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In spite of exogenous progesterone supplementation, serum progesterone levels, from as early as 4 weeks gestation (day 14 post-oocyte retrieval) were significantly elevated and predicted women destined to have viable intra-uterine pregnancies. These high levels are suggestive that endogenous progesterone is already sufficient in viable pregnancies and that exogenous progesterone administration will not rescue a pregnancy destined to result in a miscarriage. Single serum progesterone measurement could be a useful indicator of pregnancy outcome in women undergoing IVF or ICSI treatment.

Background It has been proposed that ovarian sickling and/or iron overload in women with sickle cell disease (SCD) could contribute to gonadal dysfunction, but there are very few published studies. We hypothesised that the above phenomena might impair ovarian reserve. Methods A total of 50 SCD patients were case-matched by age, ethnicity, and presence of regular cycles (28±5 days) with 73 patients without a known haemoglobinopathy who required anti-Müllerian hormone (AMH) assessment in a gynaecology clinic. SCD patients had AMH levels taken as part of routine care. The patients were case-controlled and matched with patients who had no haemoglobinopathy in a tertiary centre over a period of one year. Results The mean AMH in the SCD case group was 7.6 pmol/l compared with 13.4 pmol/l in the control group (p<0.001). The AMH distributions were subsequently categorised. This showed that SCD patients had a significantly higher chance of having lower AMH in comparison with the control group (OR 2.6 (CI 1.1–6.5, P = 0.02). The proportion of women with AMH > 20 pmol/l was significantly lower in the SCD group (6%) in comparison with the control group (19%) (P = 0.04). Conclusions This is the first study showing that women of reproductive age with SCD are more likely to have a low ovarian reserve at a younger age in comparison with patients with no haemoglobinopathy.

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We have audited the invitation for uptake and outcome of artificial reproductive techniques in patients undergoing SCT for haematological malignancy, with the aim of improving our pre-transplant counselling. A postal survey was sent to 434 patients in our centre surviving a minimum of 2 years after allo-SCT, of whom 221 patients responded. Of 112 male patients, 79 were offered sperm storage, 42 banked sperm and 25 subsequently attempted parenthood with stored sperm. A total of 18 were successful, with 29 children born a median of 8 years (range 1-22 years) following SCT. Of 72 females o42 years old, 33 were offered storage of embryos/eggs/ ovarian tissue and 12 accepted. Following SCT, four women attempted pregnancy using cryopreserved embryos, with two successes. The majority of patients who were not counselled about infertility or not offered fertility-preservation options provided a likely reason, with completion of family being the most frequent. Nonetheless, 16 patients (11/72 women and 5/112 men) could not provide a reason for the lack of information/ invitation. In conclusion, uptake of gamete/embryo storage is high when offered and collected material is used frequently. Pregnancies in partners of male patients were usually successful and our data highlight the value of prolonged cryostorage.