Methods of development and utilization or randomized evidence in guidelines for advanced gynecological malignancies.

<p>*the reference sources for the assignment of levels of evidence are as follows:</p>(1)<p><a href="http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment/HealthProfessional/page2" target="_blank">http://www.cancer.gov/cancertopics/pdq/levels-evidence-adult-treatment/HealthProfessional/page2</a>;</p>(2)<p>Scottish Intercollegiate Guidelines Network. Methodology Review Group. Report on the review of the method of grading guideline recommendations. Edinburgh: SIGN; 1999.;</p>(3)<p>Cook DL, Guyatt GH, Laupacis A, et al: Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 102:305S–311S, 1992 (suppl 4);</p>(4)<p>National Health and Medical Research Council (NHMRC). How to Use the Evidence: Assessment and Application of Scientific Evidence. Canberra, Australia: NHMRC; 2000;</p>(5)<p><a href="http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual4.htm" target="_blank">http://www.uspreventiveservicestaskforce.org/uspstf08/methods/procmanual4.htm</a>;</p>(6)<p>FIGO guidelines present a grading system for level of evidence (A–D) without specifying which system used.</p

Entities with guidelines for advanced stage gynecologic malignancies.

<p>Entities with guidelines for advanced stage gynecologic malignancies.</p

Distribution of organizations by location, society and organization type.

(a)<p>Continental American organizations include all USA national organizations along with 2 other South American organizations.</p>(b)<p>“Other” refers to any society setting that does not belong to any of the above specialty settings. This may include other specialty societies or other societies such as guideline developers.</p

Table_1_The Effect of Dose Adjustments in a Subsequent Cycle of Women With Suboptimal Response Following Conventional Ovarian Stimulation.docx

<p>Several infertile patients, who may even represent around 40% of the infertile cohort, may respond “suboptimally” (4–9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5–8) vs. 9 (6–12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte.</p

Does the type of GnRH analogue used, affect live birth rates in women with endometriosis undergoing IVF/ICSI treatment, according to the rAFS stage?

<p>Since the introduction of gonadotropin-releasing hormone (GnRH) antagonists, an extensive amount of literature investigating the role of the downregulation protocols on pregnancy outcomes has been published. However, these studies were mainly performed in the general infertile population where patients with endometriosis were often excluded or underrepresented. This study is a large retrospective cohort study including 386 endometriosis patients undergoing IVF/ICSI, who had been previously classified according to the rAFS system. Patients were stimulated either a long GnRH agonist or GnRH antagonist protocol. Depending on endometriosis stage, patients were divided into two groups: endometriosis stage I–II and endometriosis stage III–IV. Each group was subdivided, based on the type GnRH analog used. When comparing the GnRH agonist and antagonist groups, patients with endometriosis stage I–II, had a tendency toward higher β-hCG positive, clinical pregnancy, and live birth rates (42.8% vs. 26.7%; <i>p</i> = .07) in favor of GnRH agonist use. In endometriosis stage III–IV, no differences were observed between agonist and antagonist cycle in any of the pregnancy outcomes. Multivariate regression analysis did not reveal any significant predictor of live birth after adjusting for relevant confounders. Based on our findings, the chance to have a liveborn in endometriosis population seems not to be affected by the type of GnRH analog used, at least in advanced stages. Findings from stage I–II endometriosis cases merit consideration and further evaluation in a larger sample size is warranted.</p