Does poor ovarian response to gonadotrophins predict early menopause? A retrospective cohort study with minimum of 10-year follow-up.

One in 10 women reach menopause before they are 45 years of age, and 1 in 100 before 40. In most cases, poor ovarian response to gonadotrophins is a result of poor ovarian reserve. An early menopause is associated with long-term health risks. Identifying women at risk may allow appropriate measures to be instigated early. Women aged <40 years treated in the Aberdeen Fertility Centre between 1998 and 2002 were identified. Those with poor response to an age appropriate dose of gonadotrophins (obtaining ≤3 eggs or had cycle cancelled) after exclusion of hypothalamic insufficiency, or whose cycle was cancelled due to poor response were age matched with good responders (6-15 eggs). In this retrospective cohort study, women who have had IVF at least 10 years ago (157 poor responders and 314 good responders) were sent a postal questionnaire to determine age at menopause. A total of 219 women (64 poor responders, 155 good responders) returned their questionnaires. Poor responders were more likely to have premature menopause (3% vs. 0%; p = .024). A higher proportion of poor responders experienced early menopause (11% vs. 3%; p = .044). Despite being the first study with a 10-year follow-up, this study is limited to one centre and has a small number of women reaching premature menopause. Poor response to gonadotrophins in the context of IVF treatment is a marker of reduced ovarian reserve and is associated with early menopause. Results of this study underline the need for larger studies with long-term follow-up.

Can new doctors be prepared for practice? A review.

BACKGROUND: The transition from medical student to junior doctor is an important period of change. Research shows junior doctors often experience high levels of stress, and consequently burnout. Understanding how to prepare for the transition may allow individuals who are likely to struggle to be identified and assisted. The aim of this paper is to systematically review the literature on preparedness for practice in newly qualified junior doctors. METHODS: This was a systematic review of literature concerning the transition from student to junior doctor, published in the last 10 years, and that measured or explored one or more factors affecting preparedness. RESULTS: Nine papers were included in this review. These varied in design and methodological quality. Most used survey methodology (n = 7). Six found knowledge and skills, particularly deficiencies in prescribing and practical procedures, relevant in terms of preparedness. Five looked at personal traits, with high levels of neuroticism and low confidence deemed to be important. Medical school and workplace factors, including early clinical experience and shadowing, positively affected preparedness. A lack of senior support proved detrimental. The influence of demographics was inconclusive. DISCUSSION: The studies reviewed indicate that both personal and organisational factors are pertinent to managing the transition from student to junior doctor. Further prospective studies, both qualitative and quantitative, drawing on theories of change, are required to identify what precise factors would make a difference to this transition.