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Objectives: To assess 5-year compliance with hormone replacement therapy (HRT) in Hong Kong Chinese women and the reasons for long-term compliance or non-compliance. Methods: A telephone survey using a standardized questionnaire was conducted in 187 postmenopausal women who had commenced HRT in a referral-only specialist clinic of a university teaching hospital 5 years previously. Over this 5-year period, the cohort had been referred out to primary care doctors once they had become stabilized on treatment. Results: The 5-year compliance rate was 71.1%. The overall compliance rates were nearly the same from 2 and 5 years. ‘Doctors’ advice’ was the most important reason for maintenance of long-term compliance, accounting for 88.0% of all compliant cases. The most frequent reason for non-compliance was that of the experience of side effects. Other important reasons were fear of cancer, fear of other side effects, and discouragement from other doctors. Overall, 16.0% of women expressed concern regarding potential side effects or risk of breast cancer. Younger age at menopause and at time of initial consultation, shorter duration of menopause at presentation and previous history of hysterectomy were associated with a higher degree of compliance at 5 years. Presence or absence of menopausal symptoms, on the other hand, was not a significant factor. Conclusions: The 5-year compliance rate in this cohort of Hong Kong Chinese women was comparable to that reported from predominantly Caucasian populations. The physicians’ role in encouraging postmenopausal women to achieve long-term HRT compliance was observed.

The benefit of treating postmenopausal women with established cardiovascular disease with combined estrogen-progestogen hormone replacement therapy (HRT) is controversial. This study investigated the effect of treatment with estradiol and norethisterone acetate on exercise tolerance and on the frequency and severity of ischemic attacks in postmenopausal women with stable angina pectoris. A total of 74 Chinese women were recruited for this 16-week double-blind, placebo-controlled trial. They were randomly allocated into two groups; one group received placebo/placebo/placebo and the other group received placebo/estrogen-progestogen/placebo. Estrogen-progestogen continuous combined HRT increased both time to 1-mm ST depression (99.1 s, p < 0.05) compared with a mean decrease of 22.9 s with placebo (p < 0.05), and total exercise duration also showed a significant increase (32.7 s, p < 0.05) after treatment compared with placebo (2.5 s, p < 0.05). In addition, the total number of ischemic events/24 h during ambulatory electrocardiographic monitoring decreased by 0.82 events after treatment (p < 0.05) compared with an increase in the placebo group (0.94), a highly significant difference (p = 0.006). These results suggest that the administration of this particular combined hormone replacement preparation may have a beneficial effect on myocardial ischemia in postmenopausal women with established coronary disease.

Objective: To examine changes in oviductin mRNA expression in oviductal mucosal tissue from fertile women throughout an ovulatory cycle. Design: Semiquantitative reverse-transcriptase–polymerase chain reaction (RT-PCR) analysis of oviductin mRNA. Setting: University-based obstetrics and gynecology department. Subject(s): Twenty women undergoing laparoscopy for tubal sterilization or hysterectomy for uterine fibroids. Intervention(s): The mucosal layer was isolated from the oviduct tissue, and semiquantitative RT-PCR was performed. Main Outcome Measure(s): The relationship between serum estradiol, luteinizing hormone, and progesterone concentrations and the expression of oviductin mRNA. Result(s): There was a significant positive correlation between serum estradiol and luteinizing hormone concentrations and oviductin mRNA expression. There was a significant inverse correlation between serum progesterone concentrations and oviductin mRNA expression. Conclusion(s): Little is known about the regulation of human oviductin. This study was the first to examine the relationship between oviductin mRNA expression and serum estradiol and luteinizing hormone and progesterone concentrations in fertile women. Estradiol and luteinizing hormone both have a stimulatory effect on oviductin mRNA in humans, however, it is difficult to determine whether the effects are independent of one another, as the luteinizing hormone surge is dependent on the estradiol increase. Progesterone shows a clear inhibitory effect on oviductin mRNA.

Purpose: To evaluate the effects of follicular fluid and platelet-activating factor on sperm motion characteristics of cryopreserved oligospermic and normospermic samples. Methods: Sperm motion characteristics were evaluated prior to cryopreservation, immediately after thawing and following incubation in human tubal fluid, follicular fluid, or 1-μM platelet-activating factor cultures. Sixteen oligospermic samples and 20 normospermic samples were examined. Sperm motion characteristics were analyzed manually according to WHO criteria (1999) and also with an automated videomicrography system. Result(s): Incubation in follicular fluid increased overall motility and the percentage of sperm with fast progressive motility in normospermic but not oligospermic samples. Incubation with platelet-activating factor increased overall motility and the percentage of sperm showing nonprogressive motility in both oligospermic and normospermic samples. Conclusion(s): The stimulatory effects of culture in follicular fluid as seen in normospermic samples do not show a significant benefit in oligospermic cryopreserved samples. Platelet-activating factor and follicular fluid increase motility via different mechanisms. Incubation of oligospermic cryopreserved sperm with PAF increases the number of motile sperm, thereby enabling easier identification of viable sperm for intracytoplasmic sperm injection in samples with severe asthenozoospermia.

We report the case of a 29-year-old woman who was diagnosed to have premature ovarian failure (POF) and myasthenia gravis at the age of 27 years. She was treated by thymectomy and pyridostigmine. Hormone replacement was started after the operation and she subsequently conceived spontaneously. We believe this is the first report of a spontaneous pregnancy after the diagnosis of POF associated with myasthenia gravis.

Summary Objective: To examine the relationship between signs and symptoms associated with threatened abortion and viability of the pregnancy. Design: A prospective observational study Setting: A university teaching hospital Participants: One thousand consecutive women presenting with a threatened abortion. Intervention: A structured history and an examination were performed as initial clinical assessment. These were followed by transvaginal sonography to determine the status of the pregnancy. Main outcomes: The relationship between individual signs and symptoms and the status of the pregnancy was determined. Logistic regression was performed to determine which signs or symptoms were independent predictors of spontaneous abortion. Results: A history of having passed a tissue mass, the presence of products of conception in the vagina and an open cervix were the only sign or symptom associated with a greater than 90% chance that the pregnancy was non-viable. Logistic regression of signs and symptoms at presentation indicated that maternal age greater than 35 years, a history of passing clots vaginally, vaginal bleeding similar to normal menstruation, increasing vaginal bleeding and discrepancy of 4 or more weeks between the uterine size on examination and that which would have been expected by menstrual dates were significant predictors of nonviable pregnancy. A history of vomiting was predictive of a viable pregnancy. Conclusion: The clinical assessment of threatened abortion is unreliable in most cases and should be superseded by ready access to sonographic assessment.

