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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. Retrospective analysis. University infertility clinic. A total of 1,152 subfertile women undergoing their first in vitro fertilization (IVF) cycle. Women were classified into 4 groups according to the Bologna criteria for comparison. Live birth and cumulative live birth rates. 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%, p<0.0001). In the subgroup analysis, the cumulative live birth rates in expected PORs were significantly lower in those who had ≤3 oocytes retrieved (18.6% for ≤3 oocytes vs 44.0% for >3 oocytes, p = 0.006) whereas the live birth rates in fresh cycle did not differ (17.8% vs 30.9%, p = 0.108). 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.

Background and Objectives: To evaluate the significance of serum CA-125 level on the live birth rate of in vitro fertilization (IVF) in women with endometriosis. Materials and Methods: This retrospective observational study included women with endometriosis who underwent one stimulated IVF cycle. Serum CA-125 levels were measured in archived serum samples collected prior to ovarian stimulation, on the day of ovulation trigger, and during frozen embryo transfer. Serum CA-125 levels were compared between cycles with and without a live birth in both stimulated IVF and frozen embryo transfer cycles, with a subgroup analysis using a cut-off of 35 IU/L. Results: Within the same patient undergoing the same IVF cycle, serum CA-125 level on the trigger day of the stimulated cycle was significantly lower than the baseline level before stimulation started (35.1 IU/L [21.0–64.5 IU/L] vs. 46.8 IU/L [25.9–104.0 IU/L], p < 0.001), but was higher than that in the frozen embryo transfer cycles (31.7 IU/L [19.9–58.7 IU/L] vs. 27.3 IU/L [18.1–59.9 IU/L], p = 0.041). Serum CA-125 levels were not associated with the live birth rate in the stimulated IVF cycle and frozen embryo transfer cycles. In subgroup analysis, women with serum CA-125 level ≥ 35 IU/L on the trigger day had a significantly higher pregnancy rate from the fresh embryo transfer cycle than those with level < 35 IU/L (adjusted odds ratio 4.126, 95% CI 1.241–13.720, p = 0.021). The cut-off of 35 IU/L did not show significant differences in live birth rate for either stimulated or frozen embryo transfer cycles. Conclusions: In women with endometriosis, no significant differences in serum CA-125 levels were found between those with and without a live birth in fresh and frozen embryo transfer cycles. In fresh embryo transfer cycles, those with serum CA-125 ≥ 35 IU/L had significantly higher pregnancy rates.

Levonorgestrel, a standard drug for emergency contraception (EC), is not effective if administered post-ovulation. A cyclo-oxygenase inhibitor could contribute synergistic effects. We investigated whether a single 40 mg oral dose of piroxicam as co-treatment with levonorgestrel improved emergency contraceptive efficacy. This was a randomised double-blind placebo-controlled trial carried out in a major community sexual and reproductive health service in Hong Kong. Women who required levonorgestrel EC within 72 h of unprotected sexual intercourse were recruited and block-randomised in a 1:1 ratio to receive a single supervised dose of levonorgestrel 1·5 mg plus either piroxicam 40 mg or placebo orally. Group assignment was concealed in opaque envelopes and masked to the women, clinicians, and investigators. At follow-up 1–2 weeks after the next expected period, the pregnancy status was noted by history or pregnancy test. The primary efficacy outcome was the proportion of pregnancies prevented out of those expected based on an established model. All women randomised to receive the study drug and who completed the follow-up were analysed. The trial was registered with ClinicalTrials.gov, NCT03614494. 860 women (430 in each group) were recruited between Aug 20, 2018, and Aug 30, 2022. One (0·2%) of 418 efficacy-eligible women in the piroxicam group were pregnant, compared with seven (1·7%) of 418 in the placebo group (odds ratio 0·20 [95% CI 0·02–0·91]; p=0·036). Levonorgestrel plus piroxicam prevented 94·7% of expected pregnancies compared with 63·4% for levonorgestrel plus placebo. We noted no significant difference between the two groups in the proportion of women with advancement or delay of their next period, or in the adverse event profile. Oral piroxicam 40 mg co-administered with levonorgestrel improved efficacy of EC in our study. Piroxicam co-administration could be considered clinically where levonorgestrel EC is the option of choice. None.

