Pre-implantation genetic diagnosis in Hong Kong

This paper presents the first two successful cases of pre-implantation genetic diagnosis in Hong Kong and discusses the indications and the advantages over prenatal diagnosis. Patients should be informed about the procedure and extensively counselled about the possibility of misdiagnosis and the need for conventional prenatal diagnosis during pregnancy.published_or_final_versio

Live birth following double-factor pre-implantation genetic diagnosis for both reciprocal translocation and alpha-thalassaemia

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Frozen-thawed embryo transfer cycles

Objective: To review the outcomes of frozen-thawed embryo transfer cycles. Design: Retrospective review. Setting: Tertiary assisted reproduction centre, Hong Kong. Patients: Subfertile patients undergoing frozen-thawed embryo transfer between July 2005 and December 2007. Main outcome measures: Clinical and ongoing pregnancy rates. Results: A total of 983 frozen-thawed embryo transfer cycles performed during the study period were reviewed. The clinical pregnancy and ongoing pregnancy rates were 35% and 30%, respectively. Factors associated with successful outcome included younger maternal age (≤35 years) and 4 or more blastomeres at replacement, but not the method of insemination, the cause of subfertility, or the type of frozen-thawed embryo transfer cycle. The overall multiple pregnancy rate was 18%. For cycles with a single embryo replaced, embryos having 4-cell or higher stages at replacement gave an ongoing pregnancy rate of 25%, whereas those with less than 4 cells had a significantly lower ongoing pregnancy rate of 5% only. Blastomere lysis after thawing significantly reduced the clinical pregnancy and ongoing pregnancy rates of cycles with one embryo replaced. Conclusions Clinical pregnancy and ongoing pregnancy rates of frozen-thawed embryo transfer cycles were 35% and 30%, respectively. Higher pregnancy rates were associated with younger maternal age (≤35 years), blastomere numbers of 4 or more, and no blastomere lysis after thawing.published_or_final_versio

Role of Baseline Antral Follicle Count and Anti-Mullerian Hormone in Prediction of Cumulative Live Birth in the First In Vitro Fertilisation Cycle: A Retrospective Cohort Analysis

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Experience of more than 100 preimplantation genetic diagnosis cycles for monogenetic diseases using whole genome amplification and linkage analysis in a single centre

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Evaluation of pre-stimulation anti-mullerian hormone level in predicting cumulative live-birth in IVF

Theme: Building Consensus in Gynecology, Infertility and Perinatology (BCGIP)BACKGROUND: Serum anti-Mullerian hormone (AMH) level has been used as a useful marker of ovarian response in assisted reproduction. We evaluated for the first time the role of baseline AMH level in predicting cumulative pregnancy outcome during in-vitro fertilisation (IVF) treatment. METHODS: We studied 320 women (aged 22-44) undergoing IVF with or without intracytoplasmic sperm injection using GnRH agonist long protocol. Baseline AMH levels on the day before commencing ovarian stimulation were analysed. The main outcome measures were cumulative live-birth, live-birth in the fresh cycle and ovarian response. RESULTS: There was a trend of higher median AMH levels in subjects achieving live-birth in the fresh …postprin

Array comparative genomic hybridization analyses of all blastomeres of a cohort of embryos from young IVF patients revealed significant contribution of mitotic errors to embryo mosaicism at the cleavage stage

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Ovarian Response and Cumulative Live Birth Rate of Women Undergoing In-Vitro Fertilisation Who Had Discordant Anti-Mullerian Hormone and Antral Follicle Count Measurements: A Retrospective Study

OBJECTIVE: To evaluate ovarian response and cumulative live birth rate of women undergoing in-vitro fertilization (IVF) treatment who had discordant baseline serum anti-Mullerian hormone (AMH) level and antral follicle count (AFC). METHODS: This is a retrospective cohort study on 1,046 women undergoing the first IVF cycle in Queen Mary Hospital, Hong Kong. Subjects receiving standard IVF treatment with the GnRH agonist long protocol were classified according to their quartiles of baseline AMH and AFC measurements after GnRH agonist down-regulation and before commencing ovarian stimulation. The number of retrieved oocytes, ovarian sensitivity index (OSI) and cumulative live-birth rate for each classification category were compared. RESULTS: Among our studied subjects, 32.2% were discordant in their AMH and AFC quartiles. Among them, those having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate. Subjects discordant in AMH and AFC had intermediate OSI which differed significantly compared to those concordant in AMH and AFC on either end. OSI of those discordant in AMH and AFC did not differ significantly whether either AMH or AFC quartile was higher than the other. CONCLUSIONS: When AMH and AFC are discordant, the ovarian responsiveness is intermediate between that when both are concordant on either end. Women having higher AMH within the same AFC quartile had higher number of retrieved oocytes and cumulative live-birth rate.published_or_final_versio

Evaluating the role of serum AMH in predicting suboptimal or excessive ovarian response to standard dosing regimen of ovarian stimulation in in-vitro fertilisation using GNRH agonist long protocol

Poster PresentationConference Theme: The Oocyte: from Basic Research to Clinical PracticeIntroduction: Antral follicle count (AFC) is widely used for individualising gonadotrophin dosage in in-vitro fertilisation (IVF) treatment. This retrospective study tried to determine whether baseline serum anti-Mullerian hormone (AMH) measurement would offer any additional role in predicting suboptimal or excessive ovarian response among subjects classified to have normal ovarian reserve based on AFC. Methods: We reviewed 338 women undergoing the first IVF cycle using GnRH agonist long protocol who had baseline AFC of 6 to 14. Ovarian stimulation was initiated with gonadotrophin 300IU daily for two days followed by 150IU daily. Archival serum samples taken on the day before starting gonadotrophin were assayed for AMH. High responders were defined by retrieval of 15 or more oocytes or peak serum oestradiol >20000 pmol/l. Low responders were defined by retrieval of 5 or less oocytes. Results: Among the study cohort, 201 (59.5%), 77 (22.8%) and 73 (21.6%) women had optimal, low and high ovarian response respectively, and their respective median AMH concentrations differed significantly (22.5, 15.1 and 36.1 pmol/l). The area under the ROC curves for predicting high and low response were 0.740 and 0.688 respectively. At the best cut-off of 29 pmol/l, AMH has a sensitivity of 66% and specificity of 73% for predicting high response. At the best cut-off of 15 pmol/l, it has a sensitivity of 52% and specificity of 79% for predicting low response. Conclusion: Baseline serum AMH measurement offers a modest role for individualisation of gonadotrophin dosage in women with normal ovarian reserve based on AFC.published_or_final_versio

Comparison between fluorescent in-situ hybridisation and array comparative genomic hybridisation in preimplantation genetic diagnosis in translocation carriers

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