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1.  The European Society of Human Reproduction and Embryology guideline for the diagnosis and treatment of endometriosis: an electronic guideline implementability appraisal 
Clinical guidelines are intended to improve healthcare. However, even if guidelines are excellent, their implementation is not assured. In subfertility care, the European Society of Human Reproduction and Embryology (ESHRE) guidelines have been inventoried, and their methodological quality has been assessed. To improve the impact of the ESHRE guidelines and to improve European subfertility care, it is important to optimise the implementability of guidelines. We therefore investigated the implementation barriers of the ESHRE guideline with the best methodological quality and evaluated the used instrument for usability and feasibility.
We reviewed the ESHRE guideline for the diagnosis and treatment of endometriosis to assess its implementability. We used an electronic version of the guideline implementability appraisal (eGLIA) instrument. This eGLIA tool consists of 31 questions grouped into 10 dimensions. Seven items address the guideline as a whole, and 24 items assess the individual recommendations in the guideline. The eGLIA instrument identifies factors that influence the implementability of the guideline recommendations. These factors can be divided into facilitators that promote implementation and barriers that oppose implementation. A panel of 10 experts from three European countries appraised all 36 recommendations of the guideline. They discussed discrepancies in a teleconference and completed a questionnaire to evaluate the ease of use and overall utility of the eGLIA instrument.
Two of the 36 guideline recommendations were straightforward to implement. Five recommendations were considered simply statements because they contained no actions. The remaining 29 recommendations were implementable with some adjustments. We found facilitators of the guideline implementability in the quality of decidability, presentation and formatting, apparent validity, and novelty or innovation of the recommendations. Vaguely defined actions, lack of facilities, immeasurable outcomes, and inflexibility within the recommendations formed barriers to implementation. The eGLIA instrument was generally useful and easy to use. However, assessment with the eGLIA instrument is very time-consuming.
The ESHRE guideline for the diagnosis and treatment of endometriosis could be improved to facilitate its implementation in daily practice. The eGLIA instrument is a helpful tool for identifying obstacles to implementation of a guideline. However, we recommend a concise version of this instrument.
PMCID: PMC3034686  PMID: 21247418
2.  Effect of rescuing donated immature human oocytes derived after FSH/hCG stimulation following in vitro culture with or without Follicular Fluid Meiosis Activating Sterol (FF-MAS)—an embryo chromosomal and morphological analysis 
Purpose: Studies in mice and humans have shown that Follicular Fluid – Meiosis Activating Sterol (FF-MAS) induces meiotic maturation of immature oocytes in vitro. A multicenter, prospectively randomised study evaluated chromosomal status of embryos from FSH/hCG primed human immature oocytes, cultured with or without FF-MAS.
Methods: Denuded immature oocytes (n=365) were randomly allocated into inert control, FF-MAS 5 μM or 20 μM. Seventy ±2 hours after ICSI on matured oocytes, all cleaved embryos were fixed for fluorescence in situ hybridisation analysis.
Results: Only 15% of oocytes resulted in cleaved embryos. GV oocytes matured at significantly lower rates (14% and 7%) in the two FF-MAS groups compared to the inert control group (47%). High rates of chromosomal abnormalities were found in all groups.
Conclusion: Immature oocytes showed poor development with high rates of embryo chromosomal abnormalities. Exposure to FF-MAS in the concentrations, duration and/or formulation used in this study did not improve the results.
PMCID: PMC3454988  PMID: 17216347
Immature oocytes; FF-MAS; Human; Aneuploidy; In vitro fertilisation
3.  ANDROLOGY: Sperm Retrieval, Fertilization, and Pregnancy Outcome in Repeated Testicular Sperm Aspiration 
Purpose: To report the outcome of sperm retrieval and results after ICSI in up to six repeated testicular sperm aspiration procedures.
Methods: Twenty-two men with obstructive and thirty-four men with nonobstructive azoospermia underwent 50 and 91 needle aspirations, respectively. Sufficiency of spermatozoa for ICSI and cryopreservation, fertilization rate, and pregnancy outcome was analyzed retrospectively.
Results: No major differences were found in sperm recovery or pregnancy outcome in the repeated cycles. Testicular aspirate containing motile spermatozoa with maintained fertilizing capacity was obtained in up to six repeated procedures in the nonobstructive group. No postoperative complications were reported for any of the participants.
Conclusions: Testicular sperm aspiration is a simple and effective method of sperm retrieval, which can be performed from the same testis up to several times with good recovery of motile spermatozoa for ICSI and maintaining high fertilization and pregnancy rates, in men with both obstructive and nonobstructive azoospermia.
PMCID: PMC3455598  PMID: 11411434
azoospermia; fertilization; intracytoplasmic sperm injection; pregnancy outcome; testicular sperm aspiration
4.  A Simplified Ultrasound Based Infertility Investigation Protocol and Its Implications for Patient Management 
Purpose: To evaluate whether a simplified infertilityinvestigation protocol, focusing on the use of hysterocontrastsonography (HyCoSy), one blood test, and a semen analysis,would be sufficient as an initial screening test to selectcouples for specific treatment.
Methods: The infertile couples underwent gynaecologicalexamination, cervical sampling for cytology and Chlamydiatrachomatis culture, B-mode transvaginal ultrasonographyand basic hormonal analyses followed by a HyCoSy, and asemen analysis. A preliminary diagnosis was made for allpatients. A management plan for treatment was suggestedwhen possible; otherwise further examinations wererecommended. The data were stored for later analysis and theroutine investigation protocol was then adhered to and afinal diagnosis and treatment were decided upon.
Results: Agreement between the diagnosis based on HyCoSyand our routine protocol was present in 74% of cases(N = 73). In 13% (N = 13) there was partial agreement. In36% the HyCoSy based protocol was considered sufficientto suggest treatment.
Conclusions: A simplified approach may lead to asignificant reduction in both the time and cost of investigating aninfertile couple.
PMCID: PMC3455166  PMID: 10806586
hysterosalpingo contrast sonography; hysterosal pingography; infertility; laparoscopy; simplification

Results 1-4 (4)