Publications by authors named "Jennifer K Y Ko"

17 Publications

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Effect of serum vitamin D level before ovarian stimulation on the cumulative live birth rate of women undergoing in vitro fertilization: a retrospective analysis.

Endocr Connect 2022 Jan 1. Epub 2022 Jan 1.

E Ng, Department of Obstetrics and Gynecology, The University of Hong Kong, Hong Kong, Hong Kong.

Objective: Vitamin D receptors are present in the female reproductive tract. Studies on the association between serum vitamin D level and pregnancy rate of in vitro fertilization (IVF) showed inconsistent results and focused on a single fresh or frozen embryo transfer cycle. The objective of our study was to evaluate if serum vitamin D level before ovarian stimulation was associated with the cumulative live birth rate (CLBR) of the first IVF cycle.

Design: Retrospective cohort study.

Methods: Women who underwent the first IVF cycle from 2012 to 2016 at a university-affiliated reproductive medicine center were included. Archived serum samples taken before ovarian stimulation were analyzed for 25(OH)D levels using liquid chromatography-mass spectrometry.

Results: 1,113 had pregnancy outcome from the completed IVF cycle. The median age (25th-75th percentile) of the women was 36 (34-38) years and serum 25(OH)D level was 53.4 (41.9-66.6)nmol/L. The prevalence of vitamin D deficiency (less than 50nmol/L) was 42.2%. The CLBR in the vitamin D deficient group was significantly lower compared to the non-deficient group (43.9%,208/474 vs 50.9%,325/639, p=0.021, unadjusted), and after controlling for women's age, body mass index, antral follicle count, type and duration of infertility. There were no differences in the clinical/ongoing pregnancy rate, live birth rate and miscarriage rate in the fresh cycle between the vitamin D deficient and non-deficient groups.

Conclusions: Vitamin D deficiency was prevalent in infertile women in subtropical Hong Kong. The CLBR of the first IVF cycle in the vitamin D deficient group was significantly lower compared to the non-deficient group.
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http://dx.doi.org/10.1530/EC-21-0444DOI Listing
January 2022

Comparison of the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing in vitro fertilization using a standardized stimulation regime.

J Ovarian Res 2021 Dec 11;14(1):175. Epub 2021 Dec 11.

Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

Background: In vitro fertilization (IVF) is a well-established method to treat various causes of infertility. Some previous retrospective studies suggested a lower ovarian response in Asian women compared to Caucasian women. However, the ovarian stimulation regimens were not standardized, potentially confounding the findings. The objective of this study is to compare the number of oocytes obtained after ovarian stimulation between Chinese and Caucasian women undergoing IVF using a standardized stimulation regimen.

Methods: This is a prospective cohort study conducted in two tertiary IVF units in Hong Kong, China and Sydney, Australia from October 2016 to August 2019. A total of 192 women aged 18-42 years with a body weight > 60 kg underwent IVF with a standard ovarian stimulation regimen of 150 micrograms corifollitropin alfa (Elonva®) followed by 200 IU follitropin beta (Puregon®) per day. The number of oocytes retrieved in Chinese women treated in the Hong Kong center was compared to that of Caucasian women treated in the Australian center.

Results: Serum AMH levels were similar between the two groups. Although women in the Chinese cohort were older and had a higher body mass index (BMI), longer duration of infertility and lower antral follicle count (AFC) than those in the Caucasian cohort in this study, no differences in the number of oocytes retrieved [11 (8-17) vs. 11 (6-17), p=0.29], total dosage and duration of stimulation and number of follicles aspirated were noted between the two ethnic cohorts. The peak estradiol level was greater in Chinese women than in Caucasian women. After controlling for age, BMI and AFC, ethnicity was a significant independent determinant of the number of oocytes obtained.

Conclusions: Chinese women had a higher number of oocytes after ovarian stimulation using a standardized stimulation regimen compared with Caucasian women undergoing IVF after controlling for age, BMI, AFC and AMH despite presenting later after a longer duration of infertility.

