A rare case of rectovaginal fistula following consensual vaginal intercourse.

INTRODUCTION: Postcoital nonobstetric vaginal lacerations due to consensual sexual act are generally minute mucosal tears. In some cases, the vaginal mucosa is lacerated deeper and the bleeding may require suturing of opened vessel ends or even transfusion. AIM: The aim of this case report is to present a rare case of acute fistula formation by penile penetration through the full thickness of the rectovaginal wall after consensual vaginal intercourse and to its management in emergency settings. METHODS: We report a rare case of isolated rectovaginal laceration sparing anal sphincters and perineumin a 24-year-old woman following her second consensual vaginal intercourse with her new partner. Speculum examination demonstrated a 4 cm laceration on the left posterior vaginal wall forming a fistula between the rectum and vagina, 2 cm above the hymenal ring and not extending to the posterior fornix or perineum. Three layer suturing of rectal, vaginal mucosa, and rectovaginal septum was enough to treat the acute fistula in this case. RESULTS: After 2 months follow-up, we observed the complete healing of the rectovaginal laceration with no fistula formation and the patient resumed her sexual activity. Long term follow-up of patients is necessary to observe complete healing and to ensure the absence of a chronic fistula formation. CONCLUSION: Simple suturing of rectal and vaginal mucosa, appropriate antiseptic precautions, and antibiotic coverage are enough to treat acutely formed low rectovaginal fistulas resulting from coitus. Decision to form colostomy and diversion of feces in the repair of such injuries should be taken cautiously.

Effects of coasting on the outcome of intracytoplasmic sperm injection-embryo transfer cycles.

OBJECTIVES: To determine the effects of 'coasting' on the outcome of controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection-embryo transfer (ICSI-ET). DESIGN: Retrospective study. SETTING: IVF Centre, Ozel Ege Tup Bebek Merkezi, Izmir, Turkey. SAMPLE: Twenty-six coasted and 52 non-coasted COH and ICSI-ET patients were enrolled in this retrospective study. METHODS: Coasted patients were enrolled consecutively during the study period, and two non-coasted controls were selected from our database for each coasted patient. Coasting was decided when serum oestradiol level was > or = 4000 pg/mL. Groups were compared using chi2 and Mann-Whitney U-tests for statistical analysis. MAIN OUTCOME MEASURES: Number of oocytes collected, metaphase II (MII) oocytes and cleaving embryos, the fertilisation rate and clinical pregnancy rate were the main outcome measures. RESULTS: Number of oocytes collected, number of MII oocytes, number of cleaving embryos, fertilisation rate and clinical pregnancy rate for the coasted and non-coasted groups were 15.5 +/- 5.2 and 14.0 +/- 7.1, 9.7 +/- 4.8 and 9.3 +/- 3.9, 6.8 +/- 3.9 and 5.8 +/- 3.1, 0.85 +/- 0.18 and 0.78 +/- 0.18, 13/26 and 24/52, respectively; these differences were not statistically significant. None of the patients in the coasted group were hospitalised for signs or findings of severe ovarian hyperstimulation syndrome. CONCLUSIONS: Coasting does not adversely affect the number and the function of mature oocytes and the clinical pregnancy rate.

The effect of mid-luteal estradiol level on the outcome of ICSI-ET cycles.

METHODS: We investigated if mid-luteal estradiol levels could predict the outcome in intracytoplasmic sperm injection embryo transfer (ICSI-ET) cycles ( n=231). Pregnant and non-pregnant women were compared regarding their peak estradiol levels on human chorionic gonadotropin (hCG) injection day, and mid-luteal estradiol levels on the 7th day following oocyte recovery. Pregnancy rates of the groups that were designed according to the "peak/mid-luteal estradiol level" and the mid-luteal estradiol levels were also compared. RESULTS: Peak and mid-luteal estradiol levels in pregnant women were higher than in non-pregnant women in all patients, although the difference between peak and mid-luteal estradiol levels were similar in pregnant and non-pregnants. Pregnant women had higher mid-luteal estradiol levels in good responders, but the peak estradiol levels of pregnant and non-pregnant women were similar. In poor responders, pregnant and non-pregnant women were similar with respect to peak and mid-luteal estradiol levels. Both in all patients and good responders, women with mid-luteal estradiol levels <200 pg/ml had lower pregnancy rates than those with >2000 pg/ml. Peak/mid-luteal estradiol ratios of pregnant and non-pregnant women were not significantly different in all patients, good responders and poor responders; although a tendency for a lower ratio in pregnants was encountered in good responders. Pregnancy rates of the groups according to the "peak/mid-luteal estradiol ratio" were similar; in all patients, good responders and poor responders. CONCLUSION: A relation between the mid-luteal estradiol level and the outcome is encountered only in good responders.