Ovarian Pregnancy Research Articles

Ovarian Ectopic Pregnancy: Laparoscopic Excision and Ovarian Conservation

Video Objective Demonstrate technique of laparoscopic excision of ovarian ectopic pregnancy with ovarian conservation. Setting Tertiary Referral Centre and University Teaching Hospital. Interventions A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. Examination findings were unremarkable and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and primary surgical management was recommended. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary. 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydro dissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision. The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5IU/L and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy. Conclusion This case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage. Demonstrate technique of laparoscopic excision of ovarian ectopic pregnancy with ovarian conservation. Tertiary Referral Centre and University Teaching Hospital. A 23-year-old primigravida presentation at 6 weeks of gestation with a 7-day history of light bleeding and intermittent abdominal pain. Examination findings were unremarkable and the serum human chorionic gonadotropin level was 7157 IU/L. An ultrasound scan showed an ectopic pregnancy in the right adnexa, and primary surgical management was recommended. At laparoscopy, both fallopian tubes were noted to be normal with an ectopic pregnancy within the right ovary. 20 IU argipressin diluted in 80 mL 0.9% sodium hypochlorite was injected between the normal ovarian tissue and the ectopic pregnancy to assist hemostasis and hydro dissection. An ultrasonic device was used to incise the ovarian cortex to identify a plane of dissection between the ectopic pregnancy and the normal ovarian tissue. The ectopic pregnancy was excised with conservation of the ovary. The ovary was subsequently closed with absorbable sutures to ensure hemostasis. The ectopic pregnancy was removed in a bag through a 10-mm incision. The patient made an uneventful recovery. The serum human chorionic gonadotropin level in 7 days was <5IU/L and no further medical management was indicated. Histology confirmed a primary ovarian ectopic pregnancy. Ovarian function was not assessed postoperatively; however, she conceived 6 weeks later with an intrauterine pregnancy. This case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on an ultrasound scan. Ovarian preservation with excision of ectopic pregnancy can be achieved using techniques commonly used for ovarian cystectomy. Recourse to oophorectomy should only be considered in the event of acute hemorrhage.

Is prostaglandin F2α administration at the beginning of a progesterone and estradiol-based treatment for FTAI an effective strategy in Bos taurus heifers?

The objective was to evaluate effects of prostaglandin (PG) F2α administration at the beginning of a progesterone and estradiol-based treatment period on ovarian response and pregnancy rate (P/AI) in Bos taurus beef heifers. Heifers were treated with 500 μg of cloprostenol administered: a) in two half-doses (250 μg) at the time of progesterone device insertion and removal (two-PG), or b) in a single dose at the time of device removal (one-PG). In the two-PG group, administration of PG at device insertion resulted in lesser serum progesterone concentrations during the 7-d treatment period (P < 0.05). Additionally, diameter of the follicle from which ovulation occurred was greater, and ovulation occurred earlier in the two-PG compared with one-PG group (P < 0.05). Fixed-time artificial insemination (FTAI) was performed in 3479 heifers with two times for FTAI (48 compared with 54 h from device removal). There was no effect on P/AI percentage for the PG treatment or the time of FTAI. The FTAI at 54 h resulted in a greater P/AI percentage in the one-PG than two-PG group (70.5%, 253/359 and 63.5%, 254/400, respectively; P < 0.05). There were no differences between PG treatments when FTAI was performed at 48 h after device removal. In conclusion, the administration of PG at the time of intravaginal progesterone device insertion results in lesser progesterone concentrations, and an increased size of the follicle from which ovulation occurs, and the time of ovulation is earlier after device removal. The pregnancy rate was not affected by the PG administration at the time of device insertion.

