Triplet pregnancy following oocyte donation to a functionally agonadal woman

Reported is the first triplet gestation following oocyte donation to an agonadal woman. The transfer of five ova resulted in implantation of all five, with continued embryonic development in three. Pregnancy support was provided by exogenously administered oral E2 and intramuscular P for 100 days, at which time placental hormone production solely maintained the gestations.     

Establishment of 22 pregnancies after oocyte and embryo donation

Donated oocytes inseminated with partner's semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 after the transfer of fresh embryos and nine after the transfer of frozen-thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partner's semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies are progressing normally and five miscarried.     

Establishment of 22 pregnancies after oocyte and embryo donation

Summary. Donated oocytes inseminated with partner's semen or donated embryos were transferred on 95 occasions in 28 women without ovarian function and in 21 with functional ovaries. Overall, 22 pregnancies were established, 13 alter the transfer of fresh embryos and nine after the transfer of frozen-thawed embryos. Eleven of the pregnancies were established in women without ovarian function and 11 in women with functional ovaries. Nine of the pregnancies were established with donated oocytes inseminated with partner's semen and 13 with donated embryos. Fifteen healthy infants were born including one set of twins; three pregnancies arc progressing normally and five miscarried.     

Successful pregnancy in a bone marrow transplant recipient following oocyte donation

Summary We describe the successful establishment of pregnancy in a woman status post-bone marrow transplantation using assisted reproduction. Oocyte donation offers women with gonadal failure secondary to cytotoxic agents a reasonable chance at childbearing.     

Pregnancy after oocyte donation to a woman with ovarian failure and classical galactosemia

In summary, oocyte and pre-embryo donation may be used to establish pregnancy in women with galactosemia and ovarian failure. Reported is the first pregnancy after pre-embryo donation to a woman with classical galactose-1-phosphate uridyl transferase deficiency. Despite disturbances in galactose metabolism, the endometrial lining responded normally to exogenous hormone replacement and was receptive to pre-embryo implantation. Pregnancy support was provided by exogenously administered oral E2 and IM P for the initial 100 days, at which time placental hormone production solely maintained the gestation.     

Feto-maternal risks associated with pregnancy achieved through oocyte donation in a woman with Turner syndrome

We report a case of a 40-year-old primipara Caucasian woman with Turner syndrome (TS) and Hashimoto thyroiditis who had underwent a successful IVF-ET cycle with oocyte donation and single embryo transfer. All pregnancies in women with TS are considered as high risk, with cardiovascular complications being the most dangerous. Our case represents a typical case of fetal growth restriction with gradual slowing down of fetal growth after 28 weeks. At 37 + 3 gestational weeks, a healthy male newborn weighing 2240 g, with artery pH of 7.32 was delivered by cesarean section. The neonate was small for gestational age. Women with TS who become pregnant need close surveillance from a multidisciplinary team of cardiologists, obstetricians and endocrinologists. The primary goal is to prevent maternal complications and to improve perinatal outcome. In doing so, a thorough evaluation of fetal growth and uteroplacental and fetal circulation should by no means be omitted, after 26–28 weeks of gestation. The examinations should be at monthly or even shorter intervals to find early signs of growth restriction and act accordingly.     

Genital tuberculosis in a menopausal woman. A case report

We have analysed the role played by genital tuberculosis (TBC) in Italy today, and in particular in L'Aquila, in the light of a worrying recrudescence. We report the case of a 64-year-old patient, in menopause for the past 11 years or so, referred to the Gynecology and Obstetrics Clinic of the University of L'Aquila, with an anamnesis of menometrorrhagia since the age of 55. The patient was studied from a gynecological and internist profile including the following procedures: gynecological examination and pap-test, colposcopy, transvaginal scan, chest X-ray, abdominal and pelvic CAT, laboratory tests and Mantoux reaction. The uterus was found to be fibromatous during the gynecological examination and scan, whereas colposcopy revealed a small ectropion and the presence of very adherent yellowish mucus. The Mantoux test was positive. CAT showed cicatricial sequelae in the pulmonary parenchyma. It was decided to perform curettage, but this was prevented by the presence of pyometra. The patient was treated with specific chemotherapy and then underwent total laparohysterectomy with bilateral adnexectomy. The histological findings confirmed genital TBC. Genital TBC is now undergoing a worrying recrudescence. We need to have a full knowledge of the pathology, the diagnostic means with which to discover it and the correct therapeutic instruments to overcome it.     

