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BACKGROUNDCorifollitropin alfa, a fusion protein lacking LH activity, has a longer elimination half-life and extended time to peak levels than recombinant FSH (rFSH). A single injection of corifollitropin alfa may replace seven daily gonadotrophin injections during the first week of ovarian stimulation.METHODSIn this large, double-blind, randomized, non-inferiority trial the ongoing pregnancy rates were assessed after one injection of 150 µg corifollitropin alfa during the first week of stimulation and compared with daily injections of 200 IU rFSH using a standard GnRH antagonist protocol.RESULTSThe study population comprised 1506 treated patients with mean age of 31.5 years and body weight of 68.6 kg. Ongoing pregnancy rates of 38.9% for the corifollitropin alfa group and 38.1% for rFSH were achieved, with an estimated non-significant difference of 0.9% [95% confidence interval (CI): −3.9; 5.7] in favor of corifollitropin alfa. Stratified analyses of pregnancy rates confirmed robustness of this primary outcome by showing similar results regardless of IVF or ICSI, or number of embryos transferred. A slightly higher follicular response with corifollitropin alfa resulted in a higher number of cumulus–oocyte-complexes compared with rFSH [estimated difference 1.2 (95% CI: 0.5; 1.9)], whereas median duration of stimulation was equal (9 days) and incidence of (moderate/severe) ovarian hyperstimulation syndrome was the same (4.1 and 2.7%, respectively P = 0.15).CONCLUSIONCorifollitropin alfa is a novel and effective treatment option for potential normal responder patients undergoing ovarian stimulation with GnRH antagonist co-treatment for IVF resulting in a high ongoing pregnancy rate, equal to that achieved with daily rFSH. The trial was registered under ClinicalTrials.gov identifier NTC00696800.

An estimated 7% of pregnant women sustain trauma; a recent report claims 3.7 traumatic fetal deaths for every 100,000 live births. It seems likely that fetal mortality is increased even in cases of minor injury. The present survey of 112 emergency medicine residency programs at teaching hospitals yielded 87 responses (response rate, 78%). The 25-question survey asked about what routines are followed for assessing injured pregnant women and included a few hypothetical patients.A large majority of respondents (78%) reported routinely monitoring women with a viable fetus for 2 to 4 hours for anything more than minor extremity injury. One in five, however, instituted monitoring only for abdominal tenderness or pain. When fetal monitoring is carried out in the emergency department, an obstetric physician is involved more than half the time. Only 15% of programs have cardiotocographic equipment in the emergency department, and of the others, only one third have an established protocol for checking fetal heart tones (usually at 15-minute intervals). Nearly half of the programs would monitor the fetus routinely after a fall even if there were no abdominal pain or bleeding. Sonographic equipment is available in half the units. With a fetus of nonviable age, sonography usually is done only when there is lower abdominal pain. Without exception the programs have continual access to in-house emergency obstetrical consultation. When there is no obvious injury, the mechanism of injury is an important factor when deciding whether to carry out monitoring. For instance, ejection from a vehicular rollover and direct blunt abdominal trauma in an assault would prompt monitoring.This survey of emergency medicine residency programs indicate that the commonest approach to blunt trauma in pregnant women is to clear the mother in the emergency department and not monitor the fetus. Later patients are selectively sent to the obstetric area to check the fetus. ABSTRACTOver the past two decades, immediate or delayed hypersensitivity to latex antigens has assumed increasing importance as a medical problem in various patient populations. This study attempted to determine the seroprevalence of anti-latex immunoglobulin E (IgE) antibodies in patients 18 years and older who presented to an emergency department. Titers of latex-specific IgE antibody were measured using a latex-specific IgG assay (the AlaSTAT Microplate Latex-Specific IgE Assay) in 1027 patients. In addition, serum IgE antibody to 12 common inhalant allergens were estimated by the allergy screen assay. The patients included in the study had a mean age of 47. Just more than half were females, and a large majority was nonwhite.The rate of seropositivity for latex-specific IgG was 8.2%, and the rate of positive AlaTOP results was 42%. Of patients who were seropositive for latex antibody, 24% were rated as strongly positive. Being nonwhite increased the likelihood of latex-specific seropositivity (odds ratio, 4.7), as did being seropositive for inhalant allergens (odds ratio, 7.4). It s...

Computer-automated time-lapse analysis has been shown to improve embryo selection by providing quantitative and objective information to supplement traditional morphology. In this multi-centre study, the relationship between such computer-derived outputs (High, Medium, Low scores), embryo implantation and clinical pregnancy were examined. Data were collected from six clinics, including 205 patients whose embryos were imaged by the Eeva™System. The Eeva scores were blinded and not considered during embryo selection. Embryos with High and Medium scores had significantly higher implantation rates than those with Low scores (37% and 35% versus 15%; P < 0.0001; P = 0.0004). Similar trends in implantation rates were observed in different IVF centres each using their own protocols. Further analysis revealed that patients with at least one High embryo transferred had significantly higher clinical pregnancy rates than those with only Low embryos transferred (51% versus 34%; P = 0.02), although patients’ clinical characteristics across groups were comparable. These data, together with previous research and clinical studies, confirm that computer-automated Eeva scores provide valuable information, which may improve the clinical outcome of IVF procedures and ultimately facilitate the trend of single embryo selection.