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Janssen CAH, Smits AAL. [Menopausal transition]. Ned Tijdschr Geneeskd 2024; 167:D7479. [PMID: 38319301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
In this educative article 10 medical questions related to the menopausal transition are answered. The questions are related to etiology, symptomatology, lab investigation, sexuality, need for contraception, hormonal and non-hormonal treatments and their risks and benefits. The purpose of this article is to assist the healthcare practitioner to understand the impact of the menopausal transition, to recognize the symptoms and to understand the risks and benefits of treatment. As women on average work and live longer, they are on average 30 percent of their lives postmenopausal. Attention should be paid to quality of life not only during menopausal transition, but also thereafter, with special awareness of the long term sequelae on women's health.
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Affiliation(s)
- C A H Janssen
- Groene Hart Ziekenhuis, afd. Gynaecologie, Gouda
- Contact:
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van Hoogenhuijze NE, van Eekelen R, Mol F, Schipper I, Groenewoud ER, Traas MAF, Janssen CAH, Teklenburg G, de Bruin JP, van Oppenraaij RHF, Maas JWM, Moll E, Fleischer K, van Hooff MHA, de Koning CH, Cantineau AEP, Lambalk CB, Verberg M, van Heusden AM, Manger AP, van Rumste MME, van der Voet LF, Pieterse QD, Visser J, Brinkhuis EA, den Hartog JE, Glas MW, Klijn NF, van der Zanden M, Bandell ML, Boxmeer JC, van Disseldorp J, Smeenk J, van Wely M, Eijkemans MJC, Torrance HL, Broekmans FJM. Economic evaluation of endometrial scratching before the second IVF/ICSI treatment: a cost-effectiveness analysis of a randomized controlled trial (SCRaTCH trial). Hum Reprod 2022; 37:254-263. [PMID: 34864993 PMCID: PMC8804332 DOI: 10.1093/humrep/deab261] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 10/12/2021] [Indexed: 11/22/2022] Open
Abstract
STUDY QUESTION Is a single endometrial scratch prior to the second fresh IVF/ICSI treatment cost-effective compared to no scratch, when evaluated over a 12-month follow-up period? SUMMARY ANSWER The incremental cost-effectiveness ratio (ICER) for an endometrial scratch was €6524 per additional live birth, but due to uncertainty regarding the increase in live birth rate this has to be interpreted with caution. WHAT IS KNOWN ALREADY Endometrial scratching is thought to improve the chances of success in couples with previously failed embryo implantation in IVF/ICSI treatment. It has been widely implemented in daily practice, despite the lack of conclusive evidence of its effectiveness and without investigating whether scratching allows for a cost-effective method to reduce the number of IVF/ICSI cycles needed to achieve a live birth. STUDY DESIGN, SIZE, DURATION This economic evaluation is based on a multicentre randomized controlled trial carried out in the Netherlands (SCRaTCH trial) that compared a single scratch prior to the second IVF/ICSI treatment with no scratch in couples with a failed full first IVF/ICSI cycle. Follow-up was 12 months after randomization.Economic evaluation was performed from a healthcare and societal perspective by taking both direct medical costs and lost productivity costs into account. It was performed for the primary outcome of biochemical pregnancy leading to live birth after 12 months of follow-up as well as the secondary outcome of live birth after the second fresh IVF/ICSI treatment (i.e. the first after randomization). To allow for worldwide interpretation of the data, cost level scenario analysis and sensitivity analysis was performed. PARTICIPANTS/MATERIALS, SETTING, METHODS From January 2016 until July 2018, 933 women with a failed first IVF/ICSI cycle were included in the trial. Data on treatment and pregnancy were recorded up until 12 months after randomization, and the resulting live birth outcomes (even if after 12 months) were also recorded.Total costs were calculated for the second fresh IVF/ICSI treatment and for the full 12 month period for each participant. We included costs of all treatments, medication, complications and lost productivity costs. Cost-effectiveness analysis was carried out by calculating ICERs for scratch compared to control. Bootstrap resampling was used to estimate the uncertainty around cost and effect differences and ICERs. In the sensitivity and scenario analyses, various unit costs for a single scratch were introduced, amongst them, unit costs as they apply for the United Kingdom (UK). MAIN RESULTS AND THE ROLE OF CHANCE More live births occurred in the scratch group, but this also came with increased costs over a 12-month period. The estimated chance of a live birth after 12 months of follow-up was 44.1% in the scratch group compared to 39.3% in the control group (risk difference 4.8%, 95% CI -1.6% to +11.2%). The mean costs were on average €283 (95% CI: -€299 to €810) higher in the scratch group so that the point average ICER was €5846 per additional live birth. The ICER estimate was surrounded with a high level of uncertainty, as indicated by the fact that the cost-effectiveness acceptability curve (CEAC) showed that there is an 80% chance that endometrial scratching is cost-effective if society is willing to pay ∼€17 500 for each additional live birth. LIMITATIONS, REASONS FOR CAUTION There was a high uncertainty surrounding the effects, mainly in the clinical effect, i.e. the difference in the chance of live birth, which meant that a single straightforward conclusion could not be ascertained as for now. WIDER IMPLICATIONS OF THE FINDINGS This is the first formal cost-effectiveness analysis of endometrial scratching in women undergoing IVF/ICSI treatment. The results presented in this manuscript cannot provide a clear-cut expenditure for one additional birth, but they do allow for estimating costs per additional live birth in different scenarios once the clinical effectiveness of scratching is known. As the SCRaTCH trial was the only trial with a follow-up of 12 months, it allows for the most complete estimation of costs to date. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by ZonMW, the Dutch organization for funding healthcare research. A.E.P.C., F.J.M.B., E.R.G. and C.B. L. reported having received fees or grants during, but outside of, this trial. TRIAL REGISTRATION NUMBER Netherlands Trial Register (NL5193/NTR 5342).