Trial Registration Number: NCT02748278.
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http://dx.doi.org/10.1186/s13048-021-00928-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8666011PMC
December 2021

The Accuracy of Self-Screening of Group B Streptococcus in Pregnant Women-A Randomized Crossover Study.

J Obstet Gynaecol Can 2019 Jun 2;41(6):792-797. Epub 2018 Nov 2.

Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong.

Objective: Universal screening of vaginal and rectal group B streptococcus (GBS) carriage in pregnant women is now recommended in many countries to identify at-risk pregnancies and reduce the risk of early-onset GBS disease in newborn infants. This study compared self-screening by pregnant women with screening by health care workers in a largely Chinese population.

Methods: A randomized crossover study was conducted in Hong Kong. All women attending the GBS screening visit at 35-37 weeks gestation between May and October 2015 were approached for recruitment. Consenting participants underwent both self-screening and screening by health care workers. Group 1 had health care worker screening swabs first, and group 2 had self-screening first. A positive GBS diagnosis was made if either swab was positive. The sensitivity of each approach was calculated by comparison with this gold standard. Acceptance of GBS self-screening and neonatal outcomes was analyzed (Canadian Task Force Classification I).

Results: Of the 672 women approached, 428 (63.7%) consented to the study. The prevalence of GBS was 19.7% (83 of 422). Sensitivities of self-screening and screening by health care workers were 61.4% (51 of 83) and 97.6% (81 of 83), respectively (P < 0.05). Women who used vaginal pessaries and non-Chinese women had a higher positive concordance rate with health care workers (P < 0.05). Neonatal outcomes of GBS-positive mothers were similar in the concordant and discordant groups.

Conclusion: The sensitivity of self-screening of GBS in Hong Kong was lower than the sensitivity of screening by health care workers. Cultural difference needs to be considered when implementing self-screening in different populations.
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http://dx.doi.org/10.1016/j.jogc.2018.08.003DOI Listing
June 2019

Comment on: Delayed intestinal perforation and vertebral osteomyelitis after high-intensity focused ultrasound treatment for uterine leiomyoma.

Obstet Gynecol Sci 2018 Mar 22;61(2):177-178. Epub 2018 Feb 22.

Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.

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http://dx.doi.org/10.5468/ogs.2018.61.2.177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854896PMC
March 2018

A Randomized Controlled Trial Comparing Trainee-Directed Virtual Reality Simulation Training and Box Trainer on the Acquisition of Laparoscopic Suturing Skills.

J Obstet Gynaecol Can 2018 Mar 28;40(3):310-316. Epub 2017 Sep 28.

Hong Kong Jockey Club Innovative Learning Centre for Medicine, Hong Kong Academy of Medicine, Hong Kong, China.

Objective: To compare the proficiency of novices in acquiring laparoscopic suturing skills following training in a virtual reality simulator or box trainer compared to no training.

Methods: This was a RCT in a university-affiliated teaching hospital recruiting participants who had no laparoscopic suturing experience to have suturing skill training in the virtual reality simulator, box trainer, or no training as control. Trainees were allowed to terminate training when they perceived competence in the procedure. Suturing skills were tested in the box trainer and scored using a modified Global Operative Assessment of Laparoscopic Skills questionnaire by their own self-evaluation and two experienced gynaecological laparoscopists.

Results: Of the 36 participants recruited, 27 (75%) had no laparoscopic experience. Participants with no laparoscopic experience took longer to complete training than those with experience (median 90 minutes [interquartile range (IQR) 80-115] vs. 55 min [IQR 40-65], respectively; P = 0.044). There were no differences in successful completion of the task (7/12 [58.3%], 10/12 [83.3%], 7/12 [58.3%]; P = 0.325), median suturing time in seconds (628 [IQR 460-835], 611 [IQR 434-691], 609 [IQR 540-837]; P = 0.702), mean subjective (mean ± SD 9.8 ± 1.8, 10.4 ± 2.8, 9.3 ± 2.4; P = 0.710), and objective (7.2 ± 1.8, 8.2 ± 2.1, 7.6 ± 1.7; P = 0.426) modified Global Operative Assessment of Laparoscopic Skills score in the simulator, pelvic trainer, and control groups, respectively. The intraclass correlation coefficient of the two reviewers was 0.422 (95% CI 0.159-0.717).

