1/11. 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 = 1keywords = menstruation (Clic here for more details about this article) |
2/11. 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 = menstruation (Clic here for more details about this article) |
3/11. Laparoscopic management of Sertoli-Leydig cell tumors of the ovary. A report of two cases.BACKGROUND: sertoli-leydig cell tumor is a rare ovarian tumor with an incidence of < .5% of all ovarian tumors. laparotomy is the standard approach to these cases. CASES: Sertoli-Leydig cell tumors were diagnosed in two young, nulliparous, infertile women. Both presented with secondary amenorrhea. Virilization was found in one. Their testosterone levels were high, and sonography revealed a solid, echogenic mass in the fornix. Laparoscopic removal was performed. Both women achieved normal menstruation one month after the operation, and one became pregnant and gave birth to a healthy infant. CONCLUSION: There are very few case reports of laparoscopic removal of such tumors. Laparoscopic surgery, which is minimally invasive and cosmetically acceptable and has a speedy recovery, should be the approach of choice for these patients.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
4/11. Pulmonary endometriosis in a patient with unicornuate uterus and noncommunicating rudimentary horn.OBJECTIVE: To report a rare case of a patient with catamenial hemoptysis, secondary infertility, and endometriosis associated with a unicornuate uterus and noncommunicating rudimentary horn. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 29-year-old woman who developed progressive catamenial hemoptysis and secondary infertility was evaluated at the University Hospital of Crete. INTERVENTION(S): The complete history, laboratory data, laparoscopic findings, and chest magnetic resonance image of this patient were analyzed. A GnRH agonist, leuprolide acetate, was successfully administered. MAIN OUTCOME MEASURE(S): diagnosis and appropriate treatment of pulmonary endometriosis in a patient with rudimentary uterine horn. RESULT(S): Treatment with a GnRH agonist achieved suppression of both menstruation and hemoptysis. After 6 months of normal menstrual activity, the symptoms reappeared. The patient was again treated with leuprolide acetate (3.75 mg/mo IM) for 6 months and remained asymptomatic. In fact, the patient became pregnant after cessation of therapy. Finally, the patient was treated successfully with removal of the rudimentary uterine horn during cesarean section. Three-year follow-up showed disappearance of the chest symptoms. CONCLUSION(S): Pulmonary endometriosis and unicornuate uteri are rare. To our knowledge, this is the first case of catamenial hemoptysis with a congenital mullerian anomaly. We describe successful management using a combination of GnRH agonist and surgical resection of the rudimentary uterine horn.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
5/11. Spontaneous disappearance of a normal adnexa associated with a contralateral polycystic-appearing ovary.BACKGROUND: Absence of the adnexa may be congenital or acquired. However, the etiology is often uncertain. CASE: A 27-year-old woman presented with a 3-year history of subfertility. Her irregular menstruation was associated with acne vulgaris, alopecia, and elevated body mass index. Transvaginal ultrasonography of the pelvis showed a normal uterus, a normal right ovary, but a polycystic-appearing left ovary. A hysterosalpingogram demonstrated a normal uterine cavity, prompt filling and spilling of contrast material from the left fallopian tube, but no filling on the right. Subsequent laparoscopy showed an unexpected absence of right adnexa and presence of a solitary rounded free-floating mass enshrouded in the omentum. She did not have a history of abdominal pain or surgery. CONCLUSION: The evidence suggests that the patient might have had an asymptomatic infarction of the right adnexa.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
6/11. 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 = menstruation (Clic here for more details about this article) |
7/11. Programming ovulation using estrogens for patients to time intercourse.BACKGROUND: A woman wishing to conceive may be separated from her spouse at the time of ovulation. Moreover, some orthodox Jewish women have a unique problem when they are unable to initiate intercourse before ovulation. They are prohibited from participating in sexual relations from the start of menstruation until 7 days after the end of flow when they go to the ritual bath (mikveh). CASES: Two orthodox Jewish women who ovulated before restarting intercourse were treated with oral estrogens to delay ovulation. CONCLUSION: women separated from their husbands at the time of ovulation and Jewish women who ovulate before ritual cleansing can effectively use oral estrogens to program ovulation.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