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Affiliation(s)
- N E van Hoogenhuijze
- Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R van Eekelen
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology—NVOG Consortium 2.0, Amsterdam, The Netherlands
| | - F Mol
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Reproduction and Development, Amsterdam, The Netherlands
| | - I Schipper
- Division of Reproductive Endocrinology and Infertility, Department Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E R Groenewoud
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Noordwest Ziekenhuisgroep, Den Helder, The Netherlands
| | - M A F Traas
- Department of Gynaecology, Gelre Hospital, Apeldoorn, The Netherlands
| | - C A H Janssen
- Department of Gynaecology, Groene Hart Hospital, Gouda, The Netherlands
| | - G Teklenburg
- Isala Fertility Clinic, Isala Hospital, Zwolle, The Netherlands
| | - J P de Bruin
- Department of Gynaecology and Obstetrics, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | | | - J W M Maas
- Department of Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - E Moll
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - K Fleischer
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M H A van Hooff
- Department of Gynaecology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - C H de Koning
- Department of Gynaecology, Tergooi Hospital, Hilversum, The Netherlands
| | - A E P Cantineau
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Verberg
- Fertility Clinic, Fertility Clinic Twente, Hengelo, The Netherlands
| | - A M van Heusden
- Fertility Clinic, Medisch Centrum Kinderwens, Leiderdorp, The Netherlands
| | - A P Manger
- Department of Gynaecology, Diakonessenhuis, Utrecht, The Netherlands
| | - M M E van Rumste
- Department of Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - L F van der Voet
- Department of Gynaecology, Deventer Hospital, Deventer, The Netherlands
| | - Q D Pieterse
- Fertility Center, Haga Hospital, The Hague, The Netherlands
| | - J Visser
- Department of Gynaecology and Obstetrics, Amphia Hospital, Breda, The Netherlands
| | - E A Brinkhuis
- Department of Gynaecology and Obstetrics, Meander Hospital, Amersfoort, The Netherlands
| | - J E den Hartog
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - M W Glas
- Fertility Clinic, Wilhelmina Hospital Assen, Assen, The Netherlands
| | - N F Klijn
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M van der Zanden
- Department of Gynaecology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - M L Bandell
- Department of Gynaecology, Albert Schweitzer Hospital, Sliedrecht, The Netherlands
| | - J C Boxmeer
- Department of Gynaecology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - J van Disseldorp
- Department of Gynaecology and Obstetrics, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J Smeenk
- Department of Reproductive Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology—NVOG Consortium 2.0, Amsterdam, The Netherlands
| | - M J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - H L Torrance
- Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F J M Broekmans
- Department of Gynaecology and Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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van Hoogenhuijze NE, Mol F, Laven JSE, Groenewoud ER, Traas MAF, Janssen CAH, Teklenburg G, de Bruin JP, van Oppenraaij RHF, Maas JWM, Moll E, Fleischer K, van Hooff MHA, de Koning CH, Cantineau AEP, Lambalk CB, Verberg M, van Heusden AM, Manger AP, van Rumste MME, van der Voet LF, Pieterse QD, Visser J, Brinkhuis EA, den Hartog JE, Glas MW, Klijn NF, van der Meer S, Bandell ML, Boxmeer JC, van Disseldorp J, Smeenk J, van Wely M, Eijkemans MJC, Torrance HL, Broekmans FJM. Endometrial scratching in women with one failed IVF/ICSI cycle-outcomes of a randomised controlled trial (SCRaTCH). Hum Reprod 2021; 36:87-98. [PMID: 33289528 PMCID: PMC7801792 DOI: 10.1093/humrep/deaa268] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/27/2020] [Indexed: 11/18/2022] Open
Abstract
STUDY QUESTION Does endometrial scratching in women with one failed IVF/ICSI treatment affect the chance of a live birth of the subsequent fresh IVF/ICSI cycle? SUMMARY ANSWER In this study, 4.6% more live births were observed in the scratch group, with a likely certainty range between −0.7% and +9.9%. WHAT IS KNOWN ALREADY Since the first suggestion that endometrial scratching might improve embryo implantation during IVF/ICSI, many clinical trials have been conducted. However, due to limitations in sample size and study quality, it remains unclear whether endometrial scratching improves IVF/ICSI outcomes. STUDY DESIGN, SIZE, DURATION The SCRaTCH trial was a non-blinded randomised controlled trial in women with one unsuccessful IVF/ICSI cycle and assessed whether a single endometrial scratch using an endometrial biopsy catheter would lead to a higher live birth rate after the subsequent IVF/ICSI treatment compared to no scratch. The study took place in 8 academic and 24 general hospitals. Participants were randomised between January 2016 and July 2018 by a web-based randomisation programme. Secondary outcomes included cumulative 12-month ongoing pregnancy leading to live birth rate. