The problems associated with twin and higher order pregnancies have assumed major importance, with international debate about multiple pregnancy; the single biggest risk with in vitro fertilisation (IVF). We have critically reviewed published papers on female patients' and their partners' views of single embryo transfer (SET) and twin or higher level pregnancies to identify the requirements needed to improve the acceptability of SET. Twenty relevant papers were identified and included in the review. Although the majority of IVF patients and their partners, in the more recent studies, exhibited a desire for twins rather than singletons, closer examination of the evidence revealed that elective SET (eSET) could become increasingly acceptable. As success rates of IVF have improved and the risks and consequences of multiple pregnancies are well-documented, patients have accepted the transfer of two rather than three embryos as standard practice. However, more would accept eSET if success rates approached those of double embryo transfer (DET). This emphasises the importance of improving success rates of eSET so that more patients can achieve a singleton birth with one IVF cycle. If patients were offered only SET, it is likely that this would be acceptable as the normal expectation of pregnancy is one baby. Measures to improve the acceptability of SET include: using eSET, especially with younger patients; including partners when providing risk information; improving eSET success rates; improving outcomes with cryopreserved embryos; changing reimbursement/free cycles to favour eSET; using legal enforcement.
. Urinary excretion of phosphate in normal children. In 55 normal children on a normal diet, the phosphate and creatnine were estimated in a fasting 2-hour urine collection and in a simultaneous blood sample. In comparison with adults, a high serum phosphate and relatively decreased phosphaturia were found, both of which tended to adult values with the advent of puberty. A correlation between the serum phosphate and the urine phosphate/creatinine ratio (r = + 0 -42, p <0 -002) was found. The phosphate excretion index was lower in mid-childhood than in adulthood.The interpretation of any expression of phosphaturia in childhood requires its own age-specific normal range.The urinary phosphate excretion, though affected by many different hormonal and non-hormonal factors, is mainly dependent on parathyroid activity (Hiatt and Thomson, 1957;Gershberg, Shields, and Kove, 1959;Beutner and Munson, 1960; Arnaud, Tenenhouse, and Rasmussen, 1967). This action of parathyroid hormone has been widely used in the diagnosis of hyper-or hypoparathyroid disorders (Hodgkinson, 1961;Bernstein, Yamahiro, and Reynolds, 1965; Nordin and Smith, 1965). Though the phosphaturic action of parathyroid hormone is not questioned, there is no unanimity regarding the best way of expressing phosphaturia and many methods are in use (Bernstein et al., 1965; Nordin and Smith, 1965). We have found that the phosphate excretion index (PEI) of Nordin and Fraser (1960) gives consistent results and is a helpful adjunct in the diagnosis of hyperparathyroidism in the adult (Melvin et al., 1970).While investigating the cause of hypercalcaemia in a 9-year-old girl who was subsequently shown to have a parathyroid tumour (Latham et al., 1969), we found that the PEI appeared to be lower in children than in adults. We undertook the present study to investigate this apparent discrepancy and to establish a normal range for the PEI in children; it emerged that the normal range was much lower than in adults, and that the child we were investigating had an abnormally high value. Materials and MethodsOf the 55 children included in the present study, 35 were in-patients for reasons unrelated to disorders of calcium or phosphate metabolism or to endocrine disorders; usually they were in the recovery stage of acute illnesses. The remaining 20 were schoolchildren who, with their parents' consent, offered to act as normal volunteers. The in-patient children were on a normal ward diet while the normal volunteers were on their home diet.All the children fasted overnight, and first thing in the morning they passed urine which was discarded. After that, an approximate 2-hour urine collection was made, and blood for serum phosphate and creatinine was drawn at about mid-point of the urine collection.On the in-patient children the test was performed on a day that blood was due to be taken for investigations related to the reason of their admission. 5 children who had abnormal renal function as evidenced by a high blood urea or serum creatinine, or produced a urinary volume less...
People seeking fertility treatment are exposed to numerous stressors and many professionals are involved in their care. This literature review focuses on the role of nurses and midwives in the promotion of patient's well-being. Key themes identified are the need for continuity of care and support at all stages of treatment, but particularly prior to pregnancy testing, during the ante-natal period and following unsuccessful treatment. Women who conceive through fertility treatment are often anxious about the risk of potential miscarriage. It is not unreasonable that nurses and midwives receive training in acquiring skills in the provision of such support to patients which, arguably, is consistent with the general requirement that their skills and knowledge are updated to ensure safe and effective practice, but this would have resource implications. The wider question of who should provide well-being and emotional support for patients is an area of reproductive medicine which requires further research.
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