Serum Anti-Mullerian hormone levels in Turkish girls aged 18 and younger for ovarian reserve determination.

Objective: Our aim was to show that AMH may be used as a quantitative marker of ovarian reserve in Turkish girls aged 18 and younger and establish the reference values for AMH in Turkish girls. Material and Methods: This retrospective study includes girls between ages of 8-18, without premature ovarian failure or without genetic factors resulting in ovarian dysgenesis. Blood specimens were collected after overnight fasting early in the morning during the early follicular phase. Measurement of serum levels of gonadotropins and AMH is done. Mean serum AMH levels of different age groups and best fitting curve representing AMH percentiles (10th, 25th, 50th, 75th, 90th) were calculated. Results: We identified 785 Turkish girls with mean age of 16.16 ± 1.90. The girls were divided into seven age groups. The mean serum AMH level for total cohort is 5.20 ± 4.19 ng/mL. There was statistically significant difference between the mean values of AMH in age groups as follows: £12 and 17-£18 (p=0.011). The best fitting curves for AMH percentiles were 4th order polynomial functions. There is statistically significant correlation of AMH with age and FSH levels (r=0.148, p=0.000 and r=-0.092, p=0.010). Conclusion: Our results reflect the real-life data for serum AMH values in Turkish girls. Our nomogram may be useful for counseling the adolescents about their ovarian reserve and diagnosing other gynecological diseases. A longitudinal study is necessary for improving the predictive value of AMH values in girls aged 18 and younger.

Juvenile granulosa cell tumor: 20 years' experience of a Tertiary Center.

OBJECTIVES: The aim of this study is to share of the 20-year experience of a tertiary center about juvenile granulosa cell tumor (JGCT) and describe clinic manifestations, treatment, and outcome of patients who diagnosed JGCT. MATERIAL AND METHODS: Five patients who diagnosed juvenile granulosa cell tumor between 2000 and 2020 were included in the study. The demographics, clinical findings and outcomes were retrospectively evaluated. Of the 5 patients in our study, one was in the premenarcheal girl. The common complaint in all of our patients was abdominal swelling. In preoperative imaging methods, all patients had unilateral adnexal mass and no signs in favor of metastasis. All patients were staged according to FIGO classification for ovarian tumors; 3 of patients had stage IA disease, one of patients had stage IC1 and one of patients had stage IC2. All patients underwent different surgecal procedures which is appropriate for their clinical manifestations. In addition to surgery 2 patients received adjuvant chemotherapy. RESULTS: The median follow-up period of the patients was 60 mounts and recurrence was observed in two patients who were reoperated. We have no patients who died due to this disease. CONCLUSIONS: Possible diagnosis of juvenile granulosa cell tumor should be kept in mind in a patient of young age with unilateral adnexal mass with benign features.

Complete Hydatidiform Mole and Co-Existing Live Fetus after Intracytoplasmic Sperm Injection: A Case Report and Literature Review.

INTRODUCTION: Twin pregnancy with complete hydatidiform mole and co-existing fetus (CHMCF) is an uncommon obstetric entity and may occur after assisted reproductive technologies. These pregnancies are associated with severe complications for both mother and fetus and the management is challenging. Case Report: We report a twin pregnancy after intracytoplasmic sperm injection (ICSI) treatment with CHMCF which delivered at 26 gestation weeks due to severe preeclampsia. The 625g neonate survived without any complication. The woman had persistent trophoblastic disease with lung metastasis and was treated with single agent methotrexate. We also present a brief review of the literature about the outcomes of CHMCF after ICSI. Conclusion: CHMCF may occur after ICSI treatment. Pregnancies with CHMCF are associated with severe complications however under close follow-up successful outcomes could be achieved in such pregnancies.

Conservative management of 11 weeks old cervical ectopic pregnancy with transvaginal ultrasound-guided combined methotrexate injection: Case Report and Literature Review.

