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Clomiphene (clomifene) citrate (CC) and follicle-stimulating hormone (FSH) have traditionally been considered the two main modalities used for ovarian stimulation (OS). However, many adjuncts have been used to maximize the convenience and effectiveness of these two agents, often specifically targeted to subsets of women undergoing stimulation. Most of these adjuncts are not officially approved for these indications. Therefore, educators and practitioners must take it upon themselves to assess the evidence supporting their use, and make treatment recommendations and decisions accordingly. We have outlined in an editorial in Fertility and Sterility a process to aid in this endeavor . Decisions are based not only on randomized clinical trials (RCT), but also on other basic science and clinical evidence supporting their use.
This chapter examines the evidence and methods of uterine cavity evaluation and the structural abnormalities that may compromise in vitro fertilization (IVF) success. The gold standard method for the evaluation of the uterine cavity is direct visualization with hysteroscopy. One of the most commonly encountered uterine cavity abnormalities is endometrial polyps. Müllerian anomalies are structural developmental abnormalities of the female reproductive system. The American Society for Reproductive Medicine (ASRM) staging system classifies these abnormalities into hypoplastic/agenesis, unicornuate, didelphus, bicornuate, septate, arcuate, and DES-related. Uterine septae form from incomplete absorption of the intervening tissue as the two Müllerian ducts fuse. The arcuate uterus occurs when there is a mild extension from the uterine fundus caudally. Myomas are the most common benign tumor of the female reproductive system. Finally, the chapter describes a comprehensive diagnostic and treatment algorithm for patients with Asherman's syndrome (AS).
Clomiphene citrate (CC) and follicle stimulating hormone (FSH) are the two main modalities used for ovarian stimulation (OS). Decisions are based not only on randomized clinical trials (RCT), but also on other basic science and clinical evidence supporting their use. This chapter presents the effectiveness of adjuncts in enhancing outcomes in women having OS for in-vitro fertilization (IVF). The adjuncts include leuprolide acetate (LA) and gonadotropin-releasing hormone (GnRH) agonists, oral contraceptive (OC) pretreatment, estrogen pretreatment, dexamethasone (DEX), metformin (Met), human chorionic gonadotropin, aspirin (ASA), growth hormone (GH), dopamine agonists, and androgens and androgenic drugs. Most of these adjuncts are medications approved for other uses but not specifically as adjuncts for OS. The risk/benefit ratio in their use is quite favourable. Adjuncts aimed at improving ovarian response by increasing ovarian androgen concentrations appear to have real promise, but require further well-controlled studies to verify their effectiveness.
Screening instruments for autistic-spectrum disorders have not been compared in the same sample.
To compare the Social Communication Questionnaire (SCQ), the Social Responsiveness Scale (SRS) and the Children's Communication Checklist (CCC).
Screen and diagnostic assessments on 119 children between 9 and 13 years of age with special educational needs with and without autistic-spectrum disorders were weighted to estimate screen characteristics for a realistic target population.
The SCQ performed best (area under receiver operating characteristic curve (AUC)=0.90; sensitivity 0.86; specificity 0.78). The SRS had a lower AUC (0.77) with high sensitivity (0.78) and moderate specificity (0.67). The CCC had a high sensitivity but lower specificity (AUC=0.79; sensitivity 0.93; specificity 0.46). The AUC of the SRS and CCC was lower for children with IQ < 70. Behaviour problems reduced specificity for all three instruments.
The SCQ, SRS and CCC showed strong to moderate ability to identify autistic-spectrum disorder in this at-risk sample of school-age children with special educational needs.
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