Changing rate of urban creep and urban expansion over time and its impact upon the hydrologic response of a catchment.

Most previous quantitative research conducted on urban creep and urban expansion has focused on small areas, short time periods, case studies with fairly uniform housing stock and demographic makeup, and the characterisation of urban creep and expansion exclusively in terms of impervious area changes without quantification of the consequential hydrological impact, i.e., increase in surface runoff volume and peak flows in a catchment. This study, using satellite imagery, catchment characteristics data, geographic information system and hydrologic modelling, presents, for the first time, a long-term analysis of urban creep and expansion. The case study is the Ouseburn catchment in Newcastle upon Tyne, a wide-ranging catchment made up of rural, suburban and urban areas, over a period of seven decades. The rate of increase of impervious surfaces is found not to be constant in time; the significant impact of this variation on the catchment's hydrologic response is quantified. This has overall caused a substantial flow volume increase in the Ouseburn over the study period, e.g. 48% for a 1 in 5 years rainfall event. The conclusions obtained are likely representative of many large towns and cities across the United Kingdom and the methodology presented can be easily replicated in other study areas.

Interchangeability, immunogenicity and safety of a combined 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (Synflorix) and 13-valent-PCV (Prevenar13) schedule at 1-2-4-6 months: PREVIX_COMBO, a 3-arm randomised controlled trial.

BACKGROUND: Aboriginal children living in remote communities are at high risk of early and persistent otitis media. Streptococcus pneumoniae and non-typeable Haemophilus influenzae (NTHi) are primary pathogens. Vaccines with potential to prevent early OM have not been evaluated in this population. We compared immunogenicity (ELISA and opsonophagocytic activity) of a combination of Synflorix™ (PHiD-CV10, 10 serotypes and protein D of NTHi) and Prevenar13™ (PCV13, 10 serotypes plus 3, 6A, and 19A), with recommended schedules. METHODS: This open-label superiority trial randomised (1:1:1) Aboriginal infants at 28 to 38 days of age, to PCV13 (P) at 2-4-6 months (_PPP), PHiD-CV10 (S) at 2-4-6 months (_SSS), or PHiD-CV10 at 1-2-4 plus PCV13 at -6 months (SSSP). Primary outcomes (blinded) were immunogenicity against PCV13-only serotypes 3, 6A, 19A, and PHiD-CV10-only protein D at 7 months. Secondary outcomes include immunogenicity against all serotypes at 2, 4 and 7 months. FINDINGS: Between 2011 and 2017, 425 infants were allocated to _PPP(143), _SSS(141) or SSSP(1 4 1). An intention to treat approach including all available data was used. The SSSP group had superior immunogenicity against serotypes 3, 6A, and 19A compared to _SSS (OPA GMT ratios 8.1 to 59.5, p < 0.001), and against protein D compared to _PPP (GMC ratio 11.9 (95%CI 9.7 to 14.6)). Immune responses to protein D and 3, 6A, and 19A in SSSP were not significantly lower (i.e. no harm) than either _SSS or _PPP. For ten common serotypes responses at 2, 4 and 7 months were superior for SSSP (following 1-, 2-, and 4- doses) than _SSS and _PPP (following 0-, 1-, and 3- doses). At 4 months, _SSS was superior to _PPP. Reactogenicity and hospitalisations were rare and unrelated to the intervention. INTERPRETATION: From two months, the 1-2-4-6-month combined schedule (SSSP) was safe and significantly more immunogenic than 2-4-6-month schedules. The earlier responses may be beneficial in high-risk populations.

Determining meteorological drivers of salt marsh mosquito peaks in tropical northern Australia.