Objective: To compare the efficacy of surgical evacuation of the uterus with medical evacuation using misoprostol in cases of spontaneous abortion. Design: A prospective, randomized, controlled trial. Setting: A university teaching hospital. Patient(s): Six hundred thirty-five women who aborted spontaneously and who consented to pretreatment randomization. Intervention(s): Routine surgical evacuation or medical evacuation of the uterus using misoprostol. Main Outcome Measure(s): Immediate, short-term (2–3 weeks), and medium-term (6 months) medical complications. Result(s): There was a significantly lower incidence of immediate and short-term complications in the group treated with misoprostol compared with the surgically treated group. There were also fewer major complications in the 6 months after treatment in the medically treated group. Approximately 50% of the medically treated group subsequently required surgical evacuation, and these subjects required significantly more analgesia. Conclusion(s): Treatment with misoprostol can reduce the demand for surgical evacuation in cases of spontaneous abortion, and its use is associated with fewer medical complications.

Objective: The aim of this study was to examine the effect of percutaneous oestradiol on the lipid profile and on atheroma formation using an animal model. Methods: The study was of 12 weeks duration. Fifty sexually mature female New Zealand White rabbits were divided into five groups of equal size. Two groups acted as controls and received normal rabbit chow. Rabbits in one of these groups were ovariectomized. The remaining three groups were ovariectomized but received 1% cholesterol enriched rabbit chow. One of these cholesterol-fed groups received 0.3 mg/kg percutaneous oestradiol daily whilst another received 0.1 mg/kg oral oestradiol daily. Measurements of concentrations of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and triglycerides (TG) were made at the beginning and end of the study. Aortic atheroma formation was measured using computerized image analysis of uptake of Sudan III staining. Results: After 12 weeks there were significant increases in the mean concentrations of TC in the three cholesterol-fed groups compared with controls (P

Background: There is much recent interest in the biologic and diagnostic implication of cell-free non-host DNA in the plasma and serum of human subjects. To determine if quantitative abnormalities of circulating non-host DNA may be associated with certain pathologic processes, we used circulating fetal DNA in preeclampsia as a model system. Methods: We studied 20 preeclamptic women and 20 control subjects of comparable gestational age (means, 32 and 33 weeks, respectively). Male fetal DNA in maternal serum was measured using real-time quantitative PCR for the SRY gene on the Y chromosome. Results: The imprecision (CV) of the assay was 2.7%. The median circulating fetal DNA was increased fivefold in 20 preeclamptic women compared with 20 control pregnant women (381 vs 76 genome-equivalents/mL, P

Background —Gonadotropin-releasing hormone agonists (GnRHas) are a group of drugs that with long-term use induce a pseudomenopausal state in which estrogen production is suppressed. They are commonly used in the treatment of sex steroid–dependent conditions. “Add-back” hormone replacement therapy is used to prevent menopause-like symptoms and bone loss during GnRHa treatment, but it is also recognized that hypoestrogenism adversely affects vascular function. The aim of this study was to examine the effect of GnRHa and add-back therapy on vascular reactivity. This model serves as a paradigm for the effect of hormone replacement therapy in postmenopausal women. Methods and Results —Measurements of endothelium-dependent and endothelium-independent vascular reactivity were compared in 2 groups of women treated with a GnRHa for 6 months. One group received estrogen/progestogen add-back therapy during the second 3 months of GnRHa treatment. Vascular reactivity was examined by use of ultrasound measurements of changes in brachial artery diameter. Endothelium-dependent changes were assessed during reactive hyperemia, whereas endothelium-independent changes were measured after the administration of glyceryl trinitrate sublingual spray. Treatment with the GnRHa alone had an inhibitory effect on endothelium-dependent relaxation. However, endothelium-dependent relaxation significantly improved in the group receiving add-back therapy (14.6%) compared with the group treated with GnRHa alone (8.6%) ( P Conclusions —These results suggest that the administration of add-back therapy has a protective effect on vascular function in GnRHa-induced hypoestrogenism. As a model for the menopause, these results also suggest that the long-term administration of hormone replacement therapy would result in endothelium-dependent arterial relaxation, an observation previously attributed only to the acute administration of estrogen.

Apart from their influence on the hypothelamic-pituitary-ovarian axis, sex steroids also affect the areas of the brain which control sexual behaviour, cognition, memory and other skills dependent upon normal brain function. Ageing is associated with an increased risk of developing a number of neurodegenerative diseases, such as Alzheimer's disease (AD) in which there is a severe disturbance of cognition, memory and other functions. AD is more common in women than in men, and research into the effects of oestrogen on AD has been stimulated following the publication of reports suggesting that oestrogen improves memory and concentration in postmenopausal women. To date, the evidence remains contradictory, but most recent studies suggest that oestrogen use may protect against, or at least delay, the onset of AD. In addition, the use of oestrogen may improve memory and other cognitive functions in the early stages of the disease. in view of the continuing increase in the number of cases of this incurable disease, further research is required to substantiate the potential beneficial effects of oestrogen on AD.

Transvaginal sonography (TVS) was used to assess uterine contents in 100 consecutive subjects presenting with a diagnosis of spontaneous abortion. TVS assessments were correlated with findings at subsequent evacuation of retained products of conception (ERPC). There was a strong correlation between the weight of the surgical specimen at ERPC with both the sagittal (r = 0.76; p < 0.05) and transverse (r = 0.73; p < 0.05) plane area measurements of the uterine cavity. Combining the 2 sonographic measurements increased the correlation to r = 0.81 (p < 0.05). Fifteen of 25 subjects who had been categorised to have an ‘empty’ uterus had less than 5 g of tissue removed and the other 10 subjects less than 10 g of tissue. In 20 of these 25 cases, the surgeon described the amount of curettings as ‘small or non-significant’. TVS can accurately identify those women who do not have a significant amount of residual uterine tissue following spontaneous abortion.

The aims of this study were to estimate the dietary intake of phytoestrogens and to measure urinary phytoestrogen excretion in postmenopausal Chinese women.Postmenopausal Chinese women were recruited from the hormone replacement clinic of the Prince of Wales Hospital. Dietary intake of phytoestrogen-rich foods was estimated using a food frequency questionnaire. Urinary output of the isoflavonoids daidzein and genistein and the metabolite of daidzein, equol, was measured using high-performance liquid chromatography.The mean daily excretion of daidzein, genistein and equol was 3.24 (+/- 3.63), 1.47 (+/- 1.75) and 0.64 (+/- 1.53) mumol, respectively. The total mean daily isoflavonoid excretion was 5.36 (+/- 5.27) mumol.Urinary excretion of isoflavonoid phytoestrogens in this Chinese population was lower than that reported in Japanese subjects. This may be due to the higher consumption of legumes, especially soy products, in the Japanese compared to the Chinese diet. The intake of green vegetables was higher in the Chinese subjects, and this food group may be the main contributor to their total phytoestrogen intake.

