Cases reported "Infertility, Female"

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1/44. Hysteroscopic cervical canal shaving: a new therapy for cervical stenosis before embryo transfer in patients undergoing in vitro fertilization.

    OBJECTIVE: To report a case of cervical stenosis repaired by hysteroscopic cervical shaving that created a smooth passage for ET in a patient undergoing IVF. DESIGN: Case report. SETTING: University-based IVF program. PATIENT(S): A woman with a history of multiple failed IVF attempts in whom ET was extremely difficult. INTERVENTION(S): Operative hysteroscopy with creation of a cervical tract. MAIN OUTCOME MEASURE(S): Ease of postoperative ET and outcome of IVF treatment after the hysteroscopic procedure. RESULT(S): Easy performance of ET and a resulting triplet pregnancy. CONCLUSION(S): This novel hysteroscopic repair of cervical stenosis resulted in a markedly easier ET and a viable pregnancy.
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2/44. pregnancy following the laparoscopic bipolar electrocoagulation of polycystic ovaries resistant to medicamentous ovulation induction--a case report.

    The case of a primarily infertile patient with polycystic ovaries (PCOS) resistant to medicamentous ovulation induction is presented. The preoperative condition, laparoscopic ovarian drilling using an original technique of bipolar electrocoagulation and consecutive spontaneous pregnancy and delivery are described. This case suggests that bipolar forceps with jaws 1 mm wide could be a useful instrument for laparoscopic ovarian drilling.
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3/44. salpingectomy for unilateral hydrosalpinx may improve in vivo fecundity.

    The objective of this study was to determine whether unilateral salpingectomy for hydrosalpinx could improve fecundity in women with an apparently normal contralateral tube. Two women with unilateral hydrosalpinx and with an apparently normal contralateral tube, and a long history of infertility, including failure to conceive despite several cycles of in vitro fertilization (IVF), had unilateral salpingectomies prior to considering subsequent IVF cycles. Case 1 conceived after 1 month following surgery and case 2 after 8 months without the use of assisted reproductive technology. Though the ensuing pregnancies may have been fortuitous, the possibility exists that in cases of unilateral hydrosalpinx, the performance of salpingectomy may improve fecundity without the need for IVF. Hopefully the outcome of these 2 case reports may generate interest in a larger cooperative prospective study. copyright copyright 1999 S. Karger AG, Basel
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4/44. Secondary amenorrhea and infertility caused by an inhibin-B-producing ovarian fibrothecoma.

    OBJECTIVE: To report a case of secondary amenorrhea and infertility caused by an inhibin-B-producing ovarian fibrothecoma. DESIGN: Case report. SETTING: Academic medical center. PATIENT: A 37-year-old woman with a 2-year history of secondary amenorrhea and infertility. INTERVENTION(S): Operative removal of a 5-cm ovarian fibrothecoma. MAIN OUTCOME MEASURE(S): luteinizing hormone, FSH, E2, inhibin-B, TSH, and prolactin measured preoperatively and postoperatively. Immunostaining of tumor cells for inhibin and LH. RESULT(S): Preoperative hormone levels were as follows: FSH, 1.7 mIU/mL; LH, 23.4 mIU/mL; E2, 31 pg/mL; and inhibin B, 1,154 pg/mL. Three weeks postoperatively, the FSH was 1.5 mIU/mL, LH decreased to 7.1 mIU/mL, E2 increased to 276 pg/mL, and inhibin-B decreased to 17 pg/mL. The fibrothecoma did not stain for LH but was strongly positive for inhibin. Regular menstrual cycles resumed 28 days postoperatively. CONCLUSION(S): Inhibin-B produced by an ovarian tumor profoundly suppressed FSH levels and resulted in secondary amenorrhea and infertility. Use of sensitive and specific immunoassays for inhibin-A and -B may aid in the differential diagnosis of hormonally active ovarian tumors.
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ranking = 5
keywords = operative
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5/44. Treatment of prolactin-secreting pituitary tumours in young women by needle implantation of radioactive yttrium.