INTRODUCTION: The ultimate treatment approach for cervical ectopic pregnancy remains controversial. Gestational age, serum ß-hCG levels, fetal cardiac activity presence and the patient's claim for fertility preservation are the major challenges for method of choice in each individual case. Medical treatment may be a favorable option for the treatment of late diagnosed cases, as well as the early ones. PRESENTATION OF CASE: In this case report, we aim to present a case of 10 4/7 weeks of cervical ectopic pregnancy successfully treated with transvaginal ultrasound-guided local and systemic methotrexate injection. DISCUSSION: The case presented here is exceptional because even though the advanced gestational age, presence of fetal cardiac activity and high serum ß-hCG values, the abortion has occurred successfully. Conservative treatment without any need of further surgical intervention was sufficient for full recovery with the preservation of reproductive capacity. CONCLUSION: In conclusion, transvaginal ultrasound guided local and systemic methotrexate injection may be performed successfully for the cases of advanced gestational age with fetal cardiac activity and high serum ß-hCG levels.

Morphological Changes of Trichomonas vaginalis Treated by Ornidazole: An In-Vitro Study.

BACKGROUND: Nitroimidazoles, which are drugs that are used to effectively treat Trichomonas vaginalis, alter the structure of the T. vaginalis cell membrane, penetrate into its cytoplasm and nucleus and block cellular metabolism. In this study, we observed the morphological changes that occurred in T. vaginalis during in vitro exposure to 1.3 µg/mL of ornidazole at various time intervals ranging from 10 minutes to 10 hours. METHODS: Vaginal and urethral secretion samples from suspected T. vaginalis cases were inoculated into Cysteine Peptone Liver Maltose medium. In 18 sterile tubes, 9.5 mL of this solution were mixed with 0.5 mL of ornidazole. The periods of contact between ornidazole and T. vaginalis ranged from 10 minutes to 10 hours. RESULTS: The first change was vacuolization, which started in the 10th minute of exposure. The glycogen particles started to diminish in the 20th minute. CONCLUSIONS: During exposure to 1.3 mg/L of ornidazole, cell lysis began in the 30th minute and accelerated towards the 60th minute (p < 0.001). Cytoplasmic matrix integrity was impaired in the 60th minute (p < 0.001).

Homocysteine in embryo culture media as a predictor of pregnancy outcome in assisted reproductive technology.

The aim of this study was to determine whether homocysteine (hcy) concentrations in embryo culture media correlate with pregnancy outcome in assisted reproductive technology (ART) cycles. Forty patients who underwent single embryo transfer at the infertility clinic of a tertiary care center were recruited for this case-control study. Spent embryo culture media from all patients were collected after single embryo transfer on day 3 (n = 40). Hcy concentrations in embryo culture media were analyzed by enzyme cycling method. Patients were grouped according to the diagnosis of a clinical pregnancy. Sixteen patients were pregnant while 24 patients failed to achieve conception. Mean Hcy levels in the culture media were significantly different between the groups (p < 0.003), as 4.58 ± 1.31 µmol/l in the non-pregnant group and 3.37 ± 0.92 µmol/l in the pregnant group. Receiver operator curve analysis for determining the diagnostic potential of Hcy for pregnancy revealed an area under the curve of 0.792 (confidence interval: 0.65-0.94; p < 0.05). A cut-off value of 3.53 µmol/l was determined with a sensitivity of 83.3%, and a specificity of 68.8%. Lower hcy levels were associated with a better chance of pregnancy and better embryo grades. Hcy may be introduced as an individual metabolomic profiling marker for embryos.

Anti-müllerian hormone levels as a predictor of the pregnancy rate in women of advanced reproductive age.

PURPOSE: To investigate whether serum anti-müllerian hormone (AMH), follicle stimulating hormone (FSH), or antral follicle count (AFC) are predictive for clinical pregnancy in women who underwent IVF cycles at the age of 35 and older METHODS: A total of 240 consecutive women who underwent IVF cycles at the age of 35 and older were enrolled in this crsoss- sectional study. Pregnant and nonpregnant women were compared. RESULTS: The median AMH level of pregnant women was higher than non-pregnant women [3.20 (0.63-9.60) vs 1.15 (0.01-14.90) ng/ml, p < 0.001]. On logistic regression analysis, AMH was an independent predictor of clinical pregnancy rate (CPR) (OR 1.353; 95 % CI 1.141-1.605; P < 0.001). After controlling for the other independent variables (the number of retrieved oocytes, AFC and age), the significant association between AMH and clinical pregnancy rate remained strong (OR 1.677; 95 % CI 1.216-2.311; p = 0.002) on multivariate logistic regression analysis. CONCLUSIONS: AMH is an effective measure of quantitative ovarian reserve and it can predict ovarian response to controlled stimulation for advanced age women. The CPR tends to increase as AMH increases.