The aim of this study was to investigate acute changes in serum concentrations of lipoprotein(a) and other atherogenic lipids and lipoproteins after a surgical menopause.A total of 100 premenopausal Chinese women who were booked for hysterectomy for benign gynecological disorders were recruited. They study group comprised 40 subjects undergoing hysterectomy as well as bilateral oophorectomy. The control group consisted of 60 subjects undergoing hysterectomy with conservation of the ovaries. Complete data were available from 30 of the 40 subjects in the study group and from 44 of the 60 controls. Serum concentrations of lipoprotein(a) and other atherogenic lipids and lipoproteins were measured before surgery and these measurements were repeated 3 days, 8 weeks and 6 months postoperatively. Those study patients who received hormone replacement therapy and control patients who became menopausal, according to biochemical criteria, during the study period were excluded from analysis.Three days after surgery, there was a significant increase in the mean lipoprotein(a) concentration in the control group from 19.1 to 23.0 mg/dl (p0.01), but there was no significant change in the study group. There were no significant changes from baseline in the mean lipoprotein(a) concentration in either group 8 weeks or 6 months after surgery. There was a significant increase in the mean concentration of total cholesterol in the study group 8 weeks after surgery from 5.08 to 5.45 mmol/l (p0.01), in low density lipoprotein cholesterol from 3.22 to 3.49 mmol/l (p0.01), and in apolipoprotein B from 95.6 to 103.0 mg/dl (p0.05). However, the mean concentrations 6 months after surgery were not significantly different from baseline levels. The mean concentrations of high density lipoprotein cholesterol, apolipoprotein A-1 and triglycerides also did not differ significantly from baseline in the study group, either 8 weeks or 6 months after surgery.These results suggest that any increase in concentrations of lipoprotein(a), and other atherogenic lipids and lipoproteins which occur after the menopause, develops relatively slowly. The changes in concentrations which occurred within 8 weeks of surgery were probably an acute-phase reaction after surgery rather than a response to a decreasing estradiol concentration.

Objective: To compare serum concentrations of lipoprotein (a) [Lp(a)J and other atherogenic lipids and lipoproteins in pregnancies complicated by either pregnancy-induced hypertension (PIH) or intrauterine growth retardation (IUGR) with those of normal pregnancies.Methods: This was a prospective case-controlled study comprising 35 subjects with PIH and 20 with IUGR, and a control group of 35 subjects matched for gestation. The study was conducted in a tertiary institution, with recruitment taking place over a period of 12 months.Main Outcome Measures: Measurement of lipids and lipoproteins were made at the time the diagnosis was established. The placentas were examined after delivery for signs of decidual arteriopathy.Results: There were no significant differences in the serum Lp(a) concentration between those with PIH or IUGR and the control group. Decidual arteriopathy was not found in any cases in the control group, but it was present in 11/34 (32.3%) PIH and in 1/19 (5.3%) IUGR cases. In preterm pregn...

Background. To compare a 48 hour non surgical policy in the management of spontaneous abortion with a policy of routine, universal uterine curettage. Methods. A prospective, observational study on 354 women admitted to hospital with spontaneous abortion. Of these, 225 who had retained products of conception were treated with misoprostol for up to 48 hours after 101 were excluded because they had an empty uterus on transvaginal scan (TVS) and another 28 women because they were unsuitable for conservative management. Follow-up was conducted over a 3 week period to assess morbidity. A reference group of 137 women, all of whom had an evacuation of retained products of cenception (ERPC) as a routine after they had a TVS documenting retained products of conception (POCs), was used for comparison. Results. Evacuation of the uterus occurred within 24 hours in 107 women and in 148 at 48 hours after misoprostol treatment was started. There were three uterine curettages up to 14 days after discharge from hospital for persistent bleeding and two cases of pelvic infection. An ectopic pregnancy was diagnosed at follow-up in one woman. In the reference group, there were nine women who had complications, four requiring another ERPC and five had infection, an overall complication rate of 6.6% in the reference group and 1.7 % in the protocol treatment group. Conclusion A 48 hour regimen using transvaginal ultrasound and misoprostol for the management of spontaneous abortion was successful in avoiding surgery in 249 out of a possible 354 (70.6″ i) women with spontaneous abortion, with a low rate of subsequent morbidity.

Objective : Previous studies reported that 48–51% of women in Western countries developed depressive disorder following a miscarriage. There is, however, little data among non-Western populations. The aim of this study was to measure the prevalence of psychiatric morbidity following miscarriage among Chinese women in Hong Kong. Methods : Subjects were interviewed immediately after a miscarriage to collect medical, psychiatric, and sociodemographic data. Six weeks following the miscarriage, 150 subjects were assessed with the Structured Clinical Interview for DSM-III-R (SCID) to establish psychiatric diagnoses. Results : 18 subjects (12%) met the DSM-III-R criteria for major depression and 2 subjects (1.3%) were diagnosed anxiety disorder NOS six weeks after the miscarriage. Conclusions: Chinese women in Hong Kong have a lower rate of psychiatric morbidity after a miscarriage.

To obtain a normogram of measurements of the uterine cervix by transvaginal sonography during the third trimester of normal primiparous pregnancies and to relate these measurements to the events surrounding labor.A prospective observational study, set in Guangzhou, Peoples Republic of China, was undertaken. Fifty-five normal nulliparous Chinese women with singleton pregnancies were studied from 30 weeks gestation until delivery. Serial transvaginal ultrasound examinations were performed at 30, 32, 34 and 36 weeks gestation and weekly thereafter.There was a significant correlation between gestational age and cervical length and width. Funnelling of the internal os was present in 25% of cases, and its earliest appearance was at 36 weeks. There was no consistent relationship between funnel length and width and gestational age. The duration of the first stage of labor was inversely correlated with the last ultrasound measurement of cervical length, but there was no relationship with either cervical width nor the presence of funnelling. The cervical changes in this population differed from those found in Caucasians.There is a direct relationship between both cervical width and length and gestational age and an inverse relationship with cervical length and the duration of labor. Funnelling of the internal os was not a predictor of the early onset of labor. The dimensions and features of the Asian cervix differ from those of the Europeans, and this should be considered when conducting further studies of a similar nature.