EP27.02: Single port laparoscopic excision of ruptured ectopic focus in ovary

Incidence of ovarian pregnancy is rare (1/3000 to 1/50000 deliveries) and 3% of total ectopic pregnancies by natural conception. There are many reasons of ectopic pregnancy, mostly arise in using of IUD and ART. Prediagnosis of ovarian pregnancy is not easy and 28% of the cases are possible to diagnosis during the surgery, because it's findings are likely to mimic those of a tubal pregnancy or an ovary cyst rupture. If you don't get the serum beta HCG result, definitely it is suspected during surgery and confirmed by histopathology. Massive ovarian bleeding is also seen in one third of cases. The 33-year-old primi gravida with amenorrhea 6 weeks Presented. When she came to ER, she suffered frompain and vital signs were unstable; BP = 90/60mmHg, Pulse = 116/min. Serum beta HCG levels was 4907 IU/L and transvaginal USG showed no G-sac in uterine cavity and only a cyst with a wide ecogenic outer ring existed on right adnexa measuring 23 mm × 23 mm, suggestive of ectopic focus. The patient was taken for laparoscopic surgery. The right ovary was appeared to be ruptured with hemoperitoneum (amount 400ml). Single port laparoscopic excision was done and specimen was come out villous tophoblasts by histopathology. Single port laparoscopy is widely used because of the minimised potential morbidity and maximised cosmetic benefits compared to conventional Laparoscopy. Despite the advantages of Single port laparoscopy, unstable vital signs with massive hemoperitoneum are frequently avoided as contraindications. However, we performed successful diagnostic single port laparoscopy as convention. Patient's initial hemoglobin was 8.4 gm/dl. And after 2 PRC transfusion no more hemodiluted condtion was seen until end of the hospitalisation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

What are the effects of dopamine agonists on ovarian hyperstimulation syndrome and pregnancy outcomes in women undergoing assisted reproductive technology therapy?

What are the effects of dopamine agonists on ovarian hyperstimulation syndrome and pregnancy outcomes in women undergoing assisted reproductive technology therapy?

Step-up protocol gonadotrophin versus laparoscopic ovarian drilling in clomiphene citrate resistant PCOS infertile women in two Iraqi hospitals

Background: Polycystic ovarian syndrome is a common endocrine disorder affecting 6-10% of women of reproductive age and the most common cause of anovulatory infertility.&#x0D; Objective: The aim of the study was to compare the effectiveness, side effects and outcomes of step-up gonadotrophin protocol versus laparoscopic ovarian diathermy (LOD) in infertile patients with clomiphene citrate resistant polycystic ovary syndrome.&#x0D; Methods: The sample included women who attended our infertility clinic at Al-Elwiya Maternity Teaching Hospital and Kamal Al-Samarraee for Infertility and IVF Hospital in Baghdad/ Iraq from November 2013 to November 2014. Eighty cases of infertile women with polycystic ovarian syndrome who failed to ovulate with clomiphene citrate for six months where collected, forty women treated with step-up protocol with low dose recombinant FSH gonadotrophin which increased gradually according to ovulation response, another forty women treated with LOD. Ovulation monitoring in each group was done with transvaginal ultrasound to exclude monofollicullar, bifollicular ovulation, ovarian hyperstimulation syndrome, multiple pregnancy and pregnancy rate in each cycle for 6 cycles.&#x0D; Results: Higher unifollicular ovulation and pregnancy rate in LOD than step-up protocol (91.4% &amp; 25% versus 75% &amp; 10%) respectively, while multifollicular and hyperstimulation rate were higher in gonadotrophin group (24.3% &amp; 0.1% versus 8.50% &amp; nil) respectively.&#x0D; Conclusion: Ovulation induction and pregnancy rate per cycle was higher with LOD group, not time consuming, also there was no risk of hyperstimulation of the ovary or twin pregnancy as compared to the step-up protocol with gonadotrophin

Fresh versus freeze-all strategy in assisted reproductive technology – a cochrane review