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with one previous failed IVF/ICSI treatment and planning a second fresh IVF/ICSI treatment were eligible. In total, 933 participants out of 1065 eligibles were included (participation rate 88%). MAIN RESULTS AND THE ROLE OF CHANCE After the fresh transfer, 4.6% more live births were observed in the scratch compared to control group (110/465 versus 88/461, respectively, risk ratio (RR) 1.24 [95% CI 0.96–1.59]). These data are consistent with a true difference of between −0.7% and +9.9% (95% CI), indicating that while the largest proportion of the 95% CI is positive, scratching could have no or even a small negative effect. Biochemical pregnancy loss and miscarriage rate did not differ between the two groups: in the scratch group 27/153 biochemical pregnancy losses and 14/126 miscarriages occurred, while this was 19/130 and 17/111 for the control group (RR 1.21 (95% CI 0.71–2.07) and RR 0.73 (95% CI 0.38–1.40), respectively). After 12 months of follow-up, 5.1% more live births were observed in the scratch group (202/467 versus 178/466), of which the true difference most likely lies between −1.2% and +11.4% (95% CI). LIMITATIONS, REASONS FOR CAUTION This study was not blinded. Knowledge of allocation may have been an incentive for participants allocated to the scratch group to continue treatment in situations where they may otherwise have cancelled or stopped. In addition, this study was powered to detect a difference in live birth rate of 9%. WIDER IMPLICATIONS OF THE FINDINGS The results of this study are an incentive for further assessment of the efficacy and clinical implications of endometrial scratching. If a true effect exists, it may be smaller than previously anticipated or may be limited to specific groups of women undergoing IVF/ICSI. Studying this will require larger sample sizes, which will be provided by the ongoing international individual participant data-analysis (PROSPERO CRD42017079120). At present, endometrial scratching should not be performed outside of clinical trials. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by ZonMW, the Dutch organisation for funding healthcare research. J.S.E. Laven reports grants and personal fees from AnshLabs (Webster, Tx, USA), Ferring (Hoofddorp, The Netherlands) and Ministry of Health (CIBG, The Hague, The Netherlands) outside the submitted work. A.E.P. Cantineau reports ‘other’ from Ferring BV, personal fees from Up to date Hyperthecosis, ‘other’ from Theramex BV, outside the submitted work. E.R. Groenewoud reports grants from Titus Health Care during the conduct of the study. A.M. van Heusden reports personal fees from Merck Serono, personal fees from Ferring, personal fees from Goodlife, outside the submitted work. F.J.M. Broekmans reports personal fees as Member of the external advisory board for Ferring BV, The Netherlands, personal fees as Member of the external advisory board for Merck Serono, The Netherlands, personal fees as Member of the external advisory for Gedeon Richter, Belgium, personal fees from Educational activities for Ferring BV, The Netherlands, grants from Research support grant Merck Serono, grants from Research support grant Ferring, personal fees from Advisory and consultancy work Roche, outside the submitted work. C.B. Lambalk reports grants from Ferring, grants from Merck, grants from Guerbet, outside the submitted work. TRIAL REGISTRATION NUMBER Registered in the Netherlands Trial Register (NL5193/NTR 5342). TRIAL REGISTRATION DATE 31 July 2015. DATE OF FIRST PATIENT’S ENROLMENT 26 January 2016.
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Affiliation(s)
- N E van Hoogenhuijze
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - F Mol
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Reproduction and Development, Meibergdreef 9, Amsterdam, the Netherlands
| | - J S E Laven
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre Rotterdam, 3015 GD, Rotterdam, the Netherlands
| | - E R Groenewoud
- Department of Obstetrics, Gynaecology & Reproductive Medicine, Noordwest Ziekenhuisgroep, 1782 GZ, Den Helder, the Netherlands
| | - M A F Traas
- Department of Gynaecology, Gelre Hospital, 7334 DZ, Apeldoorn, the Netherlands
| | - C A H Janssen
- Department of Gynaecology, Groene Hart Hospital, 2803 HH, Gouda, the Netherlands
| | - G Teklenburg
- Isala Fertility Clinic, Isala Hospital, 8025 AB, Zwolle, the Netherlands
| | - J P de Bruin
- Department of Gynaecology & Obstetrics, Jeroen Bosch Hospital, 5223 GZ, Den Bosch, the Netherlands
| | - R H F van Oppenraaij
- Department of Gynaecology, Maasstad Hospital, 3079 DZ, Rotterdam, the Netherlands
| | - J W M Maas
- Department of Gynaecology, Maxima Medical Centre, 5504 DB, Veldhoven, the Netherlands
| | - E Moll
- Department of Gynaecology, Onze Lieve Vrouwe Gasthuis, 1061 AE, Amsterdam, the Netherlands
| | - K Fleischer
- Department of Obstetrics & Gynaecology, Radboud University Medical Centre, 6525 GA, Nijmegen, the Netherlands
| | - M H A van Hooff
- Department of Gynaecology, Franciscus Gasthuis en Vlietland, 3045 PM, Rotterdam, the Netherlands
| | - C H de Koning
- Department of Gynaecology, Tergooi Hospital, 1213 XZ, Hilversum, the Netherlands
| | - A E P Cantineau
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - M Verberg
- Fertility Clinic, Fertility Clinic Twente, 7556 BN, Hengelo, the Netherlands
| | - A M van Heusden
- Fertility Clinic, Medisch Centrum Kinderwens, 2353 GA, Leiderdorp, the Netherlands
| | - A P Manger
- Department of Gynaecology, Diakonessenhuis, 3582 KE, Utrecht, the Netherlands
| | - M M E van Rumste
- Department of Gynaecology, Catharina Hospital, 5623 EJ, Eindhoven, the Netherlands
| | - L F van der Voet
- Department of Gynaecology, Deventer Hospital, 7416 SE, Deventer, the Netherlands
| | - Q D Pieterse
- Fertility Center, Haga Hospital, 2545 AA, The Hague, the Netherlands
| | - J Visser
- Department of Gynaecology & Obstetrics, Amphia Hospital, 4818 CK, Breda, the Netherlands
| | - E A Brinkhuis
- Department of Gynaecology & Obstetrics, Meander Hospital, 3813 TZ, Amersfoort, the Netherlands
| | - J E den Hartog
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, 6229 HX, Maastricht, the Netherlands
| | - M W Glas
- Fertility clinic, Wilhelmina Hospital Assen, 9401 RK, Assen, the Netherlands
| | - N F Klijn
