1/10. 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 = physician (Clic here for more details about this article) |
2/10. Three pregnancies despite elevated serum FSH and advanced age: case report.Although the transfer of fertilized donor oocytes is the most efficacious mode of conception for infertile women with hypergonadotrophism associated with incipient or apparent ovarian failure, there are many individuals who, for religious, ethical, or personal reasons, would prefer to try to conceive with their own oocytes. The three cases presented here represent extremes to date for (i) highest serum FSH concentration in a woman with incipient ovarian failure (n = 2), and (ii) the oldest woman with apparent overt ovarian failure (n = 1) to have successful pregnancies. All three cases were treated for only a short time with pharmacological dosages of ethinyl oestradiol with luteal phase support with progesterone. The peak FSH (mIU/ml) in cases 1 and 2 was 143 and 127 respectively. The precedents set in these cases can help physician-patient consultation when patients enquire whether there is a certain critical FSH concentration above which pregnancy is not possible or an age over which successful pregnancy could not be achieved even if ovulation despite ovarian failure was possible.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Exacerbation of pulmonary lymphangioleiomyomatosis by exogenous oestrogen used for infertility treatment.Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease that affects women in the reproductive years. It is occasionally associated with tuberous sclerosis, especially in the incomplete form. As it is likely that oestrogen plays a central role in disease progression, exogenous oestrogen will cause a deterioration in LAM. However, the early stage of this disease is easy to miss unless the physician is a specialist. Although there have been some reports in menopausal women given exogenous oestrogen for osteoporosis, this is the first report of pulmonary LAM caused by exogenous oestrogen used for the treatment of infertility.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Cyclical haematuria sequel to uterine myomectomy: a case report.A thirty-year old married nulliparous lady had a difficult myomectomy done by a general practitioner one year prior to presentation. Two months after the operation, she had her menstruation, but with a concurrent total, painless haematuria. This combination continued for nine months before her family physician referred her to the urological clinic. Full urological work-up revealed an iatrogenic vesico-uterine fistula, but the features were not consistent with those of the classical vesico-uterine fistula syndrome. Transabdominal fistulectomy not only controlled the haematuria but also helped the patient to achieve a viable pregnancy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Ruptured tubo-ovarian abscess as a complication of IVF treatment: clinical, ultrasonographic and histopathologic findings. A case report.Tuboovarian abscess is a rare complication of IVF treatment, which can be lethal on rupture. Hereby, we present a case of a ruptured tubo-ovarian abscess, following transvaginal ultrasound-guided oocyte retrieval for IVF and transcervical embryo trasfer in a 38-year-old white female patient with five years of primary infertility who underwent aspiration of bilateral hydrosalpinges at the time of oocyte retrieval. This case suggests that the reactivation of latent pelvic infection due to a previous pelvic inflammatory disease (PID) was the possible route of infection after transvaginal ultrasound-directed follicle aspiration--transcervical embryo transfer. We conclude that physicians should consider the diagnosis of tubo-ovarian abscess in the differential diagnosis of abdominal pain, fever and leukocytosis after ovum retrieval and transcervical embryo transfer for IVF treatment. Preservation of the uterus and unaffected uterine adnexa should be attempted in such cases if future pregnancy is desired.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Successful infertility treatment in a cancer patient with a significant personal and family history of cancer.BACKGROUND: infertility can be a devastating problem for a couple desperate to conceive. Unfortunately, these same women with infertility also bear the burden of an increased risk of ovarian and breast cancer. We present a case of a woman with infertility who persevered despite a personal and family history of cancer to achieve her goal of having a family. Case: The patient's father had died of breast cancer at an early age. The patient had been unsuccessfully treated for infertility elsewhere before transferring to our institution. A diagnostic laparoscopy revealed an early ovarian cancer treated by oophorectomy only. RESULTS: After a period of observation, infertility treatment was resumed, leading to the successful cesarean delivery of triplets. Although recurrent ovarian cancer was diagnosed at delivery, the patient remains disease free, with three healthy children, 4 years after optimal tumor reductive surgery for stage IC low malignant potential ovarian cancer. CONCLUSIONS: infertility patients with significant cancer issues may achieve a term delivery and remain disease free for a meaningful length of time with the assistance of their physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. The importance of ultrasonography in infertile women with "forgotten" intrauterine contraceptive devices.Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. An unexpected guest in follicular fluid.Parasitic infection as the only or concomitant cause of infertility in Caucasian women is rare. A parasitic infection may also present itself quite unexpectedly as a coincidental finding as shown with this case report. Moving microfilariae of mansonella perstans were found in the aspirated follicular fluid of a patient who underwent in-vitro fertilization (IVF) with embryo transfer because of tubal pathology due to chlamydia trachomatis. The patient also appeared to have a schistosoma infection. To our knowledge, the presence of parasites in follicular fluid has never been reported before. We expect that infertility physicians may be confronted with parasitic infections more often, not only in patients originating from tropical countries but also in Western women as a result of a tendency to travel more frequently to exotic and (sub)tropical countries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Subclinical spontaneous abortion.blood samples were obtained from 5 women during the menstrual cycle in which they had conceived. Although neither the women nor their physicians were clinically aware that conception had occurred, one or more of the blood specimens from each woman contained human chorionic gonadotropin (hCG), as measured by a specific radioimmunoassay. Each patient underwent a spontaneous abortion with 4 of the 5 women describing a delayed, but otherwise normal, menses. The fifth noted an unusually abundant amount of vaginal bleeding. Immunologic urinary pregnancy slide tests were negative in the 4 women on whom the tests were performed. The levels of hCG in the serum of these women were abnormally low for the estimated length of gestation, suggesting that defective trophoblastic function may be important in the pathogenesis of this phenomenon. These examples illustrate that some women may conceive and abort so early that the pregnancy and the abortion may remain subclinical. Therefore, it is likely that the true incidence of spontaneous abortions during the first trimester is greater than the presently accepted incidence of 15%.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Well-differentiated endometrial adenocarcinoma in an infertility patient with later conception. A case report.BACKGROUND: The incidence of well-differentiated endometrial adenocarcinoma in reproductive-age women is approximately 5%. When the women desires to retain her future fertility in light of this diagnosis, choices of surgery vs. medical therapy may present a dilemma for both the physician and patient. CASE: A young infertility patient with well-differentiated endometrial adenocarcinoma conceived by ovulation induction and intrauterine insemination after medical therapy. She subsequently delivered vaginally, and follow-up dilatation and curettage revealed no evidence of recurrent carcinoma. CONCLUSION: This case illustrates that with close observation by endometrial sampling for histologic diagnosis and follow-up, medical therapy can be an option for treating this condition to allow future fertility. The patient must be extensively counseled, however, concerning the nearly 33% chance of progression or recurrence of disease. One must also stress the importance of frequent evaluation of symptoms and endometrial pathology postpartum, with endometrial sampling as indicated and discussion of definitive surgical therapy once fertility is no longer desired.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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