8/11. Successful monozygotic twin delivery following in vitro maturation of oocytes retrieved from a woman with polycystic ovary syndrome: case report.The incidence of monozygotic twinning (MZT) appears to be increasing within the field of assisted reproductive technology (art), although the factors contributing to the phenomenon are still far from being identified. On the contrary, in vitro maturation (IVM) of oocytes is becoming more accepted and more and more babies have been born worldwide using this procedure. Assessing its safety and impact on monozygotic twinning (MZT), and following up the health of these babies, is essential. We report here a first case of successful monozygotic (MZ) twin delivery following IVM. The patient was a 28-year-old Japanese female, referred to the IVF clinic for primary infertility. Several previous cycles of ovarian stimulation had resulted in ovarian hyperstimulation syndrome (OHSS). The patient received norethisterone-mestranol to initiate the menstruation, and oocyte retrieval was performed 36 h after hCG. A total of 22 immature oocytes were obtained. Following incubation for 24 h in IVM medium, 50% of the oocytes were matured to the metaphase II (MII) stage. Nine oocytes were fertilized after ICSI with the husband's sperm. Three day 3 embryos were transferred into the uterus on the fourth day following oocyte retrieval. Three weeks after embryo transfer, a single gestational sac was visualized in the uterus. At 7 weeks of gestation, two fetal poles with cardiac activity were seen in the single gestational sac. Serial ultrasound examinations revealed a MZ, monochorionic diamniotic pregnancy. After intensive perinatal monitoring, two healthy male infants were delivered by Caesarean section at 35 weeks of gestation.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
9/11. pregnancy following combined therapy with thyroid hormone and bromocriptine in a patient with amenorrhea-galactorrhea due to primary hypothyroidism.Combined therapy with thyroid hormone (desiccated thyroid) and bromocriptine (CB-154) was applied in a 29-year-old patient with amenorrhea-galactorrhea due to primary hypothyroidism. Two months after commencing administration of desiccated thyroid, the elevated serum level of TSH returned to the normal range while that of PRL remained within the supranormal range (from 134 ng/ml to 86.7 ng/ml). However, it fell to the normal range 2 weeks after administration of CB-154 with thyroid hormone. Subsequently, the galactorrhea completely ceased and ovulatory menstruation resumed with 3 months, and conception was achieved directly after that menstrual period. Only desiccated thyroid was administered during pregnancy and the patient delivered a male infant weighing 2,800 g without difficulty.- - - - - - - - - - ranking = 1keywords = menstruation (Clic here for more details about this article) |
10/11. Successful pregnancies in women following single autotransplant for acute myeloid leukemia with a chemotherapy ablation protocol.Of 30 women surviving a minimum of 18 months following treatment for AML with a high-dose chemotherapy regimen with autologous bone marrow transplantation (ABMT), 24 were premenopausal at the time of transplantation. All were given a detailed questionnaire concerning menstruation, menopausal symptoms and pregnancy; 22 responded. Of these 22, 10 had received a single transplant procedure and 12 a double transplant procedure. In the 10 recipients of a single transplant, 4 women (age range 32-50 years) developed ovarian failure and 6 (age range 21-32 years) resumed spontaneous cyclical menstruation. Five of the 6 menstruating women became pregnant between 4 and 40 months following ABMT. Three pregnancies went to term and each resulted in the delivery of a full-term apparently normal infant. Of the 12 women who received a double ABMT (age range 32-47 years), 11 developed clinical and/or biochemical evidence of ovarian failure. The median age in the latter group was 35 years, however, compared with 28 years in the single ABMT group. These data show that it is possible to give a single very high-dose course of chemotherapy in younger patients without compromising fertility.- - - - - - - - - - ranking = 2keywords = menstruation (Clic here for more details about this article) |
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