Conclusion: Trainees were unable to accurately assess themselves as to skill level in laparoscopic suturing. A longer training time is required for novices to master laparoscopic suturing using a simulator or box trainer.
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http://dx.doi.org/10.1016/j.jogc.2017.07.010DOI Listing
March 2018

Hormone replacement treatment choices in complete androgen insensitivity syndrome: an audit of an adult clinic.

Endocr Connect 2017 Aug 14;6(6):375-379. Epub 2017 Jun 14.

Department of Women's HealthUniversity College London Hospital, London, UK

Objective: To review the treatment choices of women with complete androgen insensitivity syndrome (CAIS) at a single tertiary centre.

Design: Retrospective review.

Patients: Women with CAIS identified from our database.

Results: The study group comprised 141 women with CAIS. Eleven percent (16/141) of women had gonads , 3 of whom were under workup for gonadectomy. The age of gonadectomy in the remainder 125 women was 17 (0.1-53) years. The most common form of HRT was oral oestrogen or transdermal oestrogen in 80% (113/141). 13/141 (9%) women used vaginal oestrogens alone or together with other forms of HRT. Testosterone preparations had been used by 17% (24/141) of women and were currently used in 10% (14/141). Of those who had used testosterone, 42% (10/24) had chosen not to continue after a therapeutic trial.

Conclusions: In a clinic offering individualised multidisciplinary care for women with CAIS, we found that the majority of women chose oestrogen-based treatment while a significant minority used testosterone.
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http://dx.doi.org/10.1530/EC-17-0083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527352PMC
August 2017

Sperm fucosyltransferase-5 mediates spermatozoa-oviductal epithelial cell interaction to protect human spermatozoa from oxidative damage.

Mol Hum Reprod 2015 Jun 9;21(6):516-26. Epub 2015 Apr 9.

Department of Obstetrics and Gynaecology, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong SAR Centre of Reproduction, Development and Growth, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong SAR

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 oviductal epithelial cell membrane proteins interact with the human spermatozoa and protect them from ROS-induced reduction in sperm motility, membrane integrity and DNA integrity. Sperm fucosyltransferase-5 (sFUT5) is a membrane carbohydrate-binding protein on human spermatozoa. In this study, we demonstrate for the first time that sFUT5 is involved in human spermatozoa-oviduct interaction and the beneficial effects of such interaction on the fertilizing ability of human spermatozoa. Anti-sFUT5 antibody-treated spermatozoa had reduced binding to oviductal membrane proteins. It is consistent with the result that affinity-purified sFUT5 is bound to the epithelial lining of human oviduct and to the immortalized human oviductal epithelial cell line, OE-E6/E7. Pretreatment of spermatozoa with anti-sFUT5 antibody and oviductal membrane proteins with sFUT5 suppressed the protective action of oviductal membrane proteins against ROS/cryopreservation-induced oxidative damage in spermatozoa. Asialofetuin, a reported sFUT5 substrate, can partly mimic the protective effect of oviductal epithelial cell membrane proteins on sperm motility, membrane and DNA integrity. The results enhance our understanding on the protective mechanism of oviduct on sperm functions.
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http://dx.doi.org/10.1093/molehr/gav015DOI Listing
June 2015

Uterus-Like Mass: Issues on Pathogenesis.

J Minim Invasive Gynecol 2015 Nov-Dec;22(7):1133-4. Epub 2015 Mar 10.

Department of Obstetrics and Gynaecology, University of Hong Kong, Queen Mary Hospital, Hong Kong.

