Contralateral Ovary Research Articles

Video-assisted ovariohysterectomy in domestic cats (Felis catus, Linnaeus, 1758) using two access portals.

To describe video-assisted ovariohysterectomy (OHE) with two portals access in adult intact queens. METHODS Fifty-two females cats were used. A 4 mm cannula was positioned in the abdomen through an incision close to the umbilicus (first portal), and a pneumoperitoneum was established. A second portal was positioned in the midline of the pre-pubic region. Females were positioned in right lateral recumbency to locate the left ovarian pedicle, and the uterine horn was held by a transcutaneous suture. The pedicle was cauterized and incised. The procedure was then performed on the contralateral ovary. The ovaries were exteriorized from the abdomen, along with the uterus, through the second access point. The uterine body was exposed, fixed and sectioned, and the abdominal incisions were sutured. RESULTS Surgeries were performed in an average of 41.4±14.2 minutes. The main complications included hypotension (7.7%) and subcutaneous emphysema (7.7%), and 13.5% of the surgeries were converted to laparotomy. CONCLUSION Ovariohysterectomy using a video-assisted technique and two access portals is safe, has minimal risks and is effective for the spaying of queens.

Clinical and pathological presentation of squamous metaplasia of the rete ovarii in a Zebu cow

Squamous metaplasia of rete ovarii is characterized by replacement of the normal cuboidal epithelium of rete ovarii by a keratinized stratified scamous epithelium, leading to accumulation of keratinized material within the tubules and cystic dilatation of rete ovarii. The present study decribes a case of scamous metaplasia of rete ovarii in a 10 year old Zebu cow, including clinical, surgical, ultrasonographic, histopathological and hormonal findings. At first ultrasound examination the cow had lightly asymmetric ovaries with follicles presenting echogenicity similar to luteinized follicular cysts. After transvaginal follicular aspiration creamy yellowish sanguineous-purulent content was recovered. After unilateral ovariectomy the ovary was sectioned and brownish viscous material drained from cystic cavity. Histopathology confirmed the diagnosid of squamous metaplasia of the rete ovarii. Progesterone concentrations assessed by chemiluminescent enzyme immunoassay within different time periods after ovariectomy showed that pathology did not compromise normal luteal ovarian activity in a contralateral reminiscent ovary.

Mature cystic teratoma of both the fallopian tube and contralateral ovary: a case report

Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. Materials and Methods: A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. Conclusion: Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.

First pregnancies, live birth, and in vitro fertilization outcomes after transplantation of frozen-banked ovarian tissue with a human extracellular matrix scaffold using robot-assisted minimally invasive surgery

Ovarian tissue cryopreservation is an experimental fertility preservation method and the transplantation techniques are still evolving. We attempted to improve the technique with the utility of a human decellularized extracellular tissue matrix (ECTM) scaffold, robot-assisted minimally invasive surgery, and perioperative pharmacological support. We prospectively studied 2 subjects with hemophagocytic lymphohistiocytosis (patient A) and non-Hodgkin lymphoma (patient B) who underwent ovarian tissue cryopreservation at the age of 23 years, before receiving preconditioning chemotherapy for hematopoietic stem cell transplantation. Both experienced ovarian failure postchemotherapy and we transplanted ovarian cortical tissues to the contralateral menopausal ovary 7 and 12 years later, using a human ECTM scaffold and robotic assistance. The ECTM scaffold tissue compatibility was shown in preclinical studies. Patients also received estrogen supplementation and baby aspirin preoperatively to aid in the revascularization process. Ovarian follicle development was observed approximately 10 (patient A) and 8 (patient B) weeks after ovarian tissue transplantation. Following 8 and 7 cycles of invitro fertilization, 9 and 10 day-3 embryos were cryopreserved (patients A and B, respectively). While the baseline follicle-stimulating hormone (range 3.6-15.4 mIU/mL) levels near normalized by 7 months and remained steady postovarian transplantation in patient A, patient B showed improved but elevated follicle-stimulating hormone levels throughout (range 21-31 mIU/mL). Highest follicle yield was achieved 14 (8 follicles; patient A) and 11 (6 follicles; patient B) months postintervention. Patient A experienced a chemical pregnancy after the third frozen embryo transfer attempt. She then conceived following her first fresh invitro fertilization embryo transfer and the pregnancy is currently ongoing. Patient B conceived after the first frozen embryo transfer attempt and delivered a healthy girl at term. We report the first pregnancies after the minimally invasive transplantation of previously cryopreserved ovarian tissue with an ECTM scaffold. This approach seems to be associated with steady ovarian function after a follow-up of up to 2 years.