Background It has been proven that c-kit is crucial for proliferation, migration, survival and maturation of spermatogenic cells. A periodic expression of c-kit is observed from primordial germ cells (PGCs) to spermatogenetic stem cells (SSCs), However, the expression profile of c-kit during the entire spermatogenesis process is still unclear. This study aims to reveal and compare c-kit expression profiles in the SSCs before and after the anticipated differentiation, as well as to examine its relationship with retinoic acid (RA) stimulation. Results We have found that there are more than 4 transcripts of c-kit expressed in the cell lines and in the testes. The transcripts can be divided into short and long categories. The long transcripts include the full-length canonical c-kit transcript and the 3′ end short transcript. Short transcripts include the 3.4 kb short transcript and several truncated transcripts (1.9-3.2 kb). In addition, the 3.4 kb transcript (starting from intron 9 and covering exons 10 ~ 21) is discovered to be specifically expressed in the spermatogonia. The extracellular domain of Kit is obtained in the spermatogonia stage, but the intracellular domain (50 kDa) is constantly expressed in both SSCs and spermatogonia. The c-kit expression profiles in the testis and the spermatogonial stem cell lines vary after RA stimulation. The wave-like changes of the quantitative expression pattern of c-kit (increase initially and decrease afterwards) during the induction process are similar to that of the in vivo male germ cell development process. Conclusions There are dynamic transcription and translation changes of c-kit before and after SSCs’ anticipated differentiation and most importantly, RA is a significant upstream regulatory factor for c-kit expression.

Generating male germ cells in vitro from multipotent stem cells is still a challenge for stem cell biologists. The difficulty is caused by the lack of knowledge about spermatogenesis molecular-controlling mechanisms. In vivo, PGCs differentiate into male germ cells in a very complicated environment through many middle steps. In this study, we use the pluripotent p19 cells to test their responses to different retinoic acid (RA) concentrations by evaluating markers for stem cells (bmp4, egr3), primordial germ cells (ddx4), spermatogonia (c-kit), premeiotic cells (stra8), and male germ cells (dazl and plzf). We have found that cyp26b1, which will catalyze RA, increases dramatically in p19 cells 1 d after RA treatment. Bmp3, egr3, and stra8 are stimulated after 1 d of RA treatment and then recover to normal after 3 d of RA treatment. C-kit keeps being expressed when treated with 10 nM-4 μM RA. Dazl and plzf are gained after 3 d of stimulation. The morphology of RA (100 nM-4 μM)-treated cells changes distinctively, and cell colonies are formed. Typical neural cell-like and germ cell-like morphologies appear in the 100 nM and 4 μM RA groups, respectively. We conclude that 100-500 nM RA can cause responses in p19 cells, but a high concentration of RA (1-4 μM) can drive these pluripotent cells' differentiation towards male germ cells. However, high concentrations of RA are also toxic. Some colonies that survived from 4 μM RA begin to express ddx4 and c-kit. Selection of the c-kit(+), dazl(+), and ddx4(+) cells after RA stimulation and creating a special culture medium for their propagation might benefit successful spermatogenesis induction in vitro.

Acute menopausal symptoms occur less frequently in Asian than in Caucasian women. Oestrogen replacement therapy has been shown to be effective in controlling acute symptoms in Caucasians, but the effect of oestrogens is not well documented in Asian women. A randomized, double-blind, placebo-controlled, crossover study of the effect of oral oestradiol on the incidence of acute menopausal symptoms was conducted in 83 Hong Kong Chinese women who had experienced a surgical menopause. Although there was a significant increase in the oestradiol concentration with treatment compared with placebo (P < 0.001), there were no significant differences in the reporting of symptoms between the treatment and placebo groups. There is no obvious explanation for this apparent lack of effect of oestrogen on acute menopausal symptoms in Chinese women. Whilst it may be related to the generally low incidence of symptoms or to a higher dietary intake of phytoestrogens in Chinese women, further studies are necessary to explain these findings.

The mucosal cells were isolated from the ampullary regions of 20 human oviducts and cultured with or without hCG in five different concentrations (1-100 ng/mL). As analyzed by the semiquantitative reverse-transcriptase polymerase chain reaction, hCG treatment significantly increased mRNA expression of vascular endothelial growth factor and its receptor flt-1 in the cultured mucosal cells in a dose-dependent manner but had no effect on the expression of another receptor, KDR.

Objectives: To determine the effect of percutaneous oestrogen replacement therapy on lipoprotein (a) and other plasma lipoproteins. Methods: Open longitudinal prospective study conducted at the hormone replacement clinic of the Prince of Wales Hospital, New Territories, Hong Kong. Thirty women who had undergone a total abdominal hysterectomy and bilateral salpingo-oophorectomy for benign gynaecological conditions were treated with 1.5 mg of percutaneous 17β-oestradiol gel applied daily for a period of 12 consecutive months. Measurements of plasma lipoproteins were made before the commencement of treatment and repeated at 6- and 12-month intervals. Results: There was a significant reduction in the concentrations of Lp(a) during the first 6 months of treatment, with median values falling from 7.87 mg dL−1 to 6.16 mg dL−1 (P = 0.004, 0–6 months). During the second 6 months, the median concentration increased to 9.38 mg dL−1, (P = 0.072, 66-12 months), which did not significantly differ from the baseline level (P = 0.545, 0–12 months). Significant reductions in the concentrations of apoprotein A-I (apo A-I), apoprotein B (apo B), high density lipoprotein cholesterol (HDL-C), and HDL3-C were also present after 6 months (P = 0.043, 0.049, 0.028, 0.013, respectively), but there were no differences between the baseline values of these lipoproteins and those at the completion of the study (P = 0.948, 0.244, 0.839, 0.117 respectively). Drug compliance was maintained throughout the study, with similar mean oestradiol concentrations at 6 and 12 months. Conclusions: The percutaneous administration of 17β-oestradiol has variable short term effects on plasma lipoproteins which are not maintained over a longer duration of treatment. By avoiding the ‘first pass’ effect on the liver, this method of delivery does not appear to produce the sustained changes in lipoproteins seen with oral treatment.

