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

Male infertility

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HKCOG guidelines: induction of ovulation

This guideline by The Hong Kong College of Obstetricians and Gynaecologists (HKCOG) covers the classification of ovulation disorders, treatment options of various ovulation disorders, and their associated risks.published_or_final_versio

A pilot study on the use of letrozole with either misoprostol or mifepristone for termination of pregnancy up to 63 days

Background: Letrozole is a third-generation selective aromatase inhibitor. Animal data suggested that it might be useful in medical abortion. We performed two pilot studies to assess the feasibility of using letrozole in combination with either mifepristone or misoprostol for termination of pregnancy up to 63 days. Study Design: We recruited 40 subjects who requested legal termination of pregnancies up to 63 days. Medical abortion was performed with letrozole 7.5 mg daily for 2 days followed by 800 mcg vaginal misoprostol in 20 subjects and letrozole 7.5 mg combined with 200 mg mifepristone in another 20 subjects. Results: The mean induction-to-abortion interval of the regimen of letrozole and misoprostol was 9.1 h (median 7.9 h, range 2.7-23.6 h). The complete abortion rate was 80% (95% CI: 56.3-94.3%). For those with gestation of ≤49 days, the complete abortion rate was 87.5% (14/16; 95% CI: 61.7-98.5%). The mean induction-to-abortion interval of letrozole combined with mifepristone was 90.1 h (median 93.4 h, range 66.0-121.2 h). The complete abortion rate was 71.4% (95% CI: 47.8-88.7%). Conclusion: These preliminary results suggest that a regimen of letrozole and misoprostol may be useful in medical abortion, but the combination with mifepristone is less effective and takes longer. Randomized studies comparing letrozole and misoprostol to misoprostol alone are warranted. © 2011 Elsevier Inc. All rights reserved.postprin

Sequential use of letrozole and gonadotrophin in women with poor ovarian reserve: a randomized controlled trial

Sequential use of letrozole and human menopausal gonadotrophin (HMG) was compared with HMG only in poor ovarian responders undergoing IVF. Patients (n=53) with less than four oocytes retrieved in previous IVF cycles or less than five antral follicles were randomized to either letrozole for 5days followed by HMG or HMG alone. The letrozole group had lower dosage of HMG (P<0.001), shorter duration of HMG (P<0.001) and fewer oocytes (P=0.001) when compared with controls. Live-birth rate was comparable with a lower miscarriage rate in the letrozole group (P=0.038). Serum FSH concentrations were comparable in both groups except on day 8, while oestradiol concentrations were all lower in the letrozole group from day 4 (all P<0.001). Follicular fluid concentrations of testosterone, androstenedione, FSH and anti-Mullerian hormone were higher in the letrozole group (P=0.009, P=0.001, P=0.046 and P=0.034, respectively). Compared with HMG alone, sequential use of letrozole and HMG in poor responders resulted in significantly lower total dosage and shorter duration of HMG, a comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment of follicular fluid. The management of poor ovarian responders or women with poor ovarian reserve in IVF is controversial. The use of letrozole has been studied; however, results are inconsistent. This randomized trial studied the sequential use of letrozole and gonadotrophin compared with gonadotrophin alone in poor responders undergoing IVF. The sequential use of letrozole and gonadotrophin led to a significantly lower dosage and shorter duration of gonadotrophin use, significantly fewer oocytes, comparable live-birth rate, a significantly lower miscarriage rate and a more favourable hormonal environment at a lower cost.postprin

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

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

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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