Isolated recurrent torsion of the Fallopian tube: case report

We report a rare clinical case of recurrent isolated torsion of the Fallopian tube. An 18 year old woman presented with acute right lower quadrant pain, nausea and vomiting. Torsion of the Fallopian tube was detected by laparoscopy and detorsion was performed. Two years later, a second similar episode of pelvic pain recurred. Having in mind the first episode, diagnosis was facilitated and detorsion was performed in accordance with the patient's wishes. However, the dilemma of ideal management of recurrent cases of torsion of the same tube remains open for discussion. The possibility of torsion of the Fallopian tube and recurrent torsion of the tube, although rare, should be considered in any patient with acute onset of lower abdominal pain.     

Follicle cysts after menstrual versus midluteal administration of gonadotropin-releasing hormone analog in in vitro fertilization

The incidence and behavior of follicle cysts after different timing of gonadotropin-releasing hormone analog (GnRH-a) administration was studied in 321 in vitro fertilization (IVF) cycles. Group M included 198 cycles in which GnRH-a was injected at menstruation. Of these, 171 (88.6%) were without cysts (group M1) and 27 (13.6%) with cysts (group M2). Group L comprised of 123 cycles in which GnRH-a was administered in the midluteal phase. Of them, 70 (56.9%) were without cystic finding (group L1), 19 (15.4%) with follicle cysts (group L2), and 34 cases (27.6%) with visible corpus luteum at the time of GnRH-a initiation (group L3). Both groups with follicle cysts demonstrated a higher luteinizing hormone peak and continuous elevated estradiol (E2) levels. In group M2, the E2 rise and the cysts persisted longer compared with group L2. Gonadotropin treatment was accordingly postponed until the cysts regressed spontaneously. Only two cases of group M2 required aspiration of the cysts. Follicle cyst formation is not related to the timing of GnRH-a administration and their occurrence did not have adverse effects on IVF outcome.     

Hormonal Changes Related to Impairment of Cervical Mucus in Cycles Stimulated by Clomiphene Citrate

The levels of luteinizing hormone (LH), follicular stimulating hormone (FSH), 17-oestradiol (E2), progesterone (P), and testosterone (T) were determined for the early, midfollicular and periovulatory phase of spontaneous and clomiphene citrate (CC) induced cycles in 5 patients who responded with appearance of hostile cervical mucus (Group A) and 5 patients whose cervical mucus remained unchanged during the same treatment (Group B). The patients with hostile mucus were further investigated during a third cycle stimulated by CC and ethinyloestradiol (EE). Patients treated with CC for induction of ovulation who developed hostile cervical mucus showed higher levels of LH and T in the midfollicular phase of the menstrual cycle and significantly higher levels of T in the periovulatory period compared to patients with unchanged mucus. EE treatment induced a drop in the elevated LH and T levels and improved the cervical score. No change in E2 levels was noted. A direct effect of EE on the cervical glands together with the centrally mediated lowering of serum T are suggested to be responsible for improving the cervical mucus.     

Binovular human ovarian follicles associated with in vitro fertilization: incidence and outcome

Binovular follicles were found in 15 (0.3%) of 4,695 follicles containing oocytes. These binovular follicles were either with adjacent cumulus complexes (9 cases), or separate corona radiata and common cumulus mass (1 case), or two oocytes within a single zona pellucida (5 cases). In each of the latter form, there was a smaller and a larger oocyte. All the smaller oocytes and two larger ones possessed a germinal vesicle, whereas the remaining three larger oocytes were mature and developed normally. Though being exposed to the same intrafollicular milieu, there can be a difference in the maturity of the nucleus and characteristics of the cytoplasm of both oocytes.     

Gonadotropins and combined gonadotropin-releasing hormone agonist--gonadotropins protocols in a randomized prospective study

A prospective study was designed to compare cycles stimulated by human menopausal gonadotropin (hMG) (group A) with cycles pretreated with gonadotropin-releasing hormone agonist causing pituitary desensitization followed by hMG stimulation (group B). Three hundred two cycles were randomly allocated to each group. Cancellation rate was 27.2% in group A compared with only 3.3% in group B. Significantly less hMG ampules for a shorter period were needed in group A patients. Lower estradiol and higher luteinizing hormone levels were detected in the hMG group. Patients in group B yielded significantly more oocytes and more embryos per retrieval. A significantly higher pregnancy rate per cycle was obtained in group B (27%) as compared with that of group A (13%). Moderate and severe ovarian hyperstimulation syndrome was significantly more frequent in group B than in group A.     

A comparison of the incidence, presentation, and management of ovarian pregnancies between two periods of time.

