Recombinant LH supplementation to a standard GnRH antagonist protocol in women of 35 years or older undergoing IVF/ICSI: a randomized controlled multicentre study.

Study Question: Does the addition of exogenous LH to an IVF/ICSI stimulation protocol with recombinant FSH (r-FSH) and a GnRH antagonist improve the ovarian response and pregnancy rates in women of 35 years and older?

Summary Answer: Supplementation of LH during the second half of the follicular phase has no effect on pregnancy rates, implantation rates or on ovarian response in women of 35 years and older undergoing GnRH antagonist IVF/ICSI cycles.

What Is Known Already: In IVF/ICSI stimulation protocols GnRH agonists or antagonists are administered to prevent a premature pituitary LH surge, which can have a detrimental effect on the IVF/ICSI procedure. In effect, GnRH analogues cause the levels of both gonadotrophins to drop.

Obstetric rupture of the rectovaginal septum and sphincter complex despite an intact perineum: report of three cases.

Obstetric injury comprising tearing of the rectovaginal septum, rectal mucosa, and anal sphincter complex with limited or no involvement of the perineal body may implicate the sudden appearance of an elbow, foot or head in the anal orifice during the second phase of labour. This complex type of obstetric injury is highly uncommon and reports have rarely been published. There are no guideliness as to how to respond to this obstetric emergency and there is no time for consultation.

Long-term outcome in couples with unexplained subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment.

Background: We recently reported that treatment with intrauterine insemination and controlled ovarian stimulation (IUI-COS) did not increase ongoing pregnancy rates compared with expectant management (EM) in couples with unexplained subfertility and intermediate prognosis of natural conception. Long-term cost-effectiveness of a policy of initial EM is unknown. We investigated whether the recommendation not to treat during the first 6 months is valid, regarding the long-term effectiveness and cumulative costs.

In the interest of all who value their purse and their health: a brief history of the ''Vereniging tegen de Kwakzalverij''--Society Against Quackery--of the Netherlands.

Discontentment with the massive violations of the influential Dutch Prime Minister's (Johan Rudolf Thorbecke) health laws led to the foundation of the Dutch Society Against Quackery, in 1880. Within a few years, the Society had more than 1,100 members. Initially, quackery mostly consisted of the unauthorized practice of medicine and the peddling of industrially manufactured ''secret remedies.

A Dutch view of the ''science'' of CAM 1986--2003.

Between 1986 and 2003, research efforts on complementary and alternative medicine (CAM) were subsidized by the Dutch government. This led to 12 academic theses and a considerable number of papers in medical journals. In our review, we have summarized the results of this research, grouped by therapeutic category (that is, acupuncture, paranormal therapies, naturopathy, manual therapies, homeopathy and anthroposophical medicine.

Time to pregnancy after a previous miscarriage in subfertile couples.

Objective: To assess the time to spontaneous ongoing pregnancy after a previous miscarriage in subfertile couples.

Design: A prospective cohort study.

Setting: The study was conducted in 38 fertility centers in the Netherlands.

[Dutch parliament legitimizes harmful quackery].

The Dutch parliament has recently accepted a tax law in which certain groups of alternative therapists can be exempt from VAT. To be eligible for this VAT exemption, the disciplines to which the therapists belong have to meet certain training requirements. In this article it is contended, in agreement with the Royal College of Physicians in the UK, that statutory regulation is inappropriate for disciplines whose therapies are neither of proved benefit nor appropriately tested.

[Alternative clinical-chemical laboratories: providers of incorrect or non-existant diagnoses].

Until recently, alternative doctors and healers used to employ alternative ways of making their alternative diagnoses such as electro-acupuncture, iridiscopy, plantar reflexology, live blood analysis, aura reading and bioresonance methods. Two recent papers report the emergence of unjustified diagnoses, resulting from clinical chemistry testing in commercial laboratories with an alternative philosophy and character. Dutch law considers medicine to be a profession for which no special knowledge is demanded.

[Severe disciplinary measures in the Millecam case: important precedent for revising the rules of conduct by scientific associations and the KNMG].

The popular 45-year-old Dutch actress Sylvia Millecam died in August 2001 from untreated advanced breast cancer. She refused standard medical treatment and sought solace in many alternative healers, including three medical physicians. The Dutch Healthcare Inspection accused the three physicians of malpractice and asked the Medical Disciplinary Tribunal to pass judgment.