The relationship between antiphospholipid antibodies and the clinical features of placental insufficiency, pre-eclampsia, and fetal loss has emerged as one of the most exciting new observations in obstetrics in the last 15 years. Antiphospholipid syndrome is the only convincing ‘immunologic’ disturbance of pregnancy affecting the fetus other than anti-erythrocyte or antiplatelet alloimmunization disorders, and it is now routine to test patients with fetal loss for the two best characterized antiphospholipid antibodies, lupus anticoagulant and anticardiolipin. Although there is no proven mechanism for fetal loss, treatment of antiphospholipid antibody-positive mothers during pregnancy with heparin improves pregnancy outcome.

Despite intense clinical interest, increasing numbers of infertile couples with endometriosis-associated infertility and ever more sophisticated diagnostic technology, optimal treatment of the infertility remains frustrating. In the absence of mechanical compromise of the pelvic viscera, there is no treatment directed towards the endometriosis itself, medical or surgical, which alleviates the infertility experienced by these couples. The reason for this lack of therapeutic progress is most likely related to the lack of consensus regarding the mechanism(s) by which the endometriosis or its pathophysiology may cause infertility. The possibility that infertility from another, as yet unidentifiable, cause(s) results in repetitive, nonconceptive, ovulatory menstrual cycles and leads to the development of endometriosis remains just as viable a hypothesis. The most useful current therapeutic approach is to consider these couples as having ‘unexplained’ infertility and utilize nonspecific cycle fecundity enhancement such as controlled ovarian hyperstimulation with intrauterine insemination or IVF. Since the fecundity of women with endometriosis in the later reproductive years continues to rapidly decline, this represents their most cost-effective option. While these nonspecific treatments may normalize the cycle fecundity, they are expensive and fraught with the hazards of multiple gestation and ovarian hyperstimulation. While efforts to reduce the risks of this approach are being made, improved therapeutic success with less hazard and cost will continue to remain elusive until the mechanism(s) of the infertility associated with endometriosis is conclusively defined.

Ovarian tissue freezing has been used successfully in animals and it has recently begun to be offered clinically to young women who have medical conditions with a high risk of sterility. Although no frozen human ovarian grafts have yet been returned to the donor and resulted in a pregnancy, there are many indications that this procedure should be feasible. Although live young have been derived from frozen grafts in several species, research should aim to make further improvements to the cryopreservation and grafting procedures to optimize follicle survival, and hence minimize the amount of tissue that needs to be collected, stored and returned. Ovarian tissue freezing, particular if used in combination with egg and embryo freezing, should allow a patient to safeguard their chance of becoming a parent later (Table 1). In cases where the patient has a systemic cancer or infection and malignant cells or viruses may be present in the systemic circulation and the gonadal tissue, ovarian tissue could be collected and frozen, but grafting is not currently recommended (Table 3).

The short-term risks of fertility drug treatment, such as ovarian hyperstimulation syndrome, are well recognised by clinicians providing infertility treatment. There is uncertainty, however, about whether there are any longterm risks such as an increased risk of breast or gynaecological cancer. The possibility of such long-term risks is sometimes a concern for couples who are considering or receiving infertility treatment and their concerns need to be discussed using the best available evidence. The need for appropriate evaluation of long-term health effects of treatment with fertility drugs, including cancer, has been highlighted in major reviews of infertility treatments in Australia and Canada.