A tartrate-resistant acid phosphatase (TRACP) was purified from cord plasma by use of cation-exchange chromatography (carboxymethyl Sepharose), gel-filtration chromatography (Sephacryl S-200), and preparative isoelectric focusing. After raising polyclonal antibodies to the purified TRACP in rabbit, we used the antiserum to develop an ELISA. The antiserum cross-reacted with an extract of bone, but not with extracts of spleen, erythrocytes, platelets, or osteoblasts or with prostatic acid phosphatase. With this ELISA we determined the concentration of serum TRACP in healthy men to be 197 (61-301) micrograms/L (median and range). Serum TRACP concentrations were significantly higher in children and postmenopausal women and in patients with chronic renal failure, hyperparathyroidism, or hyperthyroidism. Estrogen replacement therapy of postmenopausal women for 3-6.5 months decreased their serum TRACP concentration by 70%.

EDITORIAL COMMENT: There seems no doubt that Chinese women have a low incidence of premature delivery (less than 37 weeks) although the 5% quoted in this paper is similar to the 5.9% for Victoria in 1992 (3,874 of 65,252 confinements). Drew and Chan have confirmed the lower incidence of prematurity in Chinese women living in Hong Kong and in Melbourne than in non-Chinese women living in MelbourneA. The Chinese women in this study had a remarkably low incidence of group B streptococcal isolation (0.8%) and a very high rate of detection of Candida (30.2%). It is of interest that the authors did not treat women with tests positive for Candida. Sexual practices could understandably influence the vaginal microbiological environment. Recently we reported on the frequency of anal intercourse and other sex practices in pregnancy in a small series from South AustraliaB. Also recently the Editor was privileged to visit a number of maternity hospitals in the Jiansu province in China. When discussing premature rupture of the membranes and prematurity we were told, repeatedly (via our interpreter), that in China it was customary to abstain totally from intercourse during pregnancy even in the absence of complications such as bleeding, ruptured membranes or evidence of infection in one or other partner. Should we disbelieve what we are told when the information seems unexpected? We need more information regarding sexual activity (frequency and route) and associated complications such as premature rupture of the membranes and otherwise uncomplicated spontaneous premature labour, so that we can advise our patients appropriately. A. Drew JH, Chan DP. Incidence of prematurity and low birth-weight in an immigrant Chinese population. Aust NZ J Obstet Gynaecol 1989; 29: 303-305. B. Barclay LM, McDonald P, O'Loughlin JA. Sexuality and Pregnancy. An Interview Study. Aust NZ J Obstet Gynaecol 1994; 34: 1-7.

Background: The optimal therapeutic method for proximal tubal obstruction (PTO) has yet to be defined. In addition,the reported successful recanalisation rate and reproductive outcome from hysteroscopic proximal tubal cannulation havebeen inconsistent.Aims: To examine the morbidity and efficacy of laparoscopic–hysteroscopic proximal tubal cannulation for treating PTO.Material and Methods: This was a retrospective study evaluating 70 infertile women with PTO who underwentlaparoscopic–hysteroscopic proximal tubal cannulation in The Prince of Wales Hospital, a university-affiliated hospital,from January 2005 to December 2010. Demographical data and operative details were reviewed. Women were thencontacted by phone and completed a structured questionnaire. Recanalisation rate, intra-operative complication,pregnancy rates and pregnancy outcomes were examined.Results: Fifty women had successful proximal cannulation on at least one side of the tube, providing an overallsuccessful recanalisation rate of 71.4% per woman and 67.0% per tube. The overall pregnancy rate after successfulhysteroscopic proximal cannulation of at least one tube is 55%. The overall mean time to become pregnant from naturalconception or via clomiphene induction after successful unilateral or bilateral hysteroscopic cannulation was10.5 ± 8.9 months. The procedure is associated with minimal morbidity. No prognostic factors were significantlyassociated with recanalisation and pregnancy rate.Conclusion: Laparoscopic–hysteroscopic cannulation for proximal obstruction is a procedure with minimal morbidityand a reasonable successful recanalisation rate. It should be considered as an alternative to in vitro fertilisation.Key words: hysteroscopic proximal tubal cannulation, laparoscopic chromopertubation, proximal tubal obstruction,reproductive outcome, tubal infertility.

The conventional management of spontaneous abortion is surgical evacuation of the uterus to prevent complications which may arise from retained products of conception (POC). This procedure is not without complications and also demands operating theatre resources. The purpose of this study was to determine the efficacy of a medical approach to the management of spontaneous abortion using the prostaglandin analogue, gemeprost. From an initial 212 women presenting with spontaneous abortion, 4 groups were defined according to what they required in the way of initial management. A group of 20 women were excluded from conservative medical management at presentation because they were bleeding heavily and judged to be unsuitable. Sixty women initially required no further management other than determining that they had a complete abortion using transvaginal sonography (TVS). The 132 women were treated with the prostaglandin analogue, gemeprost. Sixty were judged to need no further management afterwards and were initially discharged. The remaining 72 women underwent evacuation of retained products of conception (ERPC) after the gemeprost treatment as medical evacuation of the uterus appeared to had been incomplete. In each of these 4 groups so defined, there was 1 case where an ERPC was required after the patients have been discharged because of complications attributable to retained POC. We therefore found that no ERPC was necessary in the management of 118 out of 212 (55.6%) women who presented with spontaneous abortion. This has important implications in patient management and economical use of hospital resources.

Recent thymic emigrants (RTEs) are antigenically naive T cells that have recently completed intrathymic maturation and have emigrated from the thymus to the periphery. RTEs are clinically and immunologically important as they are essential for maintaining peripheral T cells in sufficient numbers in order to recognize, by their αβT-cell receptors (TCRs), a diverse array of foreign peptide antigens. However, RTE frequency and function has been poorly understood because of a lack of surface markers to distinguish them from older non-RTE naive T cells. This review summarizes the biology of the intrathymic generation and function of RTEs, including the recent identification of protein tyrosine kinase 7 (PTK7) as a novel marker for human RTEs of the CD4 (helper) T-cell lineage. PTK7+ RTEs in adults have a reduced capacity for activation-induced proliferation and cytokine production (interleukin-2 and interferon-γ) than older PTK7- naive CD4 T cells. Importantly, this immaturity in CD4 RTE effector function may contribute to the reduced adaptive immune responses observed in situations in which CD4 RTEs predominate, including the fetus, neonate and young infant, and following immune reconstitution, such as post-hematopoietic stem cell transplant. The ability to identify viable CD4+ RTEs based on PTK7 surface staining may be particularly useful in the infant for better defining the impact of nutritional and environmental factors on thymic output, peripheral T-cell function and adaptive immune responses to vaccination and infection.