In northern Australia the northern salt marsh mosquito Aedes vigilax is a vector of Ross River virus and is an appreciable pest. A coastal wetland adjacent to Darwin's residential suburbs offers a favorable habitat for Ae. vigilax, and despite vigilant mosquito control efforts, peaks of Ae. vigilax occur in excess of 500/trap/night some months. To improve mosquito control for disease and nuisance biting to nearby residential areas, we sought to investigate meteorological drivers associated with these Ae. vigilax peaks. We fitted a cross-sectional logistic regression model to weekly counts of female Ae. vigilax mosquitoes collected between July, 1998 and June, 2009 against variables, tide, rainfall, month, year, and larval control. Aedes vigilax peaks were associated with rainfall during the months September to November compared with January, when adjusted for larval control and tide. To maximize mosquito control efficiency, larval control should continue to be implemented after high tides and with increased emphasis on extensive larval hatches triggered by rainfall between September and November each year. This study reiterates the importance of monitoring and evaluating service delivery programs. Using statistical modelling, service providers can obtain solutions to operational problems using routinely collected data. These methods may be applicable in mosquito surveillance or control programs in other areas.

Pneumococcal conjugate vaccines PREVenar13 and SynflorIX in sequence or alone in high-risk Indigenous infants (PREV-IX_COMBO): protocol of a randomised controlled trial.

INTRODUCTION: Otitis media (OM) starts within weeks of birth in almost all Indigenous infants living in remote areas of the Northern Territory (NT). OM and associated hearing loss persist from infancy throughout childhood and often into adulthood. Educational and social opportunities are greatly compromised. Pneumococcus and non-typeable Haemophilus influenzae (NTHi) are major OM pathogens that densely colonise the nasopharynx and infect the middle ear from very early in life. Our hypothesis is that compared to current single vaccine schedules, a combination of vaccines starting at 1 month of age, may provide earlier, broadened protection. METHODS AND ANALYSES: This randomised outcome assessor, blinded controlled trial will recruit 425 infants between 28 and 38 days of age and randomly allocate them (1:1:1) to one of three pneumococcal conjugate vaccine (PCV) schedules: Synflorix at 2, 4, 6 months of age, Prevenar13 at 2, 4 and 6 months of age, or an investigational schedule of Synflorix at 1, 2 and 4 months plus Prevenar13 at 6 months of age. The blinded primary outcomes at 7 months of age are immunogenicity of specific vaccine antigens (geometric mean concentration (GMC) and proportion of participants with above threshold GMC of 0.35 µg/L). Secondary outcomes at all timepoints are additional immunogenicity measures and proportion of participants with nasopharyngeal carriage of vaccine-type pneumococci and NTHi, and any OM, including any tympanic membrane perforation. Parental interviews will provide data on common risk factors for OM. ETHICS AND DISSEMINATION: Ethical approval has been obtained from NT Department of Health and Menzies HREC (EC00153), Central Australian HREC (EC00155) and West Australian Aboriginal Health Ethics Committee (WAAHEC- 377-12/2011). Final trial results, data analyses, interpretation and conclusions will be presented in appropriate written and oral formats to parents and guardians, participating communities, local, national and international conferences, and published in peer-reviewed open access journals. TRIAL REGISTRATION NUMBERS: ACTRN12610000544077 and NCT01174849.

Differential effects of pandemic (H1N1) 2009 on remote and indigenous groups, Northern Territory, Australia, 2009.

Pandemic (H1N1) 2009 influenza spread through the Northern Territory, Australia, during June-August 2009. We performed 2 cross-sectional serologic surveys on specimens from Northern Territory residents, with 445 specimens obtained prepandemic and 1,689 specimens postpandemic. Antibody titers were determined by hemagglutination inhibition against reference virus A/California/7/2009 on serum samples collected opportunistically from outpatients. All specimens had data for patients' gender, age, and address, with patients' indigenous status determined for 94.1%. Protective immunity (titer >40) was present in 7.6% (95% confidence interval [CI] 5.2%-10.1%) of prepandemic specimens and 19.5% (95% CI 17.6%-21.4%) of postpandemic specimens, giving a population-standardized attack rate of 14.9% (95% CI 11.0%-18.9%). Prepandemic proportion of immune persons was greater with increasing age but did not differ by other demographic characteristics. Postpandemic proportion of immune persons was greater in younger groups and around double in indigenous persons. Postpandemic proportion immune was geographically heterogeneous, particularly among remote-living and indigenous groups.

Maternal smoking and smoking in the household during pregnancy and postpartum: findings from an Indigenous cohort in the Northern Territory.

