Clinical features and management of women with Mayer-Rokitansky-Küster-Hauser syndrome in a Thai population.

OBJECTIVE: This study aimed to describe the clinical features, associated extragenital anomalies, and management of Mayer- Rokitansky-Küster-Hauser (MRKH) syndrome in a Thai population. METHODS: This retrospective study analyzed the medical records of 96 patients with MRKH syndrome diagnosed and treated at a university hospital and tertiary referral center in southern Thailand between 2000 and 2022. RESULTS: The study included 96 patients with MRKH syndrome. The most common symptom was primary amenorrhea (88.5%), followed by difficulty or inability to engage in sexual intercourse (9.4%) and pelvic mass (2.1%). Notably, 80.3% of the patients did not have extragenital malformations and were diagnosed with MRKH type I (typical form), whereas 19.7% were categorized as MRKH type II (atypical form). Skeletal malformations were the most frequent extragenital anomalies and were present in 19.5% of patients, with scoliosis being the most common skeletal condition. Other extragenital malformations included renal (8.5%) and neurological (1.0%) abnormalities. Clinical vaginal examination revealed complete atresia in 21.8% and vaginal hypoplasia (median vaginal length, 3 cm) in 78.2% of the patients. Half of the patients did not receive treatment because they had not engaged in sexual intercourse. In this cohort, 41.7% of the patients had no difficulty performing sexual intercourse. Hence, self-dilation therapy or concomitant dilation was recommended. Only eight patients (8.3%) underwent surgical reconstruction of the vagina. CONCLUSION: This study confirmed the complexity and heterogeneity of the phenotypic manifestations of MRKH, including the degree of vaginal atresia and types and rates of associated malformations.

Comparison of hyaluronan binding assay scores of spermatozoa using swim-up techniques and density gradient centrifugation.

OBJECTIVE: To compare the hyaluronan binding assay (HBA) scores of sperm preparation using two different methods, the swim-up technique and density gradient centrifugation (DGC). MATERIALS AND METHOD: This experimental study used semen specimens from 54 volunteer subjects with normal semen analysis according to the 2010 World Health Organization criteria. Each semen specimen was split into two portions: one was prepared using the swim-up method and the other the DGC method. The prepared sperm were counted in the sperm-HBA slide to determine bound and unbound motile sperm. The HBA scores between the two methods were compared using matched analysis. RESULTS: The HBA scores by either preparation method were >80%. There was no statistically significant difference in HBA scores between the swim-up preparation [median 97%, interquartile range (IQR) 94, 98] and density gradient centrifugation [median 96%, IQR 95, 98] (p = 0.96). Ten ofthe 54 specimens received the same HBA scores following the two methods and none differed by more than +/- 7%. CONCLUSION: Both preparation methods gave high HBA scores with no apparent difference in the proportions between methods.

Comparison of the TINTARA uterine manipulator with the Cohen cannula in gynecologic laparoscopy.

OBJECTIVE: To assess the efficacy of the TINTARA uterine manipulator and the Cohen cannula for gynecologic laparoscopy. MATERIAL AND METHOD: Sixty women scheduled for laparoscopy were randomized for use of TINTARA (n = 30) or Cohen (n = 30) as a uterine manipulator. The degree of anterior and lateral deviation of the uterus, operative time, surgical complications and ease of use were recorded and compared between the two groups. RESULTS: The mean ranges of anterior and lateral deviation of the uterus in TINTARA and Cohen groups were 61.17 +/- 19.37 vs. 49.33 +/- 22.58 degrees (p = 0.033) and 107.03 +/- 39.68 vs. 85.5 +/- 37.52 degrees (p = 0.035) respectively. The percentage of patients having dye leakage from the cervix in the Cohen group was greater than in the TINTARA group, but the difference was not statistically significant. Both instruments provided similar ease of use. Complications were not found in either group. CONCLUSION: TINTARA was found to have more advantages than the Cohen in moving the uterus in both anterior and lateral directions.