This retrospective study determined for the first time the role of baseline antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) level in the first in-vitro fertilisation (IVF) cycle in predicting cumulative live birth from one stimulation cycle. We studied 1,156 women (median age 35 years) undergoing the first IVF cycle. Baseline AFC and AMH level on the day before ovarian stimulation were analysed. The main outcome measure was cumulative live birth in the fresh plus all the frozen embryo transfers after the same stimulation cycle. Serum AMH was significantly correlated with AFC. Both AMH and AFC showed significant correlation with age and ovarian response in the stimulated cycle and total number of transferrable embryos. Baseline AFC and serum AMH were significantly higher in subjects attaining a live birth than those who did not in the fresh stimulated cycle, as well as those attaining cumulative live birth. There was a significant trend of higher cumulative live birth rate in women with higher AMH or AFC. However, logistic regression revealed that both AMH and AFC were not significant predictors of cumulative live birth after adjusting for age and number of embryos available for transfer. Considering only one single predictor, the areas under the ROC curves for AMH (0.646, 95% CI 0.616-0.675) and age (0.648, 95% CI 0.618-0.677) were slightly higher than that for AFC (0.617, 95% CI 0.587-0.647) in predicting cumulative live birth. However, a model combining AMH (with or without AFC) and age of the women only classified an addition of less than 2% of subjects correctly compared to the model with age alone. Baseline AFC and serum AMH have only modest predictive performance on the occurrence of cumulative live birth, and may not give additional value on top of the women's age.

Introduction/BackgroundGestational trophoblastic neoplasia (GTN) occurs in among women of reproductive age. Chemotherapy can result in the loss of primordial follicles and reduced ovarian reserve. Using anti-Mullerian hormone (AMH) as a surrogate, we evaluated the impact of chemotherapy in patients who received chemotherapy for GTN.MethodologyThis was a retrospective case-control study. Women aged between 20 and 44 years old with GTN who had received chemotherapy, or with treated molar pregnancy were identified between 2012 and 2018. AMH levels were measured at pre-treatment, 6, 12, and 24 months. Demographic factors, clinical characteristics, and the AMH levels between the 2 groups were compared using Mann Whitney U test and the difference between different timepoints was analysed using Wilcoxon signed rank test or Friedmann’s test.Results57 GTN patients and 18 age-matched controls with molar pregnancies aged 20–45 years old were identified. There was no difference in the demographic factors. No significant difference in AMH levels was observed between GTN and molar pregnancy group at all time points. However, among those receiving combination chemotherapy for GTN, post-hoc analysis showed a significant difference between pre- and 12 months post-treatment (Z=-2.29, P=0.02), pre- and 24 months post-treatment (Z= -2.29; P = 0.02). To adjust for the effect of age on AMH levels, all serum AMH levels were expressed as multiples of the median (MoM) against age-specific AMH reference ranges for Chinese women. Only the use of combination chemotherapy was correlated with the MoM.ConclusionOur results showed that single agent chemotherapy did not adversely affect the AMH level regardless of number of cycles. The only factor that might possibly lower the AMH level was the use of combination chemotherapy. This study would help provide better counselling to patients with GTN with regards to the effects of chemotherapy on subsequent ovarian reserve.