OBJECTIVE: To describe the trends in maternal smoking and smoking in the household for a cohort of Indigenous women followed from late pregnancy to 7 months postpartum. DESIGN AND SETTING: Prospective cohort study embedded within a randomised controlled trial (RCT) performed in the Northern Territory involving participants recruited between 30 June 2006 and 4 May 2010. PARTICIPANTS: 215 Indigenous women aged 17-39 years who had been recruited into the RCT, 162 of whom had completed their last study visit at 7 months postpartum by 1 June 2010. MAIN OUTCOME MEASURES: Smoking status of women, and smoking within their households, in their third trimester, and at 1 month, 2 months and 7 months postpartum. RESULTS: There were complete data on women's smoking status for 121 participants. Among these, the self-reported smoking rate was 45% (95% CI, 36%-55%) during pregnancy, increasing to 63% (95% CI, 54%-71%) at 7 months postpartum. Of the 66 women who were non-smokers at the antenatal visit, 23 (35%; 95% CI, 23%-47%) were smoking by the time their baby reached 7 months of age. Thirty-one per cent (95% CI, 23%-39%) of households included people who smoked inside during the antepartum period, whereas 16% (95% CI, 10%-23%) included people who smoked inside at 7 months postpartum. CONCLUSIONS: While an apparent reduction in indoor exposure to tobacco smoke during the postpartum period is encouraging, this is offset by an increase in the proportion of antenatal non-smokers who subsequently reported smoking after the birth of their child. More health care service delivery and research attention needs to be directed to smoking during pregnancy and to postpartum relapse in this population.

Viral-bacterial co-infection in Australian Indigenous children with acute otitis media.

BACKGROUND: Acute otitis media with perforation (AOMwiP) affects 40% of remote Indigenous children during the first 18 months of life. Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis are the primary bacterial pathogens of otitis media and their loads predict clinical ear state. Our hypothesis is that antecedent respiratory viral infection increases bacterial density and progression to perforation. METHODS: A total of 366 nasopharyngeal swabs from 114 Indigenous children were retrospectively examined. A panel of 17 respiratory viruses was screened by PCR, and densities of S. pneumoniae, H. influenzae and M. catarrhalis were estimated by quantitative real time PCR. Data are reported by clinical ear state. RESULTS: M. catarrhalis (96%), H. influenzae (91%), S. pneumoniae (89%) and respiratory viruses (59%) were common; including rhinovirus (HRV) (38%), polyomavirus (HPyV) (14%), adenovirus (HAdV) (13%), bocavirus (HBoV) (8%) and coronavirus (HCoV) (4%). Geometric mean bacterial loads were significantly higher in children with acute otitis media (AOM) compared to children without evidence of otitis media. Children infected with HAdV were 3 times more likely (p < 0.001) to have AOM with or without perforation. CONCLUSION: This study confirms a positive association between nasopharyngeal bacterial load and clinical ear state, exacerbated by respiratory viruses, in Indigenous children. HAdV was independently associated with acute ear states.

Impact of income management on store sales in the Northern Territory.

OBJECTIVE: To examine the impact of a government income management program on store sales. DESIGN AND SETTING: An interrupted time series analysis of sales data in 10 stores in 10 remote Northern Territory communities during 1 October 2006 to 30 September 2009, which included an 18-month period before income management; a 4-6-month period after the introduction of income management; a 3-month period that coincided with a government stimulus payment; and the remaining income-management period. MAIN OUTCOME MEASURES: Trends in (i) total store sales; (ii) total food and beverage sales; (iii) fruit and vegetables sales; (iv) soft drink sales; and v) tobacco sales. RESULTS: Modest monthly increases indicative of inflation were found for all outcome measures before the introduction of income management, except for soft drink sales, which remained constant. No change from the increasing rate of monthly sales before income management was seen in the first 4-6 months of income management or for the income-management period thereafter for total store sales, food and beverage sales, fruit and vegetable sales and tobacco sales. The rate of soft drink sales declined significantly with the introduction of income management and then increased significantly thereafter. The 3-month government stimulus payment period (during the period of income management) was associated with a significant increase in the rate of sales for all outcome measures. CONCLUSION: Income management independent of the government stimulus payment appears to have had no beneficial effect on tobacco and cigarette sales, soft drink or fruit and vegetable sales.

