Artificial hormonal replacement cycles have no advantage over hyperstimulated cycles in a gamete intrafallopian transfer oocyte donation program.

OBJECTIVE: To evaluate if the previously reported increased implantation rates in hormonally replaced egg donation cycles relative to hyperstimulated IVF-ET cycles apply when GIFT is used. The increased implantation rates in the recipients have been attributed to the absence of the negative effects of hyperstimulation on endometrial receptivity. DESIGN: A prospective comparison of implantation rates in hyperstimulated and hormonally replaced cycles when GIFT was used in both the egg donors and their corresponding recipients. PATIENTS: Excess mature oocytes from 35 women undergoing GIFT after controlled ovarian hyperstimulation (COH) were transferred into the fallopian tubes of 35 hormonally replaced women. RESULTS: The male partners of all donors and recipients had normal semen parameters. The two groups did not differ significantly in the mean age, duration of infertility, and quality of eggs transferred. There was no statistically significant difference in the mean number of oocytes transferred per cycle between the donors and the recipients. The mean implantation rate per mature oocyte transferred was significantly higher in the donors (19.3%) than in the recipients (6.6%). CONCLUSION: Our results with GIFT show higher implantation rates in hyperstimulated cycles than in hormonally replaced cycles. These results differ from those reported in IVF-ET that suggest an adverse effect of COH on implantation rates.

Why do cardiology out-patient appointments fail in Saudi Arabia?

In a retrospective study, 534 appointments for a cardiology clinic were analysed to determine the frequency of no-show and to identify contributory factors. The overall rate of no-show was 30.1%, which is higher than the 18% and 20% reported from other teaching hospitals. Variables with the strongest univariate association with no-show were nationality (Saudi 35%, non-Saudi 22%; p = 0.0015), gender (males 34%, females 25%; p = 0.03), heart failure (present 44%, absent 27.9%; p = 0.005) and valvular heart disease (present 23.4%, absent 32.6%; p = 0.04). Turning to a stepwise logistic regression to predict no-show behaviour, we found that nationality, gender and heart failure were significant, while valvular heart disease was not. We conclude by recommending that physicians and mass media should share in the responsibility of stressing the importance of keeping out-patient department (OPD) appointments to all patients especially those who are more prone to no-show behaviour, namely male nationals. Telephone and mailed reminders have been used successfully to improve attendance at the OPD, and can be evaluated in our community.