In vitro fertilisation (IVF) treatments imply a fresh embryo transfer, possibly followed by one or more frozen-thawed embryo transfers in subsequent cycles. Alternatively, one can opt to freeze all suitable embryos and transfer frozen-thawed embryos in subsequent cycles only, which is also known as the freeze-all strategy. We compared the effectiveness and safety of these treatment strategies. We searched the Cochrane Gynaecology and Fertility Group Trials Register, the Cochrane Central Register of Studies (CRSO), MEDLINE, Embase, PsycINFO, CINAHL, and two registers of ongoing trials in February 2019 for relevant studies, and checked references and contacted study authors in the field to obtain additional data. We used standard methodological procedures as recommended by Cochrane for our search, data extraction, and analyses. The primary outcome was cumulative live birth rate (cLBR). Secondary outcomes included ovarian hyper stimulation syndrome (OHSS), pregnancy complications, and time to pregnancy. We included six RCTs in our meta-analyses, that together reported on 4324 women. The studies compared the freeze-all strategy to IVF with fresh transfer in women with a high risk of OHSS, in ‘good prognosis' women based on the number of follicles, in women with PCOS, and in young women without PCOS. The evidence was of moderate to low quality due to serious risk of bias, serious imprecision for four studies, and serious unexplained heterogeneity for one study. For cLBR we found an OR of 1.10 (95% CI 0.97 to 1.24; 6 RCTs; 4324 women; I2 = 0%, moderate quality of evidence) for the freeze-all strategy versus IVF with fresh transfer of embryos. These data suggest that for a cLBR of 63% following IVF with fresh transfer of embryos, the cLBR following the freeze-all strategy would be between 62% and 67%. Women developed less OHSS after the freeze-all strategy compared to IVF with fresh transfer of embryos (OR 0.29, 95% CI 0.19 to 0.44; 4 RCTs; 4065 women; I2 = 5%, low quality evidence). These data suggest that for an OHSS rate of 4% following the conventional strategy, the rate following the freeze-all strategy would be between 1% and 2%. The risk of maternal hypertensive disorders and having a large for gestational age baby was increased following the freeze-all strategy (OR 2.15, 95% CI 1.42 to 3.25; 3 trials; 3940 women; I2 = 29% and OR 1.87, 95% CI 1.43 to 2.44; 3 trials; 3119 women; I2 = 0%, respectively, both low-quality evidence). The risk of having a small for gestational age baby was lowered following the freeze-all strategy (OR 0.68, 95% CI 0.53 to 0.89; 3 trials; 3119 women; I2 = 56%, low-quality evidence). One trial reported on time to conception and one trial reported on time to live birth which were both longer in the freeze all strategy. We did not find a clear difference in cLBR between the two strategies. The freeze-all strategy lowered the risk of OHSS, increased the risk of maternal hypertensive disorders of pregnancy, increased the risk of a large for gestational age baby, and lowered the risk of a small for gestational age baby. The time to pregnancy was longer in the freeze-all strategy.

Ovarian stimulation for fertility preservation or family building in a cohort of transgender men.

The purpose of this study was to compare ovarian stimulation and pregnancy outcomes between transgender men (1) with and without a history of testosterone use (HRT) and (2) to cisgender women. Retrospective chart review between January 1st 2015 and March 1st, 2019 of transgender men and cisgender women seeking ovarian stimulation (OS) matched by BMI and age. Outcomes were compared using Fisher's exact or Wilcoxon's rank sum tests. Thirteen transgender men presented for OS, 7 who used HRT. When comparing transgender men with and without a history of HRT, there were no differences in the baseline follicle count, cycle length, or FSH and hmG used (p= 0.193, 0.306, 0.200, and 0.197, respectively). Transgender men who used HRT had lower peak estradiol and oocytes retrieved compared to transgender men with no HRT use; peak estradiol levels of 1175pg/mL IQR [559.5-2684]) vs 2713.5pg/mL IQR [2335-3105]; oocytes retrieved 12 IQR [4-26]) vs. 25.5 [18-28] (p= 0.046. and 0.038, respectively). There were no differences in the estradiol level per oocyte, meiosis II oocyte yield, or maturity rate (MII/oocytes) between the two groups (p= 1.000, 0.148, and 0.147, respectively). Peak estradiol levels were lower among transgender men compared to cisgender women (p= 0.016), but the remaining cycle characteristics were similar between the two groups. Three successful pregnancies were conceived using the oocytes of transgender men who used HRT. HRT use may not negatively impact ovarian stimulation outcomes. Clinical pregnancies are possible from the oocytes of transgender men with a history of HRT.

