1/111. Successful pregnancy in an infertile patient with conservatively treated endometrial adenocarcinoma after transfer of embryos obtained by intracytoplasmic sperm injection.A rare case of successful pregnancy in a woman with early-stage endometrial adenocarcinoma conservatively treated is presented. The patient, having polycystic ovaries, was initially diagnosed with hyperplasia of the endometrium and treated with several cycles of ovulation induction following intrauterine insemination. Then dilatation and curettage were carried out when hysteroscopy was performed. The histology report identified a well-differentiated adenocarcinoma of the endometrium. After repeated endometrial curettage, in-vitro fertilization and embryo transfer were introduced for immediate treatment of the patient's infertility in order to avoid the risk of recurrence of neoplastic endometrial lesions by oestrogens. A single pregnancy was achieved after transfer of the embryos obtained after intracytoplasmic sperm injection. This was performed due to the poor semen characteristics (asthenozoospermia). The patient delivered a healthy normal male infant at term. A transvaginal ultrasound examination 2 months after delivery showed a smooth, linear endometrium. Moreover, the histology report after endometrial biopsy was free of any malignancies. The patient now desires another pregnancy. We conclude that conservative treatment of early-stage endometrial adenocarcinoma in young women wishing to preserve fertility should be considered in carefully selected cases. Assisted reproductive technologies may be helpful for immediate achievement of pregnancy in such patients.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/111. Ovarian cancer associated with ovulation induction: a case report.A case report of a 38 year old lady who developed ovarian malignancy following 3 cycles of ovulation induction therapy is presented. She was observed to have clinically normal ovaries at laparotomy for tubal infertility 12 months previously. Although direct causal link between ovarian stimulation and cancer has not been established yet, a case is made for increased monitoring of patients receiving ovulation induction medication by physicians.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
3/111. salpingectomy for unilateral hydrosalpinx may improve in vivo fecundity.The objective of this study was to determine whether unilateral salpingectomy for hydrosalpinx could improve fecundity in women with an apparently normal contralateral tube. Two women with unilateral hydrosalpinx and with an apparently normal contralateral tube, and a long history of infertility, including failure to conceive despite several cycles of in vitro fertilization (IVF), had unilateral salpingectomies prior to considering subsequent IVF cycles. Case 1 conceived after 1 month following surgery and case 2 after 8 months without the use of assisted reproductive technology. Though the ensuing pregnancies may have been fortuitous, the possibility exists that in cases of unilateral hydrosalpinx, the performance of salpingectomy may improve fecundity without the need for IVF. Hopefully the outcome of these 2 case reports may generate interest in a larger cooperative prospective study. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
4/111. Secondary amenorrhea and infertility caused by an inhibin-B-producing ovarian fibrothecoma.OBJECTIVE: To report a case of secondary amenorrhea and infertility caused by an inhibin-B-producing ovarian fibrothecoma. DESIGN: Case report. SETTING: Academic medical center. PATIENT: A 37-year-old woman with a 2-year history of secondary amenorrhea and infertility. INTERVENTION(S): Operative removal of a 5-cm ovarian fibrothecoma. MAIN OUTCOME MEASURE(S): luteinizing hormone, FSH, E2, inhibin-B, TSH, and prolactin measured preoperatively and postoperatively. Immunostaining of tumor cells for inhibin and LH. RESULT(S): Preoperative hormone levels were as follows: FSH, 1.7 mIU/mL; LH, 23.4 mIU/mL; E2, 31 pg/mL; and inhibin B, 1,154 pg/mL. Three weeks postoperatively, the FSH was 1.5 mIU/mL, LH decreased to 7.1 mIU/mL, E2 increased to 276 pg/mL, and inhibin-B decreased to 17 pg/mL. The fibrothecoma did not stain for LH but was strongly positive for inhibin. Regular menstrual cycles resumed 28 days postoperatively. CONCLUSION(S): Inhibin-B produced by an ovarian tumor profoundly suppressed FSH levels and resulted in secondary amenorrhea and infertility. Use of sensitive and specific immunoassays for inhibin-A and -B may aid in the differential diagnosis of hormonally active ovarian tumors.- - - - - - - - - - ranking = 5.3619716710404keywords = menstrual cycle, cycle (Clic here for more details about this article) |
