Harbin Consensus Conference Workshop Group. (2014) Improving the Reporting of Clinical Trials of Infertility Treatments (IMPRINT): modifying the CONSORT statement

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Management of anovulatory infertility

Anovulatory subfertility is a heterogeneous condition with various underlying causes, which should be identified with appropriate history taking, physical examination and relevant investigations. Optimisation of body weight is essential in either underweight, overweight or obese individuals. Women with hypogonadotrophic anovulation can be treated with pulsatile gonadotrophin-releasing hormone therapy or a gonadotrophin preparation containing both follicle-stimulating hormone or luteinising hormone activities. For normogonadotrophic anovulation, clomiphene citrate should be used as first-line medical treatment. Metformin co-treatment with clomiphene citrate may be considered in a subgroup of women with polycystic ovary syndrome who are obese or clomiphene-resistant. Ovulation induction with gonadotrophin or laparoscopic ovarian drilling is the next option. Dopamine agonist is indicated for anovulation as a result of hyperprolactinaemia. © 2012 Elsevier Ltd. All rights reserved.postprin

Evidence-based investigations for subfertility

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Scratching and IVF: any role?

Purpose of review: To review updated information on the influence of endometrial scratching on IVF. Recent findings: Endometrial receptivity remains an important rate-limiting step affecting the success of IVF. The current evidence on the effect of endometrial scratching on IVF ranges from marked improvement, no difference to a potentially negative impact. The heterogeneity of studies presents a challenge in interpretation of data for routine clinical practice. Summary: Endometrial scratching performed in the preceding cycle is associated with improved clinical pregnancy and live birth rates in women with recurrent implantation failure, but not in unselected subfertile women undergoing IVF. Most of the current literature are underpowered and at high risk of bias.postprin

Male infertility

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Investigating a subfertile couple

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Issues in second trimester induced abortion (medical/surgical methods)

Second trimester abortion remains a common procedure worldwide. Dilatation and evacuation (D&E) is the surgical method of choice, if the surgical expertise and facilities are available. Adequate cervical dilatation preoperatively is a prerequisite for a safe D&E. Medical abortion using misoprostol together with mifepristone is the medical method of choice. The recommended regimen is 200 mg mifepristone followed by 800 μg of vaginal misoprostol 36-48 h later. Subsequent doses of 400 μg of misoprostol can be given orally every 3 h up to a maximum of four more doses. Proper preoperative assessment would not only help to provide safe abortion treatment, but it also guides the choice of method. If the expertise and facilities of both methods are available, both methods should be discussed and offered to the patient so that the patient can make an informed choice. © 2010 Elsevier Ltd. All rights reserved.postprin

Comparison of two dosages of recombinant human follicle-stimulating hormone in Chinese women undergoing controlled ovarian stimulation: Prospective randomised double-blind study

Objective: To compare two dosages of recombinant human follicle-stimulating hormone for controlled ovarian stimulation. Design: Prospective, randomised double-blind study. Setting: Tertiary assisted reproduction unit, Hong Kong. Participants: Forty subfertile Chinese women aged 24 to 38 years undergoing in vitro fertilisation. Entry criteria included good physical and mental health, and a body mass index between 18 and 29 kg/m2. Exclusion criteria were subfertility caused by an endocrine abnormality, polycystic ovarian syndrome, or absent ovarian function; previous assisted reproduction treatment in which fewer than three oocytes were retrieved; prior hospitalisation due to severe ovarian hyperstimulation syndrome; chronic cardiovascular, hepatic, renal, or pulmonary disease; alcohol or drug abuse; and the administration of investigational drugs within the previous 3 months. Intervention: Injection of recombinant follicle-stimulating hormone, 100 IU/d or 200 IU/d. Main outcome measures: The number of oocytes, total dose of drug used, and pregnancy rates. Results: Compared with the 20 women receiving 200 IU/d, the 20 who received 100 IU/d had a significantly lower median number of oocytes retrieved and median total dose of drug used (7.5 versus 15.0 [P<0.001] and 1200 IU versus 2000 IU [P<0.001], respectively). The pregnancy rates in the fresh cycles were similar (20%) in both groups, but the cumulative pregnancy rates in the 100 IU/d and 200 IU/d groups were 20.0% and 45.0% per stimulated cycle, respectively. The incidence of ovarian hyperstimulation syndrome in the 100 IU/d and 200 IU/d groups was 5.0% and 20.0%, respectively. Conclusions: Use of 100 IU/d of recombinant follicle-stimulating hormone requires a lower total dose but results in the harvest of half the number of oocytes compared with when a dosage of 200 IU/d is used.published_or_final_versio

Nanoparticle labeling identifies slow cycling human endometrial stromal cells

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Prognostic factors for successful outcome in patients undergoing controlled ovarian stimulation and intrauterine insemination

Objective. To determine the prognostic factors associated with successful outcome following controlled ovarian stimulation and intrauterine insemination. Design. Retrospective analysis. Setting. University-based assisted reproductive technology centre, Hong Kong. Patients and methods. Patients included 292 couples undergoing 600 treatment cycles, following a standard protocol of human menopausal gonadotrophin injections. Multiple logistic regression analysis was performed to determine which demographic and sperm parameters gave the maximum discrimination to predict pregnancy. Results. One hundred and eleven pregnancies resulted from treatment. The pregnancy rates were 18.5% per cycle and 37.9% per couple. The age of the women was significantly lower for pregnant cycles, and the serum oestradiol levels and number of follicles greater than 16 mm in diameter were significantly higher, compared with non-pregnant cycles. The sperm concentration and number of motile spermatozoa were also significantly increased in pregnant cycles. Pregnancy rate was significantly increased when the raw semen sample contained 20 million/mL or more spermatozoa, normal forms comprised 7% or more, and when the number of motile spermatozoa in inseminated samples was 1 million or greater. Conclusion. Using multiple logistic regression analysis, age of the women and serum oestradiol level had the maximum power to predict pregnancy following ovarian stimulation and intrauterine insemination.published_or_final_versio