• Changing clinical practice: Ultrasound and embryo transfer
• F1000M news: Free access to evaluations
• Feature spotlight: Free full text
• Featured article: Rethinking Folic Acid Fortification

Ultrasound and embryo transfer

Changes Clinical Practice: Ultrasound should not be routinely used for embryo transfer. However, its role in specific circumstances, such as difficult transfers, is yet to be determined.

Intrauterine transfer of embryos is a critical step in the process of IVF and assisted conception.

Peter Illingworth, Faculty Member of the Women's Health Faculty, and Katrina Rowan (Associate Faculty Member) highlight a recent study dealing with abdominal ultrasound at the time of embryo transfer as one that changes clinical practice. They classify the article as a 'New Finding' and 'Refutation' and observe:

"Refining the method of embryo transfer has been a common target in the constant search for ways to improve pregnancy rates in IVF. One proposed way of improving embryo transfers is the use of abdominal ultrasound to guide the placement of embryos in the uterine cavity."

They continue, "This large, high-quality randomized controlled trial shows that there was no difference in outcomes when ultrasound was routinely used for embryo transfer in IVF. This is an important finding because it refutes a previous Cochrane review of smaller, poorer quality trials and because the routine use of ultrasound for embryo transfer is a staff- and resource-intensive practice."

Read the evaluation in full here

F1000: Access to 5 FREE evaluations in every F1000M update!

Click here to tell your friends and colleagues.

Take advantage of limited free access to the full text for some of F1000 Medicine's most popular recent evaluations.

Trauma patients with severe traumatic brain injury should be transfused with packed red blood cells to maintain a hemoglobin level above 8mg/dl during their acute care...MORE Selected by | Donald Marion (The Children's Neurobiological Solutions Foundation, USA)
Exceptional F1000 Factor 9.0		The effect of anemia and blood transfusions on mortality in closed head injury patients.
Duane TM et al. J Surg Res 2008 Jun 15 147(2):163-7
In emotionally loaded situations...a semantically positive order may be followed more easily than a semantically negative order...MORE Selected by | Andrej Michalsen with Jose M. Mulet (HELIOS Hospital, Germany)
Recommended F1000 Factor 3.2		"Allow natural death" versus "do not resuscitate": three words that can change a life.
Venneman SS et al. J Med Ethics 2008 Jan 34(1):2-6
Ultrasound should not be routinely used for embryo transfer. This is an important finding because it refutes a previous Cochrane review of smaller, poorer quality trials...MORE Selected by | Peter Illingworth with Katrina Rowan (IVFAustralia, Australia)
Must Read F1000 Factor 6.0		A randomized controlled clinical trial of 2295 ultrasound-guided embryo transfers.
Drakeley AJ et al. Hum Reprod 2008 May 23(5):1101-6
Provides evidence of another 21 loci that confer increased risk of acquiring Crohn's disease...MORE Selected by | Johan Soderholm (Linköping University, Sweden)
Exceptional F1000 Factor 9.0		Genome-wide association defines more than 30 distinct susceptibility loci for Crohn's disease.
Barrett JC et al. Nat Genet 2008 Aug;40(8):955-62
These are interesting times for mechanisms of anesthetic action. Slowly but steadily, researchers are chipping away...MORE Selected by | Misha Perouansky (University of Wisconsin, United States of America)
Must Read F1000 Factor 6.0		General anesthetics activate a nociceptive ion channel to enhance pain and inflammation.
Matta JA et al. Proc Natl Acad Sci U S A 2008 Jun 24 105(25):8784-9

Rethinking Folic Acid Fortification

As far back as 1931, the benefits of folic acid were first highlighted when pregnant women were encouraged to take supplements in order to prevent anaemia. Subsequent years led to the discovery of further possible health benefits of the supplement and, in 1998, the US made folic acid fortification mandatory in order to reduce the incidence of neural tube defects (NTDs).

However, as pointed out in a recent study highlighted this month by Young-In Kim of the Gastroenterology & Hepatology Faculty, the fortification coincided with an increase in incidences of colorectal cancer. Young-In explains that the "The most serious adverse effect of folic acid supplementation and fortification is the tumor-promoting effect on the progression of (pre)neoplastic lesions."

He asks: "can we justify the exposure of the whole population to a substance that undoubtedly prevents a proportion of cases of relatively rare diseases but may increase the risk of much more common diseases?" and concludes by saying that: "Future debate and decision regarding folic acid fortification should take into consideration all potential adverse effects and dose-response of such a measure because it may be associated with potentially very serious consequences for many generations. In addition to careful monitoring of adverse effects, preclinical and population-based studies are warranted to determine efficacy, safety, and potential deleterious effects of folic acid fortification and supplementation on cancer risk and other health outcomes."

Read his comments in full here