Dr. Lockwood Audio Issue: March 2012

It's almost time for your next issue of Contemporary OB/GYN.

Editor-in-Chief Dr. Charles J. Lockwood talks about articles of interest to you in the March issue.

Moderator: We're here with Editor in Chief Dr. Charles J. Lockwood, Dean of the College of Medicine and Vice President for Health Sciences at The Ohio State University.

Dr. Lockwood, what’s coming up in the current issue of Contemporary OB/GYN?

Dr. Lockwood: The cover article is titled, “In vitro maturation of oocytes: Improving the odds for infertile patients.” The senior author is Dr. Tan, the James Edmund Dodds Professor, in the Department of Obstetrics and Gynecology at McGill University Health Centre, and Medical Director of the Montreal Reproductive Centre at McGill University.

Dr. Tan and his colleagues not that in vitro maturation differs from in vitro fertilization in that there is no need for controlled ovarian hyperstimulation with exogenous gonadotropins and the oocytes are collected before they are fully matured.

The authors also describe a typical in vitro maturation cycle as performed at McGill Health Centre including ultrasound monitoring in the early follicular phase through oocyte collection, laboratory maturation of oocytes, embryo transfer, luteal phase support, and pregnancy outcomes.

Now, in vitro maturation has been successful in women with empty follicle syndrome, which has been diagnosed in prior IVF cycles. It has also been successful in women with polycystic ovary syndrome and women who are poor responders to gonadotropins. In select patient groups in vitro maturation has achieved success rates exceeding 35%.

And in vitro maturation is also an option for women considering oocyte donation, fertility preservation prior to cancer treatment or surgery, or for those who want to postpone childbearing, particularly when a male partner may not be available.

Rates of pregnancy, miscarriage, and aneuploidy, as well as the birth weight of infants in pregnancies following in vitro maturation are quite similar to those following in vitro fertilization.

In vitro maturation is a form of assisted reproduction technology that provides an option for subfertile patients and has fewer health risks and is less expensive than controlled ovarian hyperstimulation. So I think this is going to be a great article to read.

Another article that I want to call everybody’s attention to is “Selecting a quality compounding pharmacy for 17 hydroxyprogesterone.” Obviously, this is a very timely and topical article. The author is Joe Cabaleiro, who is a registered pharmacist and the executive director of the Pharmacy Compounding Accreditation Board in Washington, and what he does is to summarize what compounding pharmacies do.

Compounding is the traditional art of preparing medications to meet a patient's specific needs. Only in the last few decades have mass-produced manufactured products become the primary source of medications. So traditionally our medications were primarily derived from compounding.

Compounded medications can be ideal solution to problem of patient sensitivity to inactive ingredients, for example, an allergy. They can also be an ideal solution in the setting of drug shortages and when commercially available medications are simply unavailable or are discontinued or when doses that are needed are not commercially available.

Obviously, 17 hydroxyprogesterone has been in the news frequently in the past year, as an example of the issues raised by pharmacy compounding. Compounding pharmacies are accountable to federal and state regulatory entities for the quality, purity, identity, and strength of ingredients; the cleanliness of the pharmacy and the sterile conditions in which drugs are compounded; processes and equipment employed in compounding; marketing of products; pharmacy accreditation in terms of quality assurance, control, and improvement; certificates of analysis for batch quality; and other such regulations. So, in other words, compounding pharmacies really are under fairly tight control by state and federal government regulatory agencies.

Likewise, the quality of compounding pharmacies must regularly evaluated through testing of personnel, products, and facilities to ensure that the highest standards of cleanliness, quality, and accuracy are upheld throughout the process.

The author provides readers with four questions and a checklist of criteria for evaluating compounding pharmacies, and he explains the legal issues related to compounded 17 hydroxyprogesterone versus the commercially manufactured version.

Moderator: It sounds as if the March issue has quite a lot to offer readers.

Dr. Lockwood: It certainly does.

Moderator: For nearly half a century, busy practitioners have trusted Contemporary OB/GYN to translate the latest research into outstanding patient care. We're dedicated to providing you with evidence-based information on scientific advances in a clinically useful format.