STUDY OBJECTIVE: To compare the prevalence, presentation diagnostic modalities, and management of 37 ovarian pregnancies in one institution during two time periods. DESIGN: A retrospective study (Canadian Task Force classification II-2). SETTING: Department of Gynecology in a university-affiliated hospital. PATIENTS: Twenty patients with ovarian pregnancy between 1971-1989 compared with 17 patients with ovarian pregnancy between 1990-2000. MEASUREMENTS AND MAIN RESULTS: Seventeen ovarian pregnancies, diagnosed between 1990-2000, comprised 2.6% (17/634) of all ectopic pregnancies, 1:3500 of all live births leading to a mean ovarian pregnancy rate per year of 1.5, as opposed to 3.1% (20/647) of all ectopic pregnancies, 1:3600 of all live births, and a mean ovarian pregnancy rate per year of 1.1 in the previous period. Circulatory collapse was present in 4/17 (23%) patients in the 1990-2000 time period and in 6/20 (30%) in the previous period. Culdocentesis for diagnostic purposes was practically abandoned in the recent decade. Wedge resection by laparotomy was the treatment of choice in the past, and after 1997, it was performed exclusively by laparoscopy. When an ovarian pregnancy was diagnosed, an intrauterine device (IUD) was present in 65% of all patients and in 73% of women who had previously conceived in the 1999-2000 time period, compared with higher rates in the previous period (90% and 100%, respectively). CONCLUSION: The absolute number of ovarian pregnancies in the last 11 years increased when compared with the previous 19 years; however, the prevalence rate per delivery was stable. Patients still experienced circulatory collapse despite modern diagnostic modalities. Culdocentesis for diagnostic purposes has become an unnecessary procedure. Laparoscopic wedge resection was the treatment of choice. The relationship between IUD use and ovarian pregnancies was still strong.     

Endocrinology: The effect of pre-treatment with a gonadotrophin-releasing hormone agonist on reproductive functions in mature cycling rats

In order to investigate the performance of follicles in a ratmodel in which gonadotrophin-releasing hormone agonist (GnRHa)was used for hypothalamic—pituitary—ovarian axissuppression, three groups of mature cycling rats were studied.One group was treated with buserelin followed by pregnant mare'sserum gonadotrophin (PMSG), and the second group was treatedwith PMSG alone. Both these hormonally treated groups receivedhuman chorionic gonadotrophin for induction of ovulation. Thethird group received no hormonal treatment. The average numberof ovulated oocytes recovered from rat oviducts pre-treatedwith GnRHa was significantly higher than that in rats treatedwith the gonadotrophin alone, in spite of the larger numberof pre-ovulatory follicles present in the gonadotrophin-treatedgroup. The morphology of both the pre-ovulatory and the post-ovulatorycumulus—oocyte complexes in the three groups appearedsimilar. No difference in the capacity of follicles of the threegroups to synthesize progesterone in vitro in response to luteinizinghormone could be observed. We conclude that ovarian morphologyand function are not impaired by pre-treatment with buserelin.     

The outcome of intracytoplasmic injection of fresh and cryopreserved epididymal spermatozoa from patients with obstructive azoospermia--a comparative study

The aim of our study was to compare the outcome of intracytoplasmic sperm injection (ICSI) with fresh and frozen-thawed epididymal spermatozoa retrieved by percutaneous epididymal sperm aspiration (PESA) or microepididymal sperm aspiration (MESA) from patients with obstructive azoospermia. A retrospective analysis of consecutive ICSI cycles was performed, comparing the outcome in 24 patients with obstructive azoospermia undergoing surgical sperm aspiration by MESA (7 cycles) or PESA (17 cycles). In 23 of 24 patients, excess spermatozoa were cryopreserved. Following thawing, 21 ICSI cycles were performed (11 cycles after MESA, 10 after PESA). No statistically significant differences were noted in all parameters examined in ICSI cycles with fresh or cryopreserved spermatozoa from the same patients. Comparing all ICSI cycles with fresh and frozen-thawed epididymal spermatozoa, the rates of two-pronuclear fertilization (56% versus 53%), embryo cleavage (90% versus 86%), implantation (10% versus 14%), clinical pregnancy per embryo transfer (32% versus 37%) and delivery/ongoing pregnancy rate (27% versus 26%) were not statistically different. The cumulative ongoing pregnancy rate per sperm retrieval procedure was 46%, respectively. We conclude that the clinical outcome of ICSI with fresh and frozen-thawed spermatozoa after retrieval by PESA was similar to that by MESA. Epididymal sperm cryopreservation in patients with obstructive azoospermia is feasible and efficient using a simple freezing protocol and should be offered to optimize the yield of pregnancies achieved following such procedures.      

A randomized, double-blind clinical trial using fixed daily doses of 100 or 200 IU of recombinant FSH in ICSI cycles

The effect of 100 and 200 IU per day recombinant FSH (rFSH) on numbers of oocytes retrieved and the total dose used in ovarian stimulation before intracytoplasmic sperm injection was investigated in a double-blind, randomized multicentre trial. A total of 91 women was treated with a low-dose protocol and 88 with a high-dose regimen at five centres. For each started cycle, significantly more oocytes were retrieved in the 200 IU group than in 100 IU group (12.0 versus 5.7, P < 0.001); total rFSH consumption was 1121 and 1875 IU in the low- and high-dose groups respectively. Significant variations were noted between centres with regard to numbers of oocytes collected per started cycle, ranging from 2.8 to 7.2 in the 100 IU group and from 9.0 to 19.1 in the high-dose group. Exploratory analyses of secondary outcomes suggested there were no differences in vital pregnancy rates per started cycle (19.2 versus 16.9%) and per embryo transfer (26.2 versus 19.3%) in the low- and high dose groups respectively. There were four hospitalizations due to ovarian hyperstimulation syndrome, all in the 200 IU group.