Discordance between antral follicle counts and anti-M\xfcllerian hormone levels in women undergoing in vitro fertilization

BackgroundIn general, anti-Müllerian hormone (AMH) is positively associated with antral follicle count (AFC). However, there is often discordance between the AMH level and AFC in clinical practice. In cases of discordance, which indicator should be chosen to predict ovarian response and subsequently develop an ovulation induction protocol? The objective of this study was to investigate which indicator was more accurate in predicting ovarian response and pregnancy outcomes when the AMH level and AFC were discordant.MethodsA total of 1121 infertile women undergoing IVF/ICSI were recruited in this study. During the study period, patients were subjected to individualized controlled ovarian hyperstimulation (COH) protocols according to specific characteristics. The AMH levels and AFCs were measured on days 2–3 of the menstrual cycle. Serum samples were obtained to determine AMH levels. Transvaginal ultrasound was performed to determine the AFC. All patients were divided into four groups: Group A had AFCs and AMH levels in the normal range; Group B had normal AFCs and low AMH levels; Group C had low AFCs and normal AMH levels; and Group D had low AFCs and AMH levels.ResultsTwo hundred three women (18.11%) showed discordant AFCs and AMH levels. In the two groups with discordant AFCs and AMH levels, namely, Group B and Group C, the oocyte yield, good-quality embryo rate and clinical pregnancy rate were significantly higher in Group B than in Group C. The incidence of poor ovarian response (POR) was significantly lower in Group B than in Group C. According to the stratified analysis of age, for the three categories above the age of 30, oocyte yield was higher in Group B than in Group C. In all age categories, the clinical pregnancy rate was higher in Group B than in Group C.ConclusionsOur study demonstrated that approximately one in five patients in clinical practice showed discordance between AFCs and AMH levels. In view of the AFC being better than AMH for predicting POR, the AFC should be the preferred indicator for predicting ovarian response to subsequently develop an optimal individualized COH protocol.

Evaluation of Ovarian Stimulation Initiated From the Late Follicular Phase Using Human Menopausal Gonadotropin Alone in Normal-Ovulatory Women for Treatment of Infertility: A Retrospective Cohort Study.

Objective: To investigate the feasibility of ovarian stimulation initiated in the late follicular phase using human menopausal gonadotropin (hMG) alone in ovulatory patients undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatments by comparison with that of the short gonadotropin-releasing hormone agonist (GnRH-a) protocol in terms of ovarian response, embryological characteristics, and pregnancy outcomes following frozen-thawed embryo transfer (FET) cycles.Design: Retrospective cohort study.Setting: A university-affiliated tertiary hospital.Patients: 135 infertile women undergoing their first IVF/ICSI treatment with the freeze-all strategy.Interventions: In the study group, ovarian stimulation was initiated in the late follicular phase using hMG alone, with the confirmation of dominant follicular diameter ≥ 14 mm, while a short GnRH-a protocol was adopted in the control group. Oocyte maturation was induced by human chorionic gonadotropin in both groups. All good quality embryos were cryopreserved for later transfer.Main Outcome Measures: The primary outcome was the incidence of premature luteinizing hormone (LH) surge. Secondary outcomes were the number of mature oocytes retrieved, good-quality embryo rate per oocyte retrieved, and clinical pregnancy rate following FET cycles.Results: No premature LH surge was detected during ovarian stimulation in the study group. There was no statistically significant difference in the number of mature oocytes between the two groups (10 ± 5.6 in the study group vs. 8.51 ± 5.03 in the control group, P = 0.11). Good-quality embryo rate per oocyte retrieved did not differ between the two groups: 40.18% (313/779) vs. 36.67% (253/690), P = 0.167. Clinical pregnancy rate per transfer following FET was comparable between the two groups (61.33 vs. 52.5%, P = 0.267).Conclusions: Our study shows that ovarian stimulation initiated in the late follicular phase using hMG alone may be a feasible alternative for normal-ovulatory women undergoing IVF/ICSI treatment with the freeze-all strategy.