Objective To investigate whether an insulin sensitizer has any effect on amenorrhea and clinical and biochemical hyperandrogenism in Chinese women with polycystic ovarian syndrome (PCOS). Design Randomized controlled double-blind trial. Setting A tertiary referral center, Hong Kong. Patient(s) Chinese women who fulfilled the Rotterdam criteria of PCOS (n = 70). Intervention(s) Rosiglitazone 4 mg daily for the first month followed by 4 mg twice daily for 11 months. Main Outcome Measure(s) Menstrual status as well as clinical and biochemical hyperandrogenism. Result(s) There is a significantly higher rate of regular menses among the treatment arm (16 [50.0%] of 32 vs 4 [11.8%] of 34) at 6 months and the improvement appeared to be sustained (10 [41.7%] of 24 vs 6 [20.0%] of 30) at 12 months. There was no change in the acne and hirsutism scores as well as serum T levels in both arms. Conclusion(s) We found a possible benefit in menstrual cyclicity but a lack of improvement in hyperandrogenism in our Chinese population. Clinical Trial Registration Number ChiCTR-TRC-09000670 (Chinese Clinical Trial Registry).

Severe ovarian hyperstimulation syndrome is an uncommon but potentially lethal complication of treatment with in vitro fertilization and other assisted reproductive technologies. We describe such a case which was atypical in that ascites and hydrothorax occurred despite the absence of ovarian enlargement. Whilst the pathophysiology of the syndrome remains unclear, the clinician must remain alert to the possibility of such an unusual presentation of this syndrome.

Hormone replacement therapy (HRT) remains the gold standard for the management of menopausal symptoms; however, HRT use has declined due to concerns over possible adverse side-effects. Approaches to menopause management are continually being revised and these extend beyond the control of recognized menopausal symptoms to encompass wider aspects of menopausal women's health. Hypertension and associated cardiovascular risk are particularly important unmet needs in postmenopausal women, especially in the Asia-Pacific region which has a rapidly aging population and bears around half of the global burden of cardiovascular disease, two-thirds of which has been attributed to elevated blood pressure. As first point of contact for women with menopausal symptoms, gynecologists play a gatekeeper role in assessing women's health, providing appropriate lifestyle counseling, and, where appropriate, implementing treatment or referral to relevant specialists. This paper, with contributions by gynecologists and cardiologists from Asia Pacific and beyond, summarizes available evidence and provides a treatment algorithm that employs a flexible blood pressure classification strategy to assist physicians in their decision-making for the individualized management of menopausal symptoms in women with low, moderate and high cardiovascular risk, and also for women with diabetes. Individualized HRT according to cardiovascular risk may yield improvements in cardiovascular health, as well as managing menopausal symptoms.

To compare the effect of micro-dose transdermal estradiol and placebo on the incidence and severity of menopausal symptoms and well-being in postmenopausal Asian women with vasomotor symptoms.Multicenter, double-blind, randomized, placebo-controlled study.Of 165 subjects randomized to estradiol 0.014 mg/day or placebo for 12 weeks, 80 per group were included in the analysis. Groups were comparable at baseline, although time since menopause was slightly shorter in the estradiol group. There was a greater reduction in mean weekly hot flushes at week 12 in the estradiol group (55%) than the placebo group (40%; p0.01), which was evident by week 4. A similar pattern was seen for moderate and severe hot flushes (-58% vs. -39%, respectively). Reductions were statistically significant at weeks 4, 8, and 12. Vaginal pH fell significantly in the estradiol group by week 4 and then remained stable throughout the treatment period, but there were no significant changes in the placebo group. Vaginal maturation value increased more in the estradiol than the placebo group (p0.001). Few subjects had vaginal bleeding or spotting. Quality of life improved similarly in both groups. Urogenital symptoms improved considerably from baseline in both treatment groups, with no significant differences. Eight subjects experienced treatment-related adverse events (seven in the estradiol group).In Asian women, micro-dose estradiol was significantly superior to placebo in improving vasomotor symptoms. The bleeding profile was comparable with that of placebo. Micro-dose estradiol was safe and well tolerated in Asian women.

To determine whether early luteal-phase vaginal progesterone supplementation improves the outcome of in vitro fertilization-embryo transfer (IVF-ET).A randomized, controlled trial was conducted on 197 women undergoing IVF-ET cycles with human chorionic gonadotropin (hCG) as the standard luteal-phase support. The participants were randomly assigned to either the study group or the control group. The study group was given 200 mg micronized progesterone vaginally three times per day starting in the afternoon of oocyte retrieval until the morning of embryo transfer, in addition to the standard hCG luteal-phase support. The control group received only the hCG support. The pregnancy rates and the implantation rates were measured.There were no significant differences in pregnancy rates or implantation rates between groups. However, subgroup analysis revealed significantly higher pregnancy and implantation rates in the study group among those women with fibroids or difficult oocyte retrieval involving uterine puncture (38.7% vs. 15.4% and 26.8% vs. 9.4% respectively, both p = 0.04).Additional early luteal-phase vaginal progesterone supplementation may improve the outcome of IVF-ET in women with fibroids or difficult oocyte retrieval.

The objective of this study was to identify and compare the expression profiles of progesterone receptor (PR) and estrogen receptor alpha (ERalpha) in the testes of men with obstructive azoospermia (OA), maturation arrest (MA), and Sertoli cell-only (SCO) histology. Testicular biopsies were obtained from 10 patients with OA, 10 patients with MA (either early or late arrest), and 8 patients with SCO who did not have hormonal abnormalities and varicoceles. Expression of PR and ERalpha was detected by immunofluorescence and Western blot. PR was expressed in the spermatogenic, Leydig, and Sertoli cells in the testes of OA patients. In the MA and SCO patients, the expression of PR was reduced in all cell types as compared with that in the OA patients. Western blot demonstrated that both the full-size (120 KDa) and the truncated (52 KDa) isoforms of the PR were expressed in the OA and MA testes. However, in the SCO testes, only the truncated isoform of PR (52 KDa) was expressed. ERalpha (66 KDa) was expressed principally in the spermatogenic and Leydig cells in the OA testes. By immunohistochemistry staining, expression of ERalpha was decreased in the spermatogenic and Leydig cells of the MA testes, whereas its expression was enhanced in the Leydig cells of the SCO testes. However, by Western blot, expression of ERalpha was significantly reduced in the SCO testes as compared with that in the OA and MA testes. We conclude that PR and ERalpha may play a role in the pathogenesis of the MA and SCO phenotype in patients with infertility.

