Guideline for the management of conception and pregnancy in thalassaemia syndromes: A British Society for Haematology Guideline.

This comprehensive guideline, developed by a representative group of UK-based medical experts specialising in haemoglobinopathies, addresses the management of conception and pregnancy in patients with thalassaemia. A systematic search of PubMed and EMBASE using specific keywords, formed the basis of the literature review. Key terms included "thalassaemia," "pregnancy," "Cooley's anaemia," "Mediterranean anaemia," and others, covering aspects such as fertility, iron burden and ultrasonography. The guideline underwent rigorous review by prominent organisations, including the Endocrine Society, the Royal College of Obstetricians and Gynaecologists (RCOG), the United Kingdom Thalassaemia Society and the British Society of Haematology (BSH) guideline writing group. Additional feedback was solicited from a sounding board of UK haematologists, ensuring a thorough and collaborative approach. The objective of the guideline is to equip healthcare professionals with precise recommendations for managing conception and pregnancy in patients with thalassaemia.

Does measuring early basal serum follicular luteinising [correction of lutinising] hormone assist in predicting in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) outcome?

BACKGROUND: The aim was to examine the correlation of early follicular serum lutinising hormone (LH) and the clinical outcome of assisted reproduction technique (ART). METHODS: An observational study included 1333 consecutive women undergoing in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). 964 women were having their first cycle of ART. Data were entered prospectively. All women had serum LH measured in the 6 months before the index cycle studied. No repeat cycles were included. The main outcomes measured were clinical pregnancy (CP) and live birth (LB) correlation to serum LH. Forward multivariate stepwise regression analysis was applied, and other statistical tests were used as appropriate. RESULTS: There was non significant correlation between basal serum LH and CP and LB in the polycystic ovary syndrome group (R2 = 0.02, F = 1.7 and P = 0.76) (R2 = 0.01, F = 2.6 and P = 0.77) respectively after adjusting for age, BMI, day of oocyte retrieval, starting dose, total dose of stimulation, type of gonadotrophin used, number of oocytes retrieved, fertilization rate and number of embryos transferred. Other aetiological causes group there was similarly non significant correlation between basal serum LH and CP (R2 = 0.05, F = 13.1 and P = 0.66), nor for LB (R2 = 0.007, F = 4.5 and P = 0.9). CONCLUSION: Early follicular serum LH measurements in the 6 months before IVF/ICSI treatment cycle did not correlate with the clinical pregnancy or the live birth rate.

Technetium-99m MIBI imaging in diagnosis of pelvic and abdominal masses in patients with suspected gynaecological malignancy.

BACKGROUND: The aim of this study was to determine the diagnostic value of (99m)Tc MIBI planar dynamic scintigraphy in the diagnosis of gynaecological malignancies and to determine if it has a greater diagnostic accuracy than conventional ultrasound technique (US). MATERIAL AND METHODS: A prospective trial was performed to assess the accuracy of (99m)Tc MIBI scintigraphy and ultrasound in 93 female patients (mean age 50, SD 16; range 17-82 years). Three readers assessed all the imaging independently and this was compared with histological examination in 89 cases and by clinical follow-up and correlative imaging for a minimum of 6 months in 4 patients. RESULTS: There were 37 patients with cancer of gynaecological origin. There were in addition 56 benign lesions within the pelvis. (99m)Tc MIBI identified correctly 29 of the 37 malignant tumours localised within the pelvis and also correctly identified 21 of 23 metastases within the abdomen. Conventional US identified correctly 35 of the 37 tumours in the pelvis and 16 sites of metastases within the abdomen. The sensitivity and specificity of tumour detection within the pelvis for (99m)Tc MIBI were as follows: 78% and 70%; and for metastases within the abdomen 91% and 90%. The results of ultrasound for tumour detection within the pelvis: the sensitivity and specificity were 95% and 79% and for abdominal metastases 70% and 97%. Analysis of the index area under a receiver operator characteristic (ROC) curve in scintigraphy did not show a significant difference between both techniques in the diagnosis of pelvic lesions. There was however a significant increase in the sensitivity of scintigraphy (99m)Tc MIBI over US in metastases detection within the abdomen. CONCLUSIONS: (99m)Tc MIBI cannot be recommended for the imaging of pelvic cancer alone, but it may be helpful in the identification of intra-abdominal spread of ovarian carcinoma and appears to offer significant advantages over ultrasound.