Are there any limits to assisted conception possibilities? Pregnancy and birth following oocyte donation and intracytoplasmic injection of spermatozoa obtained by percutaneous epididymal aspiration

Intracytoplasmic injection of donor oocytes with spermatozoa recovered by percutaneous epididymal aspiration resulted in pregnancy and the birth of a healthy male infant.      

Utility of percutaneous epididymal sperm aspiration in situations of unexpected obstructive azoospermia

Surgical sperm retrieval through percutaneous epididymal aspiration was used to manage effectively unexpected obstructive azoospermia on the day of oocyte retrieval.      

Studies of percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection

Four distinct studies were carried out using two data sets ofpercutaneous epididymal sperm aspiration (PESA) and intracytoplasmicsperm injection (ICSI) procedures performed from March 1993to January 1997. In study A, an analysis of 181 ICSI treatmentcycles following PESA revealed a successful epididymal spermretrieval rate of 83%. It confirmed that PESA is an effectivesperm retrieval method and the associated ICSI pregnancy rate(35% per embryo transfer) compared favourably with that of othersperm retrieval methods. In study B, the relevance of a priordiagnostic PESA procedure was ascertained by comparing the spermretrieval rates in two groups of patients having their firstICSI treatment cycle with spermatozoa retrieved through PESA.Group B1 (n=50) had diagnostic PESA prior to the ICSI treatmentcycle PESA procedure, unlike patients in group B2 (n=64) whodid not. The sperm retrieval rate in the treatment cycle procedurewas not different at 90 and 82.8% for groups B1 and B2 respectively.However, the discontinuation of diagnostic PESA is fraught withproblems including liability to medico-legal sanctions. In studyC, analysis of 177 treatment cycles involving PESA and ICSIrevealed a successful sperm retrieval rate by PESA of 82% inthe first cycle, 93% in the second, 96% in the third and 100%in the fourth cycle. The same trend was evident when sperm retrievalwas examined in relation to each of the epididymides. Retrievedspermatozoa were found to be motile in 67-100% of cases andthe frequency of samples containing motile spermatozoa did notdecrease with increase in the number of PESA attempts. Theseresults show that PESA does not jeopardize future epididymalsperm retrieval. In study D, the outcome of treatment with ICSIusing ejaculated spermatozoa (305 cycles) (group D1) was comparedwith that of ICSI using spermatozoa obtained through PESA (54cycles) (group D2). The median age of women in the two groupsof couples was similar (34 years). In group D1, 70% of metaphaseII oocytes were fertilized compared with 61% in group D2 (P<0.01).The cleavage rate and the median numbers of transferred andcryopreserved embryos were similar in both groups. There wasno significant difference between the clinical pregnancy rates(33 and 42% in groups D1 and D2 respectively). Our results showthat the outcome of PESA-ICSI treatment compared favourablywith that of ICSI using ejaculated spermatozoa.     

Vaginal leiomyoma co-existing with broad ligament and multiple uterine leiomyomas

A 48 year old African American woman presented with bladder pressure leading to the diagnosis of broad ligament and multiple uterine leiomyomas. She was also found to have a lateral vaginal wall mass which was confirmed to be a leiomyoma. Unlike uterine leiomyomas, vaginal leiomyomas are uncommon and are most often found in Caucasian women. Cases of such co-existing tumors are rare and their etiologic relationship is uncertain. Received: 21 September 2000 / Accepted: 17 October 2000     

Spontaneous prolonged hypertonic uterine contractions (essential uterine hypertonus) and a possible infective etiology

The management of a pregnant woman presenting with prolonged hypertonic uterine contractions (essential uterine hypertonus) and mildly elevated temperature at term is described. Histology of the placenta, cord and membranes, following delivery, revealed evidence of chorioamnionitis, funisitis and deciduitis. Our findings raise the possibility that essential uterine hypertonus may have an infective or inflammatory component to its etiology. Received: 19 February 2001 / Accepted: 21 May 2001     

Experience with gestational surrogacy as a treatment for sterility resulting from hysterectomy

A retrospective study was carried out to assess the potential of 16 hysterectomized women to achieve surrogate pregnancies. A total of 11 patients completed 16 cycles of assisted conception treatment incorporating in-vitro fertilization and gestational surrogacy. Three other women failed to respond to ovulation induction while two more patients produced few oocytes which also failed to fertilize. Six host mothers became pregnant thereby giving a pregnancy rate of 37.5% (6/16) per patient and embryo transfer and 27.3% (6/22) per cycle of treatment commenced. Two women later miscarried, three have given birth to twins and the remaining host has delivered a male infant. The commissioning mother's age was closely related to occurrence and continuation of pregnancy in the host. Hysterectomized women demonstrate varying patterns of response to assisted conception treatment but gestational surrogacy generally appears to be a feasible option especially in younger patients.