Background Levonorgestrel (LNG) acts as an emergency contraceptive mainly by inhibiting or postponing ovulation. We carried out this study to investigate whether LNG at concentration relevant for emergency contraception (EC) affect ciliary beat frequency and muscular contraction of the human Fallopian tube, which might contribute additional actions for EC. Methods This was an in vitro experimental study on human Fallopian tube tissue collected from ten women undergoing hysterectomy. The tubal explants were cultured in vitro, primed with oestradiol and progesterone at concentrations resembling the physiological early luteal phase, and treated with LNG at 0, 1, 10 and 100 ng/ml concentrations. Ciliary beat frequency was measured from the tubal epithelial strips, and the basal tone, amplitude and frequency of contractions were recorded from longitudinal smooth muscle strips. These parameters at different LNG concentrations were compared against the control (LNG 0 ng/ml). Results Treatment of tubal tissue strips with LNG at all concentrations studied did not significantly alter the ciliary beat frequency nor basal muscle tone ( p  > 0.05 for both) compared with control. Significant reduction in the amplitude and frequency of tubal muscular contractions was shown after treatment with LNG only at 100 ng/ml ( p  < 0.05 for both) but not lower concentrations ( p  > 0.05) compared with control. Conclusion LNG did not significantly inhibit ciliary beat frequency and muscular contraction of the human Fallopian tube at the doses used for EC, suggesting that the Fallopian tube is unlikely a target for the EC action of LNG.

Background To evaluate the association of serum advanced glycation end-products (AGEs) and its soluble receptor of AGE (sRAGE) levels with dysglycaemia and metabolic syndrome in women with polycystic ovary syndrome (PCOS). Methods This was an analysis of a cohort of women with PCOS who were prospectively recruited for a longitudinal observational study on their endocrine and metabolic profile between January 2010 and December 2013. The association of serum AGEs and sRAGE levels with dysglycaemia and metabolic syndrome at the second-year visit (the index visit) and the sixth-year visit (the outcome visit) were determined. Comparisons of continuous variables between groups were made using the Mann–Whitney U-test. Spearman test was used for correlation analysis. Multivariate binary logistic regression analysis was employed to identify the factors independently associated with the outcome events. Results A total of 329 women were analysed at the index visit. Significantly lower serum levels of sRAGE (both p < 0.001), but no significant difference in AGEs, were observed in those with dysglycaemia or metabolic syndrome. At the outcome visit, those with incident metabolic syndrome had a significantly lower initial serum sRAGE levels (p = 0.008). The association of serum sRAGE with dysglycaemia and metabolic syndrome at the index visit was no longer significant in multivariate logistic regression after controlling for body mass index, free androgen index and homeostatic model assessment for insulin resistance (HOMA-IR). sRAGE was also not significantly associated with incident metabolic syndrome at the outcome visit on multivariate logistic regression. Conclusions Serum sRAGE levels are significantly lower in women with PCOS who have dysglycaemia or metabolic syndrome, and in those developing incident metabolic syndrome in four years. However, it does not have a significant independent association with these outcome measures after adjusting for body mass index, free androgen index and HOMA-IR.

ObjectivesTo revisit women’s knowledge, attitudes and practices (KAP) regarding emergency contraception (EC) in Hong Kong. The research sought to provide insights for improving the accessibility and quality of EC services.Study designA cross-sectional study, where self-administered questionnaires were distributed at a major community sexual and reproductive health service in Hong Kong over a 3-month period between July 2023 and October 2023. Descriptive and regression analyses were used.ResultsOf 1127 respondents, the majority (n=1057, 93.8%) reported using contraception and 513 (45.6%) had used EC. The main contraceptive methods used were male condoms and oral contraceptive pills. The majority (n=1035, 91.8%) of respondents demonstrated awareness about EC and 938 (83.2%) participants correctly reported the timeframe for oral EC. Around two-thirds reported the internet as being their leading source of EC knowledge. Over 93% of respondents advocated for enhancing public awareness. Acceptance of non-traditional means of obtaining EC, such as over-the-counter provision (51.3%), pharmacy provision (49.8%) and telemedicine consultation (43.1%), were higher than face-to-face EC consultations (32.9%).ConclusionsFamily planning service users’ characteristics and KAP regarding EC have significantly changed over the last 20 years. Women now demonstrate greater awareness, knowledge and openness regarding EC, indicating improved readiness for more liberal delivery of EC nowadays. This study highlights the need for restructuring EC service provision in Hong Kong to address women’s changing preferences and contraceptive needs, and to minimise barriers to EC access. We recommend reclassifying emergency contraceptive pills as non-prescription drugs in Hong Kong to align with international practice.