Growth Hormone (GH) Improvement of Ovarian Responses and Pregnancy Outcome in Poor Ovarian Responders: A Randomized Study.

Recent evidence has emphasized growth hormone benefits in increasing the ovarian response and improving the pregnancy rate in poor responders (POR), caused by aging, ovarian surgery, chemotherapy and other reasons, undergoing IVF/ICSI. The most important factor in the treatment of POR patients is the quality and quantity of oocytes following ovarian stimulation; thus, efforts should be made to provide opportunities for young patients to improve their fertility and ovarian responses. The use of GH in these patients may offer a promising aid to successful fertility.In the present single-blinded clinical trial, POR patients were randomly assigned to receive one of three regimens: (A) Gonadotropin, a GnRH antagonist and GH from the eighth day of the cycle for about 5 days (n = 34); (B) Gonadotropin, a GnRH antagonist and GH from the third day of the previous cycle for about 20 days (n = 32); and (C) Gonadotropin, a GnRH antagonist, and a placebo from the eight day of the cycle for about 5 days (n = 26). Oocyte quality and pregnancy rates were compared across the three groups. A significantly lower number of collected oocytes, MII oocytes, fertilized oocytes, transferred embryos, and clinical pregnancy rate in the placebo group was noted as compared to the two experimental groups receiving GH. Live clinical pregnancies in B group were significantly greater than in the other groups. Our results together indicate that GH may play an important role in recruitment of dominant follicles and enhance follicular survival and the cell proliferation leading to high- quality embryos. Accordingly, administration of GH can considerably elevate the ovarian response in patients with POR planned to undergo IVF.

Pattern of Ruptured Ectopic Pregnancy in a Secondary Level Healthcare Facility

Tubal rupture following an ectopic pregnancy is usually associated with profound hemorrhage which can lead to an unstable hemodynamic state that can risk the life of the patient. To explore the pattern of ruptured ectopic pregnancy in a secondary level healthcare facility, this Cross-sectional study was conducted among 100 ruptured ectopic pregnancy cases at 250 Bedded General Hospital, Tangail from January to November 2017. Cases were diagnosed by taking history (short period of amenorrhoea, acute lower abdominal pain and per-vaginal bleeding), clinical examination and relevant investigations (per-abdominal ultrasonography, TVS, CBC, serum ß-hCG level). Postoperatively, all the patients were followed up meticulously till discharge. The mean age of patients was 33.5(±7.8) years and the highest incidence (43%) was recorded in the age group of 26-30 years. All the patients were managed surgically with no record of case fatality. The most common site for the extra-uterine pregnancy was the tubal area (80%), 13% were ovarian pregnancy, 2% were abdominal and 5% were in other sites (rudimentary horn of uterus, cessarian scar). Chronic pelvic inflammatory disease was the most common risk factor (70%). Other risk factors such as, H/O receiving subfertility treatment (assisted reproduction/ ovulation inducing drugs), previous ectopic pregnancy, developmental errors of uterus, caesarean scar pregnancy and unknown cause were 10.0%, 6.0%, 3.0%, 3.0% and 8.0% respectively. The rise of serum ß-hCG level was found ≤1500 IU/L in 72% and &gt;1500 IU/L in 28% of patients. Tubal area found to be the most common site of ruptured ectopic pregnancy in this study and chronic pelvic inflammatory disease was the most common risk factor followed by undergoing subfertility treatment. Surgical intervention was the choice of treatment in all cases with zero fatality recorded.&#x0D; Bangladesh Med J. 2019 May; 48 (2): 20-23