Notch signaling pathway in cumulus cells can be a novel marker to identify poor and normal responder IVF patients.

PURPOSE: To identify expression of Notch signaling proteins and its ligands in human cumulus cells which were obtained by follicle aspiration and to compare the differences of this protein expression between the normal and poor responder patients. METHODS: 47 patients who applied to the assisted reproductive treatments with various infertility problems were included to the study. Controlled ovarian hyperstimulation was performed by using GnRH agonist and gonadotropins. Serum hormon levels were measured by using Chemilluminescent Microparticle Immunoassay method for each patient. After ultrasonographic ovarian follicle screening, oocytes were retrievaled. Cumulus cells obtained from the follicles were cultured for 72 h and immunuhistochemistry were performed for Notch1, Notch2, Notch3, Notch4, Jagged1 and Jagged2 proteins. Histological score (HSCORE) were applied to all of the samples. The association between Notch and its ligands protein expressions and the oocyte-embryo quality and fertilization rates were investigated. RESULTS: Significant differences were observed between the mean values of age, AMH and FSH in the 2 groups, respectively (p < 0.05). However, the mean female infertility duration and total gonadotropin dose did not differ significantly between normal and poor responder groups. All the patients cumulus cells expressed Notch1, Notch2, Notch3, Notch4, Jagged1 and Jagged2. There was a significant difference (p < 0.05) only for Notch2 between the 2 groups and a positive correlation between Notch2 and Notch3 (r = 547, p = 0.00) expressions were noted. Furthermore, no correlations were observed between the following: Notch1, Notch2, Notch3, Notch4, Jagged1, and Jagged2 expression; mature oocyte number; fertilization rates, and embryo quality percentage in both of the groups. CONCLUSION: Notch signalling proteins can be an indicator for understanding the ovarian response in ovulation induction.

Anti-Müllerian hormone and polycystic ovary syndrome: assessment of the clinical pregnancy rates in in vitro fertilization patients.

OBJECTIVE: The purpose of this study is to investigate the role of serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and antral follicle count (AFC) for the prediction of clinical pregnancy rates (CPR) in women with polycystic ovary syndrome (PCOS) undergoing IVF treatment. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENTS: One hundred and fifty consecutive women with PCOS. INTERVENTIONS: All women underwent controlled ovarian stimulation with long agonist protocol followed by IVF procedure. Outcomes of pregnant and non-pregnant groups were compared. MAIN OUTCOME MEASURE: CPR; AMH, FSH and AFC means and percentiles. RESULTS: Fifty-one (34%) clinical pregnancies were observed in 150 women. Mean AMH was 6.7 ± 2.8 and 7.1 ± 4.3 ng/mL in pregnant and non-pregnant women, respectively (p = 0.594). The CPR were 27.8%, 35.0% and 37.8% in <25%, 25%-75% and >75% AMH percentiles, respectively (p = 0.656). There were also no significant difference in mean FSH and AFC between pregnant and non-pregnant women (p = 0.484 and p = 0.165, respectively). CONCLUSION: AMH, FSH and AFC are not predictive for CPR in women with PCOS undergoing IVF treatment. Mean AMH values were not significantly different between pregnant and non-pregnant women. Although CRP increased in parallel with the raise in AMH percentiles, this remained insignificant.

The association between homocysteine in the follicular fluid with embryo quality and pregnancy rate in assisted reproductive techniques.

