BackgroundIn the Netherlands, 30% of subfertile women are overweight or obese, and at present there is no agreement on fertility care for them. Data from observational and small intervention studies suggest that reduction of weight will increase the chances of conception, decrease pregnancy complications and improve perinatal outcome, but this has not been confirmed in randomised controlled trials. This study will assess the cost and effects of a six-months structured lifestyle program aiming at weight reduction followed by conventional fertility care (intervention group) as compared to conventional fertility care only (control group) in overweight and obese subfertile women. We hypothesize that the intervention will decrease the need for fertility treatment, diminish overweight-related pregnancy complications, and will improve perinatal outcome.Methods/DesignMulticenter randomised controlled trial in subfertile women (age 18-39 year) with a body mass index between 29 and 40 kg/m2. Exclusion criteria are azoospermia, use of donor semen, severe endometriosis, premature ovarian failure, endocrinopathies or pre-existent hypertensive disorders.In the intervention group the aim is a weight loss of at least 5% to10% in a six-month period, to be achieved by the combination of a diet, increase of physical activity and behavioural modification. After six months, in case no conception has been achieved, these patients will start fertility treatment according to the Dutch fertility guidelines. In the control group treatment will be started according to Dutch fertility guidelines, independently of the patient's weight.Outcome measures and analysisThe primary outcome measure is a healthy singleton born after at least 37 weeks of gestation after vaginal delivery. Secondary outcome parameters including pregnancy outcome and complications, percentage of women needing fertility treatment, clinical and ongoing pregnancy rates, body weight, quality of life and costs.Data will be analysed according to the intention to treat principle, and cost-effectiveness analysis will be performed to compare the costs and health effects in the intervention and control group.DiscussionThe trial will provide evidence for costs and effects of a lifestyle intervention aiming at weight reduction in overweight and obese subfertile women and will offer guidance to clinicians for the treatment of these patients.Trial registrationDutch Trial Register NTR1530

We report on three Dutch children with a clinical diagnosis of oculoauriculovertebral spectrum (OAVS) and hydrocephalus. The clinical features are compared to 15 published cases of OAVS and hydrocephalus. Several other cerebral abnormalities were present in the whole group.

Summary. Peritoneal fluid was collected in the periovulatory phase of the cycle from 25 women undergoing laparoscopy. Endometriosis was diagnosed in 13 patients (AFS score 1, N = 9; AFS score 2, N = 4) and 12 patients without endometriosis served as controls. In endometriosis patients the total peritoneal fluid cell number and cell concentration was significantly higher than in controls, indicating peritoneal irritation by endometrial implants. Peritoneal fluid macrophages in patients with endometriosis showed significantly increased erythrophagocytosis and lower chemiluminescence than in controls, suggesting an advanced differentiation of the macrophages in endometriosis patients. The macrophages in this stage of differentiation may interfere with gametes and embryos and thus contribute to endometriosis-associated subfertility.

During a laparoscopy that was performed between Day \p=n-\6and Day +9 of the cycle as related to the day of the LH peak (Day 0), the peritoneal fluid of 100 healthy female volunteers of proven fertility was collected and analysed. Peritoneal fluid volume and concentrations of total protein, albumin, \g=a\1-,\g=a\2-,\ g=b\and \g=g\-globulins, IgA, IgG, IgM, haptoglobulin, acid-\g=a\1-glycoprotein,\g=a\1-antitrypsin,\g=a\2-macroglobulin, C3-, C4-and C-reactive protein were determined. The peritoneal fluid volume and the concentrations of most proteins analysed showed an increase during the post-ovulatory phase of the period investigated. The peritoneal fluid:serum ratio of each individual protein showed a significant inverse correlation with its molecular weight. This confirms the assumption that peritoneal fluid is mainly an exudation product, most probably of ovarian origin.

Available reports suggest that uterine artery embolization (UAE) has advantages over surgery when treating heavy menstrual bleeding caused by uterine fibroids, but some of these studies lack a control group of women treated in other ways-as by hysterectomy. The EMMY trial (comparing EMbolization with hysterectoMY), conducted at 28 Dutch hospitals, compared the efficacy of UAE with that of hysterectomy for treating menorrhagia resulting from uterine fibroids. Women describing increased or prolonged menstrual blood loss that interfered with daily life were included in the trial. A total of 88 patients were randomized to UAE and 89 to hysterectomy, which usually was performed transabdominally. The primary end point was whether, after a prospective 24-month follow-up interval, UAE avoided subsequent hysterectomy in at least 75% of cases. UAE failed bilaterally in 4 patients who later underwent hysterectomy. The rate of unilateral failure was 12%. In all, 23.5% of patients assigned to UAE had undergone hysterectomy 2 years after treatment. The hysterectomies were evenly distributed over time. All but one of them were done for persistent or recurrent menorrhagia. There were no significant group differences in the rate of improvement in either lower abdominal pain or bulk-related symptoms. Pain was less than at baseline in more than three-fourths of both patient groups, and bulk-related symptoms in at least two-thirds of women in each group. Reductions in uterine volume and fibroid volume following UAE were highly significant. Blood hemoglobin levels rose significantly in both groups compared to baseline values.The investigators conclude that UAE is a sound alternative to hysterectomy in women with symptomatic uterine fibroids. Nevertheless, hysterectomy remains the preferred treatment for patients who wish to be certain that bleeding will cease. GYNECOLOGYVolume 62, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Operative laparoscopy is a most important development in gynecological surgery, and also is a technically challenging type of surgery. In general surgery, making available an advanced endoscopic surgeon in the setting of mentor traineeship has improved the results of advanced procedures performed by residents. This study evaluated a mentor traineeship in laparoscopic surgery at a teaching hospital. Starting in 2001, an advanced endoscopic gynecologist has mentored a trainee in laparoscopic surgery. Results were reviewed for the preceding years 1997-2000 and for the training years 2001-2004. The trainee was scheduled to perform surgery 1 day a week and was mentored biweekly in the operating room. The trainee was in each instance the primary surgeon, and the mentor an assistant. ABSTRACTMucosal lichen planus (LP) is a rare variant of LP, itself a common skin disorder. Two-thirds of those affected have an erosive form of LP that causes severe vulvovaginal and, in some cases, oral mucosal symptoms, including burning, pain, and pruritus. The disease affects the vaginal orifice and often, the labia minora. P...