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

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

The impact of blogging on Hong Kong primary school students' bilingual reading literacy

This study looked at the types of blog consulted by 1,298 Primary 4 students in Hong Kong and whether such consultation influenced performance on standardised tests of Chinese and English reading comprehension. When students were asked if they consulted Chinese and English blogs, 42% said they looked at Chinese blogs and 19% said they looked at English blogs. This difference was anticipated since Chinese is the mother tongue of most primary school students in Hong Kong and English is a second language. The themes of sites consulted were categorised into types: the Chinese blogs being able to be categorised into three types, and the English blogs into two. Boys and girls differed in their choice of Chinese and English blog topics and the strength of the students' Chinese and English reading proficiency clearly had some influence on the choice of blogs consulted. Factor analysis was used to group together types of blog and analysis of variance was applied to test differences in performance. With over half of the students saying they did not consult either Chinese or English blogs, it is unwise to draw weighty conclusions about the influence of blogging on reading standards. There was little evidence that regularly consulting the Internet was associated with high grades on either Chinese or English reading tests. Given the large number of students who said they had never consulted blogs, discussion of the analytical outcomes and conclusions are guarded but recommendations are offered.published_or_final_versio

Semen analysis - what a clinician should know

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The use of sex hormones in women with rheumatological diseases

A number of rheumatological diseases predominantly affect women of reproductive age. There has always been concern that the use of oestrogen-containing agents such as combined hormonal contraception and hormone therapy might aggravate these conditions. This article reviews the up-to-date evidence regarding the safety of using these agents in women with various rheumatological diseases, with emphasis on systemic lupus erythematosus and rheumatoid arthritis. In the absence of antiphospholipid antibody or other prothrombotic risk factors, combined hormonal contraception is not contra-indicated in most rheumatological conditions including inactive systemic lupus erythematosus. Moreover, hormone therapy is generally not contra-indicated except for women with active systemic lupus erythematosus disease where its effect on disease flare is less clear and individual judgement is required.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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Correlation between three assay systems for anti-Müllerian hormone (AMH) determination

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A randomized double-blind controlled trial of the use of dydrogesterone in women with threatened miscarriage in the first trimester: study protocol for a randomized controlled trial

BACKGROUND: Miscarriage is a common complication of pregnancy occurring in 15-20 % of all clinically recognized pregnancies. Currently, there is still no good scientific evidence to support the routine use of progestogens for the treatment of threatened miscarriage because the existing studies were not large enough to show a significant difference and some of them were not randomized or double-blind. METHODS: This is a double-blind, randomized controlled trial. A total of 400 patients presenting with first-trimester threatened miscarriage will be enrolled. They will be randomized to take dydrogesterone 40 mg per os, followed by 10 mg per os three times a day or placebo until twelve completed weeks of gestation or 1 week after the bleeding has stopped, whichever is longer. The primary outcome is the percentage of miscarriage before 20 weeks of gestation. DISCUSSION: We postulate that the dydrogesterone therapy will significantly reduce the risk of miscarriage in women with threatened miscarriage. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov, NCT02128685 . Registered on 29 April 2014.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

Live birth and cumulative live birth rates in expected poor ovarian responders defined by the Bologna criteria following IVF/ICSI treatment

Objective: To determine the live birth and cumulative live birth rates of expected poor ovarian responders according to the Bologna criteria and to compare their outcomes with those of expected normal responders Design: Retrospective analysis Setting: University infertility clinic Patients: A total of 1,152 subfertile women undergoing their first in vitro fertilization (IVF) cycle Interventions: Women were classified into 4 groups according to the Bologna criteria for comparison Main Outcome Measure(s): Live birth and cumulative live birth rates Results: Women with expected poor response (POR) had the lowest live birth rate than the other 3 groups (23.8%, p = 0.031). Cumulative live birth rates were significantly lower in those with expected POR than those with expected normal ovarian response (NOR) (35.8% vs 62.8%, p3 oocytes, p = 0.006) whereas the live birth rates in fresh cycle did not differ (17.8% vs 30.9%, p = 0.108). Conclusion: Women who were expected POR according to the Bologna criteria had lower live birth and cumulative live birth than expected NOR but they still can achieve reasonable treatment outcomes and IVF treatment should not be precluded. © 2015 Chai et al.published_or_final_versio