Many complementary or alternative medicines are being used for the treatment of menopausal symptoms but most have not been properly tested for efficacy or for safety. This study examined the effect of a Chinese herbal preparation (Dang Gui Buxue Tang) on menopausal symptoms in Hong Kong Chinese women.A 6-month randomized, double-blind, placebo-controlled study of the effect of Dang Gui Buxue Tang (a 1 : 5 combination of Dang Gui (Angelicae sinensis) and Huang Qi (Astragalus membranaceus)) on acute menopausal symptoms. A total of 103 symptomatic women were enrolled. Three failed to meet inclusion criteria, leaving 50 subjects for inclusion in each group.Overall, mild hot flushes were reported more frequently than either moderate or severe flushes. In analysis by severity of flushes, there was a significant reduction in the number of mild hot flushes per month in the treatment group but not in the placebo group (from 18.9 +/- 23.5 at baseline to 8.6 +/- 17.1 at 6 months in the treatment group (p0.01) and from 26.0 +/- 43.5 to 12.4 +/- 17.6 in the placebo group (p = 0.062)). For moderate flushes, there was a significant reduction in the placebo group compared with the treatment group (from 18.9 +/- 28.7 at baseline to 11.1 +/- 29.9 at 6 months in the placebo group (p0.05) and from 10.5 +/- 22.3 to 6.0 +/- 16.0 in the treatment group (p = 0.107)). There was no significant change in either treatment or placebo groups in the reporting of severe hot flushes. Episodes of night sweats decreased significantly in the placebo but not in the treatment group (from 6.8 +/- 10.0 at baseline to 1.9 +/- 5.7 at 6 months in the placebo group (p0.05) and from 5.4 +/- 8.9 to 3.2 +/- 8.5 in the treatment group (p = 0.471)). In the vasomotor domain of the Menopause Specific Quality of Life, there was a significant reduction in scoring in the placebo group (from 2.8 +/- 1.6 to 1.7 +/- 1.3, p0.01) but not in the treatment group (from 2.8 +/- 2.1 to 2.3 +/- 1.6, p = 0.247).This study found overall no significant difference between Dang Gui Buxue Tang and placebo in the treatment of vasomotor symptoms in Hong Kong Chinese women. The frequency of mild, moderate and severe hot flushes decreased in both treatment and placebo groups, but Dang Gui Buxue Tang was statistically superior to placebo only in the treatment of mild hot flushes. There were no serious adverse events attributable to treatment during the study period.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) frequently exhibit central obesity, glucose intolerance, atherogenic dyslipidaemia and hypertension which are characteristic features of the metabolic syndrome (MetS). METHODS: A total of 295 premenopausal Chinese women with PCOS diagnosed by the Rotterdam criteria (mean age: 30.2+ +6.4 years) and 98 control subjects without PCOS were evaluated for prevalence of MetS and cardiovascular risk factors, including dyslipidaemia and dysglycaemia. RESULTS: Using the 2005 modified Adult Treatment Panel III criteria, MetS (presence of three or more risk factors) was found in 24.9% of PCOS women compared to 3.1% of controls. The prevalence of MetS in PCOS women increased from 16.7% at under 30 years of age to 53.3% at over 40 years. MetS was also more prevalent in overweight and obese (41.3%) than normal-weight PCOS women (0.9%). However, multivariate regression analysis showed that women with PCOS had a 5-fold increase in risk of MetS (odds ratio 4.90; 95% confidence interval: 1.35‐17.84) compared with women without PCOS even after controlling for age and BMI, suggesting PCOS alone is an independent risk factor for MetS. CONCLUSIONS: There is high prevalence of MetS in Hong Kong Chinese women with PCOS despite their relatively young age. Recognition of these cardiometabolic risk factors requires a high level of awareness in conjunction with early and regular screening.

To determine whether serum vascular endothelial growth factor (VEGF) concentration is correlated with arterial reactivity in postmenopausal women.An observational study was conducted on 24 postmenopausal women who did not receive any hormone therapy in the 6 months preceding the study and had no pre-existing cardiovascular diseases or cardiovascular risk factors. Serum samples were obtained from all participants and analyzed for VEGF concentrations. Arterial reactivity was assessed by the measurement of endothelium-dependent dilatation and endothelium-independent dilatation of the brachial artery, using color duplex Doppler ultrasound.The study population was aged 50.8 years on average, with about 2 years of menopause. Serum VEGF concentration in postmenopausal women was significantly correlated with both endothelium-dependent dilatation (r = -0.66, p0.01) and endothelium-independent dilatation (r = -0.65, p0.01) of the brachial artery.Serum VEGF level may be a potential indicator of arterial reactivity in postmenopausal women.

Background: Fetal RNA of placental origin has been detected in the plasma of pregnant women, but the timing of the first appearance and the detailed kinetics of postdelivery clearance of such circulating RNA have not been studied. Methods: To address the timing of the first appearance of circulating placental RNA, we collected serial maternal blood samples from 47 women who had conceived by assisted reproductive procedures. To address the postdelivery clearance kinetics, we collected serial postdelivery blood samples from 6 pregnant women who had delivered by cesarean section. Placenta-derived transcripts were sought by real-time quantitative reverse transcription-PCR. Results: The earliest gestational age at which human placental lactogen and human chorionic gonadotropin β-subunit mRNAs were detectable in a proportion of the pregnant women was the 4th week of gestation. The postdelivery study indicated that the median apparent half-life for the clearance of human placental lactogen mRNA was 14 min. Conclusions: Placenta-derived mRNA can be found in maternal plasma from very early on in gestation, suggesting a possible role for early noninvasive prenatal diagnosis or monitoring. The rapid kinetics of circulating placental mRNA suggest that its plasma concentrations may be used to monitor recent physiologic or pathologic events.

Recently, two large randomized placebo-controlled studies on long-term postmenopausal hormone replacement therapy, the Heart and Estrogen/progestin Replacement Study (HERS) and the Women's Health Initiative (WHI), have raise a lot of controversies, especially on the cardiovascular aspects. We briefly review these two trials and discuss what we know and do not know about postmenopausal hormone therapy, including the evidence on novel choices such as raloxifene and tibolone.