Two successful pregnancies obtained following oocyte vitrification and embryo re-vitrification

Recent clinical reports not only show that cryopreserved embryos can be successfully used for human fertility treatment, but also that cryopreserved oocytes may be used successfully as an adjunct to human assisted reproductive technologies. Vitrification is known to establish a glass-like solid state during the cooling process. The high concentration of cryoprotectants and an extremely rapid rate of cooling are responsible for the formation of the solid state, and also prevent formation of intracellular ice crystals. Hence, in theory, vitrification should minimize cryo-injuries, and therefore has great promise for oocyte and embryo cryopreservation. This article describes two pregnancies from vitrified-warmed blastocysts obtained after intracytoplasmic sperm injection fertilization of vitrified-warmed oocytes. Vitrification was employed to cryopreserve the oocytes and the subsequent blastocysts. The results present the intriguing implication that vitrification may serve as an efficient method for clinical oocyte cryopreservation and embryo re-cryopreservation.     

Relaxin levels in ovum donation pregnancies

STUDY OBJECTIVE: To investigate the relative contributions of the corpus luteum (CL) and the placenta to the circulating levels of relaxin during pregnancy. PATIENTS: Forty-one patients in whom pregnancy had been achieved by ovum donation. RESULTS: Relaxin was not detected in the serum of 36 patients; in the remaining 5, although it was detectable, the levels were markedly reduced when compared with those in normal pregnancies. CONCLUSION: These results demonstrate that the CL is essential for the maintenance of normal circulating levels of relaxin during pregnancy.     

Cigarette smoking in the menopausal woman

Approximately 25% of postmenopausal women smoke cigarettes. Cigarette smoking has been linked to many diseases of the mature woman, both gynecologic and non-gynecologic. Cigarette smoking is associated highly with cardiovascular disease, and in women, it is estimated that 21% of all mortality from cardiovascular disease is related to cigarette smoking. Cigarette smokers demonstrate a markedly elevated prevalence for development of airway obstruction and clinical symptoms leading to chronic obstructive pulmonary diseases, as well as to recurrent respiratory tract infections. Many nongynecologic cancers are associated with cigarette smoking. Multiple other medical problems including peptic ulcer disease, psoriasis, thyroid disease, and spinal disc disease are also associated with cigarette smoking. An earlier onset of menopause in women who smoke cigarettes has been clearly demonstrated. Cigarette smoking is associated with a decreased risk of endometrial cancer. The opposite effect is noted in other cancers; specifically, an increased risk for vulvar and cervical cancers has been observed. The association between cigarette smoking and risk for breast cancer is not clearly established. No apparent increased risk is found for ovarian cancer. Cigarette smoking also is associated with a decreased risk of benign conditions of the female reproductive tract (eg, endometriosis, leiomyomas, benign breast disease). An increased prevalence of osteoporosis is found in postmenopausal smokers when compared with non-smokers.     

Perinatal outcomes in oocyte donor pregnancies

Abstract

Objective: To assess the obstetric outcomes of pregnancy following intracytoplasmic sperm injection (ICSI) using donor oocytes.

Methods: Twenty-six deliveries from oocyte donor ICSI (d-ICSI) were compared to the next two consecutive deliveries from homologous ICSI (h-ICSI group) (n?=?52) and with the two consecutive deliveries from women older than 40 years (Advanced Maternal Age: AMA) (n?=?52). We evaluated the occurrence of gestational hypertension (GH), preeclampsia (PE), fetal growth restriction (IUGR), gestational diabetes mellitus (GDM), preterm premature rupture of membranes (pPROM), preterm birth, placental anomalies, mode of delivery, hemorrhage, gestational age at birth and birth weight.

Results: d-ICSI had significantly more PE (d-ICSI 19.2%, h-ICSI 0%, AMA 0%, p?<?0.001); higher rates of IUGR than AMA pregnancies (d-ICSI 19.2%, AMA 3.8%, p?<?0.025). Placental accretism was found only in the d-ICSI group (15.4%, p?<?0.043). No postpartum bleeding was observed.

Conclusions: This is the first study that compares the obstetric outcomes of donor pregnancies to the outcomes of h-ICSI and AMA. Obstetricians who deal with pregnancies from oocyte donation need to be aware of the more severe obstetric outcomes, especially placenta accreta and preeclampsia. All women who conceive through oocyte donation should be counseled as early as the pre-conception period and referred to specific centers for high-risk pregnancies.     

A successful pregnancy in a Turner syndrome with oocyte donation

Advances in reproductive medicine using oocyte donation have made it possible for women with Turner syndrome (TS) to achieve successful pregnancies. These pregnancies carry substantial fetal and maternal risks, with hypertensive disorders or pregnancy and fetal growth restriction common, and an increased risk of aortic dissection, sometimes fatal, for the woman. Careful prepregnancy assessment and fetal and maternal vigilance during pregnancy is a necessary prerequisite for a successful outcome. We present a case of a woman with Turner syndrome achieving a successful pregnancy from donor oocyte and review the relevant literature.