Pak Chung Ho

• Doctor of Medicine
• Chair at The University of HongKong

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...

Background: 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. Methods: This...

Abstract 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 observ...

Background: Fertility preservation is increasingly important with improving cancer survival rates and the delay in childbearing in modern societies. The objective of our study was to review the experience of the fertility preservation programme in a tertiary-assisted reproduction unit in Hong Kong. Methods: This is a retrospective study involving m...

The objective of this study was to evaluate the performance of ovarian response prediction index (ORPI) in predicting ovarian response and livebirth of women undergoing their first in-vitro fertilisation (IVF) cycle. This is a retrospective analysis of 285 women from 2013 to 2016. The outcome measures were area (AUC) under the receiver-operator cha...

Objective This study investigated the role of women’s age, serum anti-Müllerian hormone (AMH) level and semen parameters in predicting fecundability. Methods This was a prospective cohort study on couples attending for preconceptional health check. Occurrence of conception at 1 year after ceasing contraception and time to pregnancy were noted by t...

Serum anti-Mullerian hormone (AMH) levels are significantly higher in women with polycystic ovary syndrome (PCOS) than in normal ovulatory women. Different diagnostic cut-off values of AMH for discriminating women with PCOS from normal controls have been proposed. This is attributed partly to the different assay methods used with different calibrat...

Objective: To establish the age-specific centiles of serum AMH levels in Chinese women, and to explore the use of multiples of median (MOM) AMH levels for the diagnosis of polycystic ovary syndrome (PCOS). Design: An observational study SETTING: University-affiliated hospitals and community clinics POPULATION: We included 3137 healthy women aged...

When an unintended pregnancy occurs secondary to contraceptive failure, the availability of safe means of pregnancy termination is important to minimize morbidities and mortalities associated with the abortion procedure. Where allowed within the legal constraints, access to safe abortion should be facilitated without prejudice and stigmatization. T...

Obesity remains an important risk factor for women planning for pregnancy because of its adverse effects on reproductive outcome. In individuals who experience difficulty in reducing significant weight with lifestyle intervention alone, the use of antiobesity drugs can be an adjunct. Orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropio...

The popularity of in vitro fertilisation has continuously increased throughout the past 40 years owing to an increased incidence of infertility and delayed planning for pregnancy. The aim of this paper is to review the current situation of in vitro fertilization in Hong Kong. In Hong Kong, in 2018, 7995 women underwent 5055 fresh and 5050 frozen-th...

Objectives: To compare the proportion of women having a desired ovarian response following ovarian stimulation with gonadotrophin dosing determined based on AFC versus serum AMH level in women undergoing IVF using the GnRH antagonist protocol. Methods: This was a randomised double-blinded trial carried out in a university-affiliated assisted rep...

Human spermatozoa can fertilize an oocyte only after post-testicular maturation and capacitation. These processes involve dynamic modification and reorganization of the sperm plasma membrane, which allow them to bind to the zona pellucida (ZP) of the oocyte. Defective sperm-ZP binding is one of the major major causes of male subfertility. Galectin-...

Objective This study aimed at investigating the association of serum vitamin D (25(OH)D) and anti‐Mullerian hormone (AMH) levels in women with polycystic ovary syndrome (PCOS) as well as non‐PCOS healthy ovulatory women and the possible confounding effects of adiposity and androgen. Method This was a cross‐sectional study conducted on serum sample...

Study question: Do both ulipristal acetate (UPA) and mifepristone inhibit embryo-endometrial attachment at concentrations corresponding to the emergency contraception (EC) dose? Summary answer: Both UPA and mifepristone at concentrations corresponding to the EC dose do not have an inhibitory effect on embryo implantation, although mifepristone a...

The synthesis of mifepristone, an antiprogestin blocking the action of progesterone at the receptor level, started a new era of medical termination of pregnancy (MTOP). The initial results of MTOP with mifepristone alone were disappointing; however, mifepristone can sensitise the myometrium to the action of prostaglandins. Clinical trials have show...

https://deepblue.lib.umich.edu/bitstream/2027.42/138200/2/ijgo12181_am.pdf

Preimplantation genetic diagnosis (PGD) was firstly report in 1990. Thereafter, more and more indications for PGD, including monogenic diseases (MGD) and translocations, are available nowadays and the list of indications of PGD is expanding from early onset and serious conditions to late onset diseases. Polymerase chain reaction (PCR) has been used...

