Minimally-invasive surgery in a case of Herlyn-Werner-Wunderlich Syndrome

The diagnosis of the Herlyn-Werner-Wunderlich syndrome is frequently misleading, not only to underreporting of cases, but, more seriously, to suboptimal treatment that can be detrimental to the reproductive potential of the affected woman. The case of a 14-year old girl with the HWW syndrome is presented. Although the diagnosis was suggested by imaging modalities such as ultrasound and magnetic resonance imaging, the use of endoscopic procedures such as laparoscopy and hysteroscopy, provided additional vital information that allowed an accurate assessment of her condition and a definitive, minimally-invasive management that was protective of her reproductive function.

Problems encountered while managing a case of severe ovarian hyperstimulation syndrome

This is the case of a 26 year-old nulligravida with Polycystic Ovary Syndrome who developed severe Ovarian Hyperstimulation Syndrome (OHSS) during ovulation induction for Intrauterine Insemination (IUI). Three problems were encountered during treatment. The first was whether to convert a planned ovulation induction and IUI, that resulted in multiple follicular development, to an in vitro Fertilization - Intracytoplasmic Sperm Injection cycle. The second problem was determining what strategies are relevant in preventing OHSS in a woman at high risk for developing severe hyperstimulation. The third problem was why, when and how to employ abdominal paracentesis in the management of severe OHSS. Though the patient's course was turbulent, management was successful. She is now awaiting embryo transfer and, ultimately, motherhood.

Comparative analysis of the accuracy of transvaginal ultrasonography, hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in the investigation of female infertility

To compare the accuracy of transvaginal ultrasound, hysterosalpingography and hysteroscopy in the detection of intrauterine lesions that may be associated with infertility, the medical records of 452 women who each underwent all three procedures from January 2007 to July 2010 were reviewed. Hysteroscopy appears to have the highest sensitivity for the diagnosis of endometrial polyp, submucous myomas and endometrial hyperplasia. On the other hand, hysterosalpingography has the highest specificity for the diagnosis of endometrial polyp, submucous myomas, endometrial hyperplasia, and intrauterine septa. Combination of procedures improved diagnostic accuracy in terms of specificity.

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.