Should non-patient volunteers donate eggs?

Egg donation is associated with medical and surgical risks regardless of the source of eggs, be it through commercial, altruistic or more recent egg-share donors. Egg sharing is the only system that does not turn a healthy woman (the donor) into a patient. Using carefully selected egg-share donors, pregnancy rates for both donor and recipient are as good as any egg-donation programme, with one cohort of eggs being used with more efficiency. We propose that anonymous egg sharing, as licensed by the Human Fertilisation and Embryology Authority (HFEA), minimizes risk, is ethically sound and should be considered as the only acceptable form of anonymous egg donation.

One hundred and three concurrent IVF successes for donors and recipients who shared eggs: ethical and practical benefits of egg sharing to society.

Egg sharing is a form of egg donation where complete strangers can collaborate anonymously to overcome their involuntary childlessness. In a retrospective analysis, results of egg sharing treatments were analysed in 37 consecutive donors and 39 recipients who had achieved concurrent success following IVF treatment. The interval between being accepted onto the programme and receiving treatment was less than 6 months for most patients. Births of 103 infants are expected. Multiple pregnancy rates were high and equivalent in both the groups (donors 32.4%, recipients 25.6%) despite the original number of eggs available being halved at egg collection and equal numbers being allocated to donors and recipients. On average fewer than six eggs were required for the birth of each baby. More successes are expected in time as 33 couples (43.4%) have their excess embryos stored for future use. The programme avoided the need to advertise for donors. This had particular significance for members of minority ethnic groups. It is surmised that promotion of concurrent treatment of egg sharers and recipients will attract funds from insurance providers or health boards who are unimpressed by IVF treatments with indifferent success rates and runaway costs. In the event of such funds materializing, meagre NHS resources for IVF treatment could be better focused. Overall, the benefit derived from applying the simultaneous treatment of anonymous donors and recipients is so compelling as to make it the preferred IVF option for qualifying couples.

Are high levels of oestradiol after implants associated with features of dependence?

OBJECTIVE: To determine whether features of dependence develop in women receiving oestradiol implants, and if so, whether these features are related to serum oestradiol levels. DESIGN: A questionnaire survey of women attending for implants over a six month period. SETTING: An implant clinic in a district general hospital. MAIN OUTCOME MEASURES: Psychological symptoms and their relationship to serum oestradiol levels. RESULTS: Women with serum oestradiol levels below 500 pmol/L were generally asymptomatic of psychological symptoms. CONCLUSION: Serum oestradiol levels of women receiving implants should be kept in the range of 300-500 pmol/L. Higher levels appear to be associated with the development of psychological symptoms which could be classified as features of dependence.

Complications of unopposed oestrogen following radical surgery for endometriosis.

Four cases are presented here of patients who had total abdominal hysterectomy and bilateral salpingooophorectomy for severe endometriosis. All were eventually placed on unopposed oestrogen replacement therapy, two immediately and the other two after a few months. All subsequently developed recurrence of their endometriosis whilst on oestrogen therapy, one developing an endometroid carcinoma. All required surgery and three were placed on continuous oestrogen/progestogen preparation or alternatively tibolone (which has oestrogenic, progestogenic and androgenic properties) postoperatively. No further recurrence of their disease occurred. The literature was reviewed regarding oestrogen therapy for women who have had bilateral oophorectomy. There were various suggestions as to management but no report on using continuous oestrogen/ progestogen or tibolone. We suggest this as a logical form of replacement therapy for patients who have bilateraloophorectomy for severe endometriosis, as unopposed oestrogen therapy can cause recurrence.

Pregnancy following intracytoplasmic sperm injection treatment with dead husband's spermatozoa: ethical and policy considerations.

This paper describes the first pregnancy in a childless widow after intracytoplasmic sperm injection (ICSI) treatment with her deceased husband's spermatozoa which had been stored for nearly 3 years before use. Before his death the husband had received treatment for testicular cancer and he had given the appropriate written consent for the future use of his spermatozoa. Of the 10 eggs injected, six resulted in normal embryos. Three embryos were transferred and the remaining three embryos are currently stored for possible future use. The treatment resulted in a continuing singleton pregnancy. The case demonstrated the suitability of ICSI in those difficult cases where the sperm quality is extremely poor. This success is also compared with a widely debated case of another widow who was refused permission to use her deceased husband's spermatozoa. It is concluded that in the case of posthumous use of frozen spermatozoa, the current laws are conveniently applicable in a chronic illness but not so in an acute illness leading to death. In the light of the wide public debate on the issues raised by this legal case, the UK Government has also decided to conduct a review of consent procedures involving the storage and use of genetic material.

The levonorgestrel intrauterine system in the management of menorrhagia.