Primary Ovarian Pregnancy after Interval Tubal Ligation- An Unexpected Conception at an Unusual Location

Primary Ovarian Pregnancy after Interval Tubal Ligation- An Unexpected Conception at an Unusual Location

Age at sexual maturity, first parturition and reproductive senescence in wild lowland pacas (Cuniculus paca): Implications for harvest sustainability

Generation length (GL) of a mammal, calculated through the age at sexual maturity, first reproduction and reproductive senescence can be used to assess the capacity of a population of a species to withstand differing amounts of hunting pressure by humans without depletion of animal numbers. Due to the lack of reproductive data for wild mammals, the GL is often difficult to determine for most species. In the present study, the GL parameters were assessed for the wild lowland paca (Cuniculus paca) from a sample of 119 female genitalia obtained during a 15-year hunter participatory program in the Amazon. The probability of female pacas being sexually active, with observable ovarian functionality or pregnancy, increased as both body and genitalia masses increased. The average body mass at puberty was 5.46 kg. Puberty was estimated to occur at 4 months of age, from which there was estimation when age at first parturition would occur 9 months after birth. Additionally, there was no indication that there was a decrease in parturition rate at more advanced ages. The estimated age of first reproduction for pacas was much less than previous estimates, most from assessments of captive animals. In addition, because there was no evidence of reproductive senescence, it is suggested that the average age of mature hunted pacas should be used to determine optimal harvesting rates of pacas by humans. The present study highlights the importance of in situ studies on reproduction of animals in their natural habitat because these will yield more accurate reproductive variable estimates than those obtained from captive animals. It is suggested that similar methods be used to accurately assess reproductive parameters of other tropical species that are hunted by humans.

Treatment of hydrosalpinx in relation to IVF outcome: a systematic review and meta-analysis.

Salpingectomy is the most widely used treatment for hydrosalpinx. The effect of salpingectomy on the stimulation response during subsequent IVF treatment, however, remains unclear. The aim of this systematic review was to evaluate the ovarian response and pregnancy outcome of IVF treatment carried out after salpingectomy compared with other pre-IVF treatment options for hydrosalpinx. We conducted a literature search using PubMed, Ovid MEDLINE, Google Scholar, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Five randomized studies and nine observational studies were included in the systematic review and evaluated using Cochrane Collaboration's tool for randomized, Newcastle-Ottawa scale for observational studies and GRADE guidelines for certainty of evidence assessment. The mean number of retrieved oocytes was similar between the groups in randomized (mean difference [MD] = -0.03, 95% CI -0.75 to 0.70) and observational studies (MD = -0.15, 95% CI -2.32 to 2.02). Live birth (RR 1.59, 95% CI 1.17 to 2.16), clinical pregnancy (RR 1.27, 95% CI 1.02 to 1.57) and implantation rates (RR 1.55, 95% CI 1.16 to 2.08) were higher in the salpingectomy group in randomized studies. The present systematic review and meta-analysis showed that salpingectomy does not impair the ovarian response during subsequent IVF treatment.

THE TREATMENT OF UNRUPTURED OVARIAN PREGNANCY (OP) FOLLOWING INTRAUTERINE INSEMINATION (IUI): CASE REPORT

Ovarian pregnancy (OP) seen quite rarely in ectopic pregnancy (EP). A 29-year-old multigravid woman came us for routine first ultrasound (US) control to see gestational sac (GS) after IUI. Beta-human chorionic gonadotropin (β hCG) amount (10396 mUI/mL) and ultrasound outcomes were doubtful for tubal pregnancy (TP). She has no complaints. Laparoscopy and incision of right ovarian EP were fulfilled. Ovarian pregnancy were approved histologically.

