Insulin-mediated pseudoacromegaly and ovarian insufficiency via a single enzymatic defect: a case report

Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to exert its effects. Polycystic Ovarian Syndrome (PCOS) is one of the metabolic syndromes that link insulin resistance with diabetes mellitus, hyperandrogenism, and ovulatory dysfunction. PCOS often has a menarcheal age of onset characterized by a failure to establish a regular pattern of menses. In the case presented, the patient has primary amenorrhea assoicated with the development of secondary sexual characteristics, acanthosis nigricans, and acromegaloid attributes. Evaluation of pituitary function revealed that the patient's amenorrhea is secondary to hypergonadotropic hypogonadism, particularly, ovarian insufficiency. This case provides a unique setting to relate the syndrome of insulin-mediated expression of an acromegaloid pnenotype with insulin-mediated pathogenic mecahnisms for ovarian failure to exist concurrently.

Risk factors associated with malignant endometrial lesions in postmenopausal women presenting with abnormal uterine bleeding: a retrospective review

Objectives: To identify clinical, sonographic and hysteroscopic characteristics associated with malignant endometrial lesions. Methods: This is a retrospective descriptive study that included all menopausal women presenting with vaginal bleeding in a tertiary care hospital from January 2007 to June 2010. Clinical, sonographic and hysteroscopic findings were evaluated as predictor variables for development of endometrial adenocarcinoma. Results: Thirteen out of the 215 patients had endometrioid adenocarcinoma, in women presenting with postmenopausal bleeding, with a prevalence rate of 6%. A trend towards harm is seen among the following factors: age of > 60 years (OR 1.19; 95% CI, 0.29-4.46), menarche /- 10mm (OR 2.02; 95% CI, 0.58-7.09), lesion of diameter /- 10mm, hysteroscopic characteristics (lesion diameter of less than 1 em, presence of cystic space and soft consistency) increases the probability of carcinoma.

Successful management of septate uterus in patients with recurrent pregnency loss: A report of two cases

Two women presenting with recurrent pregnancy loss were both diagnosed to have septate uterus. After hysteroscopic resection of the septum under laparoscopic guidance, successful term pregnancy was achieved in one patient, while second patient is currently on her 24th week of gestation. Septate uterus is the most common type of congenital uterine anomaly and has long been known to be associated with recurrent miscarriages, late-term abortion, and preterm labor. The pre-treatment abortion rate is 90%, which is both distressing for the patient and frustrating for the physician. Hysteroscopic septal resection under laparoscopic guidance is considered the standard for treatment, and is shown to improve reproductive outcome.

Intrauterine insemination among Filipino couples with processed total motile count of 1.0 x 106 or less: Semen quality profile and prognosis for pregnancy

Objective: To determine the pregnancy rate after intrauterine insemination using samples with. processed total motile count of 1.0 x 106 and less and describe the semen quality profile of Filipino males with severe male factor infertility in both the raw and processed semen samples. Design: Retrospective descriptive study. Setting: Andrology Laboratory, St. Luke's Medical Center. Patients: 307 infertile Filipino couples who underwent 426 IUI cycles. Main Outcome Measures: Pregnancy rate (PR) after intrauterine insemination. Results: A total of 10 pregnancies were obtained out of 426 IUI cycles, for a pregnancy rate per cycle of 2.4%. Seven of these eventually delivered to term, for a live birth rate of 1.6%. Among those who did not get pregnant with IUI, 8 had spontaneous pregnancies within 1 to 5 year period of follow-up for a spontaneous pregnancy rate of 1.9%. As expected, all the semen parameters analysed showed improvement after semen processing in all subjects. However, these improvements failed to result in a more acceptable pregnancy rate. Among the parameters, morphology was notably better among those who had pregnancies. Conclusion: The chance of pregnancy with IUI using semen samples with processed total motile count of 1.0 x 106 or less is relatively low. For these couples, it may be more prudent to proceed directly to IVF-ICSI than to try several cycles of IUI in futility.

Intrauterine insemination: A cross-sectional study on determinants of success / Philippine Journal of Obstetrics and Gynecology

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Successful management with artificial reproductive technology and preimplantation genetic diagnosis of a patient with alpha-thalassemia trait and repeated Hemoglobin Bart's Hydrops Fetalis Syndrome

A 38 year-old woman who had history of repeated Hemoglobin Bart's Hydrops Fetalis Syndrome in her first two consecutive pregnancies, was diagnosed as having alpha-thalassemia trait. On further investigation was likewise found to have a-thalassemia trait. Successful term pregnancy wa achieved through in-vitro fertilization with preimplantation diagnosis. Alpha-thelassemia is a common genetic disease that is prevalent in Southeast Asia. A couple with a-thalassemia trait is asymptomatic, but, they have 25 percent chance of having a child with the most fatal type of thalassemia-Hemoglobin Bart's Hydrops Fetalis Syndrome. Preimplantation genetic diagnosis is an established technique that provides an alternative to prenatal diagnosis for patients who are at risk of transmitting serious genetic disorder to their offspring.