- Department of Gynaecology, Leiden University Medical Centre, 2333 ZA, Leiden, the Netherlands
| | - S van der Meer
- Department of Gynaecology, Haaglanden Medical Centre, 2512 VA, The Hague, the Netherlands
| | - M L Bandell
- Department of Gynaecology, Albert Schweitzer Hospital, 3364 DA, Sliedrecht,the Netherlands
| | - J C Boxmeer
- Department of Gynaecology, Reinier de Graaf Gasthuis, 2625 AD, Delft, the Netherlands
| | - J van Disseldorp
- Department of Gynaecology & Obstetrics, St. Antonius Hospital, 3435 CM, Nieuwegein, the Netherlands
| | - J Smeenk
- Department of Reproductive Medicine, Elisabeth-TweeSteden Hospital, 5042 AD, Tilburg, the Netherlands
| | - M van Wely
- Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology - NVOG Consortium 2.0
| | - M J C Eijkemans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands.,Julius Centre for Health Sciences and Primary Care, Department of Medical Humanities, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - H L Torrance
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
| | - F J M Broekmans
- Department of Gynaecology & Reproductive Medicine, University Medical Centre Utrecht, Utrecht University, PO Box 85500, 3508 GA, Utrecht, the Netherlands
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker W, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1578-1588. [PMID: 32353142 PMCID: PMC7368397 DOI: 10.1093/humrep/dez284] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER In women with a septate uterus, septum resection does not increase live birth rate nor does it decrease the rates of pregnancy loss or preterm birth, compared with expectant management. WHAT IS KNOWN ALREADY The septate uterus is the most common uterine anomaly with an estimated prevalence of 0.2-2.3% in women of reproductive age, depending on the classification system. The definition of the septate uterus has been a long-lasting and ongoing subject of debate, and currently two classification systems are used worldwide. Women with a septate uterus may be at increased risk of subfertility, pregnancy loss, preterm birth and foetal malpresentation. Based on low quality evidence, current guidelines recommend removal of the intrauterine septum or, more cautiously, state that the procedure should be evaluated in future studies. STUDY DESIGN, SIZE, DURATION We performed an international multicentre cohort study in which we identified women mainly retrospectively by searching in electronic patient files, medical records and databases within the time frame of January 2000 until August 2018. Searching of the databases, files and records took place between January 2016 and July 2018. By doing so, we collected data on 257 women with a septate uterus in 21 centres in the Netherlands, USA and UK. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women with a septate uterus, defined by the treating physician, according to the classification system at that time. The women were ascertained among those with a history of subfertility, pregnancy loss, preterm birth or foetal malpresentation or during a routine diagnostic procedure. Allocation to septum resection or expectant management was dependent on the reproductive history and severity of the disease. We excluded women who did not have a wish to conceive at time of diagnosis. The primary outcome was live birth. Secondary outcomes included pregnancy loss, preterm birth and foetal malpresentation. All conceptions during follow-up were registered but for the comparative analyses, only the first live birth or ongoing pregnancy was included. To evaluate differences in live birth and ongoing pregnancy, we used Cox proportional regression to calculate hazard rates (HRs) and 95% CI. To evaluate differences in pregnancy loss, preterm birth and foetal malpresentation, we used logistic regression to calculate odds ratios (OR) with corresponding 95% CI. We adjusted all reproductive outcomes for possible confounders. MAIN RESULTS AND THE ROLE OF CHANCE In total, 257 women were included in the cohort. Of these, 151 women underwent a septum resection and 106 women had expectant management. The median follow-up time was 46 months. During this time, live birth occurred in 80 women following a septum resection (53.0%) compared to 76 women following expectant management (71.7%) (HR 0.71 95% CI 0.49-1.02) and ongoing pregnancy occurred in 89 women who underwent septum resection (58.9%), compared to 80 women who had expectant management (75.5%) (HR 0.74 (95% CI 0.52-1.06)). Pregnancy loss occurred in 51 women who underwent septum resection (46.8%) versus 31 women who had expectant management (34.4%) (OR 1.58 (0.81-3.09)), while preterm birth occurred in 26 women who underwent septum resection (29.2%) versus 13 women who had expectant management (16.7%) (OR 1.26 (95% CI 0.52-3.04)) and foetal malpresentation occurred in 17 women who underwent septum resection (19.1%) versus 27 women who had expectant management (34.6%) (OR 0.56 (95% CI 0.24-1.33)). LIMITATIONS, REASONS FOR CAUTION Our retrospective study has a less robust design compared with a randomized controlled trial. Over the years, the ideas about the definition of the septate uterus has changed, but since the 257 women with a septate uterus included in this study had been diagnosed by their treating physician according to the leading classification system at that time, the data of this study reflect the daily practice of recent decades. Despite correcting for the most relevant patient characteristics, our estimates might not be free of residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that septum resection, a procedure that is widely offered and associated with financial costs for society, healthcare systems or individuals, does not lead to improved reproductive outcomes compared to expectant management for women with a septate uterus. The results of this study need to be confirmed in randomized clinical trials. STUDY FUNDING/COMPETING INTEREST(S) A travel for JFWR to Chicago was supported by the Jo Kolk Studyfund. Otherwise, no specific funding was received for this study. The Department of Obstetrics and Gynaecology, University Medical Centre, Groningen, received an unrestricted educational grant from Ferring Pharmaceutical Company unrelated to the present study. BWM reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck, personal fees from Guerbet, other payment from Guerbet and grants from Merck, outside the submitted work. The other authors declare no conficts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the Netherlands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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5
