Successful surrogate pregnancy after ovarian transposition, pelvic irradiation and hysterectomy

BACKGROUND: Treatment of cervical cancer is often effective but at the cost of the woman's fertility. Ovarian transposition with subsequent oocyte retrieval and surrogate pregnancy can enable these patients to become genetic parents. We present the third reported such case. CASE: A 22-year-old woman was diagnosed with bulky, stage IB cervical cancer. Following transposition of both ovaries to the upper abdomen, she underwent pelvic irradiation followed by total abdominal hysterectomy. Eleven years later she presented for assisted reproduction. Two oocytes were retrieved following ovarian stimulation and transcutaneous, abdominal oocyte retrieval. One embryo was transferred to the gestational surrogate, resulting in a single intrauterine pregnancy and successful delivery at term. CONCLUSION: These procedures can preservefertility while successfully treating cervical cancer.     

Successful multidisciplinary treatment of uterine serous carcinoma in a patient who had previously undergone renal transplantation

Objective

Renal transplantation is a risk factor for premalignant and malignant changes of the endometrium. Thus, prompt and aggressive treatment of postoperative complications remains a major issue. We report the case of an asymptomatic postmenopausal woman with a history of renal transplantation who underwent surgery for uterine serous carcinoma (USC).

Successful spontaneous pregnancy in a patient with rectal carcinoma treated with pelvic radiotherapy and concurrent chemotherapy: the unique role of laparoscopic lateral ovary transposition

Concurrent administration of external beam pelvic radiotherapy (RT) and chemotherapy (CT) is an effective treatment modality for rectal cancer. In adults in reproductive age, one of the most important side-effects resulting from this treatment is gonadal toxicity. Fortunately, it is possible to protect the ovaries by transporting them out of the RT area through lateral ovary transposition (LOT), as a minimally invasive method, which is performed before the application of RT. A 24-year-old female was diagnosed as having rectal adenocarcinoma in May 2003, and she was scheduled to receive adjuvant 5-fluorouracil-based CT followed by concurrent chemoradiotherapy (CRT). Before the onset of the adjuvant treatments, laparoscopic LOT was performed, and the patient was followed-up appropriately. Although amenorrhea developed during the CRT, the menstrual cycle of the patient resumed without performing any medical treatment eight weeks after the completion of the CRT. In July 2005, the patient became pregnant spontaneously with no local or systemic recurrences of rectal cancer. The present case shows that ovarian functions can be successfully protected in rectal cancer patients receiving RT by laparoscopic LOT, and by modifying the RT fields.     

Preliminary experience with in vitro fertilization-surrogate gestational pregnancy

This report documents the medical details and 3-year follow-up evaluation of the infertile and surrogate couples involved in the first successful in vitro fertilization gestational surrogate pregnancy and summarizes clinical experience and outcome of all patients treated to date. Results of the first 28 couples treated are presented. The pregnancy rate for 39 cycles reaching attempts at oocyte retrieval is 18%. The procedural aspects, ethical issues, legal issues, and subsequent program development are summarized. Recommendations are of a similar program. There are numerous potential pitfalls and traps for the unwary, but our experience has thus far been gratifyingly positive, and we endorse the further provision, observation, and documentation of this controversial approach to the care of the infertile couple.     

Ovarian pregnancy resulting from cornual fistulae in a woman who had undergone bilateral salpingectomy

OBJECTIVE: To report a case of ovarian pregnancy following in vitro fertilization-embryo transfer (IVF-ET) treatment for which the cornual fistulae was the most probable explanation of the cause. DESIGN: Case report. SETTING: University department and assisted reproduction unit. PATIENT(S): A 29-year-old woman with primary infertility. INTERVENTION(S): Hydrosalpinx of the bilateral fallopian tubes has been noted in patients who have decreased pregnancy rates in the IVF-ET treatment cycles. Salpingectomy before IVF cycles has been suggested to increase the pregnancy rate. We report a patient who presented with bilateral hydrosalpinx for whom bilateral salpingectomy was performed before IVF treatment. MAIN OUTCOME MEASURE(S): Clinical pregnancy. RESULT(S): The treatment cycle resulted in a primary ovarian pregnancy and required laparoscopic operation. A cornual fistulae was found that have might led to ectopic implantation of the embryos. CONCLUSION(S): Ovarian pregnancy may be an unexpected complication of those receiving bilateral salpingectomy before IVF treatment. The presence of cornual fistulae after salpingectomy was probably the cause of the ectopic pregnancy.     

