1/4. Genetic origin of a trophoblastic choriocarcinoma.Gestational choriocarcinoma can follow a term birth, a nonmolar abortion, or a complete hydatidiform mole. Among hydatidiform moles, heterozygous ones resulting from fertilization of an egg devoid of a nucleus by a diploid sperm (XY) or by dispermy (XX or XY) have been suggested to carry an increased predisposition to transformation to choriocarcinoma. Data on genetic analysis of choriocarcinoma are meager, being limited to cytogenetic analysis of a handful of established cell lines. Although the majority of these were heterozygous, antecedent pregnancies or molar tissues have not been investigated in any of them to clearly establish their genetic origin. We present here the results of a study of chromosomal heteromorphisms and dna restriction fragment length polymorphisms in a choriocarcinoma, the host, her spouse, and her son from the antecedent pregnancy. Our data show that the choriocarcinoma in this case most probably arose from the product of the same fertilization that led to the antecedent pregnancy.- - - - - - - - - - ranking = 1keywords = fertilization (Clic here for more details about this article) |
2/4. hydatidiform mole after in-vitro fertilization: a case report.A 25 year old patient was accepted on the in-vitro fertilization programme at Groote Schuur Hospital in Cape Town and her first IVF cycle resulted in a pregnancy. The patient did not return to the usual follow-up ultrasound until about 4 months after the embryo transfer when an ultrasound revealed the typical picture of a molar pregnancy which was confirmed by histology after evacuation.- - - - - - - - - - ranking = 2.5keywords = fertilization (Clic here for more details about this article) |
3/4. Recurrent gestational trophoblastic disease following in-vitro fertilization.recurrence of gestational trophoblastic disease (GTD) following two attempts at in-vitro fertilization (IVF)/embryo transfer is reported in a childless couple after 17 years of unsuccessful trials of ovulation induction. The diagnosis of bilateral tubal obstruction was finally established, indicating IVF treatment. After the first IVF/embryo transfer treatment, the woman developed GTD and was treated with methotrexate. After a second IVF attempt, GTD was again diagnosed. This time there was no response to methotrexate, thus necessitating second-line chemotherapy. etoposide, methotrexate, actinomycin D, cyclophosphamide, oncovine was used, and after only four treatment cycles the beta-human chorionic gonadotrophin (HCG) dropped to < 5 mIU/ml. After 26 months of follow-up, the beta-HCG continues to be undetectable. Preimplantation evaluation and ovum donation are described as measures to minimize the risk for GTD recurrence in a future IVF/embryo transfer.- - - - - - - - - - ranking = 2.5keywords = fertilization (Clic here for more details about this article) |
4/4. Intracytoplasmic sperm injection combined with preimplantation genetic diagnosis for the prevention of recurrent gestational trophoblastic disease.A strategy for the prevention of repeated molar pregnancies by using intracytoplasmic sperm injection (ICSI) coupled with preimplantation genetic diagnosis (PGD) with fluorescence in-situ hybridization (FISH) was developed. In this approach, complete moles which arise from dispermic fertilization are avoided by the use of ICSI. ICSI is followed by preimplantation selection against the transfer of 46,XX embryos, thus preventing complete moles resulting from a fertilization of an inactive oocyte, by a haploid X-bearing spermatozoon which subsequently duplicates. Triploid partial moles which arise mainly from dispermic fertilization may also be prevented by ICSI. The preimplantation confirmation of diploidy by FISH guards against triploid partial moles which may result from mechanisms other than dispermic fertilization. The employment of this strategy in an attempt to prevent a repeated event of molar pregnancy in a patient with a history of two previous episodes of gestational trophoblastic disease is reported.- - - - - - - - - - ranking = 2keywords = fertilization (Clic here for more details about this article) |