STUDY QUESTION Does the use of hCG as luteal phase support in natural cycle frozen embryo transfer (FET) increase the ongoing pregnancy rate? STUDY ANSWER The use of hCG in natural cycle FET did not improve the ongoing pregnancy rate. WHAT IS KNOWN ALREADY The use of luteal phase support in stimulated cycles has been associated with higher live-b...

Introduction: Preimplantation genetic screening has been proposed to improve the in-vitro fertilisation outcome by screening for aneuploid embryos or blastocysts. This study aimed to report the outcome of 133 cycles of preimplantation genetic diagnosis and screening by array comparative genomic hybridisation. Methods: This study of case series w...

Study question: Are multimeric sperm plasma membrane protein complexes, ERp57 and sperm surface thiol content involved in human spermatozoa-zona pellucida (ZP) interaction? Summary answer: ERp57 is a component of a multimeric spermatozoa-ZP receptor complex involved in regulation of human spermatozoa-ZP binding via up-regulation of sperm surface...

STUDY QUESTION How do the three new anti-Müllerian hormone (AMH) assay methods, manufactured by Beckman Coulter, Roche and Ansh Labs compare with each other and with the Gen II assay? SUMMARY ANSWER The three new AMH assays are well correlated among themselves and with the Gen II assay, although differences in calibration do exist. WHAT IS KNOWN...

Objective: There are currently no local data on the sperm retrieval and pregnancy rates in in-vitro fertilisation and testicular sperm extraction cycles, especially with regard to the presence of genetic abnormalities. This study aimed to determine the sperm retrieval and pregnancy rates in infertile couples who underwent in-vitro fertilisation an...

Study question: Does ulipristal acetate (UPA) have similar efficacy as emergency contraception (EC) when administered before and after ovulation? Summary answer: The efficacy of UPA-EC was significantly better when administered before than after ovulation. What is known already: Levonorgestrel (LNG) is effective as EC only when administered be...

Designer babies are either created from an embryo selected by preimplantation genetic diagnosis (PGD) or genetically modified in order to influence the traits of the resulting children. The primary aim of creating designer babies is to avoid their having heritable diseases coded by mutations in DNA. With the development on mitochondria DNA transfer...

Objective: To evaluate if letrozole-induced suppression of estradiol reduces progesterone receptor expression and apoptosis in the first trimester placenta. Study design: We performed a double-blinded, randomized, placebo-controlled trial. We randomized 20 women requesting first trimester abortion with gestation up to 63 days to receive either l...

Objective: To evaluate the association of serum adiponectin level with the metabolic syndrome in Chinese women with polycystic ovary syndrome (PCOS). Methods: This was a cross-sectional study carried out in Hong Kong Chinese women with PCOS at a university-affiliated tertiary hospital between January 2010 and January 2011. Clinical and biochemic...

Objective: To assess the effect of dehydroepiandrosterone (DHEA) on antral follicle count (AFC), ovarian response to a standard low dose of gonadotrophin stimulation and number of oocytes in anticipated normal responders undergoing in vitro fertilisation (IVF). Design: Randomised, double-blind, placebo-controlled study. Setting: Tertiary repro...

Research on medical abortion has been conducted in Hong Kong since the 1990s. It was not until 2011 that the first-trimester medical abortion service was launched. Mifepristone was registered in Hong Kong in April 2014 and all institutions that are listed in the Gazette as a provider for legal abortion can purchase mifepristone from the local provi...

Objectives To evaluate the efficacy of local lidocaine gel and intrauterine lidocaine infusion in reducing pain level during saline infusion sonogram (SIS).Methods This is a randomized, double-blinded, placebo controlled trial. 120 recruited women were randomized into one of the following three groups: (1) 3 ml of 2% lidocaine gel on the cervix and...

Should fasting glucose (FG) or an oral glucose tolerance test (OGTT) be used to screen for dysglycaemia in women with polycystic ovary syndrome (PCOS)? A full OGTT should be recommended as the screening method for dysglycaemia in women with PCOS, regardless of BMI or family history of diabetes mellitus (DM). A cross-sectional study on 467 Chinese w...

