Utilidad de la determinación de la reserva ovárica como predictor de la posibilidad de embarazo espontáneo: revisión sistemática / Usefulness of determining ovarian reserve as a predictor of the possibility of spontaneous pregnancy: a systematic review

ANTECEDENTES: En la actualidad, muchos especialistas determinan la reserva ovárica para aconsejar a sus pacientes acerca de su futuro reproductivo. OBJETIVO: Definir, a través de una revisión sistemática, si existe evidencia que justifique la determinación de la reserva ovárica como predictor de la posibilidad de embarazo espontáneo. MÉTODO: Realizamos una revisión sistemática usando las palabras claves "ovarian reserve" y "spontaneous pregnancy" en las bases MEDLINE y EMBASE, entre los años 2000 y 2015. RESULTADOS: Sólo tres artículos cumplieron con los criterios de selección. Si bien difieren en la forma de determinar la reserva ovárica y la población analizada, ninguno de los estudios encontró que la determinación de la reserva ovárica tuviera utilidad clínica en predecir la posibilidad de un embarazo espontáneo. CONCLUSIÓN: No existe evidencia que justifique la determinación de reserva ovárica, en forma rutinaria, para aconsejar a las parejas acerca de sus posibilidades de embarazo espontáneo.

BACKGROUND: Many specialists use ovarian reserve tests to determine their patient's reproductive potential. OBJECTIVE: To determine whether the ovarian reserve determine the possibility of spontaneous pregnancy. METHOD: We searched in MEDLINE and EMBASE, articles published between 2000 and 2015, with the keywords "spontaneous pregnancy" and "ovarian reserve". RESULTS: Only three articles complied with the selection criteria. Although the studies have different approaches to evaluate ovarian reserve and study subjects, none of them found that that ovarian-reserve testing have clinical utility in predicting the chance of a spontaneous pregnancy. CONCLUSION: There is no utility to assess ovarian reserve routinely in order to predict chances of spontaneous pregnancy.

Spontaneous Pregnancy after Cystectomy and Urinary Diversion by Indiana Pouch Method for Congenital Bladder Exstrophy: A case Report.

Aims: To share our experience in the management of a patient of congenital bladder exstrophy, who conceived spontaneously following Indiana pouch surgery for urinary diversion. surgery for congenital bladder exstrophy, reported for antenatal care. In the first year of her life, an ineffective operation was performed for closure of her abdominal wall defect. At 10 years of age she underwent cystectomy, trygonocuteneostomy, diastasis of pubic bones were fixed and urinary diversion operation was performed by Indiana pouch method. She was followed up at the antenatal clinic of Dicle University until 38th week of pregnancy. Thereafter, an elective caesarean section was performed and a live healthy female baby was delivered. Discussion and Conclusion: Bladder exstrophy is an extremely rare congenital abnormality. Woman with bladder exstrophy and lower urinary tract reconstruction surgery may conceive spontaneously. However they have a high risk pregnancy and an elective caesarian section is advocated for delivery. Review of literature and our experience is presented.

Edad máxima en la que una mujer puede ser madre con sus propios óvulos: revisión sistemática / Maximum age at which a woman can be a mother: systematic review

Antecedentes: La amplia realización de ciclos de ovodonación, en todo el mundo, se ha traducido en elevadas tasas de embarazos y partos en mujeres de diversas edades, incluyendo a postmenopáusicas tardías. Esto ha generado controversias y desafíos éticos, motivando a que muchos centros en los cuales se practican estas técnicas limiten la edad máxima de las mujeres receptoras. Objetivo: Buscar un criterio biológico y objetivo para definir esta edad, para conocer las edades máximas reportadas, en las cuales la mujer es capaz con sus propios gametos lograr un embarazo espontáneo y parto. Método: Se realizó una búsqueda amplia en las bases de datos de PUBMED y MEDLINE de artículos que reportaran mujeres que concibieron sobre 40 años y que especificaran la edad al momento del último parto, excluyéndose aquellos en los cuales se usaron técnicas de reproducción asistida. Resultados: Sólo dos trabajos completaron los criterios de inclusión y no presentaron los de exclusión. Las máximas edades reportadas fueron 49 y 52 años respectivamente. Conclusión: La edad máxima reportada en la literatura en la cual una mujer ha logrado un embarazo espontáneo y parto es a los 52 años.

Background: The broad use of oocyte donation cycles has resulted in high rates of pregnancy and child birth in women of different ages, including postmenopausal women. This has generated controversy and ethical challenges, motivating many centers to limit the maximum age of oocytes recipients. Aims: To seek a biological and objective criteria to define such maximal age, in which a woman is able to achieve a spontaneous pregnancy and give a birth. Methods: We performed a broad search PUBMED and MEDLINE including articles that reported women who conceived after age40 years and specify the age at last birth, excluding those who received donated eggs. Results: Only two articles presented the inclusion criteria and no exclusion. The maximum reported ages were 49 and 52 years respectively. Conclusion: The maximum age reported in the literature in which a woman has achieved a spontaneous pregnancy and birth with her own gametes is at 52 years.

Spontaneous Pregnancy in a Patient with Sheehan's Syndrome.

