The aims of this prospective study were to investigate the relationship between anti-Müllerian hormone (AMH) and antral follicle count (AFC), and to determine whether these markers of ovarian reserve correlate with lifestyle factors, ethnicity, chronological age and reproductive history. Participants were 136 normo-ovulatory women undergoing infertility work-up within 3 months of their first ovarian stimulation cycle for in vitro fertilization. On day 3 of a spontaneous menstrual cycle, a blood sample for measurement of plasma AMH levels was taken and a transvaginal ultrasound scan to determine the AFC (follicles measuring 2-5 mm in diameter) was performed. Information about smoking, body mass index, alcohol consumption, ethnic origin, chronological age, age at menarche, years since menarche and gravidity were recorded using a case report form. The main outcome measures were plasma AMH concentrations and total number of small antral follicles (AFC). Median plasma levels of AMH were 2.0 ng/ml (interquartile range 1.1-3.6) and AFC was 10 (interquartile range 7-15). A positive correlation between AMH and AFC (r = 0.54, p < 0.0001) was found. AMH and AFC correlated negatively with age (r = -0.30, p < 0.001 and r = -0.27, p = 0.001 respectively) and number of years since menarche (r = -0.23, p = 0.007 and r = -0.21, p = 0.015 respectively), but not with any of the other measures. Circulating AMH levels and AFC correlated with each other and declined significantly with age. There were only weak, non-significant, correlations with lifestyle factors and reproductive history. These putative markers could be used individually or together to assess the age-related decline of ovarian function in normo-ovulatory candidates for IVF.

This article describes a revised ovarian stimulation protocol (DuoStim) for fertility preservation in female oncology patients which aims to maximise the number of gametes obtained with subsequent improvement in cumulative birth rate, without delaying cancer treatment. Ten patients diagnosed with malignancy between September 2014 and October 2015 were included. The patients were treated with the DuoStim protocol, undergoing two consecutive ovarian stimulation cycles and two oocyte retrievals. The primary outcome was the number of oocytes collected and vitrified during each oocyte retrieval and in total. The protocol was evaluated regarding medical risk and patients' feedback. During the first oocyte collection 81 oocytes (61 metaphase II) were retrieved (mean = 8.1; range = 1-13) and during the second oocyte collection 82 oocytes (67 metaphase II) were retrieved (mean= 8.2; range = 1-19). A total of 163 oocytes (128 metaphase II) were collected (mean = 16.3; range = 6-32) and cancer treatment was not delayed for any of these patients. There were no cases of ovarian hyperstimulation syndrome recorded. More patients and long-term follow-up is needed to assess the efficacy and safety of the DuoStim protocol. However, these early results are encouraging, demonstrating an increase in number of mature oocytes retrieved during ovarian stimulation for oncology patients, without delaying cancer treatment.

During the course of an investigation into the behaviour of the ureter (Gould, Hsieh & Tinckler, 1955 a, b), it became apparent that this organ is adapted to the task of feeding urine into the bladder against a considerable resistance, and also of protecting the kidney against high pressures developed at its lower end.The necessity for these functions remained obscure, since we shared the common view that bladder pressure remains low, except during micturition, by virtue of the power of adaptation shown by the muscle of the bladder wall in the face of filling (Denny-Brown & Robertson, 1933). These authors found that resting vesical tension at moderate volumes varied from 5 to 10 cm of water, and came to regard this range as the normal pressure of the vesical contents. Lapides (1948) states that in the normal individual intra-abdominal and intravesical pressure are approximately constant.It then occurred to us that investigations into bladder pressures have always been carried out on animals or human subjects who were lying down. It seemed probable that a change of posture such as would cause the bladder to bear the weight of the intestines would necessarily produce a rise in intravesical pressure.As a simple preliminary experiment to test this view, a long glass tube was attached to a catheter which had been passed into the bladder of an elderly man for another purpose. Taking the symphysis pubis as an arbitrary reference point, it was found that urine rose in the tube to a height of 6 cm when the patient was lying down, and to a height of 36 cm when he stood up.We therefore undertook an investigation into the effect of posture on bladder pressure. METHODSWe acted as our own subjects and enjoyed, in addition, the help of two volunteers. A stretcher was fixed to a length of piping so that it could be swung vertically through 360°. The subject swallowed a small latex rubber balloon attached to a length of rubber tubing. He was then secured to the stretcher (as it lay horizontal) by a harness, and by having his feet bound to a foot-board. A catheter was passed into the bladder. A stethograph was fixed around the chest.

This is a retrospective cohort study aiming to examine the response of oncology patients undergoing controlled ovarian stimulation (COS) for fertility preservation and to review the incidence of short-term complications. The study group consisted by all oncology patients undergoing ovarian stimulation for fertility preservation (n = 157) between April 2009 and April 2016. Patients undergoing COS for IVF/ICSI for male factor only infertility in the same time period (n = 2,128) provided a comparator group. Oncology patients underwent COS to retrieve eggs for storage and future use. The cancer patients had a very similar distribution of oocyte yield to the comparator group. Those with ovarian cancer did have significantly lower oocyte recovery than those with other cancers (age-adjusted difference 7, 95% CI: 2-12). None of the patients in the study group were admitted with ovarian hyperstimulation syndrome or any other complication of COS or oocyte retrieval. This is one of the largest reported cohorts of patients treated for fertility preservation before oncology treatment. Our data have demonstrated a good response to stimulation, offering a reasonable chance of pregnancy in the future. In contrast to previous studies, we have demonstrated a similar number of oocytes retrieved to that of women undergoing IVF/ICSI treatment for male factor infertility.

To complement the study on the isolated buffalo ureter reported in the preceding paper (Gould, Hsieh & Tinckler, 1955 a) an investigation has been made on the behaviour of the intact ureter in dogs, rabbits and rats. METHODSPressure tracings were made in experiments on sixteen dogs anaesthetized with intravenous sodium pentobarbitone (Nembutal 50 mg/kg). The abdomen was opened by a mid-line incision from top to bottom, and the abdominal contents packed away from one or other ureter. Simultaneous pressure records were obtained from each third of the ureter, or from two points on the ureter and from the bladder. To record pressures from the ureter, hypodermic needles sealed to fine polythene tubing were thrust into the lumen. The tubing was attached to Statham straingauge manometers, and these were connected to a Sanborn 'Poly-Viso' physiological recorder. Bladder pressure was recorded from a catheter inserted through the urethra. In four dogs the bladder was opened and the discharge of urine from the ureteric orifice was observed and signalled. When diuresis was required, 5 % dextrose solution was given by rapid intravenous drip. Bladder pressure was varied either by manual compression or by emptying and filling by way of a widebore needle thrust through the wall. The flow of urine down the ureters of nine dogs, eleven rabbits and two rats were observed after intravenous injection of indigo carmine. RESULTS Pressure records from the dogPressures recordedfrom three points on the ureter. Pressure patterns from each of three points were often found to differ sharply from one another, both in respect to basic pressure (that is the pressure existing between peristaltic waves) and in respect to the rise of pressure caused by passage of a peristaltic wave. Basic pressures mostly fell within a range of 0-30 cm water, and wave amplitudes ranged from 4 to 70 cm water. The general pattern of the triple trace also varied greatly between animals, and in the same animal from time to time (Text- fig. 1).