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Bordewijk EM, Weiss NS, Nahuis MJ, Bayram N, van Hooff MHA, Boks DES, Perquin DAM, Janssen CAH, van Golde RJT, Lambalk CB, Goddijn M, Hompes PG, van der Veen F, Mol BWJ, van Wely M. Gonadotrophins versus clomiphene citrate with or without IUI in women with normogonadotropic anovulation and clomiphene failure: a cost-effectiveness analysis. Hum Reprod 2020; 34:276-284. [PMID: 30576539 DOI: 10.1093/humrep/dey359] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 11/21/2018] [Indexed: 12/28/2022] Open
Abstract
STUDY QUESTION Are six cycles of ovulation induction with gonadotrophins more cost-effective than six cycles of ovulation induction with clomiphene citrate (CC) with or without IUI in normogonadotropic anovulatory women not pregnant after six ovulatory cycles with CC? SUMMARY ANSWER Both gonadotrophins and IUI are more expensive when compared with CC and intercourse, and gonadotrophins are more effective than CC. WHAT IS KNOWN ALREADY In women with normogonadotropic anovulation who ovulate but do not conceive after six cycles with CC, medication is usually switched to gonadotrophins, with or without IUI. The cost-effectiveness of these changes in policy is unknown. STUDY DESIGN, SIZE, DURATION We performed an economic evaluation of ovulation induction with gonadotrophins compared with CC with or without IUI in a two-by-two factorial multicentre randomized controlled trial in normogonadotropic anovulatory women not pregnant after six ovulatory cycles with CC. Between December 2008 and December 2015 women were allocated to six cycles with gonadotrophins plus IUI, six cycles with gonadotrophins plus intercourse, six cycles with CC plus IUI or six cycles with CC plus intercourse. The primary outcome was conception leading to a live birth achieved within 8 months of randomization. PARTICIPANTS/MATERIALS, SETTING, METHODS We performed a cost-effectiveness analysis on direct medical costs. We calculated the direct medical costs of ovulation induction with gonadotrophins versus CC and of IUI versus intercourse in six subsequent cycles. We included costs of medication, cycle monitoring, interventions, and pregnancy leading to live birth. Resource use was collected from the case report forms and unit costs were derived from various sources. We calculated incremental cost-effectiveness ratios (ICER) for gonadotrophins compared to CC and for IUI compared to intercourse. We used non-parametric bootstrap resampling to investigate the effect of uncertainty in our estimates. The analysis was performed according to the intention-to-treat principle. MAIN RESULTS AND THE ROLE OF CHANCE We allocated 666 women in total to gonadotrophins and IUI (n = 166), gonadotrophins and intercourse (n = 165), CC and IUI (n = 163), or CC and intercourse (n = 172). Mean direct medical costs per woman receiving gonadotrophins or CC were €4495 versus €3006 (cost difference of €1475 (95% CI: €1457-€1493)). Live birth rates were 52% in women allocated to gonadotrophins and 41% in those allocated to CC (relative risk (RR) 1.24:95% CI: 1.05-1.46). The ICER was €15 258 (95% CI: €8721 to €63 654) per additional live birth with gonadotrophins. Mean direct medical costs per woman allocated to IUI or intercourse were €4497 versus €3005 (cost difference of €1510 (95% CI: €1492-€1529)). Live birth rates were 49% in women allocated to IUI and 43% in those allocated to intercourse (RR = 1.14:95% CI: 0.97-1.35). The ICER was €24 361 (95% CI: €-11 290 to €85 172) per additional live birth with IUI. LIMITATIONS, REASONS FOR CAUTION We allowed participating hospitals to use their local protocols for ovulation induction and IUI, which may have led to variation in costs, but which increases generalizability. Indirect costs generated by transportation or productivity loss were not included. We did not evaluate letrozole, which is potentially more effective than CC. WIDER IMPLICATIONS OF THE FINDINGS Gonadotrophins are more effective, but more expensive than CC, therefore, the use of gonadotrophins in women with normogonadotropic anovulation who have not conceived after six ovulatory CC cycles depends on society's willingness to pay for an additional child. In view of the uncertainty around the cost-effectiveness estimate of IUI, these data are not sufficient to make recommendations on the use of IUI in these women. In countries where ovulation induction regimens are reimbursed, policy makers and health care professionals may use our results in their guidelines. STUDY FUNDING/COMPETING INTEREST(S) This trial was funded by the Netherlands Organization for Health Research and Development (ZonMw number: 80-82310-97-12067). The Eudract number for this trial is 2008-006171-73. The Sponsor's Protocol Code Number is P08-40. CBLA reports unrestricted grant support from Merck and Ferring. BWM is supported by a NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy for Merck, ObsEva and Guerbet. TRIAL REGISTRATION NUMBER NTR1449.