    Twenty-one young female patients are described who presented with amenorrhoea, galactorrhoea or infertility, and were treated by 90Y pituitary implantation of 20,000 rads. There was no morbidity. In all patients serum prolactin values were elevated and radiographs of the pituitary fossa were abnormal. Observations are available for 1--76 months (mean 27) after implantation. The median fall in prolactin values was 60 per cent while there was no deterioration in pituitary function if normal pre-operatively. luteinizing hormone values, both basally and following gonadotrophin-releasing hormone, rose to normal after operation; several instances of sellar remodelling were observed radiologically, and no instance of relapse was found radiologically, biochemically or clinically. Thirteen patients desiring fertility have been observed since implantation; so far nine have become pregnant, in three instances without any additional therapy; since four patients became pregnant twice, a total of 13 pregnancies have occurred. No case of tumour expansion was observed during pregnancy. 90Y implantation can be considered as a therapeutic procedure in young female patients requiring fertility which is competitive with surgical methods, and together with a short course of bromocriptine if needed, could prove to be the treatment of choice.
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keywords = operative
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6/44. hand-assisted laparoscopy for megamyomectomy. A case report.

    BACKGROUND: In cases of uterine myomas of massive size, minimally invasive laparoscopic or laparoscopically assisted myomectomy techniques are not feasible alternatives to traditional laparotomy. This report introduces the use of hand-assisted laparoscopy, a novel approach that permits the insertion of the hand into the abdomen through a glove-sized incision while preserving the pneumoperitoneum, as an alternative to laparotomy for patients with massive myomas unsuitable for conventional laparoscopic myomectomy. CASE: A 28-year-old nullipara requested minimally invasive myomectomy and fertility preservation for the treatment of a massively enlarged uterus reaching the level of the liver. Myomectomy was safely performed by hand-assisted laparoscopy using the Pneumo Sleeve System (Dexterity, Blue Bell, pennsylvania), a 7.5-cm transverse suprapubic incision and a 1-cm umbilical laparoscopic incision. Surgery lasted 120 minutes, and the estimated blood loss was 250 mL. The total weight of the myomas was 3,120 g. The patient was discharged on the second postoperative day and had an uneventful recovery. CONCLUSION: The successful outcome of this initial case suggests that hand-assisted laparoscopic myomectomy is a feasible and safe minimal-access option that could effectively replace routine laparotomy in patients with massive uterine enlargement.
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ranking = 1
keywords = operative
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7/44. Laparoscopic therapy of an intact primary ovarian pregnancy with ovarian hyperstimulation syndrome: case report.

    A case of an intact primary ovarian pregnancy with ultrasonographic demonstration of heart motion following ovarian stimulation is presented. After preoperative ultrasonographic confirmation of an extrauterine pregnancy, proof of the ovarian localization was achieved by intra-operative ultrasonographic visualization during a diagnostic laparoscopy on post-menstrual day 48. A moderate ovarian hyperstimulation syndrome with a concomitant increase in size, vulnerability and vascularity of the ovaries presented an additional challenge for the surgical approach. However, thanks to the early diagnosis of the ectopic pregnancy localization, a laparoscopic organ-preserving removal of the intact ovarian pregnancy was successfully performed. In this way, the fertility of the patient, who had previously undergone contralateral ovariectomy, was preserved. To our knowledge, this represents the first such treatment to be reported in the medical literature. Improvements in diagnosis and therapy of ovarian pregnancy are reviewed.
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ranking = 2
keywords = operative
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8/44. A case report on vesico-uterine fistula: a very rare complication of the lower caesarean section.

    Vesico-uterine fistula is a very rare complication of lower caesarean section. There has only been two cases seen at the Department of urology in the past 2 decades. patients usually present in the early post operative period with the problem of continuous urinary incontinence. On the rare occasion, recurrent urinary tract infection, recurrent gross painless haematuria, or secondary infertility associated with secondary amenorrhoea would be the presenting complaint.
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keywords = operative
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9/44. Postoperative ascites developing after laparoscopic surgery can become a difficult diagnostic dilemma.

    Postoperative ascites is a rare complication of laparoscopic surgery. life-threatening and serious etiologies such as unrecognized bowel or urinary tract injury should be excluded promptly to avoid prolonged morbidity and even mortality. Occasionally, no definitive cause can be identified after an extensive diagnostic work-up. In such cases, idiopathic allergic or inflammatory peritoneal reaction may be the final diagnosis.
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ranking = 5
keywords = operative
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10/44. Preliminary experience with vascularised Fallopian tube transplants in the human female.

    The preoperative screening and postoperative case records of two patients that underwent vascularised Fallopian tube transplants are described. In both cases the operation was followed by immunological rejection. This was chronic and clinically quiescent in the first patient, but an accelerated rejection associated with a pyrexial illness and a rise in serum fibrinogen, blood platelet and serum lactic dehydrogenase levels was observed in the second case. Technical feasibility was demonstrated but further progress in the field of Fallopian tube transplants will be dependent on the development of safer techniques of immunosuppression considered necessary for graft survival.
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ranking = 2
keywords = operative
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