Conservative management of an 11-week cervical pregnancy. A case report.

BACKGROUND: Cervical pregnancy is a rare form of ectopic pregnancy. This condition is usually treated with hysterectomy. CASE: A woman with an 11.3-week cervical pregnancy was treated with methotrexate, angiographic embolization of the anterior division of the hypogastric artery, dilatation and curettage, and minimal rollerball ablation of bleeding cervical vessels only. The patient was discharged on postoperative day 1. Complications included a malodorous discharge, which was treated with oral antibiotics, and claudication of the thighs for two weeks. CONCLUSION: Advanced cervical pregnancies can be treated conservatively.

Oolemma rupture inside the intracytoplasmic sperm injection needle significantly improves the fertilization rate and reduces oocyte damage.

OBJECTIVE: To compare the effect on fertilization, oocyte damage, embryo freezing, and pregnancy rates of two different techniques for rupturing the oolemma during intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective study. SETTING: Fertility Center, Alliant Health System Hospital. PATIENT(S): Seventy-nine consecutive IVF-ICSI cases. INTERVENTION(S): Patients in group I had ICSI performed by pushing the needle into the oocyte until the oolemma was observed to break outside the needle. In group II the oolemma was aspirated into the needle until it ruptured inside the needle. MAIN OUTCOME MEASURE(S): In group II ICSI resulted in significantly higher fertilization and lower oocyte damage rates (66% and 13%) than in group 1 (39% and 29%). There were no statistically significant differences in embryo cleavage rates or pregnancy rates per retrieval between the two groups. A greater number of cases had embryos cryopreserved in group II than in group I. RESULT(S): Rupturing the oolemma by aspirating it into the ICSI needle (group II) improved laboratory outcomes compared with the more traditional technique of breaking this membrane by the stabbing action of the needle (group I). This modification of the ICSI technique also increased the number of patients with cryopreserved embryos and therefore could increase the pregnancy rate per patient. CONCLUSION(S): The site and technique used to rupture the oolemma during ICSI has a significant effect on the fertilization and damage rates.

Recurrent pregnancy loss.

This review of recurrent pregnancy loss examines our current understanding of the major etiologies of this unfortunate condition including genetic and endocrine abnormalities, anatomic variations, autoimmune conditions, alloimmune problems, systemic disease, and infection. Diagnostic protocols and treatment strategies are briefly presented. With a high rate of spontaneous normal pregnancy outcome, great care must be taken to do more good than harm.

Endometriosis after neosalpingostomy.

A patient seen for infertility developed severe endometriosis within 2 years of neosalpingostomy for bilateral fallopian tube obstruction. A retrospective review of infertility surgeries revealed none of 20 patients with obstructed tubes to have endometriosis, compared with 66 of 125 (52.8%) with at least one patent fallopian tube (p < 0.001, 95% confidence interval 0% to 17% vs 44% to 62%.

Endometrial inadequacy after treatment with human menopausal gonadotropin/human chorionic gonadotropin.

The incidence of abnormal endometrial histology in patients undergoing human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG) treatment during cycles of in vitro fertilization (IVF) or gamete intrafallopian transfer has been reported to be 52% to 91%. The incidence of endometrial inadequacy, as judged by a single late luteal endometrial biopsy, has not been studied in hMG/hCG non-IVF cycles. In the current study, 30 patients (30 cycles) undergoing hMG/hCG treatment were evaluated by an endometrial biopsy. The incidence of endometrial inadequacy was found to be 27%. No preovulatory predictors for endometrial inadequacy could be identified. Therefore, luteal support for patients undergoing non-IVF hMG/hCG cycles should be considered.

The presence of gonadotropin receptors in nonpregnant human uterus, human placenta, fetal membranes, and decidua.

The possible presence of gonadotropin receptors in nonpregnant human uterus and human fetoplacental unit was investigated by light microscope immunocytochemistry using a monoclonal antibody to rat luteal hCG/LH receptors. The receptor antibody cross-reacted with human and bovine hCG/LH receptors and appears to be directed against the receptor rather than other proteins, including HLA class I antigens. Uterus and fetoplacental unit contained receptor antibody-binding sites, which indicates the presence of hCG/LH receptors. In the endometrium these receptors were present in glandular and luminal epithelial cells as well as in stromal cells. In the myometrium the receptors were detected in circular and elongated myometrial smooth muscle and vascular smooth muscle. Comparison of immunostaining intensities, which indicates the presence of different amounts of receptors, revealed that luminal and glandular epithelial cells contained more receptors than stromal cells. These cells, in turn, contained more receptors than myometrial and vascular smooth muscle. All cells in secretory phase uterine specimens contained more receptors than corresponding cells from the proliferative phase of the cycle. Midpregnancy placenta, amniotic epithelium, chorionic cytotrophoblasts, and decidual cells contained hCG/LH receptors. At term pregnancy, while receptors in fetal membranes and decidua continue to be detected, placental tissues did not show any detectable receptors unless the tissues were pretreated with neuraminidase. This indicated that term pregnancy placenta contain hCG/LH receptors masked by sialic acid residues. Comparison of immunostaining intensities suggested that syncytiotrophoblasts contained more receptors than cytotrophoblasts at midpregnancy; mesenchymal cells or blood vessels contained no detectable receptors. There were more receptors in decidua than in fetal membranes at mid- and term pregnancy. While the amniotic epithelial receptors decreased, the receptors in chorionic cytotrophoblasts and decidual cells increased from mid- to term pregnancy. In summary, hCG/LH receptors were demonstrated in the nonpregnant human uterus, human placenta, fetal membranes, and decidua. This indicates that hCG/LH may directly regulate functions of these tissues by endocrine, autocrine, or paracrine mechanisms.

Follicular fluid Lidocaine levels during transvaginal oocyte retrieval.

Lidocaine has been shown to have adverse effects on mouse oocyte fertilization and embryo development. We have demonstrated the presence of pharmacologic levels of lidocaine in human serum and follicular fluid obtained during ultrasound guided transvaginal oocyte retrieval. The significance of this finding is unclear, as four of the eight patients studied became pregnant, including the patient with the highest follicular fluid lidocaine levels. Further evaluation of the effect of lidocaine on human embryos is warranted.

Hirsutism in the adolescent female.

Prompt evaluation should be carried out for any adolescent complaining of excessive hair growth. The workup should be directed toward the exclusion of androgen secreting neoplasms and correctable adrenal pathology. A minimal workup must include total serum testosterone, DHEA-S, and prolactin. The clinician must then determine if further testing will alter management substantially. Treatment includes removal or neutralization of any discrete source of serum androgens, normalization of altered steroid physiology, and cosmetic correction (electrolysis) of existing hair growth. Successful management will allow normal socialization of the young woman afflicted with this distressing condition.