 week in most clinics. In case of incomplete expulsion, only 42.3% of the respondents routinely administer a second dose. The timing of the final visit and the definition of successful treatment also differed greatly among respondents.

Conclusions:

There is large variability in the use of misoprostol for the management of EPL. High-quality research is necessary to examine several aspects of the treatment. Particularly, the timing and effectiveness of a second dose administration and the criteria to decide on treatment failure or success deserve more research in the future.

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Background:

The purpose of this research was to calculate the minimum sample size needed to obtain reliable results from crowdsourced retrospective online surveys of IVF clinics, where the sample was IVF cycles performed annually per clinic– a new metric that may offer more survey flexibility than number of clinics or respondents.

Methods:

This analysis used two statistical formulas to calculate sample sizes and confidence intervals, initially assessing a published self-report survey conducted online by IVF-Worldwide of global IVF practices. The survey covered 592,900 IVF cycles from 795 clinics worldwide. A subset of 275,600 European IVF cycles was used as a test sample population, which was compared statistically with the actual survey population. To validate results, two additional geographic subsets (North America and Asia) from the initial survey and three additional previously published surveys were also evaluated in same fashion. Only one survey entry was accepted per clinic.

Results:

Results showed that to obtain reliable survey outcomes, the estimated minimum sample size was 35,000 cycles. Given a 99% confidence level, 0.5 probability, and a 5% estimation error, the minimum sample size for Europe was 35,340. Similarly, sample sizes for earlier surveys and other continent subsets were between 35,280 and 35,340.

Conclusions:

Surveyors often strive for small sample sizes to savecost, effort, time and/or management overhead. Currently, however, sample size standards for online surveys do not exist. The results presented here suggest that sample sizes below 35,000 may lead to unreliable results. Finding the right sample size for multiple-choice crowdsourced surveys will save cost and effort, accelerate research, and empower surveys originally deemed too difficult and/or expensive due to inordinate sample sizes required. Surveys that count number of IVF cycles as the survey population may offer researchers more options for how to conduct and analyze surveys. Further research is required to apply findings to other areas of medicine, such as surveying using the number of procedures performed by clinic.

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Short description:

This longitudinal survey reveals that trends in the practice of luteal phase support have remained practically unchanged over a 10-year period, and shows a considerable gap between practice and science. Despite extensive research, the quality of evidence remains low for most luteal phase support topics, which emphasizes the need for further research.

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Background:

It has been demonstrated that luteal phase support (LPS) is crucial in filling the gap between the disappearance of exogenously administered hCG for ovulation triggering and the initiation of secretion of endogenous hCG from the implanting conceptus. LPS has a pivotal role of in establishing and maintaining in vitro fertilization (IVF) pregnancies. Over the last decade, a plethora of studies bringing new information on many aspects of LPS have been published. Due to lack of consent between researchers and a dearth of robust evidence-based guidelines, we wanted to make the leap from the bench to the bedside, what are the common LPS practices in fresh IVF cycles compared to current evidence and guidelines? How has expert opinion changed over 10 years in light of recent literature?

Methods:

Over a decade (2009-2019), we conducted 4 web-based surveys on a large IVF-specialist website on common LPS practices and controversies. The self-report, multiple-choice surveys quantified results by annual IVF cycles.

Results:

On average, 303 IVF units responded to each survey, representing, on average, 231,000 annual IVF cycles. Most respondents in 2019 initiated LPS on the day of, or the day after egg collection (48.7 % and 36.3 %, respectively). In 2018, 72 % of respondents administered LPS for 8-10 gestational weeks, while in 2019, 65 % continued LPS until 10-12 weeks. Vaginal progesterone is the predominant delivery route; its utilization rose from 64 % of cycles in 2009 to 74.1 % in 2019. Oral P use has remained negligible; a slight increase to 2.9 % in 2019 likely reflects dydrogesterone's introduction into practice. E2 and GnRH agonists are rarely used for LPS, as is hCG alone, limited by its associated risk of ovarian hyperstimulation syndrome (OHSS).

Conclusions:

Our Assisted reproductive technology (ART)-community survey series gave us insights into physician views on using progesterone for LPS. Despite extensive research and numerous publications, evidence quality and recommendation levels are surprisingly low for most topics. Clinical guidelines use mostly low-quality evidence. There is no single accepted LPS protocol. Our study highlights the gaps between science and practice and the need for further LPS research, with an emphasis on treatment individualization.

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Short description:

Preimplantation genetic testing for aneuploidy (PGT-A) has become increasingly controversial since normal euploid births have been reported following transfer of embryos diagnosed as “abnormal.” There is an increasing trend in transferring “abnormal” embryos; but it is still unknown how many IVF centers transfer “abnormal” embryos and with what efficiency.

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Purpose:

Preimplantation genetic testing for aneuploidy (PGT-A) has become increasingly controversial since normal euploid births have been reported following transfer of embryos diagnosed as "abnormal." There is an increasing trend in transferring "abnormal" embryos; but it is still unknown how many IVF centers transfer "abnormal" embryos and with what efficiency.

Methods:

We performed a worldwide web-survey of IVF centers to elucidate PGT-A related practice patterns including transfer of human embryos found "abnormal" by PGT-A. Participating centers reflected in vitro fertilization (IVF) cycles in the USA, Canada, Europe, Asia, South America, and Africa.

Results:

One hundred fifty-one IVF centers completed the survey; 125 (83%) reported utilization of PGT-A. Europe had the highest utilization (32.3%), followed by the USA and Canada combined at 29.1%. The leading indications for PGT-A were advanced maternal age (77%), followed by recurrent implantation failure (70%), unexplained pregnancy loss (65%), and sex determination (25%); 14% of respondents used PGT-A for all of their IVF cycles; 20% of IVF units reported transfers of chromosomally "abnormal" embryos, and 56% of these took place in the USA, followed by Asia in 20%. Remarkably, 106 (49.3%) cycles resulted in ongoing pregnancies (n = 50) or live births (n = 56). Miscarriages were rare (n = 20; 9.3%).

Conclusions:

The transfers of "abnormal" embryos by PGT-A offered robust pregnancy and live birth chances with low miscarriage rates. These data further strengthen the argument that PGT-A cannot reliably determine which embryos should or should not be transferred and leads to disposal of many normal embryos with excellent pregnancy potential./dd>

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