PURPOSE: To investigate the association between follicular fluid homocysteine levels and embryo quality and pregnancy rates in patients undergoing assisted reproduction. METHODS: Fifty infertile women who were admitted to our clinic were enrolled in the study. Ovulation induction was performed by using GnRH agonist and gonadotropins. For each patient, homocysteine level in the follicular fluid was measured by using nephelometric method after the oocyte pick-up. The association between the homocysteine concentration in the follicular fluid and the oocyte-embryo quality, pregnancy rates and hormone levels were investigated. RESULTS: Mean ± SD Hcy was 9.6 ± 2.02 µmol/L and 14.9 ± 2.93 µmol/L in pregnant and non-pregnant women, respectively (p < 0.0001). There were no statistically significant differences between pregnant and non-pregnant women in mean age, duration of infertility, body mass index, the oocyte-embryo quality parameters, and hormone levels. Homocystein did not have any correlation with M2, late M2, and total number of oocytes, number of fertilized oocytes and transferred embryos, and embryo quality grade. Area under curve (AUC) of hcy for prediction of pregnancy failure was 0.922 (p = 0.0001, 95% Confidence interval 0.85-0.99). A threshold of 11.9 µmol/L of hcy had a sensitivity of 82%, specificity of 100%, positive predictive value of 100% and negative predictive value of 91.6% for prediction of pregnancy failure. The subgroup analysis in male factor infertility group (n = 28), showed that mean homocystein was 9.9 ± 2.44 µmol/L and 14.1 ± 2.72 µmol/L in pregnant and non-pregnant women, respectively (p = 0.002). CONCLUSION: Low follicular fluid homocysteine level is associated with a better chance of clinical pregnancy.

Recurrent implantation failure is more frequently seen in female patients with poor prognosis.

BACKGROUND: This study evaluated the characteristics and results of patients who suffer from recurrent implantation failure (RIF). MATERIALS AND METHODS: In this cross sectional study, a total of 2183 cases who were evaluated retrospectively at the Istanbul University Cerrahpasa Medical Faculty, Department of Obstetrics and Gyneacology, IVF unit between 2000-2007. According to the data gathered, we included 1822 cases in this study. We compared 185 patients with RIF to 1637 women without RIF. RESULTS: Pregnancy was achieved by 589 couples out of 1822 (32%). The implantation rate was 10%, which declined to 5.8% after the fourth attempt. In the RIF group, patients' mean age was higher and there were more overweight women, the duration of fertility was longer, day 3 follicle stimulation hormone (FSH) levels and the total gonadotropin dose administered were higher, mean level of Estradiol (E2) on the human chorionic gonadotropin (hCG) day was lower, and the mean level of progesterone on the hCG day was elevated compared to the non-RIF group. Although the comparison of MII oocyte number was not significant, the mean number of fertilized oocytes was found to be significant in favor of the non-RIF group. The endometrial thicknesses were found to be similar for both groups. Comparison of sperm motility and morphology were statistically significant in favor of the RIF group. CONCLUSION: In our study, we have found that the group with RIF were comprised of patients with poor prognosis who were older, overweight, had a longer infertility duration, a higher FSH level, and needed more gonadotropin doses in controlled ovarian hyperstimulation (COH). Sperm motility and morphology were better in the RIF group compared to the non-RIF group, and multiple pregnancy rates were lower in RIF patients.

Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles.

OBJECTIVE: To evaluate predictive role of day-3 serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) in ovarian hyperstimulation syndrome (OHSS) in patients undergoing IVF/ICSI cycles. MATERIALS AND METHODS: Forty-one women with moderate/severe OHSS and 41 age matched women without OHSS were compared to evaluate the predictive value of certain risk factors for OHSS. AFC, and E(2), FSH, LH, AMH, inhibin-B levels measured on day 3 of the menstrual cycle before controlled ovarian hyperstimulation. RESULTS: Mean FSH was significantly lower (p < 0.0001); and mean LH, AFC and AMH were significantly higher in women with OHSS compared to women without OHSS (p = 0.049, p < 0.0001 and p < 0.0001, respectively). There was no significant difference in inhibin B (p = 0.112) and estradiol (p = 0.706) between the groups. The ROC area under curve (AUC) for AMH presented the largest AUC among the listed risk factors. AMH (AUC = 0.87) and AFC (AUC = 0.74) had moderate accuracy for predicting OHSS while Inhibin B (AUC = 0.58) and LH (AUC = 0.61) had low accuracy. The cut-off value for AMH 3.3 ng/mL provided the highest sensitivity (90%) and specificity (71%) for predicting OHSS. It's positive (PPV) and negative predictive values (NPV) were 61% and 94%, respectively. The cut-off value for AFC was 8 with 78% sensitivity, 65% specificity, 52% PPV and 86% NPV. CONCLUSION: Measurement of basal serum AMH and AFC can be used to determine the women with high risk for OHSS.