Objective: To report the outcomes of more than 100 cycles of preimplantation genetic diagnosis for monogenetic diseases. Setting: Tertiary assisted reproductive centre in Hong Kong, where patients needed to pay for the cost of preimplantation genetic diagnosis on top of standard in-vitro fertilisation charges. Patients: Patients undergoing pre...

Oxidative damage by reactive oxygen species (ROS) is a major cause of sperm dysfunction. Excessive ROS generation reduces fertilization and enhances DNA damage of spermatozoa. Interaction between spermatozoa and oviductal epithelial cells improves the fertilizing ability of and reduces chromatin damage in spermatozoa. Our previous data showed that...

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....

Embryos produced by in vitro fertilization (IVF) have a high level of aneuploidy, which is believed to be a major factor affecting the success of human assisted reproduction treatment. The aneuploidy rate of cleavage stage embryos based on 1-2 biopsied blastomeres has been well-reported, however, the true aneuploidy rate of whole embryos remain unc...

Objectives: To compare the pregnancy outcome of the fluorescent in-situ hybridisation and array comparative genomic hybridisation in preimplantation genetic diagnosis of translocation carriers. Design: Historical cohort. Setting: A teaching hospital in Hong Kong. Patients: All preimplantation genetic diagnosis treatment cycles performed for...

Objective To evaluate ovarian response and cumulative live birth rate of women undergoing in-vitro fertilization (IVF) treatment who had discordant baseline serum anti-Mullerian hormone (AMH) level and antral follicle count (AFC). Methods This is a retrospective cohort study on 1,046 women undergoing the first IVF cycle in Queen Mary Hospital, Hon...

Purpose: To perform Preimplantation Genetic Diagnosis (PGD) on a paternal Brca2 unknown mutation carrier with early-onset breast cancer, whose paternal grandmother and mother had breast cancer at 60s. Method: Elucidating the linkage via single sperm haplotyping on patient's carrier brother, and identifying the genomic deletion via BLAST followed...

Study question: Does endometrial injury in the cycle preceding ovarian stimulation for in vitro fertilization (IVF) improve the ongoing pregnancy rate in unselected subfertile women? Summary answer: Endometrial injury induced by endometrial aspiration in the preceding cycle does not improve the ongoing pregnancy rate in unselected subfertile wom...

Ulipristal acetate (UPA) and mifepristone are currently well-established agents for emergency contraception. Both drugs are selective progestogen receptor modulators which have been shown to have better efficacy than the widely used levonorgestrel in prevention of pregnancy. However, there is only limited information on the action of UPA on sperm f...

STUDY QUESTION Do ulipristal acetate (UPA) and mifepristone have an effect on ciliary beat frequency and muscular contractions in the human Fallopian tube?

No: 263 Health and Hygiene Olfactomedin-1 (Olfm-1) is a secretary glycoprotein constituted in the extracellular matrix (ECM). Recent studies suggested that suppression of Olfm-1 in endometrial epithelium during the window of implantation (WOI) is favorable for the embryo attachment. Up-regulation of canonical Wnt-signaling pathway was also found to...

This review summarises the development of emergency contraception (EC) methods, and provides an overview on the currently available options of EC which are effective and safe back-up methods in case of non-use or failure of the regular contraception. The copper intrauterine contraceptive device is currently the most effective method. In most countr...

To evaluate whether pretreatment dehydroepiandrosterone (DHEA) supplementation improves ovarian response markers, ovarian response to standard low-dose gonadotropin stimulation, and in vitro fertilization (IVF) outcomes in poor responders. Randomized, double-blind, placebo-controlled pilot study. Tertiary reproductive medicine unit. Thirty-two wome...

Objective To assess the incidence of P elevation (PE) in natural cycles and evaluate its effect on frozen–thawed embryo transfer cycles performed in natural cycles (FET-NC). Study Design Retrospective analysis. Setting A tertiary assisted reproductive unit. Patient(s) Subfertile woman who did not conceive in their stimulated IVF cycle and underw...

Abstract 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...

Objective: To compare the live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers. Design: Case series with internal comparisons. Setting: University affiliated hospital, Hong Kong. Participants: Between October 2009 and December 2011, 206 women underwent their first in-vitro fertilisat...

