Outcome of arterial embolization of uterine leiomyoma: case report.

OBJECTIVE: To describe the outcomes after uterine artery embolization treatment of leiomyoma. DESIGN: Case report. SETTING: Department of Gynecology - Federal University of São Paulo. PATIENT: a 34-year-old woman with a diagnosis of leiomyoma for two years. INTERVENTION: embolization of uterine arteries with 500 to 700-microm diameter polyvinyl alcohol particles. MAIN OUTCOME MEASURE: pregnancy and delivery. RESULTS: After embolization, the follow-up revealed a good clinical response with significant reduction in uterus and leiomyoma volume. Also, the patient became spontaneously pregnant, but the delivery was cesarean section due to placenta accreta.. CONCLUSION: Regardless of arterial embolization results for controlling uterine bleeding, this procedure might have some consequences on pregnancy outcome.

High implantation and pregnancy rates with transfer of human blastocysts developed in preimplantation stage one and blastocyst media.

OBJECTIVE: To evaluate the proficiency of preimplantation stage one (P1) and blastocyst media in supporting human blastocyst development and to document implantation and clinical pregnancy rates from the transfer of the normally developed blastocysts. DESIGN: Retrospective clinical study. SETTING: Private IVF unit of a university-affiliated center. PATIENT(S): Twenty-eight women aged 33.7 +/- 2.9 years who underwent IVF treatment for infertility. INTERVENTION(S): Bipronucleate oocytes obtained from IVF and intracytoplasmic sperm injection were cultured in vitro with P1 and blastocyst media for 96-120 hours. One to three embryos were transferred (2.1 +/- 0.2 for the patients who became pregnant and 1.5 +/- 0.3 for those who did not become pregnant). MAIN OUTCOME MEASURE(S): Total number and percentage of developed blastocysts, frequency of blastocysts of grades A and B, and implantation and pregnancy rates. RESULT(S): From 431 oocytes retrieved, 269 bipronucleate oocytes were cultured, producing 81 blastocysts that resulted in the transfer of 54 embryos in 27 procedures. Blastocysts developed in 39.7% +/- 5.5% of the pregnant group and 30.2% +/- 4.5% of the nonpregnant group. From 15 (15/27 = 55.6%) clinical pregnancies, 18 (18/54 = 33.3%) gestational sacs were visualized. The rate of implantation in the pregnant group was 58.1% (18/31). CONCLUSION(S): These results provide evidence for the benefits of extending human embryo culture with P1 and blastocyst media for all normally fertilized embryos in vitro.

Effect of estrogen-progestin hormonal replacement therapy on plasma antithrombin III of postmenopausal women.

BACKGROUND: This study was performed to evaluate antithrombin III levels in postmenopausal women receiving hormonal replacement treatment. METHODS: It is a prospective randomized study concerning 19 postmenopausal patients, aged 40 to 65 years, who received either continuous daily oral equine conjugated estrogen 0.625 mg (group A, N=10) or daily transdermal 17beta-estradiol 50 microg (group B, N=9). Medroxyprogesterone acetate (5 mg/day, 14 days monthly) was given to all patients. Blood samples were obtained before and after 3, 6, 9 and 12 months of treatment. Coagulation tests included Antithrombin III (functional method), prothrombin time, partial activated prothrombin time, thrombin time, factor V, fibrinogen, platelet count and euglobulin lysis time. Friedman analysis of variance and Mann-Whitney test were used for statistical analysis. RESULTS: Antithrombin III level was reduced (p<0.05) in group A but not in group B, although it remained within normal range. No changes were detected in the other coagulation tests. CONCLUSIONS: These data suggest that oral conjugated estrogen replacement reduces functional ATIII, whereas transdermal estradiol replacement therapy does not modify it.

Successful birth after intrafallopian transfer of microhatched embryos.

OBJECTIVE: To present a successful transfer of microhatched embryos to the fallopian tubes via microlaparoscopy. DESIGN: Case report. SETTING: Private practice affiliated with a medical university. PATIENT: A 40-year-old woman with primary infertility, mildly elevated baseline FSH levels, and a history of poor ovarian response to ovulation induction. Her husband had severe oligoospermia after vasectomy reversal. INTERVENTION(S): Late luteal leuprolide acetate to pituitary down-regulation followed by pure FSH, 300 IU, and hMG, 300 IU, daily for ovulation induction. Transvaginal oocyte retrieval, intracytoplasmic sperm injection, assisted embryo hatching, microlaparoscopic intrafallopian ET. MAIN OUTCOME MEASURE(S): Amniocentesis at the 14th week of gestation revealed a normal karyotype (46,XX), birth of a normal female infant (3700 g). RESULT(S): Establishment of a single, viable intrauterine gestation followed by a vaginal delivery at term. CONCLUSION(S): This case shows the possibility of using assisted-hatched embryos for laparoscopic intrafallopian tube transfer.

Polycystic ovary syndrome: clinical and laboratory evaluation.

OBJECTIVE: To evaluate clinically, and with laboratory, tests, women with polycystic ovary syndrome (PCO). PATIENTS: One hundred and twelve women with PCO were studied. METHODS: The following data was recorded: Current age; age at menarche; menstrual irregularity, occurrence of similar cases in the family; fertility, obstetric history; body mass index (BMI); and presence of hirsutism. Serum measurements of follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, free testosterone, and dehydroepiandrosterone sulfate were taken. RESULTS: All patients presented either oligomenorrhea (31 percent), periods of secondary amenorrhea (9 percent), or both alterations (60 percent). The majority of the patients were infertile (75.6 percent). The LH/FSH ratio was higher than 2:1 in 55 percent of the patients and higher than 3:1 in 26.2 percent. The ultrasonographic aspect of the ovaries was considered to be normal in 31 percent. CONCLUSION: The main clinical feature of the PCO is the irregularity of menses since menarche, and that the laboratory tests would be important to exclude other disorders such as hyperprolactinemia or hyperandrogenemia caused by late-onset congenital adrenal hyperplasia.