Ultrasound classification and clinical analysis of ovarian pregnancy: A study of 12 cases

ObjectiveTo evaluate the clinical significance of preoperative ultrasound diagnosis and classification of ovarian pregnancy (OP). MethodsThe ultrasonographic reports, medical records, and operative summaries were reviewed for twelve women with a confirmed diagnosis of OP. According to the ultrasonographic appearance, OP was classified into two types. For every type, we analyzed the possibility and clinical significance of preoperative ultrasound diagnosis, combining with its clinical manifestations and treatments. ResultsAccording to sonographic features, twelve cases of OP can be classified into ruptured type (n = 6) and unruptured type (n = 6), the latter was subclassified into embryo sac type (n = 2) and non-homogeneous mass type (n = 4). All the unruptured OP have the characteristic solid hyperechoic rings or masses, and 66.7% (4/6) were correctvly diagnosed by preoperative ultrasound. No characteristic ultrasonogram was detected in ruptured OP which were all diagnosed as ruptured ectopic pregnancy (EP) or corpus luteum by preoperative ultrasound.The diagnostic and surgical procedures of four cases diagnosed by preoperative ultrasound were all laparoscopy and removal of the gestational products, and their average hemoperitoneum, operation time, hospital days was 313 ± 278 ml, 57 ± 9 min, and 4.25 ± 0.5days, respectively. While ruptured OP cases (6 cases diagnosed at first visit and 1 underdiagnosed but ruptured after 6 days), the diagnostic procedures was laparoscopy(3/7) or laparotomy(4/7), the surgical procedure was removal of the gestational products(2/7), wedge resection(3/7), or adenexectomy(2/7), and their average hemoperitoneum, operation time, and hospital days was 1914 ± 1059 ml, 93 ± 17 min, and 5.9 ± 1.3days, respectively. ConclusionsUltrasound plays a significant role in diagnosis of OP, and part of the unruptured OP based on the typical sonographic characteristics could be correctly diagnosed by an experienced sonographer, this is beneficial and effective in terms of the risk of patient's operation and life. Whereas ruptured OP were generally diagnosed as ruptured EP or corpus luteum because there were no characteristic ultrasound manifestations.

Does myotonic dystrophy affect ovarian reserve, response to controlled ovarian stimulation and ivf-preimplantation genetic diagnosis outcome in female patients?

Introduction Myotonic dystrophy type 1 (DM1) is the most common adult-onset muscular dystrophy with incidence of 1 in 8,000 worldwide. The relationship between DM1 and female infertility remains controversial. This study investigated ovarian reserve, ovarian response to stimulation and IVF-PGD outcome in women with DM1 Materials & Methods This study included female patients with DM1 who performed IVF-PGD cycles in Cheil General Hospital & Women's Healthcare Center from January 2013 to December 2017. During this period, a total of 12 women undergoing PGD for DM1 were compared with 10 age matched women undergoing PGD for X-linked disorders (XLD). Ovarian reserve markers, response to controlled ovarian stimulation, embryo quality, and clinical pregnancy rate were compared. Results Day 3 FSH, E2 and anti-mullerian hormone concentration (median, range: 7.5 (4.6-14.8) verse 7.0 (5.7-10.0) mIU/ml; 22.3 (15.9-53.2) verse 27.5 (9.4-54.3) pg/ml; 1.8 (0.7-7.3) verse 3.6 (1.0-7.5) ng/ml, respectively), the mean number of oocytes retrieved and metaphase II oocytes (15.7±12.7 verse 15.6±6.2; 11.9±10.3 verse 12.4±4.9 respectively), fertilization rate (77.3% verse 83.9%) and prevalence of top quality embryo (39.3% vs 33.4%) showed no significant difference between DM1 and XLD groups. Clinical pregnancy rates (17% vs 21%) were similar in both groups Conclusions The results showed that DM1 does not influence ovarian reserve and reproductive outcomes in female patients. Further studies with sufficient number of cases are required to elucidate the impact of DM1 on female infertility.

