Rescue human chorionic gonadotropin for false empty follicle syndrome: optimism for successful pregnancy outcome.

OBJECTIVE: To describe two cases of successful pregnancy after a rescue course of hCG in the setting of false empty follicle syndrome. DESIGN: Case report. SETTING: Academic medical center. PATIENT(S): Two patients undergoing ultrasound-guided oocyte retrieval with failure to obtain oocytes during oocyte retrieval. INTERVENTION(S): Rescue course of hCG with second oocyte retrieval 35 hours later. MAIN OUTCOME MEASURE(S): Live birth. RESULT(S): Two live-birth pregnancies. CONCLUSION(S): Live-birth pregnancies are a realistic possibility after administration of a rescue course of hCG and repeat oocyte retrieval in the setting of false empty follicle syndrome.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with a single septate uterus: a novel anomaly and description of treatment options.

OBJECTIVE: To report a rare Mayer-Rokitansky-Kuster-Hauser (MRKH) anomaly with a septate midline uterus and describe management options. DESIGN: Case report. SETTING: Major academic medical center. PATIENT(S): Two adolescent patients presented with pelvic pain and primary amenorrhea. Radiographic imaging showed evidence of a bicornuate uterus with two uterine horns, cervical hypoplasia, and absence of the upper vagina. INTERVENTION(S): Owing to pain, both patients planned laparoscopy with bilateral hemihysterectomies, but in each case laparoscopy showed evidence of a single midline uterus. Continuous hormone therapy was used to suppress pain and retrograde menstruation. MAIN OUTCOME MEASURE(S): Uterine preservation and future fertility management. RESULT(S): Given the fertility potential, the treatment plan was to continue hormone therapy until adulthood, when the young woman could select a treatment option for herself. After 2 years, one patient elected hysterectomy at age 18.5 due to persistent pain, while the other patient continues uterine preservation. CONCLUSION(S): We present two cases of a rare and uniquely described anomaly of MRKH with a single septate midline uterus. We recommend uterine preservation until the age of 18, at which point the patient may select her treatment option. Novel options include septal resection with subsequent assisted reproductive technology (ART) and cesarean delivery or ART and a gestational carrier.

Effect of endometrioma cyst fluid exposure on peritoneal adhesion formation in a rabbit model.

OBJECTIVE: To determine whether copious lavage and suction of human endometrioma fluid placed in the peritoneal cavity of rabbits reduces adhesion formation compared to no lavage. DESIGN: Prospective, randomized, blinded study. SETTING: Academic research environment. ANIMAL(S): Twenty-four female New Zealand white rabbits. INTERVENTION(S): Rabbits randomized into three groups: [1] laparoscopy with instillation of human endometrioma material, no lavage; [2] laparoscopy with instillation of human endometrioma material, followed by clearance of all visible endometrioma fluid by saline lavage and suction; [3] laparoscopy alone. MAIN OUTCOME MEASURE(S): Six weeks after laparoscopy, adhesions scored by laparotomy using standard visual assessment scoring system and histologic microscopic evaluation. Data evaluated using Kruskal-Wallis and median nonparametric tests. RESULT(S): For groups 1, 2, and 3, respectively, mean total clinical adhesion scores were 0.67 (95% confidence interval [CI] -0.87, 2.2), 3.67 (95% CI 1.27, 6.07), and 0 (95% CI 0, 0). Group 2 had statistically significantly higher mean adhesion scores compared to group 1. Histologic adhesion scores followed the trend of clinical adhesion scores. CONCLUSION(S): In this rabbit model, human endometrioma fluid exposure in the peritoneal cavity is not associated with adhesion formation. Instillation of endometrioma fluid followed by copious saline lavage is strongly associated with adhesion formation.