Case Of Spontaneous Pregnancy Research Articles

The effect of laparoscopic ovarian drilling on pregnancy outcomes in polycystic ovary syndrome women with more than 2 in-vitro fertilization cycle failures: A pilot RCT.

Background: The effect of laparoscopic ovarian drilling (LOD) before in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles on pregnancy outcomes is an unclear and challenging subject. Objective: To evaluate the impact of LOD before IVF/ICSI cycles on controlled ovarian stimulation and pregnancy outcomes in polycystic ovary syndrome (PCOS) women with a history of more than 2 IVF failures. Materials and Methods: In this randomized clinical trial, women with PCOS diagnosis who referred to Arash Women's hospital, Tehran, Iran for IVF/ICSI cycle from August 2015-January 2018 were evaluated. Eligible participants were allocated into 2 groups randomly (n = 17/each group). The participants in the LOD group (intervention) were treated with laparoscopic couture, and after one month, they underwent IVF/ICSI cycles using the gonadotropin-releasing hormone antagonist protocol. The control group had no intervention. The oocyte and embryo qualities, ovarian hyperstimulation syndrome rate, the rates of chemical and clinical pregnancy and early miscarriage, live birth, and pregnancy complications, were compared between groups. Results: Finally, 34 participants were evaluated. The controlled ovarian stimulation outcomes were similar between groups. The ovarian hyperstimulation syndrome rate in the LOD group was significantly lower than in the control group (p = 0.04). One case of spontaneous pregnancy was reported in the LOD group. No significant difference was observed between groups in clinical pregnancy, miscarriage, and live birth rates. The rates of pregnancy complications (gestational diabetes mellitus, preeclampsia, and preterm birth) were similar between groups. Conclusion: Performing LOD before IVF/ICSI cycles did not improve the pregnancy outcomes in PCOS women, a clinical trial with a larger sample size is needed to prove these results.

THU622 Spontaneous Pregnancy In Isolated 17,20-lyase Deficiency

Abstract Disclosure: J.M. Oliveira: None. P.M. Sobral: None. C.M. Genari: None. R.J. Auchus: None. C.E. Kater: None. F.C. Barbosa: None. Introduction: 17-Hidroxylase/17,20-lyase deficiency (17OHD) is Brazil's second most common form of congenital adrenal hyperplasia and results from pathogenic variants in the CYP17A1 gene. The typical manifestations of 17OHD are a female phenotype, sexual infantilism, arterial hypertension, and hypergonadotrophic hypogonadism. In contrast, isolated 17,20-lyase deficiency (ILD) is due to pathogenic variants of genes in the catalytic system of the 17,20-lyase, which include: CYP17A1, POR, or CYB5A. In 46XX ILD patients, primary amenorrhea, absence of pubarche, and irregular menses have been reported whereas in 46XY ILD patients, hypospadias, micropenis, and bifid scrotum have been described. Both ILD and 17OHD are associated with infertility. Assisted reproductive technology may rarely result in pregnancy. In this challenging scenario, we present the first known case of spontaneous pregnancy in a patient with ILD. Clinical case: A 16y female was referred to the Endocrinology Department due to the absence of pubarche. She developed thelarche at 9y and menarche at 11y, with oligomenorrhea (6-month-interval cycles) ever since. She had normal blood pressure, external vulvovaginal genitalia, and a complete absence of pubarche and axillary hair. ILD was suspected. Laboratory: undetectable levels of testosterone, androstenedione, and DHEAS. Estradiol: 25.9 (12.5-166.0)pg/mL, 17OHP: 290 (20-130)ng/dL, Progesterone: 111 (3.1-15.2)ng/dL, FSH: 4.2 (3.5-12.5)mUI/mL, LH: 9.5 (2.4-12.6)mUI/mL (all reference intervals are for follicular phase). Pre/post-ACTH stimulation test cortisol: 10/14.5 (7-25/≥18) mcg/dL, corticosterone: 2131/12342 (95-1500/-) ng/dL, 17OHP: 149/159 (up to 110/63.2-296.4) ng/dL, DOC: 10/34 (up to 25/-) ng/dL, respectively. Pelvic USG showed right and left ovaries of 11.0 and 14.9cm3, respectively. CYP17A1 sequencing identified the homozygous pathogenic variant R347H at exon 6, confirming ILD. The patient was oriented to use glucocorticoids during stressful situations and oral contraceptives continuously. She lost follow-up for one year and, at 19y, returned with 20 weeks of gestation. Prenatal was uneventful and cesarean delivery was performed at 41 weeks, giving birth to a healthy boy. Conclusions: There are very few case reports of pregnancy among 46XX patients with ILD. In all cases, fertility treatments were necessary. This is, to the best of our knowledge, the first spontaneous gestation in a patient with an established diagnosis. The Homozygous R347H variant, associated with excessive gonadotrophic stimulation, might be linked to the intermittent and residual enzymatic 17OHase (65%) and 17,20-lyase activity (<5%). The resulting estrogenic gonadal effect (even in the lower range) may have been sufficient for folliculogenesis, ovulation, and the development of an adequate uterine environment for fertilization and spontaneous gestation. Presentation: Thursday, June 15, 2023