Efficacy of alpha-cypermethrin and lambda-cyhalothrin applications to prevent Aedes breeding in tires.

The efficacy of alpha-cypermethrin (Cyperthor) and lambda-cyhalothrin (Demand) to prevent mosquito larval colonization of water-containing receptacles was investigated using 2 differing applications in disused car tires in Darwin, Australia. Insecticide treatments were applied uniformly to the inside surfaces of 2 categories of tires: 1) dry tires that were partially filled with water 24 h after spraying and 2) wet tires partially filled with water prior to spraying. All mosquito larvae, pupae, and dead adults were collected from the treatment and control tires weekly over the 24-wk study period and were later identified to species in the laboratory. Control tires were colonized by Aedes notoscriptus in wk 2 and by Culex quinquefasciatus in wk 4. Aedes notoscriptus failed to colonize any alpha-cypermethrin-treated tires until wk 22 and did not colonize any lambda-cyhalothrin-treated tires during the 24-wk trial. Culex quinquefasciatus colonized alpha-cypermethrin and lambda-cyhalothrin-treated tires from wk 11 and wk 15, respectively. These results indicate both insecticides using either application method can prevent colonization of Ae. notoscriptus for at least 20 wk and demonstrate great potential for the prevention of breeding in receptacles for other receptacle-breeding Aedes species, such as the dengue vectors, Ae. aegypti and Ae. albopictus.

Relationships between birthweight and biomarkers of chronic disease in childhood: Aboriginal Birth Cohort Study 1987-2001.

Reports of relationships between lower birthweight and later chronic diseases are mainly from populations with low rates of low birthweight (LBW) and growth-restricted births. A prospective study of an Australian Aboriginal birth cohort with a mean birthweight of 3050 g (SD 630), 16% LBW and 28% fetal growth restriction was used to examine the relationships between birthweight and selected biomarkers of chronic adult disease. At a mean age of 11.4 years (range 8.9-14), the mean weight was 35.7 kg (SD 11.8) and the mean height was 143.8 cm (SD 10.6). Using the Centers for Disease Control and Prevention (CDC) 2000 growth references, weight and height-for-age z-scores were -0.8 (SD 1.4) and -0.5 (SD 1.07) respectively and using World Health Organisation criteria, 19% of children were classified as underweight (weight for age Z-score <2.0). The relationships between birthweight and blood pressure (n = 475), total cholesterol (n = 461), Apolipoprotein A-1 (n = 343), Apolipoprotein B (n = 390), respiratory function tests (n = 427), kidney size determined by ultrasound (n = 446), urinary albumin/creatinine ratio (n = 420) and fasting triglycerides (n = 281), insulin (n = 272) and glucose (n = 279) were examined using regression models adjusted for sex, gestational age, current age and puberty status. In this population with high rates of fetal growth restriction at birth and an excess of under-nutrition at age 11 years we found that birthweight had a negative relationship with child blood pressure only, while current child weight was positively related to blood pressure, total cholesterol, Apolipoprotein B, respiratory function tests, kidney size, and fasting triglycerides, insulin and glucose.

Healthy country, healthy people: the relationship between Indigenous health status and "caring for country".