Sperm motility stimulation and preservation with various concentrations of follicular fluid.

PURPOSE: The purpose of this study is to evaluate the optimal concentrations of follicular fluid (FF) for sperm motility stimulation and preservation. METHODS: Thirty normal semen samples and FF from women in an in vitro fertilization programme were used in an experiment. The semen was processed and incubated in Earle culture media with 20, 50, 80, and 100% FF (v/v) with controls. Sperm motility was evaluated and followed up for 48 h. RESULTS: FF could stimulate progressive sperm motility at all concentrations and last for at least 12 h. However, at more than 50% v/v of FF, sperm demonstrated a rapid decline in progressive motility after 12 h of incubation compared to other concentrations and the control group. CONCLUSION: FF can stimulate the sperm motility properly at not more than 50% (v/v) concentration.

Outcomes of multifetal pregnancies.

AIM: To determine the outcomes of multifetal pregnancies and to compare maternal and neonatal complications between spontaneously conceived and assisted reproductive therapy. METHODS: A retrospective analysis was conducted of the information from medical records relating to all multifetal pregnancies. The outcomes were analyzed and used for a comparison between spontaneous and assisted multifetal pregnancies. RESULTS: There were 387 multifetal pregnancies during the study period, which was 1.3% of all the deliveries; 334 cases (86.3%) were spontaneous conceptions and 53 cases (13.7%) were the result of assisted reproductive therapy. Higher-order fetuses (> or =3) represented 8% of all multifetal pregnancies, 13% in the spontaneous group and 87% in the assisted group. The overall cesarean delivery rate was 73.9%. The assisted reproductive therapy group had a cesarean rate of 90.6% compared with 71.3% in the spontaneous group (P = 0.008). The assisted multifetal pregnancy group had more preterm labors and a longer maternal hospital stay than the spontaneous group. One maternal death occurred in the assisted group. The main causes of early neonatal death were prematurity, infection and congenital malformation. The newborns in the assisted group had more complications than the spontaneous group; most notable were respiratory distress syndrome, newborn intensive care admission, infection and longer hospital stay (6 days vs 15 days, P < 0.001). More complications occurred in higher-order fetuses than with twins. CONCLUSIONS: Assisted multifetal pregnancies were more likely to be delivered by cesarean section and had a higher rate of higher-order fetuses, preterm birth and neonatal prematurity-related complications with a longer hospital stay in both mothers and newborns, than spontaneous multifetal pregnancies.

Endometrial thickness screening in premenopausal women with abnormal uterine bleeding.

AIM: To assess the role of measuring endometrial thickness by transvaginal ultrasonography (TVS) as a screening tool for abnormal uterine bleeding triage in premenopausal women. METHODS: Between November 2002 and October 2004, endometrial thickness was measured by TVS in 111 premenopausal women with non-cyclic abnormal uterine bleeding before dilatation and curettage. RESULTS: Of the 111 women, 31 (27.9%) had an abnormal endometrium (hyperplasia 13.5%, polyps 5.4%, submucous myoma 5.4%, and adenocarcinoma 3.6%). An endometrial thickness of 8 mm showed optimal sensitivity and specificity (83.9% and 58.8%, respectively) and 90.4% negative predictive value (NPV) for an abnormal endometrium. When submucous myoma was excluded, the sensitivity, specificity, and NPV were 80%, 53.8%, and 89.6%, respectively. CONCLUSION: Endometrial thickness of 8 mm or less is less likely to be associated with malignant pathologies in premenopausal uterine bleeding.

Spontaneous intra-abdominal bleeding during pregnancy.

Two cases of spontaneous hemoperitoneum caused by ruptured uterine vessels plexus during the second and third trimester of pregnancy were reported. All presented with acute abdominal pain. Emergency exploratory laparotomy and suture-ligation were performed One case had a recurrent intra-abdominal bleeding. The outcomes were good. One infant had complications from prematurity and both were discharged in good condition.