5/111. Midcycle administration of single-dose GnRHa for luteal phase failure in women with ovarian hyperstimulation. A report of five cases.BACKGROUND: Exogenous administration of gonadotropin-releasing hormone agonist (GnRHa) induces an endogenous midcycle gonadotropin surge. However, its use to induce ovulation and maintain luteal function in non-in vitro fertilization patients who receive ovarian stimulation is unknown. CASES: Five infertile women who underwent controlled ovarian hyperstimulation with human menotropin developed multiple ovarian follicles. In an attempt to circumvent the potential ovarian hyperstimulation syndrome, 1 mg of leuprolide acetate was administered subcutaneously to three patients in an attempt to induce the endogenous luteinizing hormone surge. All three patients began menstruation six to seven days after GnRHa administration with serum progesterone levels between 0.2 and 0.5 ng/mL. Similar ovarian stimulation cycles with ovulation induced by human chorionic gonadotropin in these individuals revealed a normal luteal phase length and midluteal progesterone levels. When double doses of leuprolide acetate were used on two patients, normal luteal length and midluteal serum progesterone levels occurred. CONCLUSION: A single bolus of GnRHa during the late follicular phase may be inadequate to initiate normal luteal function in cycles with ovarian hyperstimulation.- - - - - - - - - - ranking = 7keywords = cycle (Clic here for more details about this article) |
6/111. Ovarian stimulation in a woman with premature ovarian failure and X-autosome translocation. A case report.BACKGROUND: There are only a few reports on ovulation induction in women with premature ovarian failure resulting from an x chromosome abnormality. Up to now, there have been no publications on ovulation stimulation in a patient with an X-autosome translocation. CASE: A healthy, 29-year-old woman had premature ovarian failure (POF) but no other discernible pathologic clinical features. Laboratory tests prior to initiating a stimulation cycle revealed a 46,XX t(X;16) karyotype. genetic counseling was proposed, and the risk of x chromosome abnormality was discussed. The couple decided to undergo ovulation induction. For treatment of infertility, clomiphene citrate had been administered in the past. Because those treatments were not successful, GnRH-a and follicle stimulating hormone treatment was recommended. The first treatment cycle was successful in inducing ovulation, but on the 15th day after human chorionic gonadotropin administration, menstruation occurred. The couple refused a second stimulation, and menstruation occurred 32 days after the first. The patient then became amenorrheic again. CONCLUSION: At least some hope can be offered to infertile women with hypergonadotropinism and X-autosomal translocation, although it is impossible to determine whether ovulation induction will result in pregnancy. New treatments can be anticipated for women with POF and X chromosome aberrations who have similar hormonal environments.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |
7/111. Induction of endometrial cycles and ovulation in a woman with combined 17alpha-hydroxylase/17,20-lyase deficiency due to compound heterozygous mutations on the p45017alpha gene.OBJECTIVE: To describe the case of a Japanese woman with combined 17alpha-hydroxylase/17,20-lyase deficiency (congenital adrenal hyperplasia type V) and to discuss possible therapeutic procedures in such patients. DESIGN: Case report. SETTING: University hospital. PATIENT(s): A 26-year-old woman with secondary amenorrhea and primary sterility. INTERVENTION(s): Nucleotide sequencing of the P45017alpha gene (CYP17), induction of endometrial maturation with steroid hormone replacement, and ovulation induction with gonadotropin. MAIN OUTCOME MEASURE(s): Nucleotide sequence of CYP17, endometrial thickness and follicle diameter measured by transvaginal ultrasonography, and histologic evaluation of the endometrium. RESULT(s): Two different mutations were detected on CYP17: One was a deletion of the phenylalanine codon (TTC) at either amino acid 53 or 54 in exon 1, and the other was a missense mutation with the substitution of histidine (CAC) by leucine (CTC) at position 373 in exon 6. Repeated histologic evaluations performed during treatment with P consistently revealed an unripe endometrium with glands of the early secretory phase and markedly scanty stroma. Ultrasound examination revealed follicular growth and ovulation after gonadotropin administration, but insufficient thickness of the endometrium. CONCLUSION(s): ovulation induction was possible in this patient with 17alpha-hydroxylase/17,20-lyase deficiency, but the endometrial response to steroid hormone replacement was extremely poor.- - - - - - - - - - ranking = 4keywords = cycle (Clic here for more details about this article) |