OBJECTIVE: To investigate associations between "caring for country" -- an activity that Indigenous peoples assert promotes good health -- and health outcomes relevant to excess Indigenous morbidity and mortality. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study involving 298 Indigenous adults aged 15-54 years in an Arnhem Land community, recruited from March to September 2005. MAIN OUTCOME MEASURES: Self-reported involvement in caring for country, health behaviours and clinically measured body mass index (BMI), waist circumference, blood pressure, type 2 diabetes status, albumin to creatinine ratio (ACR), levels of glycated haemoglobin (HbA(1c)) and high-density lipoprotein (HDL) cholesterol, lipid ratio, score on the five-item version of the Kessler Psychological Distress Scale (K5), and 5-year cardiovascular disease (CVD) risk. RESULTS: Controlling for sociodemographic characteristics and health behaviours, multivariate regression revealed significant and substantial associations between caring for country and health outcomes. An interquartile range rise in the weighted composite caring-for-country score was significantly associated with more frequent physical activity, better diet, lower BMI (regression coefficient [b] = - 2.83; 95% CI, - 4.56 to - 1.10), less abdominal obesity (odds ratio [OR], 0.43; 95% CI, 0.26-0.72), lower systolic blood pressure (b = - 7.59; 95% CI, - 12.01 to - 3.17), less diabetes (OR, 0.12; 95% CI, 0.03-0.52), lower HbA(1c) level (b = - 0.45; 95% CI, - 0.79 to - 0.11), non-elevated ACR (OR, 0.28; 95% CI, 0.13-0.60), higher HDL cholesterol level (b = 0.06; 95% CI, 0.01-0.12), lower K5 score (b = - 0.97; 95% CI, - 1.64 to - 0.31) and lower CVD risk (b = - 0.77; 95% CI, - 1.43 to - 0.11). CONCLUSIONS: Greater Indigenous participation in caring for country activities is associated with significantly better health. Although the causal direction of these associations requires clarification, our findings suggest that investment in caring for country may be a means to foster sustainable economic development and gains for both ecological and Indigenous peoples' health.

Monitoring local trends in Indigenous tobacco consumption.

OBJECTIVE: To compare two methods of monitoring tobacco consumption in remote Indigenous communities. METHODS: We examined the monthly difference between wholesale invoice and point-of-sale data for tobacco products from three stores from remote Aboriginal communities in the Northern Territory. We assessed three measures of wholesale data. RESULTS: The average monthly difference between the sale data and the average of wholesale invoices for the previous, same and following month was -33 cigarettes per day (95% CI -157, 92). This average of three months' wholesale invoices provided a more precise estimate than either wholesale invoices from the same or previous month. CONCLUSION: Tobacco wholesale data provided a close estimate of sales data in these stores. IMPLICATIONS: This wholesale data could be used to monitor local trends in remote Indigenous tobacco consumption, facilitating the evaluation of the impact of tobacco control activities and informing future work to reduce Indigenous smoking and its harms.

Total fertilization failure and idiopathic subfertility.

BACKGROUND: To gain more insight in whether failure of intrauterine insemination (IUI) treatment in patients with idiopathic subfertility could be related to diminished fertilization, the aim of this study is to compare the fertilization of an initial IVF procedure after six cycles of IUI and the fertilization of an initial IVF procedure without preceding IUI cycles in couples with idiopathic subfertility. METHODS: We performed a complimentary analysis of a randomized controlled trial, in which the number of total fertilization failure (TFF) in the first IVF procedure after unsuccessful IUI was compared to those of IVF without preceding IUI in patients with idiopathic subfertility. These patients participated in a previous study that assessed the cost effectiveness of IUI versus IVF in idiopathic subfertility and were randomized to either IUI or IVF treatment. RESULTS: 45 patients underwent IVF after 6 cycles of unsuccessful IUI and 58 patients underwent IVF immediately without preceding IUI. In 7 patients the IVF treatment was cancelled before ovum pick. In the IVF after unsuccessful IUI group TFF was seen in 2 of the 39 patients (5%) versus 7 of the 56 patients (13%) in the immediate IVF group. After correction for confounding factors the TFF rate was not significantly different between the two groups (p = 0.08, OR 7.4; 95% CI: 0.5-14.9). CONCLUSION: Our data showed that TFF and the fertilization rate in the first IVF treatment were not significantly different between couples with idiopathic subfertility undergoing IVF after failure of IUI versus those couples undergoing IVF immediately without prior IUI treatment. Apparently, impaired fertilization does not play a significant role in the success rate of IUI in patients with idiopathic subfertility.

Immunogenicity for 16 serotypes of a unique schedule of pneumococcal vaccines in a high-risk population.