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Affiliation(s)
- E M Bordewijk
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - N S Weiss
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Center for Reproductive Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - M J Nahuis
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Center for Reproductive Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - N Bayram
- Department of Obstetrics and Gynaecology, Zaans Medisch Centrum, Zaandam, The Netherlands
| | - M H A van Hooff
- Department of Obstetrics and Gynaecology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - D E S Boks
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - D A M Perquin
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - R J T van Golde
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - C B Lambalk
- Center for Reproductive Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - M Goddijn
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - P G Hompes
- Center for Reproductive Medicine, VU Medical Center, Amsterdam, The Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
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6
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker WKH, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Corrigendum. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1722. [PMID: 32472131 PMCID: PMC7368394 DOI: 10.1093/humrep/deaa141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the NetherNetherlandslands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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7
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Stegwee SI, Jordans IPM, van der Voet LF, Bongers MY, de Groot CJM, Lambalk CB, de Leeuw RA, Hehenkamp WJK, van de Ven PM, Bosmans JE, Pajkrt E, Bakkum EA, Radder CM, Hemelaar M, van Baal WM, Visser H, van Laar JOEH, van Vliet HAAM, Rijnders RJP, Sueters M, Janssen CAH, Hermes W, Feitsma AH, Kapiteijn K, Scheepers HCJ, Langenveld J, de Boer K, Coppus SFPJ, Schippers DH, Oei ALM, Kaplan M, Papatsonis DNM, de Vleeschouwer LHM, van Beek E, Bekker MN, Huisjes AJM, Meijer WJ, Deurloo KL, Boormans EMA, van Eijndhoven HWF, Huirne JAF. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development - the 2Close study: a multicentre randomised controlled trial. BMC Pregnancy Childbirth 2019; 19:85. [PMID: 30832681 PMCID: PMC6399840 DOI: 10.1186/s12884-019-2221-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Double-layer compared to single-layer closure of the uterus after a caesarean section (CS) leads to a thicker myometrial layer at the site of the CS scar, also called residual myometrium thickness (RMT). It possibly decreases the development of a niche, which is an interruption of the myometrium at the site of the uterine scar. Thin RMT and a niche are associated with gynaecological symptoms, obstetric complications in a subsequent pregnancy and delivery and possibly with subfertility. METHODS Women undergoing a first CS regardless of the gestational age will be asked to participate in this multicentre, double blinded randomised controlled trial (RCT). They will be randomised to single-layer closure or double-layer closure of the uterine incision. Single-layer closure (control group) is performed with a continuous running, unlocked suture, with or without endometrial saving technique. Double-layer closure (intervention group) is performed with the first layer in a continuous unlocked suture including the endometrial layer and the second layer is also continuous unlocked and imbricates the first. The primary outcome is the reported number of days with postmenstrual spotting during one menstrual cycle nine months after CS. Secondary outcomes include surgical data, ultrasound evaluation at three months, menstrual pattern, dysmenorrhea, quality of life, and sexual function at nine months. Structured transvaginal ultrasound (TVUS) evaluation is performed to assess the uterine scar and if necessary saline infusion sonohysterography (SIS) or gel instillation sonohysterography (GIS) will be added to the examination. Women and ultrasound examiners will be blinded for allocation. Reproductive outcomes at three years follow-up including fertility, mode of delivery and complications in subsequent deliveries will be studied as well. Analyses will be performed by intention to treat. 2290 women have to be randomised to show a reduction of 15% in the mean number of spotting days. Additionally, a cost-effectiveness analysis will be performed from a societal perspective. DISCUSSION This RCT will provide insight in the outcomes of single- compared to double-layer closure technique after CS, including postmenstrual spotting and subfertility in relation to niche development measured by ultrasound. TRIAL REGISTRATION Dutch Trial Register ( NTR5480 ). Registered 29 October 2015.
