Successful intrauterine pregnancy after endometrial ablation

The frequency of pregnancy after endometrial ablation is reported in the literature to be 0.7%, with a variety of complications and adverse outcomes for the fetus. A 30-year-old woman underwent rollerball endometrial ablation for menometrorrhagia. Her menses returned to normal and she conceived 16 months later. The pregnancy was uncomplicated apart from diet-controlled gestational diabetes and cesarean delivery for a transverse lie. To our knowledge, this is the first literature report of a viable pregnancy after rollerball ablation.     

A successful live birth with in vitro fertilization and thawed embryo transfer after conservative treatment of recurrent endometrial cancer

Estrogen-dependent early stage endometrial cancer is relatively common in young women of reproductive age. The standard treatment is hysterectomy and bilateral salpingo-oophorectomy (BSO), even in early stage well-differentiated endometrial cancer patients. This surgical option results in permanent loss of fertility. There have been some reports of live births using in vitro fertilization after conservative management of endometrial cancer with high-dose progestin for the purpose of fertility preservation. However, most were not recurrent cases and pregnancy was achieved through conventional in vitro fertilization, which usually raises serum estradiol levels and may lead to the recurrence of endometrial cancer. To date, it is hard to find a case that can be referred for any possible different approach needed for the patients who experience recurrence. Here we report a successful live birth with in vitro fertilization using letrozole to maintain physiological levels of estradiol, and subsequent thawed embryo transfer after elective cryopreservation of embryos in a patient with recurrent endometrial cancer. There has been no evidence of disease recurrence at one year after delivery.     

Ovarian pregnancy after in vitro fertilization

We report a rare ovarian pregnancy after in vitro fertilization and transcervical embryo transfer. Ultrasound guidance of embryo transfer does not eliminate the risk of this potentially lethal complication.     

A rare case of choroidal metastasis presented after conservative management of endometrial cancer

Hematogenous dissemination from endometrial cancer is quite rare. We report a 31-year-old woman who developed choroidal metastasis following conservative management of early-stage endometrial carcinoma. She had received kidney transplantation and was taking steroids and cyclosporine. Three years after hysterectomy for persistent endometrial carcinoma, she developed multiple metastatic disease (to both lungs and right pelvis), and while on treatment with paclitaxel and carboplatin, she complained of a rapid visual deterioration. Ophthalmologic evaluation revealed a metastatic choroidal tumor associated with multiple central nervous system metastases. The patient refused further treatment and died 1 month after diagnosis of choroidal involvement. In conclusion, this is the first reported case of choroidal metastasis from endometrial cancer and highlights the need to consider immunosuppressive treatment as an absolute contraindication to conservative fertility-sparing treatment in gynecological malignancies.     

Successful human pregnancy following in vitro fertilization using frozen semen

Frozen-thawed husband's semen was utilized for insemination of spouse's oocytes in vitro. Postthhaw semen had a low motility (40%) with a poor forward progression (+2), which subsequently decreased rapidly in the regalarly used Ham's F-10 medium (pH 7.42, 280 mosmoll kg) supplemented with 7.5% fetal cord serum. When Fam's F-10 was supplemented with an additional 0.5 mmol each of magnesium sulfate (MgSO₄) and potassium bicarbonate (KHCO₃) at a higher pH (pH 7.69, 280 mosmol/kg), the sperm maintained their motility and forword progression and fertilized all the oocytes, which subsequently cleaved and developed into normal embryos. Transfer of therse embryos resulted in a normal pregnancy. Our results indicate that cryopreserved semen of poor quality can be successfully employed for an in vitro fertilization-embryo transfer (IVF-ET) program, especially when MgSO₄ and KHCO₃ are used in Ham's F-10 at a higher pH.     

Efficacy of IVF following conservative management of endometrial cancer

Five cases of conservative management of early stage uterine carcinoma were reported. All patients successfully underwent in vitro fertilization (IVF). Role of conservative treatment, IVF and prophylactic surgery followed competition of parity was discussed.     

Successful conservative management of cervical ectopic pregnancy: a case series

Objective  

To report our experience of conservative treatment in four patients with cervical ectopic pregnancy.     

Successful conservative treatment of endometrial carcinoma permitting subsequent pregnancy: report of two cases

Two women with endometrial carcinoma who wished to preserve their childbearing ability received conservative treatment by medroxyprogesterone acetate (MPA, 600 mg/day for 22 weeks and 29 weeks, respectively). Following regression of endometrial lesions, their infertility was treated by inducing ovulation. Intact pregnancy was diagnosed 13 months and 11 months after completion of the MPA treatment, respectively. One patient had a twin pregnancy and delivered two infants at 35 weeks of gestational age. The other patient delivered a full-term baby. They had no evidence of recurrence 60 months and 31 months after the conservative treatment, respectively. We believe this conservative treatment with progestin may be safely performed for young patients with endometrial cancer who wish to preserve their fertility.     

Successful in vitro fertilization and pregnancy by micromanipulation with epididymal sperm

Purpose To examine the effectiveness of micromanipulation on the treatment of the patients with obstructive azoospermia, subzonal insemination or partial zona dissection was performed using epididymal sperm of the 23 patients, and the in vitro fertilization and embryo transfer (IVF-ET) outcomes were analyzed.Results Fertilized oocytes were obtained in 11 cycles of the 25 treated cycles, and six pregnancies were established by the subsequent ET. Through the analysis of 13 cycles in which both the micromanipulation and usual IVF insemination were performed, the fertilization rate per oocyte with the micromanipulation [25% (28/113)] was significantly higher than that with the usual insemination method [4% (4/102)]. The micromanipulation was most useful for the treatment of the patients with congenital absence of the vas deferens. Moreover, there was no need to aspirate a large volume of the epididymal fluid, but it was essential to prepare more than 10 mature oocytes retrieved.Conclusions These results indicate that micromanipulation with epididymal sperm is an effective treatment for obstructive azoospermia, and careful preparations of sperm and wellcontrolled ovarian hyperstimulation are necessary for successful IVF-ET.