8/111. Partial follicular aspiration for salvaging an IVF cycle after improper hCG administration. A case report.BACKGROUND: Failure of oocyte retrieval during in vitro fertilization (IVF) is considered "empty follicle syndrome." Many theories have been postulated, some related to an underlying ovulatory disorder or premature oocyte atresia. As illustrated in this case and in a review of empty follicle syndrome at our institution, often it is related to improper administration of human chorionic gonadotropin (hCG). CASE: A 40-year-old woman underwent IVF for a 10-year history of unexplained secondary infertility. Two ultrasound-guided oocyte retrievals were performed 34 hours apart due to improper hCG administration prior to the first procedure. The number of oocytes successfully aspirated at the second retrieval, fertilization rate and pregnancy outcome were analyzed. Successful retrieval of 16 oocytes, all mature and fertilized, occurred subsequent to the second oocyte retrieval. No pregnancy was established with the fresh cycle. CONCLUSION: This case report supports the premise that an IVF cycle in which improper hCG administration occurs can be salvaged. After partial follicular aspiration, no ovulation or luteinization of the remaining follicles occurred because of continued suppression by the gonadotropin releasing hormone analog. It is critical to consider the possibility of improper hCG administration when facing failure of oocyte retrieval. The procedure should be terminated and hCG readministered, and a second retrieval should be performed 34 hours later.- - - - - - - - - - ranking = 6keywords = cycle (Clic here for more details about this article) |
9/111. Allergic reaction to a highly purified urinary follicle stimulating hormone preparation in controlled ovarian hyperstimulation for in vitro fertilization.We report a case of general hypersensitivity-like allergic reactions to intramuscular injections of highly purified urinary follicle stimulating hormone (uFSH-HP) successfully managed by using intramuscular recombinant FSH (rFSH). The patient underwent a first cycle of in vitro fertilization (IVF) and controlled ovarian hyperstimulation (COH) was achieved with a combination of gonadotropin releasing hormone against (GnRH-a) and uFSH-HP. Because, after oocyte recovery, no fertilization occurred, the couple subsequently entered an intracytoplasmic sperm injection (ICSI) program. During the COH, the woman developed general hypersensitivity-like allergic reactions with itching, redness and swelling. Although there was regular follicular growth, the allergic symptoms worsened and, on day 8 of COH, the stimulation cycle was suspended. A few months later, the patient entered a new ICSI cycle. COH was achieved by using a combination of GnRH-a and rFSH. The cycle was completed and the patient did not report any allergic reaction. To avoid allergic reaction to the protein components of the urine-derived FSH preparations, the use of rFSH is suggested in those patients who present local and/or general hypersensitivity-like allergic reactions.- - - - - - - - - - ranking = 4keywords = cycle (Clic here for more details about this article) |
10/111. Bilateral undescended ovaries: association with infertility and treatment with IVF.OBJECTIVE: To describe the clinical findings in a patient with bilateral undescended ovaries and infertility who was successfully treated by IVF. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 35-year-old woman with bilateral undescended ovaries. INTERVENTION(S): hysterosalpingography, laparoscopy, and an IVF cycle. MAIN OUTCOME MEASURE(S): Anatomic description and pregnancy test. RESULT(S): This patient conceived and delivered a twin gestation after laparoscopic retrieval of oocytes and transfer of two blastocysts. CONCLUSION(S): Bilateral undescended ovaries is a rare condition that can be associated with infertility but can be successfully treated by IVF.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
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