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Affiliation(s)
- S. I. Stegwee
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - I. P. M. Jordans
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - L. F. van der Voet
- Department of Obstetrics and Gynaecology, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, the Netherlands
| | - M. Y. Bongers
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, the Netherlands
- Department of Obstetrics and Gynaecology, Research school ‘GROW’, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - C. J. M. de Groot
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - C. B. Lambalk
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - R. A. de Leeuw
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - W. J. K. Hehenkamp
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
| | - P. M. van de Ven
- Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - J. E. Bosmans
- Department of Health sciences, Faculty of Science, Research institute ‘Amsterdam Public Health’, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - E. Pajkrt
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - E. A. Bakkum
- Department of Obstetrics and Gynaecology, OLVG-oost, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - C. M. Radder
- Department of Obstetrics and Gynaecology, OLVG-west, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands
| | - M. Hemelaar
- Department of Obstetrics and Gynaecology, Westfriesgasthuis, Maelsonstraat 3, 1624 NP Hoorn, the Netherlands
| | - W. M. van Baal
- Department of Obstetrics and Gynaecology, Flevo hospital, Hospitaalweg 1, 1315 RA Almere, the Netherlands
| | - H. Visser
- Department of Obstetrics and Gynaecology, Tergooi hospital, Rijksstraatweg 1, 1261 AN Blaricum, the Netherlands
| | - J. O. E. H. van Laar
- Department of Obstetrics and Gynaecology, Máxima Medical Centre, De Run 4600, 5504 DB Veldhoven, the Netherlands
| | - H. A. A. M. van Vliet
- Department of Obstetrics and Gynaecology, Catharina hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - R. J. P. Rijnders
- Department of Obstetrics and Gynaecology, Jeroen Bosch hospital, Henri Dunantstraat 1, 5223 GZ ‘s-Hertogenbosch, the Netherlands
| | - M. Sueters
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - C. A. H. Janssen
- Department of Obstetrics and Gynaecology, Groene Hart hospital, Bleulandweg 10, 2803 HH Gouda, the Netherlands
| | - W. Hermes
- Department of Obstetrics and Gynaecology, Haaglanden Medical Centre – Westeinde hospital, Lijnbaan 32, 2512 VA Den Haag, the Netherlands
| | - A. H. Feitsma
- Department of Obstetrics and Gynaecology, Haga hospital, Els-Borst-Eilersplein 275, 2545 AA Den Haag, the Netherlands
| | - K. Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf hospital, Reinier de Graafweg 5, 2625 AD Delft, the Netherlands
| | - H. C. J. Scheepers
- Department of Obstetrics and Gynaecology, Research school ‘GROW’, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - J. Langenveld
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - K. de Boer
- Department of Obstetrics and Gynaecology, Rijnstate hospital, Wagnerlaan 55, 6815 AD Arnhem, the Netherlands
| | - S. F. P. J. Coppus
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - D. H. Schippers
- Department of Obstetrics and Gynaecology, Canisius-Wilhelmina hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, the Netherlands
| | - A. L. M. Oei
- Department of Obstetrics and Gynaecology, Bernhoven hospital, Nistelrodeseweg 10, 5406 PT Uden, the Netherlands
| | - M. Kaplan
- Department of Obstetrics and Gynaecology, Röpcke-Zweers hospital, Jan Weitkamplaan 4a, 7772 SE Hardenberg, the Netherlands
| | - D. N. M. Papatsonis
- Department of Obstetrics and Gynaecology, Amphia hospital, Langendijk 75, 4819 EV Breda, the Netherlands
| | - L. H. M. de Vleeschouwer
- Department of Obstetrics and Gynaecology, Sint Franciscus hospital, Kleiweg 500, 3045 PM Rotterdam, the Netherlands
| | - E. van Beek
- Department of Obstetrics and Gynaecology, Sint Antonius hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
| | - M. N. Bekker
- Department of Obstetrics and Gynaecology, Birth Centre Wilhelmina Children hospital/University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - A. J. M. Huisjes
- Department of Obstetrics and Gynaecology, Gelre hospital – location Apeldoorn, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, the Netherlands
| | - W. J. Meijer
- Department of Obstetrics and Gynaecology, Gelre hospital – location Zutphen, Den Elterweg 77, 7207 AE Zutphen, the Netherlands
| | - K. L. Deurloo
- Department of Obstetrics and Gynaecology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, the Netherlands
| | - E. M. A. Boormans
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, the Netherlands
| | - H. W. F. van Eijndhoven
- Department of Obstetrics and Gynaecology, Isala clinics, Dokter van Heesweg 2, 8025 AB Zwolle, the Netherlands
| | - J. A. F. Huirne
- Department of Obstetrics and Gynaecology, Research institutes ‘Amsterdam Cardiovascular Sciences’ and ‘Amsterdam Reproduction and Development’, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
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8
