Gonadotrophin-releasing hormone (GnRH) antagonists suppress gonadotrophin secretion resulting in dramatic reduction in treatment cycle duration. Assuming comparable clinical outcomes, these benefits may justify changing the standard long GnRH agonist protocol to GnRH antagonist regimens. To evaluate the evidence, databases (e.g. Cochrane Library, MEDLINE, EMBASE) were electronically searched, hand searches were performed, and manufacturers in the field were contacted. Twenty-seven randomized controlled trials (RCT) fulfilled inclusion criteria for comparison of GnRH antagonist with long GnRH agonist protocol. Clinical pregnancy rate and ongoing pregnancy/live-birth rate were significantly lower in the antagonist group (P = 0.009; OR = 0.83, 95% CI 0.72-0.95 and P = 0.02; OR = 0.82, 95% CI 0.68-0.97 respectively). Conversely, incidence of severe OHSS was significantly reduced with the antagonist protocol (P = 0.01; OR = 0.60, 95% CI 0.40-0.88), and interventions to prevent OHSS were administered more frequently in the agonist group (P = 0.03; OR = 0.43, 95% CI 0.20-0.92). Concluding, GnRH antagonist protocols are short, simple, with good clinical outcomes and significant reduction in severe OHSS incidence and gonadotrophin amount; however, the lower pregnancy rate compared with the GnRH agonist long protocol necessitates counselling subfertile couples before recommending change from GnRH agonist to antagonist.

Objective: To prospectively investigate the effects on urinary tract infection (UTI) of indwelling urinary catheter placement during cesarean delivery.Study Design: Randomized controlled trial.Result: There were no significant differences between the two groups regarding patient demographics. There was, however, a statistically significant increase in women using general anesthesia in the catheterized group (CG). Even so, the incidence of UTI was significantly greater in the CG (P<0.001). In addition, mean time to patient ambulation, first postoperative voiding, oral rehydration, intestinal movement and duration of hospital stay were significantly less in the uncatheterized group (UG; P<0.001), with most patients (95.3%) selfvoiding without any intervention. Moreover, no intraoperative complications were recorded in the UG.Conclusion: Non-placement of indwelling urinary catheter during cesarean was more convenient to women with no increase in intraoperative complications, or urinary retention. Indwelling catheter placement in hemodynamically stable patients proved not to be beneficial in this study.

No abstract

This Cochrane review shows a clear benefit from administration of i.v. albumin at the time of oocyte retrieval in prevention of severe OHSS in high-risk cases. Whether the number needed to treat would justify the routine use of albumin infusion in cases at risk of severe OHSS needs to be judged by clinical decision-makers.

No abstract