Spontaneous Pregnancy in Postoperative Microperforated Hymen: A Case Report

Abstract: Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its  size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords:Abstract: Female genital tract anomalies have important effects on reproductive function, and usually recognized after puberty. The membrane canalization process end to various hymenal forms. Microperforate hymen appears as a partial obstruction depending on its  size. Most often, patient will present with menstrual disorders, dyspareunia, and infertility. The aim of this research was to report a case of spontaneous pregnancy in postoperative microperforated hymen in form of case report. A 27-year-old woman, P0A0, complained of pain during intercouse. Patient had been married for 1,5 years, had reguler menstrual cycles without any contraceptive method, but not conceived yet. Inspection showed an obstructed vaginal introitus with a small opening laterally at 3 o’clock, consistent witn microperforate hymen. During surgery, short vaginal introitus was observed and no vaginal canal was seen. A sound was inserted through a small opening of 1 mm in diameter laterally at 3 o'clock, followed by sufficient incision and excision of the distal vaginal tissue. Interrupted suture of the proximal and distal mucosa was performed. The vaginal portion as well as uterus appeared normal. Postoperative tissue healing was good. A spontaneous pregnancy occurred 56 days after the surgery and a healthy term baby was born by caesarean section. In the case of microperforated hymen, menstrual flow can be normal. The patient complained of dyspareunia or impaired sexual penetration leading to infertility, although the presence of a small opening may allow passage of sperm and spontaneous pregnancy may occur before the surgery. Surgery can reduce psychological stress and improve reproductive function, allowing pregnancy to occur. Keywords: hymen, microperforate, infertility, spontaneous pregnancy

Эффективность применения комплекса Сперотон при мужском факторе бесплодия

One of the principles of contemporary management of male infertility is a correction of oxidative stress, replenishment of vitamins, microelements and low molecular weight peptides, and therefore multicomponent biologically active complexes, one of which is the Speroton, are widely used. To investigate the effect of the Speroton complex on the functional sperm characteristics and fertility of men with pathozoospermia. We examined 60 men aged from 25 to 40 years old with male infertility against the background of various spermatogenesis disorders. Patients were randomized into two groups of 30 people each. A control group (CG) underwent general therapy. In the study group (SG) patients received a combination of general therapy and Speroton. The study participants were subsequently examined at four study visits. The parameters of the spermogram were assessed according to WHO criteria: sperm concentration, sperm motility, the total number of sperm with normal morphology, ejaculate volume and ejaculate liquefaction time, the level of fructose and zinc, and cases of pregnancy in the partner. The use of the Speroton complex resulted in a 10% increase in ejaculate volume, a 15.6% increase in sperm concentration, and a 32% reduction in liquefaction time. The proportion of progressively motile spermatozoa (grade A + B) showed a 2.6 fold increase due to activation of grade C spermatozoa. This, in our opinion, may be associated with a change in the ejaculate enzyme composition, which is indirectly confirmed by a 1.6 fold increase in the level of fructose and 15% increase in the amount of zinc in sperm biochemistry. The effectiveness of therapy in SG patients is also confirmed by 4 cases of spontaneous pregnancy, which occurred against a background of qualitative changes in sperm count. The use of Speroton increases the sperm concentration and motility in patients with male factor infertility, and an increase in the number of spontaneous pregnancies in their partners.

Pregnancy During Recovery from Hematopoietic Stem Cell Transplant for Mycosis Fungoides.

We report a case of spontaneous pregnancy with subsequent full-term live birth following hematopoietic stem cell transplantation (HSCT) for mycosis fungoides in a 24-year-old nulligravida with 4 years of prior infertility due to primary ovarian insufficiency. Four months post-transplant, the patient was found to be 10 weeks pregnant. Her pregnancy was complicated by first trimester fetal exposure to mycophenolate mofetil (pregnancy category D), delayed-onset acute gastrointestinal graft-versus-host disease, and multiple systemic infections. This report highlights the importance of discussing potential fertility outcomes in patients undergoing HSCT, including the necessity for adequate contraception post-transplant, even in the setting of previous infertility.