BACKGROUND: A unique schedule of 7-valent pneumococcal conjugate vaccine (7PCV) at 2, 4 and 6 months of age and 23-valent pneumococcal polysaccharide vaccine (23PPV) at 18 months commenced for Australian Aboriginal infants in 2001. METHODS: Anti-capsular IgG concentrations in vaccinated and non-vaccinated (historic control) infants were determined (blinded) by (22F absorbed) ELISA. RESULTS: One month after dose 3 of 7PCV, geometric mean concentrations (GMCs) were >1.95 microg/ml and at least 89% of infants had IgG >0.35 microg/ml to all 7PCV serotypes. One month post-23PPV, IgG to 7PCV serotypes was >0.35 microg/ml for more than 96% infants (>1.3 microg/ml for at least 70%), and IgG to non-7PCV serotypes was >0.35 microg/ml for more than 50% infants (including serotype 6A, but not 12F (17%) or 19A (44%). CONCLUSION: 7PCV and 23PPV are immunogenic in this population.

Diagnostic laparoscopy is needed after abnormal hysterosalpingography to prevent over-treatment with IVF.

The additional value of laparoscopy was investigated with respect to diagnosis and further treatment decisions after abnormal hysterosalpingography (HSG) and prior to intrauterine insemination (IUI). In a retrospective chart review, the number of patients with abnormal HSG who finally need IVF treatment based on the laparoscopic findings was evaluated. Independent of whether HSG showed unilateral or bilateral tubal pathology, IVF was the final treatment decision in only 74 (29%) cases where laparoscopy showed bilateral abnormalities. IUI treatment was advised in 121 (48%) patients with laparoscopically normal findings or unilateral abnormalities. Fifty-seven (23%) patients were treated by IUI after receiving laparoscopic surgery of unilateral adhesions or endometriosis stage 1-2 or after ablation of moderate-severe endometriosis in a second operation. In cases of bilateral tubal abnormalities revealed by HSG, bilateral pathology was confirmed by laparoscopy in at least 58 (46%) patients and they were advised to be treated by IVF after laparoscopy. The agreement between abnormalities found by HSG and abnormalities found by laparoscopy requiring IVF treatment was poor even when HSG showed bilateral pathology. Based on these findings, it is concluded that laparoscopy is mandatory after abnormal HSG findings in the work-up prior to IUI to prevent over-treatment with IVF.

Evaluation of anti-Müllerian hormone as a test for the prediction of ovarian reserve.

OBJECTIVE: To compare in an integral way the value of the basal serum anti-Müllerian hormone (AMH) level with most of the established ovarian reserve tests. DESIGN: Prospective randomized controlled trial. SETTING: Fertility center of a university hospital in the Netherlands. PATIENT(S): One hundred ten patients undergoing their first IVF cycle who were randomized, by a computer-designed four-block system, into two groups. INTERVENTION(S): Fifty-six patients underwent a clomiphene citrate challenge test (CCCT), and 54 patients underwent an exogenous FSH ovarian reserve test (EFORT). In all patients, basal AMH, basal FSH, basal inhibin B, antral follicle count (AFC), and basal volume of the ovaries were measured. In all patients, the test was followed by a standard IVF treatment. MAIN OUTCOME MEASURE(S): Ovarian response after ovarian hyperstimulation in an IVF treatment, expressed as the total number of stimulated follicles, retrieved oocytes, and ongoing pregnancies. RESULT(S): The best prediction of ovarian reserve (Y) was seen in a multiple regression prediction model that simultaneously included AFC, inhibin B increment in the EFORT, and basal volume of the ovaries. Univariate logistic regression showed that the best predictors for poor response were AMH, the CCCT, basal FSH, and the AFC. For hyperresponse, univariate logistic regression showed that the best predictor was AFC. Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response or hyperresponse. The best predictors for the prediction of non-pregnancy were the CCCT and the E(2) increment in the EFORT. CONCLUSION(S): Anti-Müllerian hormone is comparable with other commonly used ovarian reserve tests but is probably most applicable in general practice.

Infertility, assisted reproduction technologies and imprinting disturbances: a Dutch study.