Spontaneous pregnancy in patients with Sheehan's syndrome is very rare, even after ovulation induction in such patients' pregnancy outcome is poor. We report a case of women with Sheehan's syndrome who became pregnant without ovulation induction with successful outcome of pregnancy

Spontaneous Pregnancy in a Patient with Sheehan's Syndrome.

Spontaneous pregnancy in patients with Sheehan's syndrome is very rare, even after ovulation induction in such patients' pregnancy outcome is poor. We report a case of women with Sheehan's syndrome who became pregnant without ovulation induction with successful outcome of pregnancy.

Prognostic factors for predicting spontaneous pregnancy after laparoscopic surgical treatment of endometriosis / 대한산부인과학회지

OBJECTIVE: To identify the prognostic factors for predicting spontaneous pregnancy after laparoscopic surgical treatment of endometriosis. METHODS: Retrospective analysis was performed in 82 patients who underwent elective laparoscopic surgery with subsequent pathological confirmation of the endometriosis at Gangnam Severance Hospital from January 2003 to March 2008. We investigated the spontaneous pregnancy rate during the 12 months following surgical treatment and administration of Gonadotropin-Releasing Hormone agonist (GnRH agonist). Factors associated with clinical characteristics, blood tests and operative findings were compared with pregnant and non-pregnant women. RESULTS: The number of patients succeed to spontaneous pregnancy was 32 and failed to pregnancy was 50. Cumulative pregnancy rate was 39.02%. Mean pregnancy duration after surgical treatment was 5.96+/-3.43 months. r-AFS stage or grouping into two stages (mild/severe) (P=0.018), r-AFS score (P=0.008) and cul-de-sac obliteration (P=0.038) was significantly different between pregnant and non-pregnant group. Complete cul-de-sac obliteration was the independent factor of pregnancy failure in women with endometriosis after laparoscopic surgery. CONCLUSION: Complete cul-de-sac obliteration may be the important factors for predicting spontaneous pregnancy outcome in women with endometriosis after laparoscopic surgical treatment.

A spontaneous pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages / 대한산부인과학회지

Ovarian failure and infertility are typical features in Turner syndrome. Conception without ovum donation is very rare. We experienced one case of pregnancy and Cesarean delivery in a Turner mosaic with previous recurrent miscarriages.

Two cases of spontaneous pregnancy in women with premature ovarian failure: Case report / 대한산부인과학회지

Premature ovarian failure (POF) is a syndrome defined as hypergonadotropic hypogonadism associated with amenorrhea, oligomenorrhea or other forms of menstrual irregularity for at least 3 consecutive months before the age of 40. The management of POF is approached by HRT, emotional support and infertility treatment. Women with premature ovarian failure who desire to become pregnant are best treated by assisted reproductive technology with donor oocyte. However, POF has the possibility of a 5-10% spontaneous pregnancy. The physician should recommend the patient to consult with their physician if they have any symptoms of pregnancy or no withdrawal bleeding after HRT. Therefore we report two cases of spontaneous pregnancies in women with premature ovarian failure.

A Case of Spontaneous Pregnancy in Patient with Premature Ovarian Failure Who Has a Y Chromosome / 대한산부인과학회잡지

Premature ovarian failure is a condition causing amenorrhea, hypoestrogenism, and elevated gonadotropins in women younger than 40 years. A karyotype should be performed as part of basic laboratory evaluation for all patients with premature ovarian failure and prodromal premature ovarian failure. Gonadal dysgenesis represents a wide spectrum of clinical phenotypes, gonadal structures that include the presence of at least one streak gonad, and a variety of X chromosome abnormalities and mosaicism. Development of a malignancy in a dysgenetic gonad is of major concern. The presence of a fragment of the Y chromosome is thought to be a key to the oncogenic potential of these gonads. Malignant potential is clearly not linked to the testicular determining factor itself (SRY). Failure to display SRY or a closely related sequence does not rule out the presence of the segment of the Y chromosome postulated to be associated with the development of malignancies. Pregnancy in premature ovarian failure with chromosomal abnormality is rare. Furthermore, the incidence of pregnancy in patient with Y chromosome is very rare. We have experienced a case of premature ovarian failure with chromosomal abnormality involving Y chromosome fragment. She has got pregnant spontaneously and gave birth to male baby but he was found to have the same karyotype as his mother. So we report this case with a brief review of literatures.

A Case of Ovarian Hyperstimulation Syndrome Associated Spontaneous Pregnancy without Ovulation Induction / 대한산부인과학회잡지

The ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of ovulation induction therapy with gonadotropin. The pathogenesis of OHSS is unclear, but the proposed mechanisms are the production of vasoactive substances that increase local capillary permeability resulting in shifting of fluid from the intravascular space to the third space. The clinical manifestations varies from ascites, hypovolemia, oliguria, hemoconcentration, thromboembolism, and even death. We have experienced a case of severe OHSS with severe ascites, pleural effusion and bilateral enlarged ovaries associated with spontaneous pregnancy without any ovarian stimulation for ovulation induction.

3 Cases of Spontaneous Pregnancies and Deliveries in Turner's syndrome / 대한산부인과학회잡지

Spontaneous pregnancy in Turner's syndrome is very rare because of ovarian dysgenesis and subsequent streak gonads. Recently we experienced 3 cases of pregnancies and deliveries in Turner's syndrome, so we report with a brief review of literature.