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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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

Spatial and temporal characterization of endometrial mesenchymal stem-like cells activity during the menstrual cycle

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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