Granulosa cell tumours in the mare: A review of 52 cases

SummaryGranulosa cell tumour (GCT) is reported to be the most common ovarian neoplasm in the mare. A multicentre retrospective study evaluating the medical records of horses undergoing ovariectomy for treatment of aGCTwas undertaken, documenting the presenting clinicopathological features, treatment and outcome. Follow‐up information was obtained by telephone questionnaire. Fifty‐two mares were included. Most presented with behavioural/reproductive abnormalities, including stallion‐like behaviour (50%), aggression (31%), prolonged oestrus or nymphomania (19%), and persistent anoestrus (8%). Most (93%) affected ovaries had a multilocular appearance when examined ultrasonographically. Only 60% of horses with histopathologically confirmedGCTs demonstrated elevations in serum inhibin concentrations. Twenty‐five percent of horses had histopathologically confirmed bilateralGCTs. Ninety‐four percent of horses that underwent ovariectomy were discharged from the hospital. Standing laparoscopic ovariectomies had a lower complication rate (34%) than other surgical methods. Long‐term complications were uncommon (11%). In conclusion, histopathologically confirmedGCTs can occur in the presence of normal serum inhibin concentrations. The high prevalence of bilateralGCTs indicates that thorough evaluation of the contralateral ovary is necessary. Surgical ovariectomy for treatment ofGCTs has favourable short‐ and long‐term outcomes. Standing laparoscopic ovariectomy may be associated with a lower complication rate than other surgical methods.

Could the unilateral ovarian endometriosis affect the contralateral ovary? new insights from Fourier Transform infrared (FTIR) spectroscopy

Up to date, endometriosis’ possible impact on follicle cells metabolism has never been highlighted. In this light, the aim of this study was to evaluate, by FT-IR microspectroscopy, metabolic changes on granulosa cells (GCs) isolated from endometriosis affected ovaries and contralateral healthy ones

Assessment of ovarian reserve by antral follicle count in ovaries with endometrioma.

To evaluate whether the antral follicle count (AFC) is underestimated in the presence of an endometrioma. This was a retrospective cohort study assessing all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) at our clinic between January 2011 and December 2012 who had both ovaries and unilateral endometrioma. The primary outcome of the study was the difference between AFC and the number of oocytes retrieved per ovary. Within the study period 787 women underwent IVF/ICSI at our clinic. Sixty of these women had at least one endometrioma, but 23 were excluded from the analysis as six had only one ovary and 17 had bilateral endometriomas. Therefore a total of 37 women were included in this study and analysis. Compared with the contralateral ovaries, ovaries with an endometrioma were significantly larger in volume (median, 10.3 (interquartile range (IQR), 4.7-18.9) cm(3) vs median, 3.6 (IQR, 2.7-6.5) cm(3); P < 0.001) and presented a significantly lower AFC (median, 3.0 (IQR, 1.0-6.0) vs median, 5.0 (IQR, 2.0-6.5); P = 0.001). However, the median number of oocytes retrieved was similar (P = 0.60) between ovaries with an endometrioma (2.0 (IQR, 0.5-5.0)) and the contralateral ovaries (2.0 (IQR, 0.0-4.0)). Accordingly, the median difference between AFC and number of oocytes retrieved was significantly smaller (P = 0.005) for ovaries with an endometrioma (0.0 (IQR, -1.0 to 1.5) than for those without (2.0 (IQR, 0.0-4.0)). Although the AFC is reduced in ovaries with an endometrioma, the number of oocytes retrieved is similar, suggesting that the AFC is underestimated in such ovaries. We believe that this is a consequence of an impaired ability to detect small follicles in the presence of an endometrioma.