The ideal time to perform abortion is in the first trimester as abortion-related mortality and morbidity increase significantly as gestation advances. As described in Chapter 22, biopsychosocial factors including failure to recognize an unplanned pregnancy in the first trimester, difficulties in accessing abortion services, late diagnosis of fetal...

Obesity remains an important risk factor for women planning for pregnancy because of its adverse effects on reproductive outcome. In individuals who experience difficulty in reducing significant weight with lifestyle intervention alone, the use of anti-obesity drugs can be an adjunct. Orlistat and metformin are the options currently, and their use...

This retrospective cohort study evaluated the cumulative live birth rate in women with polycystic ovary syndrome (PCOS) and isolated polycystic ovaries (PCO) undergoing in-vitro fertilisation (IVF) treatment. We studied 104 women with PCOS, 184 with PCO and 576 age-matched controls undergoing the first IVF treatment cycle between 2002 and 2009. The...

To validate the use of the ovarian sensitivity index (OSI) as a measure of ovarian response during in-vitro fertilization (IVF) treatment. This is a retrospective study carried out in an assisted reproduction unit in a teaching hospital. We analysed data from 2,556 women undergoing the first IVF cycle between 2002 and 2009. OSI was calculated as th...

To assess the feasibility of adding letrozole to the standard regimen of mifepristone and misoprostol for termination of pregnancy up to 63 days. We recruited 50 subjects who had requested legal termination of pregnancy up to 63 days. Medical abortion was performed with a singe dose of 200mg mifepristone and 10mg of letrozole daily for 3 days follo...

What is the effect of letrozole on the expression of steroid receptors in the placentae in cases of termination of pregnancies? The expression of estrogen receptor-α (ERα) and progesterone receptor (PR) transcripts, as well as ERα protein, in placentae was suppressed by letrozole pretreatment in second trimester termination of pregnancy. There have...

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...

OBJECTIVE: To investigate whether the live birth rate following in-vitro fertilization (IVF) is affected by thyroid autoimmunity (TAI) and/or subclinical hypothyroidism in subfertile women. DESIGN AND SETTING: Retrospective study in a university infertility clinic. PATIENTS: A total of 627 women without past or current history of thyroid disorder u...

Objective: To evaluate pregnancy outcomes with and without use of luteal phase support (LPS) in frozen-thawed embryo transfer (FET) performed in natural cycles (NC). Study design: Retrospective analysis. Before 1st July 2009, two doses of 1500 IU intramuscular human chorionic gonadotrophin were given on the day of FET and 6 days after the transf...

There is increasing recognition that chronic pain is a problem affecting women survivors of intimate partner violence (IPV), and in Western literature evidence is emerging about significant factors mediating the relationship between IPV and chronic pain. However, little is known about the factors mediating IPV and chronic pain in Chinese women for...

Objective: To study the potential protective action in vitro of oviductal epithelial cell membrane proteins against oxidative damage in human spermatozoa. Design: Prospective in vitro study. Setting: University research laboratory and infertility clinic. Patient(s): Semen from men attending the infertility clinic at the Queen Mary Hospital w...

Objectives. This study examined the efficacy of a group intervention, the Integrative Body-Mind-Spirit (I-BMS) intervention, which aims at improving the psychosocial and spiritual well-being of Chinese women undergoing their first IVF treatment cycle. Design. The I-BMS intervention facilitates the search of meaning of life in the context of family...

Context: Preliminary reports have shown encouraging effects of dehydroepiandrosterone (DHEA) in women with poor ovarian reserve undergoing assisted reproduction and primary ovarian insufficiency (POI), although data from randomized controlled trials are limited. The present study assesses the effect of DHEA on ovarian response markers in women wit...

Purpose Analysis of anti-Müllerian hormone (AMH) is becoming of recognized importance in reproductive medicine, but assays are not standardized. We have evaluated the correlation between the new Gen II ELISA kit (Beckman-Coutler) and the older ELISA kits by Immunotech (IOT) and Diagnostic Systems Laboratories (DSL). Methods A total of 56 archived...

Background: Buccal misoprostol 800 mcg and sublingual misoprostol 800 mcg show high efficacy when used with 200 mg mifepristone for early pregnancy termination but have different side effect profiles. This is the first double-blind randomized trial comparing the side effect profiles of these two routes of administration of misoprostol when used wi...