BACKGROUND: Evaluation of relationships between assisted reproduction technologies (ART), fertility problems and disorders caused by disturbed genetic imprinting such as Angelman syndrome (AS) and Beckwith-Wiedemann syndrome (BWS). METHODS: A nation-wide questionnaire survey was performed regarding ART in families with a child with AS, BWS or Prader-Willi syndrome (PWS) including questions on fertility. Molecular data on the genetic disorder in affected children were gathered. RESULTS: Of the 220 affected children in this study, 14 (6.4%) were born following any form of ART compared with 83 818 (2.1%) in the Dutch population. Of AS, PWS or BWS children 15 (6.8%) were born after a fertility problem (Time To Pregnancy > 12 months, no forms of ART) compared to 141,340 (3.5%) in the Dutch population. Maternal age in the individual syndromes was higher than in the Dutch population. Families with affected children were three times more likely to experience fertility problems than the general population. All three syndromes were also individually associated with increased fertility problems in the families. CONCLUSIONS: After correction for the increased fertility problems of the parents, there is no increased incidence of ART related birth of AS, PWS or BWS children. ART does not seem to have a direct effect on the increase of imprinted diseases.

Ovarian volume and antral follicle count for the prediction of low and hyper responders with in vitro fertilization.

BACKGROUND: The current study was designed to compare antral follicle count (AFC) and basal ovarian volume (BOV), the exogenous FSH ovarian reserve test (EFORT) and the clomiphene citrate challenge test (CCCT), with respect to their ability to predict poor and hyper responders. METHODS: One hundred and ten regularly menstruating patients, aged 18-39 years, participated in this prospective study, randomized, by a computer designed 4-blocks system study into two groups. Fifty six patients underwent a CCCT, and 54 patients underwent an EFORT. All patients underwent a transvaginal sonography to measure the basal ovarian volume and count of basal antral follicle. In all patients, the test was followed by a standard IVF treatment. The result of ovarian hyperstimulation during IVF treatment, expressed by the total number of follicles, was used as gold standard. RESULTS: The best prediction of ovarian reserve (Y) was seen in a multiple regression prediction model that included, AFC, Inhibin B-increment in the EFORT and BOV simultaneously (Y = -3.161 + 0.805 x AFC (0.258-1.352) + 0.034 x Inh. B-incr. (0.007-0.601) + 0.511 BOV (0.480-0.974) (r = 0.848, p < 0.001). Univariate logistic regression showed that the best predictors for poor response were the CCCT (ROC-AUC = 0.87), the bFSH (ROC-AUC = 0.83) and the AFC (ROC-AUC = 0.83). Multiple logistic regression analysis did not produce a better model in terms of improving the prediction of poor response. For hyper response, univariate logistic regression showed that the best predictors were AFC (ROC-AUC = 0.92) and the inhibin B-increment in the EFORT (ROC-AUC = 0.92), but AFC had better test characteristics, namely a sensitivity of 82% and a specificity 89%. Multiple logistic regression analysis did not produce a better model in terms of predicting hyper response. CONCLUSION: In conclusion AFC performs well as a test for ovarian response being superior or at least similar to complex expensive and time consuming endocrine tests. It is therefore likely to be the test for general practise.

Effect of an oral contraceptive pill on follicular development in IVF/ICSI patients receiving a GnRH antagonist: a randomized study.

This randomized controlled study compared the effectiveness of a gonadotrophin releasing hormone (GnRH) antagonist protocol with or without oral contraceptive (OC) pretreatment on the number of oocytes retrieved in IVF or intracytoplasmic sperm injection (ICSI) patients. Sixty-four patients were randomized to start recombinant human FSH (r-hFSH) on day 2 or 3 after OC withdrawal (OC group) or on day 2 of a natural cycle (control group). From stimulation day 6 onwards, all patients were treated with daily (0.5 mg/ml) GnRH antagonist (Antide). OC pretreatment resulted in significantly lower starting concentrations of FSH, LH and oestradiol (P < 0.001) and a thinner endometrium (P < 0.0001). In the early stimulation period, fewer large follicles were found after OC pretreatment, leading to a significantly extended stimulation period (11.6 versus 8.7 days, P < 0.0001) with more follicles on the day of recombinant human chorionic gonadotrophin administration (15.4 versus 12.5, P = 0.02) and more oocytes retrieved (13.5 versus 10.2, P < 0.001) as compared with the control group. GnRH antagonist regimen, pretreated with OC, prevented the early endogenous FSH rise and improved follicular homogeneity, resulting in more oocytes. As a consequence of the extended treatment period, more rhFSH was required.