A new approach for laparoscopic ovarian transposition before pelvic irradiation

OBJECTIVE: To evaluate and describe our special design of laparoscopic ovarian transposition to a high anterolateral position using Lee-Huang point as first entrance and landmark before pelvic irradiation in premenopausal patients with a gynecologic malignancy. METHODS: Laparoscopic surgery was conducted to transpose bilateral ovaries in consecutive cases of premenopausal women with a gynecologic malignancy requiring pelvic irradiation in a university-based, tertiary-level training center for endoscopic surgery. Ovaries were transposed to a high anterolateral position, 3-4 cm above umbilical line. RESULTS: Laparoscopic ovarian transpositions were performed bilaterally in consecutive fourteen cases without conversion to laparotomy. The mean operating time was 128 min (range, 83-181 min) and average blood loss was 74 mL (range, 10-150 mL). No intraoperative or immediate postoperative complication related to the laparoscopic ovarian transposition procedure was observed. The mean follow-up period was 72 months (range, 42-142 months) and only one of the seven (14.29%) patients under 39 years old became ovarian failure after receiving concurrent chemoradiation. CONCLUSION: The new designed method of laparoscopic ovarian transposition is a simple and safe procedure. We recommend this process to premenopausal women who required pelvic irradiation, especially for those less than 40 years old.     

Pregnancy hemoperitoneum and placenta percreta in a patient with previous pelvic irradiation and ovarian failure

Placenta percreta in a patient with previous pelvic irradiation has never been described. Reported is a case of placenta percreta with hemoperitoneum associated with a second-trimester incomplete abortion in a patient with previous pelvic irradiation and ovarian failure.     

Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries

OBJECTIVE: To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. DESIGN: Case report. SETTING: A maternity hospital in Tel Aviv that is a major tertiary care and referral center. PATIENT(S): A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. INTERVENTION(S): Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. MAIN OUTCOME MEASURE(S): Outcome of IVF cycle. RESULT(S): A twin pregnancy in the first cycle. CONCLUSION(S): This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.     

Successful pregnancy in a patient with Hallermann-Streiff syndrome

Reproductive capacity has not been studied in patients with Hallermann-Streiff syndrome, but successful pregnancy in these patients is rare. A patient with the classic signs--plus a müllerian developmental anomaly, hypertension, glaucoma, and an extensive surgical history--was artificially inseminated, and a term gestation ensued.     

Successful pregnancy and delivery in a patient with bladder exstrophy

Bladder exstrophy (BE) is a rare congenital anomaly. Owing to the advanced reconstructive surgical techniques and effective antibiotics, the incidence of urinary and systemic complications in patients with BE has decreased and the life expectancy has increased. However, this brings along social, sexual, and psychological problems; particularly, successful pregnancy and delivery is extremely rare in females with BE. We present a pregnancy of an 18-year-old female with BE, who has been followed at our university hospital since birth.     

Successful pregnancy in a patient with a single ventricle.

Single ventricle is an uncommon form of congenital heart disease. We report a successful pregnancy and delivery in a mother with surgically confirmed single ventricle.     

Successful pregnancy following in vitro fertilization-embryo transfer despite imminent ovarian failure

There have been previously published several anecdotal cases of women in apparent or imminent ovarian failure who subsequently ovulated and became pregnant. Many of these women had been treated with estrogen. A series of cases were reported where women with hypergonadotropic hypogonadism who failed to stimulate despite gonadotropin therapy were able to ovulate when treated with pharmacologic doses of estrogen alone or in combination with human menopausal gonadotropins. Presented herein is a case of a woman with imminent ovarian failure with tubal disease who failed to stimulate with gonadotropins alone but was successful with estrogen and gonadotropins. We believe this is the first successful case of hypergonadotropic hypogonadism to conceive by in vitro fertilization.     

Successful transvaginal ultrasound-guided ablation of a cervical pregnancy in a patient with simultaneous intrauterine pregnancy after in vitro fertilization and embryo transfer

Heterotopic pregnancy, or simultaneous intrauterine and extrauterine gestation, is a relatively rare condition. However, induced ovulation and assisted reproductive technologies have markedly increased the incidence of this condition. In this article, a case of heterotopic pregnancy after in vitro fertilization and embryo transfer is presented in which the viable cervical pregnancy was treated by transvaginal ultrasound-guided puncture and injection of potassium chloride in conjunction with methotrexate at week 6 of gestation. At week 12 of gestation, the intrauterine gestation was viable and complete resorption of the cervical pregnancy had occurred. At week 30 of gestation, a healthy baby was delivered by Caesarian section after prelabour rupture of membranes.