Recurrent implantation failure refers to failure to achieve a clinical pregnancy after transfer of at least four good-quality embryos in a minimum of three fresh or frozen cycles in a woman under the age of 40 years. The failure to implant may be a consequence of embryo or uterine factors. Thorough investigations should be carried out to ascertain whether there is any underlying cause of the condition. Ovarian function should be assessed by measurement of antral follicle count, FSH and anti-Mu¨llerian hormone. Increased sperm DNA fragmentation may be a contributory cause. Various uterine pathology including fibroids, endometrial polyps, congenital anomalies and intrauterine adhesions should be excluded by ultrasonography and hysteroscopy. Hydrosalpinges are a recognized cause of implantation failure and should be excluded by hysterosalpingogram; if necessary, laparoscopy should be performed to confirm or refute the diagnosis. Treatment offered should be evidence based, aimed at improving embryo quality or endometrial receptivity. Gamete donation or surrogacy may be necessary if there is no realistic chance of success with further IVF attempts.

Background: The role of 18 fludeoxyglucose ( 18 F-FDG) PET/CT in the management of limited stage small-cell lung cancer (LS-SCLC) is uncertain. Previous studies have shown that 18 F-FDG PET/CT upstages up to 30% of LS-SCLC patients. Data from the CONVERT trial was analysed to investigate the impact of 18 F-FDG PET/CT in the management of LS-SCLC. The prognostic significance of pre-treatment 18 F-FDG PET parameters was also investigated in an exploratory analysis. Method: CONVERT is an international multi-centre phase III trial that randomly assigned fit patients to receive either twice-daily (45Gy in 30 fractions) or once-daily (66Gy in 33 fractions) radiotherapy starting on day 22 of chemotherapy cycle 1 (NCT00433563). Chemotherapy consisted of 4-6 cycles of cisplatin and etoposide. Prophylactic cranial irradiation was offered, if indicated. Contrast-enhanced thorax and abdomen CT and brain imaging (with/ without bone scintigraphy according to clinical indication) were mandated for all CONVERT participants (conventional imaging). Staging with 18 F-FDG PET/CT was allowed but not mandated. The primary endpoint was overall survival. Pre-treatment 18 F-FDG PET metabolic parameters were investigated in a subset of patients (n¼96) including standardised uptake values (max, mean and peak), volumetric and heterogeneity parameters. Result: Of 547 patients recruited to CONVERT, 540 patients with data on staging investigations and outcome were included in this analysis. The use of staging 18 F-FDG PET/CT was variable in the 8 countries recruiting to CONVERT (range, 41-100%). Compared to patients who underwent conventional imaging (n¼231), patients who were also staged with 18 F-FDG PET/CT (n¼309) had smaller gross tumour volume (p¼0$003), were less likely to have elevated pre-treatment serum lactate dehydrogenase (p¼0$035), and received more chemotherapy cycles (p¼0$026). There were no other significant differences in baseline and treatment characteristics between the two groups. There were no significant differences in overall (hazard ratio 0$87 [95% CI 0$70-1$08]; p¼0$192) and progression-free survival (hazard ratio 0$87 [95% CI 0$71-1$07]; p¼0$198) between patients staged with 18 F-FDG PET/CT in addition to conventional imaging or with conventional imaging alone. These results were observed irrespective of treatment group (once-daily and twice-daily radiotherapy). Pre-treatment 18 F-FDG PET parameters were also not prognostic. Conclusion: In CONVERT, survival outcomes were not different in LS-SCLC patients staged with or without 18 F-FDG PET/CT. This was despite those patients staged with 18 F-PET/CT having more favourable baseline and treatment characteristics. Our findings suggest that conventional imaging is sufficient to select LS-SCLC patients for concurrent chemoradiotherapy.Background: The interim analysis of our prospective trial, which compared irradiation to pre-chemotherapy or post-chemotherapy tumour extent while application of involved field radiotherapy (IFRT) for limited-stage small cell lung cancer (SCLC...

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