OBJECTIVE: To assess the effect of a levonorgestrel releasing intrauterine system in the management of menorrhagia. DESIGN: A prospective study. SETTING: A district general hospital in South Wales. METHODS: Fifty women with a failed trial of medical therapy and awaiting hysterectomy or transcervical resection of the endometrium (TCRE) were treated with a levonorgestrel intrauterine system. The menstrual loss was estimated using a modified pictorial chart together with a full blood count and ferritin measurement preinsertion and at three and six to nine months postinsertion. RESULTS: The menstrual loss was reduced to acceptable levels in 37 women at three months and a further four by six to nine months. In all, 41 patients were taken off the waiting list for surgery, four of whom became amenorrhoeic. There was no significant change in full blood count nor ferritin measurement despite unscheduled bleeding for six to eight weeks postinsertion. Fifty-six percent of patients noticed considerable improvement or cure of their premenstrual syndrome symptoms; 80% noted a reduction in dysmenorrhoea. CONCLUSION: The levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for the management of menorrhagia and dysmenorrhoea that has additional benefit as a contraceptive and in relieving premenstrual syndrome.

PIP: A prospective study involving 50 women recruited from a district general hospital in South Wales indicated that the levonorgestrel-releasing intrauterine system (LNG-IUS) represents an effective nonsurgical treatment for menorrhagia and dysmenorrhea. Treatment for menorrhagia with a combination of prostaglandin synthetase inhibitors and antifibrinolytic drugs had failed in these women, and they were on a waiting list for hysterectomy or transcervical resection of the endometrium. Menstrual loss was estimated using a modified pictorial chart and the full blood count and ferritin were measured preinsertion and at 3 and 6-9 months postinsertion. The device was spontaneously expelled in 6 women and almost all subjects experienced some unscheduled bleeding during the first 6-8 weeks postinsertion. Of the 42 women who attended the 3-month visit, 37 were satisfied with the results of the LNG-IUS device and wished to continue; only 5 had no significant reduction in their menstrual scores. Also observed was a reduction in clots and "flooding" and marked improvements in associated dysmenorrhea. 4 women became amenorrheic and 28 were cured of their premenstrual syndrome symptoms. There was no significant change in the full blood count or ferritin. At the 6-9 month visit, 4 of the 5 women who previously reported no change in menstrual scores now reported their menstrual loss was acceptable.

The effect of oestradiol implants on regional and total bone mass: a three-year longitudinal study.

OBJECTIVE: Although there is evidence from cross-sectional studies that percutaneous oestrogen administration protects against menopausal bone loss, few longitudinal data are available. We have examined the effect of 3 years' treatment with percutaneous oestradiol on total body calcium, spinal trabecular bone mineral density and radial bone mineral content in post-menopausal women. DESIGN AND PATIENTS: Twenty-nine post-menopausal women, aged 37-55 years, who had undergone hysterectomy and had experienced the onset of menopausal symptoms within the previous 2 years, were studied before and for 3 years during hormone replacement with oestradiol implants, given at approximately 6-monthly intervals. MEASUREMENTS: Total body calcium was measured by prompt gamma neutron activation analysis, spinal trabecular bone mineral density by quantitative computed tomography and radial bone mineral content by single-photon absorptiometry. RESULTS: There was a significant increase in the mean total body calcium, spinal trabecular bone mineral density and radial bone mineral content over the 3 years of the study. The mean (+/- SEM) percentage change per annum was +2.4% (+/- 0.8) for total body calcium (P < 0.01), +3.3% (+/- 0.6) for spinal trabecular bone mineral density (P < 0.001) and +1.2% (+/- 0.6) for radial bone mineral content (P < 0.05). CONCLUSIONS: Percutaneous oestradiol replacement therapy prevents menopausal bone loss and is associated with a sustained and significant increase in total body calcium, spinal trabecular bone mineral density and radial bone mineral content over a 3-year treatment period. Oestradiol implants thus have skeletal effects comparable to those of oral or transdermal oestrogens.

Survey of attitudes to testing for human immunodeficiency virus infection in antenatal clinics in West Glamorgan.

A total of 1023 women attending hospital antenatal clinics in West Glamorgan was surveyed by means of a self-administered questionnaire, to determine their attitudes to HIV testing in pregnancy. The response rate was 98%. Of the responders, 94% had no objection to their antenatal blood specimen being tested for HIV infection. Of the non-objectors, 55% wished their permission to be asked first, and 92% wished to be informed of the result, i.e. they wished for named testing. With regard to knowledge of other tests for infectious diseases performed on antenatal blood specimens, only 1.5% had totally correct knowledge, and only one in three knew that their blood was tested for syphilis. The implications of anonymous and named HIV testing are discussed, together with estimates of prevalence of HIV infection in women attending antenatal clinics, the rate of vertical transmission, and the prognosis for an infected baby.

Contraception by age group.

PIP: From menarche to menopause, women choose different methods of contraception for many different reasons. Some of the reasons include: convenience, expense, availability, benefits, sexual intentions, attitudes and the maturity of the contraceptive user. Contraceptive choices such as condoms, IUDs, natural family planning, spermicides and others are explored in relationship to a women's age and choice. The age groups are divided as follows: menarche to 18, 18 to 35 and 35 years to menopause. Hormonal methods, particularly the combined oral contraceptive pill, are a viable choice for young women from menarche age to 35 as is the choice of condoms. Both require, however, an understanding of effective use. In the 35 to menopause age group, there is a discussion of cycle irregularity and its affect on contraceptive choice and the uncertainty surrounding fertility. It is of importance to note that as fertility decreases so does the safety of nearly any method of contraception. Side effects of each choice, both good and bad, on the user's health are discussed.^ieng