Updated status of assisted reproductive technology activities in the Asia-Oceania region.

AIM: To report on a descriptive survey on the availability, regulation and funding issues of assisted reproductive technology (ART) activities in member countries of the Asia and Oceania Federation of Obstetrics and Gynaecology (AOFOG). METHODS: A survey questionnaire was initially sent out to representatives of the 28 member national societies of AOFOG in 2015, and final verification and compilation of data were completed in November 2017. RESULTS: A response was received from 24 countries. Artificial insemination and in vitro fertilization treatments were available in 23 and 22 of them respectively. Of the 23 responding countries where ART activities were carried out, these were governed by legislation or national regulations in 12 of them, and 15 had a national registry, to which reporting was compulsory in 11 of them. Only Australia, Nepal, New Zealand and Saudi Arabia allowed ART treatment for both single men and women, while only Australia and New Zealand allowed ART treatment for homosexual couples. In Vietnam, ART treatment was allowed only for single women (but not men) from the same country. In Israel, only single or homosexual women but not men were allowed to receive ART treatment. Government subsidy was available for artificial insemination and in vitro fertilization treatments in 10 and 9 responding countries respectively. Compensation to gamete donors and surrogate mothers were allowed in some countries, mostly on the basis of covering the medical treatment cost and compensation for leave from work. CONCLUSION: There is great diversity in the availability of various forms of ART treatments, their regulations and data-monitoring mechanisms, as well as funding issues, among Asian-Oceanic countries. Availability of ART activities involving donor gametes or surrogacy, or those for nonheterosexual unions, is still limited in this region.

Role of baseline antral follicle count and anti-Mullerian hormone in the index stimulation cycle of IVF treatment in predicting outcome of subsequent frozen-thawed embryo transfers.

This retrospective cohort study aims at determining whether baseline antral follicle count (AFC) and serum anti-Mullerian hormone (AMH) level in the index stimulation cycle predict live-birth outcome in subsequent frozen-thawed embryo transfer (FET) cycles. We studied 500 women undergoing the first IVF cycle who had embryo(s) cryopreserved. The main outcome measures were live-birth in the first FET cycle and cumulative live-birth in all the FETs combined after the same stimulation cycle. Our results showed that baseline AFC and AMH level on the day before ovarian stimulation showed significant correlation. In the first FET cycle, AFC and AMH level were significantly higher in subjects attaining live-birth in the first FET cycle or cumulative live-birth from all FETs than those who did not. Both AMH and AFC were insignificant predictors of live-birth in the first FET cycle or cumulative live-birth after adjusting for age. The areas under the ROC curves for AMH, AFC and age were 0.654, 0.625 and 0.628, respectively, for predicting cumulative live-birth. In conclusion, we reported for the first time that baseline AFC and AMH in the index stimulation cycle have only modest predictive performance on cumulative live-birth in subsequent FET cycles.

Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization.

PURPOSE: To evaluate the role of Anti-mullerian hormone (AMH) in predicting cumulative pregnancy outcome during in-vitro fertilization (IVF) treatment. METHODS: Serum AMH levels on day 6 of ovarian stimulation were taken from 180 women undergoing IVF with or without intracytoplasmic sperm injection (ICSI). The main outcome measures were ongoing pregnancy in the fresh cycle, cumulative ongoing pregnancy and ovarian response. RESULTS: There was a trend of higher median AMH levels in subjects achieving ongoing pregnancy in the fresh IVF cycle. The median AMH levels were significantly higher in subjects attaining ongoing pregnancy cumulatively and in subjects showing ovarian hyper-response in the stimulated cycle. Areas under the ROC curves were 0.606 and 0.792 for the prediction of cumulative ongoing pregnancy and ovarian hyper-response respectively. CONCLUSIONS: Serum AMH concentration on day 6 of stimulation was significantly higher in subjects who achieved cumulative ongoing pregnancy in IVF compared to those who did not. Serum AMH is a reasonably good predictor of ovarian hyper-response.

Gonadotrophin ovulation induction is a successful treatment for World Health Organisation Group II anovulatory subfertility in women aged up to 40 and with body mass index up to 34.

Gonadotrophin-induced ovulation (GnOI) is generally an effective treatment when anti-estrogen therapy is unsuccessful. It remains uncertain how appropriate it is in older and obese women. We carried out an analysis of a GnOI programme between 2000 and 2008, including 514 treatment cycles in 140 women with World Health Organisation Group II anovulation. A low-dose step-up stimulation protocol using recombinant follicle stimulating hormone (FSH) (with natural intercourse) was used throughout in the treatment of women aged up to 40 years and with body mass index (BMI) up to 34 kg/m(2), with a rigorously-applied cancellation criterion. The livebirth rates in first stimulated cycle and cumulatively over six cycles (or until pregnancy) were 19.2% and 74.2%, respectively and the multiple livebirth rate was 2.5%. There was no significant relationship between age and BMI with pregnancy rates, although higher BMI was associated with higher threshold dose and longer duration of stimulation. Anti-estrogen resistant patients attained significantly higher cumulative ongoing pregnancy rates than those who were anti-estrogen responsive. These data demonstrate that judicious administration of gonadotrophins to women with WHO Group II anovulatory subfertility can result in a good pregnancy rate with low risk of multiple pregnancy in women aged up to 40 years and with BMI of up to 34 kg/m(2).

Expression of maspin in gestational trophoblastic disease.

BACKGROUND: Maspin is a tumor suppressor gene whose expression is altered in neoplasia and malignancies of many tissues. In the human placenta, the maspin gene is expressed in trophoblastic cells and might act as an inhibitory regulator of trophoblastic invasion. Hence, in gestational trophoblastic disease (GTD), where there is increased propensity for invasion in the trophoblastic tissue, we hypothesized that maspin expression would be decreased. The present study aimed at investigating the expression of maspin in GTD and its prognostic significance. METHODS: Using immunohistochemical staining, we firstly studied the expression of maspin in hydatidiform moles, with gestational age-matched normal first trimester placenta used as control. A total of 38 cases of hydatidiform moles were studied, including 20 complete moles (CM) and 18 partial moles (PM). Among them, 10 cases of the CM group and 8 cases of the PM group subsequently developed gestational trophoblastic neoplasia (GTN). Immunostaining was also performed on tissue from 4 cases of choriocarcinoma and 5 cases of placental site trophoblastic tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was further performed on RNA extracted from 10 hydatidiform moles (5 with GTN and 5 without) and 6 normal first-trimester placentae. RESULTS: In all tissue sections, nuclear expression of immunostaining signal was demonstrated, mainly in the cytotrophoblasts. The percentage of trophoblastic nuclei stained in both complete and partial moles was significantly lower than that in normal first-trimester placenta (P < 0.001). However, there was no significant difference in immunostaining between complete and partial moles (P > 0.05). There was also significantly lower expression of maspin in those cases subsequently developing GTN than those which did not (P = 0.01). Immunostaining on choriocarcinoma and placental site trophoblastic tumor showed reduced expression of maspin in all the tumor cells. Reverse transcriptase-polymerase chain reaction revealed that the expression of maspin was consistently down-regulated in all the hydatidiform mole samples. CONCLUSIONS: Our results suggest that there is down-regulated expression of maspin in gestational trophoblastic diseases, and the down-regulation is more prominent in cases developing gestational trophoblastic neoplasia. This may play a role with prognostic significance in the pathogenesis and malignant transformation of hydatidiform moles.