We previously demonstrated that a sequential regimen of letrozole and misoprostol resulted in a marked reduction in the serum estradiol concentration and in a higher efficacy of first-trimester termination of pregnancy than misoprostol alone. The aim of this study was to evaluate the effect of letrozole on uterine artery Doppler flow indices during...

Human embryonic stem cells (hESCs) have great potential for regenerative medicine as they have self-regenerative and pluripotent properties. Feeder cells or their conditioned medium are required for the maintenance of hESC in the undifferentiated state. Feeder cells have been postulated to produce growth factors and extracellular molecules for main...

Cytotrophoblasts are the key trophoblast cells which differentiate into different trophoblast lineages. In this report, glycodelin-A action on fusion of a cytotrophoblast-like cell line (BeWo) was investigated. It significantly reduced the spontaneous fusion of BeWo cells. The treatment enhanced the invasion and extracellular-signal regulated kinas...

To determine whether women use emergency contraception (EC) repeatedly instead of regular contraception methods if they have access to EC. Data from the records of 9201 women who underwent EC 11014 times in the years 2006 through 2008 at Hong Kong clinics were retrospectively analyzed. The χ(2) test was used to look for associations between demogra...

To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect of recent IPV on the link between IPV during pregnancy and subsequent CAN. This study was a longitudinal follow-up of a population-based study on pregnancy IPV conduc...

Letrozole inhibits estrogen production. It has been shown to increase efficacy in medical abortion when used with misoprostol. This study investigated if letrozole acts as an abortifacient due to a synergistic effect with misoprostol on uterine contractility. Sixteen healthy women requesting surgical abortion were randomized to receive either no pr...

Tubal ectopic pregnancy (tEP) is currently the leading cause of pregnancy-related deaths during the first trimester. Our current knowledge on the molecular pathogenesis is limited. The objective of the study was to find out the possible role of adrenomedullin (ADM) in the pathogenesis of tEP. This was an experimental in vitro study on oviductal tis...

Ectopic pregnancy (EP) occurs when the embryo fails to transit to the uterus and attach to the luminal epithelium of the Fallopian tube (FT). Tubal EP is a common gynecological emergency and more than 95% of EP occurs in the ampullary region of the FT. In humans, Wnt activation and downregulation of olfactomedin-1 (Olfm-1) occur in the receptive en...

Introduction Sperm head elongation and acrosome formation which take place during the last stages of spermatogenesis are paramount to produce competent spermatozoa able to cross the oocyte zona pellucida and to achieve fertilization. During acrosome biogenesis, acrosome attachment and spreading over the nucleus are still poorly understood and to da...

The aim of this randomized trial was to evaluate the abortion rate of combined regimen of letrozole and misoprostol in second-trimester abortion. This was a randomized, double-blinded, placebo-controlled trial of 130 women requesting legal termination of pregnancy at gestational age between 12 and 20 weeks. Letrozole 7.5 mg or placebo were given fo...

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...

This letter to the editor emphasized previous finding about hormone levels among women using hormonal contraceptives. The presentation showed no significant difference between hormone levels pre and post anti-Mullerian hormone usage. Conflicting reports in the literature can be due to intra and inter-cycle variability among women using combined ora...

The pharmacokinetics of vaginal misoprostol as a dry tablet or as a tablet moistened with normal saline or with acetic acid were studied. For this study, 42 women requesting termination of pregnancy at gestational age of <12 weeks were recruited and received 400 µg vaginal misoprostol tablets. They were randomized into three groups: (i) dry tablets...

During placentation, the cytotrophoblast differentiates into the villous cytotrophoblast and the extravillous cytotrophoblast. The latter invades the decidualized endometrium. Glycodelin-A (GdA) is abundantly synthesized by the decidua but not the trophoblast. Previous data indicate that GdA suppresses the invasion of trophoblast cell lines by down...

To evaluate the performance of antimullerian hormone (AMH) and inhibin B as ovarian function markers for differentiating common causes of secondary oligoamenorrhea, namely hypogonadotrophic hypogonadism (HH), polycystic ovary syndrome (PCOS), premature ovarian failure (POF), and hyperprolactinemia (HPRL). Retrospective analysis. Two university hosp...