11/17. Unusual presentation of a woman with polycystic ovaries and complex endometrial pathology.A 28-year-old woman with polycystic ovarian syndrome (PCOS) had attempted four assisted conception treatments, all of which were complicated by lack of response of the endometrium to the hypo-oestrogenic state induced with gonadotrophin releasing hormone analogue (GnRHa). Consequently, two treatment cycles were abandoned, one prior to the ovulation induction of a fresh IVF treatment and the other prior to oestrogen replacement for a frozen-thawed embryo transfer treatment cycle. Extended down-regulation eventually resulted in endometrial thinning and allowed completion of the other two treatments, but the outcome was negative. A targeted mid-cycle ultrasound scan in a natural cycle at follow-up showed thick, non-homogenous endometrium. A repeat hysteroscopy on this occasion showed abnormal endometrium with chalk-like deposits. Histological diagnosis was chronic endometritis and endometrial hyperplasia with focal atypia. Microbiological tests, including those for mycobacterium tuberculosis, were negative. Because of atypical endometrial hyperplasia, this patient is currently under close follow-up by the original referring team. This case highlights inherent endometrial pathology presenting as non-responding endometrium to hormonal down-regulation, the limitations of conventional ultrasound scans, and the complimentary role of concomitant hysteroscopy in the correct identification of endometrial lesions that may negatively affect the assisted conception treatments.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
12/17. 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 = 2keywords = embryo (Clic here for more details about this article) |
13/17. myocardial infarction complicating the initial phase of an ovarian stimulation protocol.Two previous reports have reported myocardial infarction during ovarian hyperstimulation syndrome, a complication of controlled ovarian stimulation characterized by ascites, pleural effusion, hemoconcentration and an increased thromboembolic risk, but no association with the initial phase (before treatment with human chorionic gonadotropin) of a normal ovarian stimulation protocol for infertility has ever been described. We report the first case, to our knowledge, of acute myocardial infarction occurring during the initial phase of an otherwise uncomplicated ovarian stimulation protocol. A young woman with infertility associated to polycystic ovary syndrome was treated with leuprolide acetate and recombinant follicle stimulating hormone to induce ovarian stimulation for in vitro fertilization and embryo transfer. After 12 days the patient presented a non-ST elevation myocardial infarction, which was treated with aspirin, clopidogrel, enoxaparin, intravenous nitrates and beta blockers. cardiac catheterization showed angiographically normal coronary arteries. echocardiography showed a circumscribed akinesis of the inferior apical segment of the left ventricle and right ventricular apex, which was confirmed by cardiac magnetic resonance. A screening for thrombophilic diathesis was negative. The patient was discharged and remained asymptomatic at 1 and 3 months follow up. Further ovarian stimulations were excluded and a trial of oocyte retrieval on spontaneous cycle was planned. myocardial infarction can complicate ovarian stimulation protocols for infertility even in their early phase without any sign of ovarian hyperstimulation syndrome.- - - - - - - - - - ranking = 1keywords = embryo (Clic here for more details about this article) |
14/17. pregnancy after transfer of cryopreserved embryos in clomiphene citrate resistant polycystic ovarian syndrome.Transfer of cryopreserved embryos in PCOS patients resistant to CC stimulation is an intriguing problem. Ovarian stimulation with hMG/hCG to create a secretory endometrium, will entail an unnecessary risk of OHSS. In this case study, we report the accomplishment of a successful pregnancy after transfer of cryopreserved embryos after secretory transformation of the endometrium by E2/P substitution in the absence of corpus luteum formation. However, the success rate of this treatment modality in terms of pregnancy per embryo transfer has still to be evaluated in an ongoing study.- - - - - - - - - - ranking = 7keywords = embryo (Clic here for more details about this article) |
15/17. Management of multiple conceptions after gonadotropin-releasing hormone analog/human menopausal gonadotropin/human chorionic gonadotropin therapy.The treatment course of a 31-year-old infertility patient due to PCO disease is presented. Because the patient failed to conceive after various treatment cycles with CC, she was subjected to a combined GnRHa/hMG/hCG therapy. After plasma E2 levels had reached 2400 pg/ml, three leading follicles, with diameters of 20 to 24 mm, were detected. Induction of ovulation was achieved by 10,000 IU hCG. The patient conceived and developed ovarian hyperstimulation. At 8 weeks of gestation, seven cystic structures were detected within the uterine cavity, five containing single embryos, and two with twin embryos. All nine embryos were vital, as evidenced by their heart beats. Embryo reduction was achieved by transabdominal puncture on three occasions. The three surviving fetuses were carried to the 34th week of gestation. After delivery by cesarean section, three healthy babies developed normally. This communication illustrates the complications that can be associated with ovulation induction in PCO disease: ovarian hyperstimulation, polyovulation, multiple conceptions, and their clinical management.- - - - - - - - - - ranking = 3keywords = embryo (Clic here for more details about this article) |
16/17. Severe ovarian hyperstimulation syndrome, selective embryo reduction and heterotopic pregnancy.ovarian hyperstimulation syndrome is common (21.4%) in patients with polycystic ovarian disease, treated by gonadotrophins. It is much frequent (50%) in conceptual cycles. We report a case associated with a quadruplet pregnancy that underwent selective embryo reduction at 8 weeks' gestation to a twin pregnancy and was subsequently found to have an unruptured ectopic pregnancy at 11 weeks' gestation. After laparotomy and partial salpingectomy a successful twin pregnancy ensued.- - - - - - - - - - ranking = 5keywords = embryo (Clic here for more details about this article) |
17/17. Endometrial carcinoma in a young patient with polycystic ovarian syndrome: first suspected at time of embryo transfer.adenocarcinoma of the endometrium is a rare condition in women under 40 years of age. However, patients with anovulatory polycystic ovarian syndrome are at risk of developing endometrial carcinoma due to the unopposed and prolonged effect of oestrogen on the endometrium. This case report discusses the dilemma of various treatment options for early disease in such patients.- - - - - - - - - - ranking = 4keywords = embryo (Clic here for more details about this article) |
| <- Previous | |