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http://dx.doi.org/10.1016/j.jmig.2015.03.003DOI Listing
February 2016

Two-dimensional versus three-dimensional laparoscopy: evaluation of physicians' performance and preference using a pelvic trainer.

J Minim Invasive Gynecol 2015 Mar-Apr;22(3):421-7. Epub 2014 Nov 21.

Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.

Study Objective: To compare the proficiency and preference of physicians in performing standard tasks in a box trainer using 2-dimensional (2D) versus 3-dimensional (3D) laparoscopy.

Design: Prospective randomized controlled trial.

Design Classification: Prospective, randomized controlled trial (Canadian Task Force classification I).

Setting: Tertiary care teaching hospital.

Participants: Thirty physicians from the Department of Obstetrics and Gynecology.

Intervention: Participants were randomly assigned to perform a set of 3 to 4 tasks in a pelvic trainer using 2D laparoscopy first and then 3D laparoscopy, and vice versa.

Main Results And Measurements: The time taken to complete the tasks and side effects experienced were noted. Participants were asked to complete a modified Global Operative Assessment of Laparoscopic Skills (GOALS) form at the end of their tasks to evaluate their experiences and to assess their own proficiency with both visual modalities.

Results: The time taken for peg transfer, duct cannulation, and suturing was significantly faster using 3D laparoscopy compared with 2D laparoscopy. There were no significant differences in the time taken for pattern cutting with both visual modalities. Participants experienced more dizziness using 3D laparoscopy (6.9% vs 37.9%; p = .004). The GOALS self-evaluation score was significantly higher for 3D compared with 2D laparoscopy. After the study, 11 of 29 (37.9%) participants preferred 2D, 16 of 29 (55.2%) preferred 3D, and 1 of 29 (8.3%) had no preference.

Conclusion: Although 3D laparoscopy scored higher on self-evaluation and was preferred by more participants, it only gave better objective performance in the completion of some selected tasks by participants with intermediate skill levels and was associated with more dizziness. Further studies are needed to determine the value of 3D laparoscopy, especially when used in the clinical setting.
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http://dx.doi.org/10.1016/j.jmig.2014.11.007DOI Listing
August 2015

Caesarean scar pregnancy: a 10-year experience.

Aust N Z J Obstet Gynaecol 2015 Feb 28;55(1):64-9. Epub 2014 Oct 28.

Department of Obstetrics and Gynecology, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China.

Aims: To review the management and outcome of all women with caesarean scar pregnancy (CSP) at a single centre.

Methods: A retrospective review of women diagnosed with CSP between January 2004 and December 2013 was performed. Women were identified from the admission and Early Pregnancy Assessment Clinic records.

Results: Twenty-two cases of CSP were identified during the study period. The median gestational age at diagnosis was 6.7 weeks (range 4.7-11.8 weeks). All diagnoses were made by ultrasound, the most common finding of which was a heterogeneous mass at the site of the caesarean scar (100%). The median duration for human chorionic gonadotropin to return to undetectable level was 10 weeks (range 2-20 weeks), although the duration for sonographic resolution of the CSP can take much longer. The success rate of intralesional methotrexate was 80% in our series.

Conclusion: There is no consensus regarding the method of choice for managing CSP. Medical management using intralesional methotrexate appears to be an acceptable treatment in clinically stable women.
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http://dx.doi.org/10.1111/ajo.12273DOI Listing
February 2015

Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location.

J Ultrasound Med 2014 Mar;33(3):465-71

MBMRCOG, Queen Mary Hospital, 102 Pokfulam Rd, 6/F, Professorial Block, Hong Kong.

Objectives: The purpose of this study was to review the management and outcomes of all patients with pregnancy of unknown location who had serum human chorionic gonadotropin (hCG) levels greater than 1000 mIU/mL in our institution and to determine the likelihood of a subsequent normal intrauterine pregnancy at different hCG discriminatory levels.