Borderline ovarian tumor and pregnancy

Borderline ovarian tumor and pregnancy

Corifollitropin alfa for ovarian stimulation in in vitro fertilization: a systematic review and meta-analysis of randomized controlled trials

To evaluate the effectiveness of corifollitropin alfa in improving the success of IVF. Systematic review and meta-analysis. Not applicable. Infertile women undergoing conventional IVF or intracytoplasmic sperm injection (ICSI). Randomized controlled trials (RCTs) of infertile women undergoing a single IVF/ICSI cycle with either corifollitropin alfa or a conventional ovarian stimulation protocol based on daily injections. The review protocol was registered in PROSPERO before starting the data extraction (CRD42018088605). Primary outcomes were live birth rate and/or ongoing pregnancy rate. Clinical pregnancy rate, miscarriage rate, multiple pregnancies, number of oocytes and embryos obtained, cancellation rate, and rate of ovarian hyperstimulation syndrome and ectopic pregnancy were considered as secondary outcomes. Eight randomized controlled trials were included; 2,345 women were assigned to the intervention group and 1,995 to the control group. The analysis of 4,340 IVF cycles did not reveal any difference in live birth rate and/or ongoing pregnancy rate between groups (risk ratio [RR], 0.92; 95% confidence interval [CI], 0.80-1.05). Similarly, no difference was found in clinical pregnancy rate (RR, 0.96; 95% CI, 0.88-1.05; I2 = 0%), miscarriage rate (RR, 0.94; 95% CI, 0.71-1.25; I2 = 0%), or multiple pregnancy rate (RR, 1.22; 95% CI, 0.99-1.50; I2 = 0%). Also, the rates of cycle cancellation, ovarian hyperstimulation syndrome, and ectopic pregnancy were similar in both groups. Sensitivity and subgroup analyses did not provide statistical changes to pooled results. Corifollitropin alfa seems to be an alternative for daily recombinant FSH injections in normal and poor responder patients undergoing ovarian stimulation in IVF/ICSI treatment cycles.

Combined study on the single nucleotide polymorphisms in the follicle-stimulating hormone receptor (Ser680Asn) and anti-Müllerian hormone receptor type II (-482A>G) as genetic markers in assisted reproduction.

Background Infertile women may have underlying genetic abnormalities. There is, at present, a significant number of studies on the relation between the follicle stimulating hormone receptor (FSHR) or anti-Müllerian hormone type II receptor (AMHRII) polymorphisms and response to in-vitro fertilisation (IVF) treatment. However, it is not yet clear which genotype or combination of genotypes is favourable towards a better ovarian stimulation and pregnancy outcome. Materials and methods In this study we assessed the distribution of the genotypes of FSHR Ser680Asn and of AMHRII -482A>G gene polymorphisms in a group of 126 infertile women and a control group of 100 fertile women by using real-time polymerase chain reaction (RT-PCR). Results Statistical analysis showed that the frequency of the genotypes is similar in both control and IVF/ intracytoplasmic sperm injection (ICSI) groups. Further investigation of the frequency of the nine possible combinations of these polymorphisms in the groups revealed no correlation between infertility and combination of the polymorphisms. Women with one polymorphism have on average 5.5 units higher levels of AMH compared to women carrying no polymorphism. In women with no polymorphisms, for each unit of FSH increase, the average concentration of blood AMH is expected to be 72% lower. Conclusion The distribution of the FSHR Ser680Asn and of the AMHRII -482A>G gene polymorphisms, in the Greek population is similar in fertile and infertile women. The study showed that FSH and AMH correlated levels in certain cases could be used to estimate a patient's ovarian reserve.