Is there a place for corifollitropin alfa in IVF/ICSI cycles? A systematic review and meta-analysis

29 02 2012

To the Editor:

As the sponsor of all four trials included in a recent systematic review and meta-analysis of corifollitropin alfa, we reviewed the manuscript authored by Youssef and co-workers (1) with great interest. This combined analysis includes two phase II dose-finding trials and two phase III randomized controlled trials.

Related to the OHSS incidence per woman randomized, the authors report on page 3 that the number needed to harm (NNH) is equal to 1. This is an obvious error. If the absolute risk increase is 1% as the authors state, the NNH should have been 100. However, the absolute risk increase is less than 1%. This can be demonstrated by combining the control OHSS rate of 2% (page 3) with the OHSS odds ratio of 1.29 (figure 2C). This gives an Elonva OHSS rate of 2.6%, an increase of 0.6% corresponding to an NNH of 177. In a recent pooled analysis by Tarlatzis (2), only the two phase III randomized controlled trials were included and the odds ratio for OHSS, adjusted for trial, was 1.18 (95%CI 0.81-1.71). Read the rest of this entry »

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Inadequate Description of an Acupuncture Treatment Study for PCO

28 02 2012

To the Editor:

In the February issue of the Journal, Stener-Victorin et al. [1] have published an article that confuses concepts and methods of acupuncture. In the title of the publication, the authors refer to the effects of acupuncture; however, in the publication itself they refer to electroacupuncture. Electroacupuncture does not belong to the traditional treatment methods in Chinese Medicine [2-4]. Practitioners of acupuncture, as ourselves, are confused by such title-line statements. In addition to this, traditional acupuncture works with clearly and exactly defined acupoints in order to allow reproducibility and comprehension of any kind of treatment [5]. Stener-Victorin et al. fail to describe the points used in their therapeutic approach. They vaguely mention the use of acupoints, described as “…inserted bilaterally in acupuncture points in abdominal muscles and in muscles below the knee…” [1]. Their publication does not provide any reproducible thoughts that adhere to acupuncture. In addition to this, the use of acupoints related to muscular structures can be seen as a defined interrelationship within the concept of the Five Elements [6], as we demonstrated in 2009 [7]. Read the rest of this entry »





Quantification of mitochondrial abundance

28 02 2012

To the Editor:

We read the article by Duran et. al. entitled “The association of reproductive senescence with mitochondrial quantity, function, and DNA integrity in human oocytes at different stages of maturation” (1) with great interest. In this article, authors aimed to investigate the contribution of mitochondrial aging to female reproductive senescence in humans. In order to test this hypothesis, an attempt was made to estimate the number of mitochondria by the quantification of mtDNA copy number which is measured via real-time polymerase chain reaction (PCR). They also studied some other biochemical and molecular parameters. They found that the number of mitochondria in the oocytes from various maturational stages did not show any statistically significant differences. They hypothesized that reproductive aging may lead to decreased numbers of mitochondria in human oocytes, which are interpolated by using mtDNA copy number. In their discussion, they concluded that inherently imperfect ovarian reserve indicators, such as follicle stimulating hormone (FSH) level and total number of oocytes retrieved by controlled ovarian hyperstimulation, may also predict the number of mitochondria in individual human oocytes. Read the rest of this entry »





Commentary to: “Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis.”

28 02 2012

To the Editor:

Zheng et al (1) claim in their meta-analysis that there is no significant difference between acupuncture and placebo when it comes to live birth rates among women undergoing in vitro fertilization because the Streitberger procedure where needles do not enter the skin, which was used as placebo acupuncture, appears to be more effective than acupuncture itself. This might be interpreted as a recommendation to choose the Streitberger procedure over acupuncture as the active treatment. The authors seem to agree, saying “…the harmful reaction produced by real acupuncture can be avoided by this noninvasive stimulation…”.

However, we do not share this implied recommendation, since nothing in this article distinguishes the direct effect of acupuncture from the effect of the broad psychological/social/cultural environment in which it is performed. The authors use the term ‘acupuncture’ without making this distinction. Is acupuncture something that could be performed by a robot on robot-like participants with no deeper meaning involved? Acupuncture probably means much more than that to the authors, as it does to us. Read the rest of this entry »





Letter regarding use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation.

3 02 2012

To the Editor:

We read with great interest the article by Avendaño et al (1), “Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation.” We want to congratulate the authors for their original and interesting work. However, this study has also raised a few questions.

First of all, the issue of sperm analysis method should be addressed. Indeed, sperm analysis was performed manually before selection, after swim up, and after 4 hours of incubation under the computer or not (control group). Despite efforts towards improvement and standardization of laboratory procedures (2), manual sperm analysis still suffers from a lack of precision and accuracy (3), particularly when counting progressive motile spermatozoa in an enriched supernatant. Moreover, sperm analysis was conducted here by a single observer and apparently not repeated, which leads to a high risk of intra observer variability. We also would like the authors to precise if the study was operator-blinded or if the operator was aware of the origin of the samples he was assessing. All these limitations could constitute a bias and prevent from relevant interpretation of the results. Could the authors consider automated sperm analysis as a reliable alternative in order to improve reproducibility and precision of their results? (4) Moreover, CASA could bring new insights into a potential WiFi-induced sperm motility alteration and kinetics modification. Read the rest of this entry »