Transvaginal sonography in early human pregnancy

Efforts to employ transvaginal sonography as a method to visualise the internal genitalia and their contents already date from the late 1960's, when it was used to detect the embryonic heart beat and to study the female genital tract. It was reported that embryonic cardiac activity could be detected as early as 46 days menstrual age or 32 days after ovulation, which is much earlier than by then available conventional abdominal ultrasound techniques. However, the equipment was bulky and consisted of a large device producing A-mode images. Creation of two-dimensional images was extremely difficult and soon the method was forgotten. It was only after the introduction of the grey scale technique and of realtime imaging in the mid-seventies that transvaginal sonography became feasible again. However, it took a considerable time before its value was rediscovered. This was probably due more to apprehension on behalf of the investigator than to lack of acceptance by the patient. Although the significance of the transvaginal approach was recognised in the early eighties, notably in the German speaking countries and the United States, the major breakthrough came from IVF centres where it was first employed for the puncture of follicles and later for routine monitoring of induction of follicular growth. It soon became clear that transvaginal sonography could give more detailed information in the field of early embryonic development and gynaecological disease. Recently, a host of data on the first topic has been reported. Its role in late pregnancy is mainly determined by its accuracy in diagnosing placenta praevia

Risk of cancer in children and young adults conceived by assisted reproductive technology

STUDY QUESTION: Do children conceived by ART have an increased risk of cancer? SUMMARY ANSWER: Overall, ART-conceived children do not appear to have an increased risk of cancer. WHAT IS KNOWN ALREADY: Despite the increasing use of ART, i.e. IVF or ICSI worldwide, information about possible long-term health risks for children conceived by these techniques is scarce. STUDY DESIGN, SIZE, DURATION: A nationwide historical cohort study with prospective follow-up (median 21 years), including all live-born offspring from women treated with subfertility treatments between 1980 and 2001. PARTICIPANTS/MATERIALS, SETTING, METHODS: All offspring of a nationwide cohort of subfertile women (OMEGA study) treated in one of the 12 Dutch IVF clinics or two fertility clinics. Of 47 690 live-born children, 24 269 were ART-conceived, 13 761 naturally conceived and 9660 were conceived naturally or through fertility drugs, but not by ART. Information on the conception method of each child and potential confounders were collected through the mothers’ questionnaires and medical records. Cancer incidence was ascertained through linkage with The Netherlands Cancer Registry from 1 January 1989 until 1 November 2016. Cancer risk in ART-conceived children was compared with risks in naturally conceived children from subfertile women (hazard ratios [HRs]) and with the general population (standardized incidence ratios [SIRs]). MAIN RESULTS AND THE ROLE OF CHANCE: The median follow-up was 21 years (interquartile range (IQR): 17–25) and was shorter in ART-conceived children (20 years, IQR: 17–23) compared with naturally conceived children (24 years, IQR: 20–30). In total, 231 cancers were observed. Overall cancer risk was not increased in ART-conceived children, neither compared with naturally conceived children from subfertile women (HR: 1.00, 95% CI 0.72–1.38) nor compared with the general population (SIR = 1.11, 95% CI: 0.90–1.36). From 18 years of age onwards, the HR of cancer in ART-conceived versus naturally conceived individuals was 1.25 (95% CI: 0.73–2.13). Slightly but non-significantly increased risks were observed in children conceived by ICSI or cryopreservation (HR = 1.52, 95% CI: 0.81–2.85; 1.80, 95% CI: 0.65–4.95, respectively). Risks of lymphoblastic leukemia (HR = 2.44, 95% CI: 0.81–7.37) and melanoma (HR = 1.86, 95% CI: 0