First clinical report of 179 surrogacy cases in the UK: implications for policy and practice.

RESEARCH QUESTION: What implications for policy and practice can be derived from outcomes and trends observed across 8 years of a surrogacy programme in two UK-regulated IVF centres (London, Cardiff)? DESIGN: Retrospective cohort study analysing surrogacy treatments undertaken between 2014 and September 2021. RESULTS: Surrogacy continues to rise in popularity in the UK despite the inability of those supporting safe and professional practice to advertise to recruit surrogates. In two IVF centres regulated by the Human Fertilisation and Embryology Authority (HFEA), both the number of surrogacy treatments and the proportion of those undertaken on behalf of same-sex male intended parents increased year on year in the period studied. From a cohort of 108 surrogates, 71 babies were born to 61 surrogates (with five pregnancies ongoing) by February 2022. No statistically significant difference in live birth rates (LBR) was observed between the heterosexual couples and same-sex male couples. Sample sizes of single and transgender intended parents were too small (n < 5) to compare. The use of vitrified oocytes in surrogacy treatments has increased year on year, while fresh oocyte use has declined since peaking in 2019. There was no significant difference in LBR between fresh and vitrified oocyte usage across the cohort. CONCLUSIONS: The number of surrogacy treatments steadily increased, with clear evidence that the proportion of same-sex male couples accessing surrogacy is a major contributor to this growth. Vitrified/warmed oocyte use now outstrips the use of fresh oocytes in the surrogacy treatment cycles studied here. The results represent a strong basis for supporting the liberalization of regulatory reform expected to be introduced in the UK later in 2022.

Factors predicting clinical outcomes from 494 vitrified oocyte donation cycles at a UK-regulated egg bank.

RESEARCH QUESTION: Do donor age, AMH, AFC, BMI and reproductive history predict response to ovarian stimulation? Do donor and recipient clinical markers and embryology parameters predict recipient pregnancy and live birth? DESIGN: Retrospective cohort study of 494 altruistic oocyte donors aged 18-35 years; 340 were matched to 559 recipients. Predictors of donor total oocyte yield and total mature oocyte yield were identified. Total and mature oocyte number were compared according to stratified donor AMH and age. Donor, recipient and embryology parameters predictive of recipient primary outcomes (clinical pregnancy and live birth) were identified. RESULTS: Donor age and AMH predicted total oocyte yield (P = 0.030 and P < 0.001)) and total mature oocyte yield (P = 0.011 and P < 0.001). Donors aged 30-35 years with AMH 15-29.9 pmol/l had lower total oocyte yield (P = 0.004) and mature oocyte yield (P < 0.001) than donors aged 18-24 years. Up to an AMH threshold of 39.9 pmol/l, increasing AMH levels predicted higher total oocyte yield (<15 pmol/l versus 15-29.9 pmol/l, P = 0.001; 15-29.9 pmol/l versus 30-39.9 pmol/l, P < 0.001; 30-39.9pmol/l versus ≥ 40 pmol/l, P = 1.0) and mature oocyte yield (<15 pmol/l versus 15-29.9 pmol/l, P = 0.005; 15-29.9 pmol/l versus 30-39.9 pmol/l, P = 0.006; 30-39.9 pmol/l versus ≥40 pmol/l, P = 1.0). In recipients, the rate of transferrable embryos per oocytes received, fertilized and number of embryo transfers needed to achieve the primary outcome were predictors of cumulative clinical pregnancy (P = 0.011, P = 0.017 and P < 0.001) and live birth (P = 0.008, P = 0.012 and P < 0.001) rates. Recipient BMI (P = 0.024) and previous miscarriages (P = 0.045) were predictors of cumulative live birth rate. Donor age 18-22 years was associated with a lower incidence of recipient clinical pregnancy (P = 0.004) and live birth (P = 0.001) after the first embryo transfer versus donor age 23-29 years. CONCLUSIONS: Donor age and AMH are independent predictors of oocyte yield. Raised recipient BMI and history of miscarriages reduce cumulative live birth rates, which may be increased by selecting donors aged 23-29 years, instead of younger donors.

Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women.

PURPOSE: Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research. MATERIALS AND METHODS: The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network. RESULTS: BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight reductions significantly decreased urinary incontinence. CONCLUSIONS: Strategies for future research on urinary incontinence should include a focus on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.

Effects of Postprandial Blood Pressure on Gait Parameters in Older People.

Postprandial hypotension (PPH), a fall in systolic blood pressure (SBP) within 2 h of a meal, may detrimentally affect gait parameters and increase the falls risk in older people. We aimed to determine the effects of postprandial SBP on heart rate (HR), gait speed, and stride length, double-support time and swing time variability in older subjects with and without PPH. Twenty-nine subjects were studied on three days: glucose ("G"), water and walk ("WW"), glucose and walk ("GW"). Subjects consumed a glucose drink on "G" and "GW" and water on "WW". The "G" day determined which subjects had PPH. On "WW" and "GW" gait was analyzed. Sixteen subjects demonstrated PPH. In this group, there were significant changes in gait speed (p = 0.040) on "WW" and double-support time variability (p = 0.027) on "GW". The area under the curve for the change in gait parameters from baseline was not significant on any study day. Among subjects without PPH, SBP increased on "WW" (p < 0.005) and all gait parameters remained unchanged on all study days. These findings suggest that by changing gait parameters, PPH may contribute to an increased falls risk in the older person with PPH.

Intermittent walking: a potential treatment for older people with postprandial hypotension.

BACKGROUND: Exercise has been proposed as a possible treatment for postprandial hypotension (PPH), yet, its use has not been extensively investigated. This study aimed to determine the effects of intermittent walking on blood pressure (BP) and heart rate (HR) following ingestion of a glucose drink in older people with PPH. METHODS: Thirteen persons with PPH were recruited and studied on 2 randomized days (control, intervention). On both study days, participants ingested 200 mL of water containing 50 g glucose, followed by ambulatory BP and HR monitoring 6 minutely for 60 minutes, then 15 minutely until 120 minutes. On the intervention day, participants walked at their usual pace for 30 m every 30 minutes for 120 minutes. RESULTS: On the control day, significant falls in systolic blood pressure (SBP) (P < .005) and diastolic blood pressure (DBP) (P = .016) were demonstrated between t = 0-120 minutes. On the intervention day, over the same period, there was no significant fall in SBP (P = .520), however, DBP still fell significantly (P = .045). There was a statistically significant difference (P = .005) for the area under the curve for the change in SBP from baseline for the study days but not DBP (P = .716). There was no significant change in HR (control: P = .854; intervention, P = .168) nor between the area under the curve (P = .798) for the change in HR from baseline for the study days. CONCLUSIONS: This study suggests that in older people with PPH, intermittent walking at a usual pace attenuates the fall in SBP after ingestion of a glucose drink.

Geriatric medicine course to senior undergraduate medical students improves attitude and self-perceived competency scores.

AIMS: The aims were to evaluate the effect of a 4.5-week geriatric medicine course on 5th-year medical students' attitudes and self-perceived competency scores. Student performance in the summative multiple choice questions examination in 2011 was compared with results from 2008. METHODS: Pre- and post-course attitudes (University of California, Los Angeles Attitudes Survey) and self-perceived competency surveys were administered to 65 5th-year medical students following a 4.5-week geriatric medicine course at one South Australian teaching hospital as part of course evaluation and improvement. RESULTS: Significant improvements in students' attitude (mean pre- and post-attitude score (± standard deviation): 3.34 (1.66) vs 3.66 (1.06); P < 0.001) and self-perceived competency (mean pre and post-competency scores: 2.89 (0.84) and 4.03 (0.56); P < 0.001) were observed. The 2011 multiple choice question results were much better than in 2008 (91.5 (3.6) vs 75.2 (7.9); P < 0.001). CONCLUSIONS: A geriatric medicine course for senior medical students allows for improvement in attitudes and self-perceived competency scores.