Purpose : To examine changes in the ratio of Bax and Bcl-2 mRNA expression throughout the ovulatory cycle in the ampullary region of the human oviduct. Methods : The mucosal layer was isolated from the human oviduct tissue and semiquantitative reverse-transcriptase polymerase chain-reaction (RT-PCR) analysis of mRNA of Bax and Bcl-2 was performed. Immunohistochemistry provided the cellular localization of the Bax and Bcl-2 proteins. The ratio of expression of Bax and Bcl-2 mRNA was examined in the ampullary region of the oviduct in samples obtained in the follicular, periovulatory, and luteal phases of the ovulatory cycle. Results : Bax expression was constant in the follicular and periovulatory phase but showed a significant increase in the luteal phase. The Bax protein was present in all oviduct mucosal epithelial cells and the intensity of staining increased in luteal phase samples. Bcl-2 was expressed at a relatively constant level throughout the ovulatory cycle. The Bcl-2 protein was present in some but not all mucosal epithelial cells and the proportion of positive cells remained constant throughout the ovulatory cycle. Conclusion : The proapoptotic gene Bax shows a significant increase in mRNA expression in the luteal phase of the ovulatory cycle while the expression level of the antiapoptotic gene Bcl-2 remains constant throughout the ovulatory cycle. The ratio of Bax:Bcl-2 increases significantly in the luteal phase consistent with cells undergoing apoptosis.

The ratio of the active progesterone receptor B isoform is higher in the ampullary region of the oviduct. Purpose: To examine mRNA expression of progesterone receptor isoforms AB and B in oviduct mucosal tissue during the ovulatory cycle and in the different functional regions of the human oviduct. Methods: The mucosal layer was isolated from human oviduct tissue and semi-quantitative RT-PCR for progesterone isoforms AB and B was performed. The RT-PCR results were verified by immunohistochemistry. Results: The isthmic region showed no mRNA expression of either progesterone receptor isoform while the relative ratio of the B isoform was significantly higher in the ampullary region compared to the fimbrial region. There was a significant increase in the ratio of PRB to PRAB in the ampullary region compared to the fimbrial region in all samples. Conclusions: We found an increase in the relative abundance of the progesterone receptor B isoform in the ampullary region which is the site of fertilization and early embryo cleavage. Our results indicate that progesterone responsive genes are more likely to be activated in the ampullary region of the oviduct due to the difference in PRAB to PRB ratio. Providing support for the hypothesis that progesterone may play a specific role in providing an appropriate environment for sperm capacitation, fertilization and early embryo cleavage.

Danggui Buxue Tang (DBT) is a simple decoction, having about 800 years of usage in China to treat menopausal irregularity in women, which contains two herbs: Radix Astragali (Huangqi) and Radix Angelicae Sinensis (Danggui). Traditionally, boiling water has been used for preparing DBT; however, the optimized conditions of extraction have not yet been determined. Here, the amounts of Radix Astragali-derived astragaloside IV, calycosin, formononetin, and Radix Angelicae Sinensis-derived ferulic acid and ligustilide were determined in DBT, which were extracted according to an orthogonal array experimental design having three variable parameters: extraction time, extraction volume and number of repeats of the extraction. Our results suggest that extraction time and number of repeats of the extraction are two crucial factors, while extraction volume is a subordinate factor. The optimized conditions for extraction were therefore established. Besides the chemical composition, the estrogenic and anti-platelet aggregation activities of DBT were determined in different groups of the extraction, and the results of bioassays were in line with the amounts of the analyzed chemical ingredients. The results provide a model system for establishing the quality assurance of the herbal preparation.

MediClinic Panorama and Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa; * Department of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, USA; † Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR; ‡ Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; * * Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA; † † University of Geneva, Switzerland; ‡ ‡ Reader Emeritus, University of Oxford, UK

BACKGROUND. This is the first published report of a prospective, randomized, controlled trial comparing a fixed, multi-dose GnRH antagonist protocol with a long GnRH agonist protocol in poor responders undergoing IVF. METHODS. Sixty-six poor responders were randomized into two groups: the study group received 0.25 mg of cetrorelix daily starting on day 6 of stimulation; the control group received 600mg of buserelin acetate daily starting in the mid-luteal phase of the preceding cycle. Both groups were given a fixed dose of recombinant FSH (300 IU daily) for stimulation. RESULTS. There were no significant differences in the cycle cancellation rates, duration of stimulation, consumption of gonadotrophins, and mean numbers of mature follicles, oocytes and embryos obtained. The implantation rates were similar, but the number of embryos transferred was significantly higher for the antagonist group (2.32 6 0.58 versus 1.50 6 0.83; P 5 0.01). The pregnancy rates were also higher in the antagonist group, but the difference was not statistically significant. CONCLUSION. A fixed multi-dose GnRH antagonist protocol is feasible for patients who are poor responders on a long agonist protocol; however, our study failed to demonstrate an overall improvement in ovarian responsiveness. Clinical outcomes may be improved by developing more flexible antagonist regimens, an approach that requires further evaluation.

Purpose: To investigate whether commonly used test tube warming devices maintain a constant temperature in follicular fluid aspirates. Methods: By using a digital thermocouple, temperature was measured and comparisons were made between an analog dry block heater, a digital dry block heater, and a thermostatic test tube heater. Results: For small fluid volumes, temperature in the block heaters increased above 37°C after being in the block for over 2 min. The thermostatic heater maintained a constant temperature, but this was below the factory setting of 36.9°C. Temperature maintenance was influenced by fluid volume in each tube. Conclusions: One of the key factors in the handling of gametes and embryos is the maintenance of constant temperature. Test tube warming devices require verification of their ability to maintain fluid at the desired temperature. Temperature may vary with fluid volume and the type of test tube warming device used.

Objective To report the birth of a healthy baby after transfer of blastocysts derived from frozen eggs and frozen spermatozoa. Design Case report. Setting University-based assisted reproduction center. Patient(s) A 37-year-old woman with secondary infertility of 4 years' duration. Intervention(s) Retrieved oocytes were cryopreserved in 1.5 M 1,2-propanediol (PROH) and 0.3 M sucrose by a slow freezing–rapid thawing protocol, semen cryopreservation, and insemination by intracytoplasmic sperm injection (ICSI) at 4 hours after thawing. Main Outcome Measure(s) Fertilization and embryo development to blastocyst stage, pregnancy, and outcome. Result(s) Ten of 14 frozen oocytes survived after thawing. Eight of them were fertilized by performing ICSI and three developed into 7- to 8-cell embryos on day 3. Two of these embryos developed into blastocysts on day 5 and were transferred. This resulted in a successful pregnancy and the delivery of a healthy baby boy. Conclusion(s) This case demonstrates the feasibility of inseminating the frozen-thawed human oocytes after 4 hours of in vitro culture and the zygotes derived from frozen oocytes and frozen spermatozoa can be cultured to blastocysts resulting in the live birth of a healthy baby boy.