RESUMO
Purpose. To improve success of in vitro fertilization (IVF), assisted reproductive technology (ART) experts addressed four questions. What is optimum oocytes number leading to highest live birth rate (LBR)? Are cohort size and embryo quality correlated? Does gonadotropin type affect oocyte yield? Should "freeze-all" policy be adopted in cycles with progesterone >1.5 ng/mL on day of human chorionic gonadotropin (hCG) administration? Methods. Electronic database search included ten studies on which panel gave opinions for improving current practice in controlled ovarian stimulation for ART. Results. Strong association existed between retrieved oocytes number (RON) and LBRs. RON impacted likelihood of ovarian hyperstimulation syndrome (OHSS). Embryo euploidy decreased with age, not with cohort size. Progesterone > 1.5 ng/dL did not impair cycle outcomes in patients with high cohorts and showed disparate results on day of hCG administration. Conclusions. Ovarian stimulation should be designed to retrieve 10-15 oocytes/treatment. Accurate dosage, gonadotropin type, should be selected as per prediction markers of ovarian response. Gonadotropin-releasing hormone (GnRH) antagonist based protocols are advised to avoid OHSS. Cumulative pregnancy rate was most relevant pregnancy endpoint in ART. Cycles with serum progesterone ≥1.5 ng/dL on day of hCG administration should not adopt "freeze-all" policy. Further research is needed due to lack of data availability on progesterone threshold or index.
RESUMO
BACKGROUND: Prediabetes is a precursor of overt Type 2 Diabetes Mellitus (DM) and it is associated with insulin resistance and an increased risk for cardiovascular disease. ACE and AACE recommend only lifestyle modifications for the management of prediabetes. A recently published meta-analysis suggested that drug therapy was associated with a better control of diabetes. Voglibose was recently approved for the management of prediabetes in Japan. MATERIAL AND METHODS: A well-structured questionnaire was sent to 117 doctors across India (52 diabetes specialists, 45 general practitioners, and 20 specialists from other branches of medicine) to understand their views on the management of prediabetes, especially with regards to voglibose. RESULTS AND CONCLUSION: There was an equivocal response to the question as to whether only diet and exercise were sufficient for the management of prediabetes. Most of the respondents used metformin for the management of prediabetes, while voglibose was the most favoured second-line drug. Almost all the respondents agreed that the approval which voglibose got in Japan for the management of prediabetes was relevant in India as well. Only 51.3% of all respondents had prescribed voglibose for prediabetes. Thus, voglibose appears to be popular second-line drug for the management of prediabetes.