Improvement of development of equine preantral follicles after 6 days of in vitro culture with ascorbic acid supplementation

The aim of this study was to evaluate the effects of different concentrations of ascorbic acid (25, 50, and 100 μg/mL) in supplemented minimum essential medium (MEM+) on the development of equine preantral follicles that were cultured in vitro for 2 or 6 days. The contralateral ovaries (n = 5) from five mares in seasonal anestrus were collected from a local abattoir. Nine ovarian tissue fragments of approximately 5 × 5 × 1 mm were obtained from each animal. One fragment was immediately fixed and subjected to histologic analysis (control group; Day 0), and the other eight were placed in PBS supplemented with penicillin (200 IU/mL) and streptomycin (200 mg/mL) at 4 °C for 1 hour (during transport to the laboratory). The fragments were cultured in situ for 2 days (D2) or 6 days (D6) in MEM+ or MEM+ plus ascorbic acid at three different concentrations, establishing the following nine groups: control; MEM+ (D2); MEM+ (D6); MEM+ 25 μg/mL of ascorbic acid (D2); MEM+ 25 μg/mL of ascorbic acid (D6); MEM+ 50 μg/mL of ascorbic acid (D2); MEM+ 50 μg/mL of ascorbic acid (D6); MEM+ 100 μg/mL of ascorbic acid (D2); and MEM+ 100 μg/mL of ascorbic acid (D6). The preantral follicles were classified according to their stage (primordial, primary, secondary, or antral) and their morphology (normal or abnormal). Slides (n = 951) including 4450 histologic sections were evaluated. Follicles were observed in only 4.85% (216 of 4450) of the histologic sections. Of the 407 follicles evaluated, 120 were in the primordial stage and 287 were in different developmental stages; additionally, 43.5% were morphologically normal. After 6 days of culture, the groups cultured with 50 and 100 μg/mL of ascorbic acid differed in terms of follicular development compared with the other groups. On the basis of occurrence of follicular development and the presence of viable follicles, it can be concluded that a positive effect of culture for 6 days in MEM+ supplemented with 50 and 100 μg/mL of ascorbic acid was observed on equine ovarian fragments.

Embarazo cornual después de salpingectomía: reporte de un caso inusual

El embarazo ectópico es una patología frecuente de encontrar para el ginecoobstetra, siendo posible que dicho embarazo tenga una diversidad de lugares de desarrollo extrauterino, algunas de ellas ni sospechadas. Se presenta un caso de embarazo ectópico cornual (muñón) con ausencia de trompa, debido a salpingectomía un año antes por otro ectópico y evidencia de ovulación por el ovario contralateral (presencia de cuerpo lúteo), incluyendo la trompa de este lado intacta, que lo convierte en un embarazo abdominal. Se realizó la resección del trofoblasto por laparoscopia, corroborando la patología el diagnóstico de embarazo ectópico. La evolución postoperatoria fue satisfactoria.

The Effect of Controlled Reperfusion in the Prevention of Infertility Caused by Ischemia Induced in the Contralateral Ovary in Rats with Unilateral Ovariectomy

Background/Aims: To investigate the effectiveness of controlled reperfusion (CR) on ovarian tissue malondialdehyde, total glutathione and 8-hydroxyguanine levels and infertility rates in a rat model of induced ischemia-reperfusion (I/R) injury with unilateral oophorectomy. Methods: A total of 135 adult female albino Wistar rats were divided into 9 groups (n = 15 for each group): unilateral ovariectomy + ovarian I/R (OIR), unilateral ovariectomy alone (OEG), a sham operation group (SG), and unilateral ovariectomy + CR performed at different intervals (the clips were released 10 times for 10, 8, 6, 4, 2 or 1 s and closed again 10 times for 10, 8, 6, 4, 2 or 1 s; OCR-1-6, respectively). Five rats from each group were sacrificed, and their ovaries were removed. Results: Higher ovarian tissue malondialdehyde and 8-hydroxyguanine levels and lower ovarian tissue total glutathione levels were found in the OIR group compared with the SG, OEG and OCR-4-6 groups. The number of rats giving birth during the study period was found to be similar among the SG (n = 8), OEG (n = 8) and OCR-6 (n = 7) groups. Conclusion: These results suggest that sterility and ovarian oxidative stress caused by I/R injury decreases in parallel to the shortening of CR duration.

Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles.

To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function. A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (E-Ov) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles. Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2 ± 2.0 vs. 5.1 ± 3.3, P = 0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6% vs. 69.5%, P = 0.43) and the rate of top-quality embryos (40.0% vs. 49.0%, P = 0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0% vs. 25.0%, P = 0.39 and 20.0% vs. 20.8%, P = 0.96). The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.