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Danhof NA, van Wely M, Koks CAM, Gianotten J, de Bruin JP, Cohlen BJ, van der Ham DP, Klijn NF, van Hooff MHA, Broekmans FJM, Fleischer K, Janssen CAH, Rijn van Weert JM, van Disseldorp J, Twisk M, Traas M, Verberg MFG, Pelinck MJ, Visser J, Perquin DAM, Boks DES, Verhoeve HR, van Heteren CF, Mol BWJ, Repping S, van der Veen F, Mochtar MH. The SUPER study: protocol for a randomised controlled trial comparing follicle-stimulating hormone and clomiphene citrate for ovarian stimulation in intrauterine insemination. BMJ Open 2017; 7:e015680. [PMID: 28550023 PMCID: PMC5729997 DOI: 10.1136/bmjopen-2016-015680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To study the effectiveness of four cycles of intrauterine insemination (IUI) with ovarian stimulation (OS) by follicle-stimulating hormone (FSH) or by clomiphene citrate (CC), and adherence to strict cancellation criteria. SETTING Randomised controlled trial among 22 secondary and tertiary fertility clinics in the Netherlands. PARTICIPANTS 732 women from couples diagnosed with unexplained or mild male subfertility and an unfavourable prognosis according to the model of Hunault of natural conception. INTERVENTIONS Four cycles of IUI-OS within a time horizon of 6 months comparing FSH 75 IU with CC 100 mg. The primary outcome is ongoing pregnancy conceived within 6 months after randomisation, defined as a positive heartbeat at 12 weeks of gestation. Secondary outcomes are cancellation rates, number of cycles with a monofollicular or with multifollicular growth, number of follicles >14 mm at the time of ovulation triggering, time to ongoing pregnancy, clinical pregnancy, miscarriage, live birth and multiple pregnancy. We will also assess if biomarkers such as female age, body mass index, smoking status, antral follicle count and endometrial aspect and thickness can be used as treatment selection markers. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethical Committee of the Academic Medical Centre and from the Dutch Central Committee on Research involving Human Subjects (CCMO NL 43131-018-13). Results will be disseminated through peer-reviewed publications and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER NTR4057.
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Affiliation(s)
- NA Danhof
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - CAM Koks
- Obstetrics and gynaecology, Maxima Medical Center, Veldhoven, The Netherlands
| | | | - JP de Bruin
- Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - BJ Cohlen
- Isala Zwolle, Zwolle, The Netherlands
| | | | - NF Klijn
- Leiden University Medical Centre, Leiden, The Netherlands
| | - MHA van Hooff
- Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | - FJM Broekmans
- Reproductive Medicine, UMC Utrecht, Utrecht, The Netherlands
| | - K Fleischer
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - CAH Janssen
- Groene Hart Hospital, Gouda, The Netherlands
| | | | | | - M Twisk
- MC Zuiderzee, Lelystad, The Netherlands
| | - M Traas
- Gelre Hospital, Apeldoorn, The Netherlands
| | - MFG Verberg
- Fertility Clinic Twente, Twente, The Netherlands
| | - MJ Pelinck
- Scheper Hospital, Emmen, The Netherlands
| | | | - DAM Perquin
- Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - DES Boks
- Spaarne Hospital, Hoofddorp, The Netherlands
| | | | | | - BWJ Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelade, Adelaide, Australia
| | - S Repping
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - F van der Veen
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - MH Mochtar
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Dijkhuizen K, Dekkers OM, Holleboom CAG, de Groot CJM, Hellebrekers BWJ, van Roosmalen GJJ, Janssen CAH, Helmerhorst FM. Vaginal misoprostol prior to insertion of an intrauterine device: an RCT. Hum Reprod 2010; 26:323-9. [DOI: 10.1093/humrep/deq348] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van Dongen H, Janssen CAH, Smeets MJGH, Emanuel MH, Jansen FW. The clinical relevance of hysteroscopic polypectomy in premenopausal women with abnormal uterine bleeding. BJOG 2009; 116:1387-90. [DOI: 10.1111/j.1471-0528.2009.02145.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giordano PC, Plancke A, Van Meir CA, Janssen CAH, Kok PJMJ, Van Rooijen-Nijdam IH, Tanis BC, van Huisseling JCM, Versteegh FGA. Carrier diagnostics and prevention of hemoglobinopathies in early pregnancy in The Netherlands: a pilot study. Prenat Diagn 2006; 26:719-24. [PMID: 16752436 DOI: 10.1002/pd.1490] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We have offered, for the first time in The Netherlands, carrier diagnostics for hemoglobinopathies (HbP) to early pregnant women. The aim of this study was to establish whether carrier analysis would be welcome by the public and feasible at the outpatient level. METHOD One hundred and thirty-nine randomly selected women were informed and offered basic carrier diagnostics at the first pregnancy control. RESULTS Carrier diagnostics was accepted by 136 women (97.8%). The population consisted of 31% of recent immigrants and 69% of native Dutch. One carrier of HbS and one of beta-thalassemia were found, both among the group of the recent immigrants. In both cases, partners were tested excluding a couple at risk. In addition, five carriers of alpha(+)-thalassemia were diagnosed at the molecular level, one of them in the native Dutch population. Basic carrier analysis was done both at the Hospital Laboratory and at the Reference Laboratory. No discrepancies were found. CONCLUSIONS This pilot study shows that (1) as predicted the prevalence of risk-related HbP and of alpha(+)-thalassemia is high in the immigrant population. (2) The compliance with carrier analysis in both native Dutch and immigrants is virtually total and (3) carrier diagnosis in early pregnancy and partner analysis in Hospital Laboratories is possible and is an effective tool for primary prevention of HbP in The Netherlands.
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Affiliation(s)
- P C Giordano
- Hemoglobinopathies Laboratory, Department of Human and Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.
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