Optimizing the modified laparoscopic Vecchietti procedure.

OBJECTIVE: To enhance the modified laparoscopic Vecchietti procedure. MATERIALS AND METHODS: A case series of five women with Mayer-Rokitansky-Küster-Hauser syndrome at the Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia underwent the modified laparoscopic Vecchietti procedure with intraperitoneal placement of sutures. This involved perforation of the vaginal dimple by a straight thread guide with two threads attached to the olive followed by pulling the two threads intra-peritoneally and through the abdominal wall to the traction device by grasping instruments under laparoscopic control. RESULTS: Intraperitoneal placement of the sutures was easily done without complications in all five women. The operative time was 50 ± 10 (mean ± SD) minutes. After five postoperative days, the average vaginal length was seven to 7.5 cm. Two women were able to have vaginal intercourse without problems. After six months to one year of follow up, the vaginal length was at least ten cm and no postoperative complications occurred. CONCLUSIONS: Intraperitoneal placement of sutures makes the modified laparoscopic Vecchietti procedure easy and appealing. Furthermore, it avoids potential damage to the vital structures at the pelvic side walls.

Psychosexual and social consequences in a woman with undiagnosed Mayer-Rokitansky-Küster-Hauser syndrome.

PURPOSE: To report a woman with devastating psychosexual and social consequences as a result of undiagnosed Mayer-Rokitansky- Küster-Hauser syndrome (MRKH) syndrome. MATERIALS AND METHODS: An 18-year-old woman was referred after being divorced for "absent vagina and uterus". On examination, secondary sexual characteristics were normal. Vaginal and rectal examinations revealed absent vagina and uterus. Investigations showed normal hormonal profile, 46 XX karyotype, and normal intravenous pyelography. Pelvic ultrasonography and magnetic resonance imaging (MRI) confirmed the absence of the uterus and presence bilateral ovaries. RESULTS: A diagnosis of MRKH syndrome was made and she underwent successful modified laparoscopic Vecchietti operation for creation of a new vagina. Vaginal dilators were used after the surgery. Two years of follow up confirmed that vaginal length was about ten cm. CONCLUSION: The proper diagnosis, counseling, and prompt treatment of MRKH syndrome can prevent tragic consequences.

Infertility and endometriosis: a need for global management that optimizes the indications for surgery and ART.

Endometriosis causes pelvic pain and infertility. Infertility results from effects of endometriosis exerted in the pelvic cavity, in the ovaries and/or on the uterus. Medical treatment effective on pain and at preventing disease recurrence following surgery is of no use for improving the chances of conceiving naturally. Surgery however improves the chances of conceiving in the 12-18 months afterward. Endometriosis through extension of the disease to the ovaries may harm ovarian response to COS needed in ART. Surgery for endometrioma(s) may further reduce ovarian responses to COS in case of endometriosis. Remarkably however, reduced ovarian responses due to endometriosis are not necessarily associated with reduced oocyte quality and ART outcome. Pre-ART treatment with oral contraceptives (OC) improves ART outcome in case of ovarian endometriosis particularly, if endometriomas are present at the time of oocyte retrieval. This measure requires however that a proper OC-FSH/hMG interval is respected and that "LH" effects are provided during the ovarian stimulation, using either hMG or small doses of hCG. These latter precautions prevent the adverse outcome reported in case of pre-ART use of OC when ovarian stimulation is conducted using r-FSH exclusively.