Granulosa cells tumor in mules

Due to the current understanding of infertility and absence of ovarian activity in the female mule, scientificmaterial regarding their reproductive tract is lacking. Information regarding evaluation of the reproductivesystem, as well as diagnoses of ovarian neoplasms, is scarce for female mules. The purpose of this paperis to report the first case of granulosa cell tumor (GCT) in a female mule, characterized through histology,which suggests evidence of cyclicity. During the breeding season, within the Southern hemisphere, mules’ovaries were obtained from slaughterhouses. Notably, a pair ovarian rated was remarkable in size (16.5cm in diameter), weight (1.92 kg) as well as number of antral follicles. On sagittal section, the tissue wastrabecular and fluid filled. Histology revealed irregular cyst formations full of amphophilic fluid ranging incolor from pinkish to purple. The granulosa cells showed up in abnormal histology, featuring a granulosacell tumor. The contralateral ovary was evaluated, demonstrating anatomy, weight and granulosa cellsfrom normal. Therefore, we have described the first granulosa cells tumor report in a mule via gross andhistological features, which suggests evidence of cyclicity in female mules.

Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study

To investigate the impact on ovarian reserve of second laparoscopic surgery for recurrent unilateral endometriomas. Case-control study. University teaching hospital. This study included patients who underwent stripping of endometriomas (diameter ≥4cm) and were followed-up at our institution. Case subjects had second surgery for recurrent unilateral endometriomas (n = 18); control subjects had no recurrence and no second surgery (n = 18). This case-control study was based on a retrospective analysis of a prospectively collected database including patients who underwent surgery for endometriomas at our institution. The primary outcome of the study was to assess the changes in antimüllerian hormone (AMH) levels in each study group and between the two study groups. The secondary outcomes of the study were to assess the changes in basal FSH, antral follicle count (AFC), and ovarian volume in each study group and between the two study groups. In both study groups, primary surgery decreased AMH, increased basal FSH, and decreased the AFC of the operated ovary. Before second surgery, case subjects had AMH, basal FSH, and AFC similar to control subjects. After second surgery, case subjects had lower AMH, higher basal FSH, and lower AFC of the affected ovary than before surgery; the volume of the operated ovary was lower than that of the contralateral ovary. The laparoscopic stripping of recurrent ovarian endometriomas is associated with a high risk of ovarian reserve damage and ovarian failure. NCT02047838.

Management of bilateral malignant ovarian germ cell tumors: a MITO-9 retrospective study.

Bilaterality is rare in malignant ovarian germ cell tumors (MOGTs). The bilateral ovarian involvement represents a critical issue when diagnosed in young women desiring to preserve fertility. The aim of this study was to evaluate clinical characteristic and management of patients bilateral MOGTs. Patients affected by bilateral MOGT and treated at MITO group centers were reviewed. In 145 patients with MOGTs, 5.5% were bilateral. Three patients were affected by dysgerminoma (associated with bilateral gonadoblastoma in 1), 2 by immature teratoma, 2 by mixed germ cell tumors, and 1 by embryonal carcinoma. International Federation of Gynecology and Obstetrics stage was 3 IB, 1 IC, 3 IIIC, and 1 IV. Three patients received radical surgery, and the patient with dysgerminoma associated with gonadoblastoma received bilateral adnexectomy. Four patients received fertility-sparing surgery; 2 patients received unilateral salpingo-oophorectomy and contralateral cystectomy; in 2 patients, the ovaries were completely transformed in neoplastic tissue; suspecting a contralateral dysgerminoma histology, a unilateral salpingo-oophorectomy and contralateral biopsy were performed, and the contralateral neoplastic ovary was left unresected. Six patients received adjuvant chemotherapy. Seven patients are disease free after a median follow-up of 54 months. The patient affected by embryonal carcinoma died of disease. Two patients resumed menstruation, and one had a pregnancy. A compromised ovarian function was found in 2 patients, and they were addressed to oocyte cryopreservation. Bilateral MOGTs have a good prognosis. In dysgerminoma histology, residual disease could be left to spare fertility. An oncological and reproductive function follow-up is recommended.

Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery

To evaluate the excised specimen with histologic analysis and to assess the antral follicle count (AFC) at follow-up. This is to determine whether excisional surgery for recurrent endometriomas is more harmful to ovarian tissue and to the ovarian reserve than first surgery. Prospective controlled study. University hospital. Consecutive patients with pelvic pain and/or infertility undergoing laparoscopic excision of a monolateral ovarian endometrioma for the first time (17 patients) or for recurrence after previous surgery (11 patients). Laparoscopic excision of ovarian endometrioma and ultrasonographic evaluation 3months after surgery. Cyst wall histologic evaluation (specimen thickness, presence and morphology of ovarian tissue) and evaluation of ovarian reserve with AFC and ovarian volumes of both the operated and contralateral, nonoperated ovary at follow-up. The cyst wall specimen was significantly thicker in the recurrent endometrioma group than in the first surgery group (1.7 ± 0.3mm vs. 1.1 ± 0.3mm). Both main components of the cyst specimen (i.e., endometriosis tissue and ovarian tissue) were more represented in the recurrent endometrioma group than in the first surgery group. At sonographic follow-up, the operated ovary had a significantly lower AFC and volume than the contralateral nonoperated ovary in the recurrent endometrioma group, but not in the primary surgery group. Surgery for recurrent endometriomas is associated with evidence of a higher loss of ovarian tissue and is more harmful to the ovarian reserve evaluated by AFC and ovarian volume, if compared with endometriomas operated for the first time. Indications to surgery for recurrent endometriomas should be reconsidered with caution.

Preservation of the fertility and the ovaries in women with benign adnexal tumors

To evaluate the sparing of fertility and ovaries in women submitted to surgical treatment for benign adnexal tumors. Between February 2010 and January 2014, 206 patients were included in this observational study as they were submitted to surgical treatment for benign ovarian tumors at CAISM, a tertiary hospital. Fertility sparing surgery was defined as tumorectomy or unilateral salpingoophorectomy without hysterectomy in premenopausal women. Preservation of the ovary occurred when at least one ovary or part of it was mantained. Of the 206 women with benign tumors, 120 (58%) were premenopausal and 86 (42%) were postmenopausal. There were 36 (30%) ovarian germ cell tumors, 31 (26%) epithelial neoplasms and 11 (9%) sex-cord stromal tumors among premenopausal women. In the group of postmenopausal women, 35 (41%) epithelial neoplasms, 27 (31%) sex-cord stromal tumors and 8 (9%) ovarian germ cell tumors were identified. Among 36 women with non-neoplastic ovarian tumors, 21 (58%) had endometriomas and 8 (22%) functional cysts. Among 22 women with extra-ovarian tumors, uterine leiomyomatosis was the most frequent finding (50%). In the group of women who were ≤ 35 years old, 26 (57%) were treated by tumorectomy and 18 (39%) were submitted to unilateral salpingoophorectomy with sparing of the uterus and the contralateral ovary. Women who were ≤ 35 years old were more frequently operated by laparoscopy which was associated with a higher number of fertility sparing procedures when compared to laparotomy (p<0.01). Twenty-six (28%) women submitted to hysterectomy with bilateral salpingoophorectomy were premenopausal. Although there is a trend to perform only tumorectomy in women who are ≤ 35 years old, a significant number of young women is still treated by salpingoophorectomy. Among 36- to 45-year-old women, only 70% had their fertility spared, while 20% had both ovaries removed. However, whenever possible, we must try to preserve the ovaries, mainly in premenopausal women.

Multiple Successful Pregnancies Following Fertility-Sparing Surgery for Advanced Ovarian Cancer

Juvenile Granulosa Cell Tumors (JGCTs) of the ovary are rare. They usually present in children and adolescents. About 90% are diagnosed in early stage (FIGO I) with a favorable prognosis. More advanced stages (FIGO II-IV) usually have a poor clinical outcome. We report a case of long-term survival of a teenager with Stage III JGCT treated with aggressive debulking and thorough staging, but conservative surgery relative to the uterus, contralateral uninvolved ovary, and fallopian tube, plus combination chemotherapy. Her tumor recurred twice, 18 months and 17 years later, for which she had two additional surgeries and more chemotherapy. Because of the fertility sparing surgery, she was able to achieve 3 pregnancies and 4 children.