Methods: A retrospective review was performed on all women admitted with the diagnosis of pregnancy of unknown location and an hCG level greater than 1000 mIU/mL over a 5-year period (July 2007 to June 2012). Patients were identified from a computerized hCG result database. The medical records, including sonographic findings, hCG levels, and outcomes, were reviewed.

Results: A total of 113 patients were identified. There were 23 viable intrauterine pregnancies (20.4%) and 22 visualized ectopic pregnancies (19.5%). The highest hCG level associated with a subsequent normal intrauterine pregnancy was 9083 mIU/mL in a patient with triplet pregnancy. Possible factors associated with nonvisualization of a normal intrauterine pregnancy included uterine fibroids, adenomyosis, endometrial polyps, and obesity. The negative laparoscopy rate was 48.8%.

Conclusions: Viable intrauterine pregnancy is possible in patients with pregnancy of unknown location and hCG levels above the generally accepted discriminatory zone, strict adherence to which can potentially disrupt a normal pregnancy. We support the need for judicious use of the hCG discriminatory level in hemodynamically stable patients with pregnancy of unknown location, and the decision to intervene should not be based solely on a single hCG level.
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http://dx.doi.org/10.7863/ultra.33.3.465DOI Listing
March 2014

Urethral prolapse in a postmenopausal woman.

J Obstet Gynaecol Can 2014 Feb;36(2):105-6

Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong.

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http://dx.doi.org/10.1016/s1701-2163(15)30650-2DOI Listing
February 2014

Cell membrane proteins from oviductal epithelial cell line protect human spermatozoa from oxidative damage.

Fertil Steril 2013 Apr 8;99(5):1444-1452.e3. Epub 2013 Jan 8.

Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong, PR China.

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 with normal semen parameters (World Health Organization, 2010).

Intervention(s): We studied the effect of oviductal epithelial cell membrane proteins on the sperm functions and endogenous antioxidant enzyme activities.

Main Outcome Measure(s): Sperm motility, lipid peroxidation, DNA fragmentation, intracellular reactive oxygen species (ROS) level, superoxide dismutase, and glutathione peroxidase activities.

Result(s): Oviductal epithelial cell membrane proteins bind to the human spermatozoa and protect them from ROS-induced damages in terms of sperm motility, membrane integrity, DNA integrity, and intracellular ROS level. Spermatozoa-oviduct epithelial cell interaction also enhances the antioxidant defenses in spermatozoa.

Conclusion(s): Our results demonstrated the protective effects of spermatozoon-oviductal epithelial cell interaction against oxidative stress in human spermatozoa. The results enhance our understanding of the protective mechanism of oviduct on sperm functions.
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http://dx.doi.org/10.1016/j.fertnstert.2012.11.056DOI Listing
April 2013

A 12-year experience of the management and outcome of heterotopic pregnancy at Queen Mary Hospital, Hong Kong, China.

Int J Gynaecol Obstet 2012 Nov 11;119(2):194-5. Epub 2012 Aug 11.

Department of Obstetrics and Gynecology, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.

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http://dx.doi.org/10.1016/j.ijgo.2012.06.006DOI Listing
November 2012

Cesarean scar molar pregnancy.

Obstet Gynecol 2012 Feb;119(2 Pt 2):449-451

From the Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.

Background: Molar pregnancy found in a cesarean scar is exceedingly rare. It can be challenging to manage and can have potentially catastrophic consequences.

Case: A 34-year-old multigravid woman presented with persistent symptoms of pregnancy after a surgical termination of pregnancy. Cesarean scar molar pregnancy was suspected on ultrasonography, and suction evacuation was performed under ultrasound guidance. This was followed by bimanual compression, oxytocin, and uterine artery embolization to reduce bleeding.

Conclusion: A high index of suspicion is needed for early diagnosis and management of cesarean scar molar pregnancy.
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http://dx.doi.org/10.1097/AOG.0b013e3182322f31DOI Listing
February 2012
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