Congenital Ovarian-Fallopian Tube Agenesis Predisposes to Premature Surgical Menopause: A Report of Two Cases

Background: Congenital agenesis of the Fallopian tube and ovary is a rare condition. Although several cases have been published on this condition, none have reported surgical menopause. We present two cases of congenital unilateral tubal and ovarian absence leading to surgical menopause. Case presentation: Case 1 underwent laparoscopic surgery for recurrent ovarian torsion and was found to have agenesis of the distal Fallopian tube and ovary. Case 2 underwent laparotomy for an adnexal mass and was found to have unilateral absence of the Fallopian tube and ovary with a contralateral large mucinous cystadenocarcinoma. Conclusion: Two cases of unilateral ovarian and partial tubal agenesis predisposed the patients to early menopause by requiring removal of the contralateral ovary due to recurrent torsion or ovarian cancer. Upon discovery of congenital absence of an ovary during surgery, an effort should be made to preserve the functionality of the contralateral adnexa and uterus if fertility is desired. retroperitoneal. The patient was started on oral contraceptive pills, but two years later, her right lower quadrant pain recurred. Ultrasound and CT scans showed a large pelvic mass with no identification of the left ovary. The uterus and kidneys bilaterally were normal. During the second laparoscopy, the right ovary was found to be necrotic and torsed (Figure 1A) with blood in the pelvis, and a laparoscopic right salpingo-oophorectomy was performed. The left Fallopian tube again appeared blunted with a possible retroperitoneal rudimentary ovary (Figure 1B). After surgery, the patient reported hot flashes and amenorrhea, and was referred to the Reproductive Endocrinology office. Laboratory studies were consistent with menopause, including an FSH of 35 mIU/ml and an anti-Mullerian hormone level of < 0.3 ng/ml. She was started on vitamin D supplementation and combination estrogen plus progestin patch hormone therapy. She was counselled that she would require donor egg or adoption in the future if she desired children. Case 2

Does ischemia-reperfusion injury affect ovarian reserve and follicle viability in a rat model with adnexal torsion?

Objective(s)To evaluate the effect of ischemia-reperfusion on follicle count and viability of follicles in a rat model with adnexal torsion. Study designA total of 24 female adult Wistar albino rats were included in the study. In the first laparotomy, right ovaries were twisted at 720° in the counterclockwise for a duration of two (n=12), four (n=6) or 16hours (n=6), whereas contralateral sites were kept as controls. In the second laparotomy, the right ovaries were detorsioned. Twenty-eight days after the detorsion, both ovaries were retrieved with the third laparotomy and placed in formaldehyde for subsequent examination under light microscopy and immunohistochemistry for proliferating cell nuclear antigen (PCNA). Besides histological evaluation by only using a standard scoring system, the viability of the follicles was also assessed by PCNA with immunohistochemical staining. ResultsMacroscopically, after two, four and 16hours of torsion, all the twisted ovaries had enlarged and demonstrated a dark, dusky appearance. However, under light microscopy with 10X magnification, the mean primordial+primary follicle count was comparable in twisted and control sides (26.7±7.6 vs. 28.1±5.9 respectively). In terms of the means of total tissue damage, only the loss of cohesion was found to be significantly different compared to the control sides (2.78±0.86 vs. 2.17±0.86, p=0.017). Immunohistochemical staining revealed significantly lower PCNA counts in the 16-hour torsion group only. Conclusion(s)Even though ovarian reserves, reflected by primordial and primary follicle count, are similar between torsioned and contralateral ovaries, the viability of the remaining follicles might be affected by a long-standing ischemia-reperfusion phenomenon. Follicle count may reflect an idea of fertility potential, but immunohistochemical staining using viability markers such as PCNA confirms the viability of the counted follicles and appears to be a more precise approach necessary for demonstrating the functional status.

Unembriyonic pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report

This is a case report of an unembriyonic pregnancy in the non-communicating rudimentary horn of a unicornuate uterus with the contralateral ovary carrying a corpus luteum. A 24-year-old nullipara was admitted to our outpatient clinic with the complaint of primary infertility for 3 years. Her hysterosalpingographic and laparoscopic evaluation revealed a mullerian anomaly; non-communicating rudimentary uterine horn. One year later, the patient was admitted with a 10-week amenorrhea. The examination showed unembriyonic pregnancy in the left uterine rudimentary horn and corpus luteum on the contralateral ovary. The case at hand is an evidence of transperitoneal migration of both the sperm and the ovum, so the belief that unicornuate uterus with a non-communicating rudimentary horn goes asymptomatic without causing any trouble is not true. In such cases, the rudimentary horn should be removed.