[Comparing the occurrence of Trichomonas vaginalis infections today to ten years ago among women prostitutes and gynecology and obstetrics patients in Istanbul]. / Istanbul'da Kadin Hastaliklari Hastalari ile Hayat Kadinlarinda Trichomonas vaginalis Görülme Sikliginin 10 Yil Önceki Oranla Karsilastirilmasi

OBJECTIVE: Trichomonas vaginalis is is a monoxenous parasite which lives in human urogenital systems and causes sex transmitted disease through human sexual contact. Disease frequency has been seen at different rates in different communities or in the same community depending on people's sociocultural status. Previously we made a study for determining prevalence of T. vaginalis infection in woman living in Istanbul. We made this present study for determining any difference in prevalence in comparison to the results of ten years earlier. METHODS: A total number of 207 vaginal discharge samples which were collected from two different hospitals, (93 from Venereal Diseases Hospital [VDH] and 114 from Cerrahpasa Ob&Gyn Clinic), were evaluated under direct microscopy and were cultured for T. vaginalis in a Cystein-Peptone-Liver-Maltose (CPLM) medium. RESULTS: T. vaginalis was observed under direct microscopy and grew in culture in 2 (0.97%) of 207 vaginal discharge samples [1 (1.1%) patient from VDH and 1 (0.9%) patient from Cerrahpasa]. CONCLUSION: The incidence of trichomoniasis has significantly decreased compared to the year 2000 in both VDH and Cerrahpasa populations (p=0.038) according to X2 test results. This epidemiologic study shows the importance of social development in the incidence of infectious diseases.

An alternative treatment option in tubal ectopic pregnancies with fetal heartbeat: aspiration of the embryo followed by single-dose methotrexate administration.

OBJECTIVE: To present 13 cases of unruptured tubal ectopic pregnancies successfully treated with ultrasound-guided aspiration and local and systemic methotrexate (MTX) administration. DESIGN: Case series. SETTING: University hospital. PATIENT(S): Thirteen women with an unruptured tubal ectopic pregnancy. INTERVENTION(S): Transvaginal ultrasound-guided aspiration of the tubal ectopic pregnancy followed by MTX administration into the gestational sac (half of the calculated total dose of 25 mg/m(2)) and intramuscular injection (the remaining half of the calculated total dose of 25 mg/m(2)). MAIN OUTCOME MEASURE(S): Recovery of the patients, successful conservative treatment of the tubal ectopic pregnancies with preservation of the fallopian tubes. RESULT(S): Twelve (92%) of 13 women were successfully aborted, without need for salpingectomy or salpingostomy. CONCLUSION(S): Transvaginal ultrasound-guided aspiration of fetus followed by local and systemic methotrexate administration can be safely used to treat unruptured tubal ectopic pregnancies.

Randomized trial of oral misoprostol treatment for cervical ripening before tandem application in cervix cancer.

PURPOSE: To investigate the efficacy of oral misoprostol administered to facilitate tandem application to the cervix as a part of brachytherapy in patients with cervical cancer. METHODS AND MATERIALS: Eighty patients with cervical cancer who had been planned to undergo brachytherapy at Dr. Lütfi Kirdar Kartal Training and Research Hospital were evaluated in a double-blind, prospective, randomized trial. Patients were divided randomly into two groups of 40 patients. The first and second groups received 400 µg of misoprostol orally and placebo, respectively, 3 h before tandem application. The two groups were compared in terms of age, diameter of tumor, parity, age at first intercourse, amount of bleeding and pain at first tandem application, length of endometrial cavity measured by hysterometer, and size of Hegar dilators used for cervical dilatation. RESULTS: Of all cases, 63.6%, 16.3%, 10%, 6.3%, 2.5%, and 1.3% were Stage IIB, IIIB, IIIA, IVA, IIA and IIC, respectively. Mean (±SD) age (range) was 49.3 ± 13.1 (25-83) years and 56.6 ± 13.2 (30-78) years in the study and control groups, respectively (p = 0.015). Age at first intercourse, diameter of tumor, parity, amount of bleeding at first tandem application, and length of endometrial cavity measured by hysterometer were not significantly different between the two groups. Pain score was significantly higher in the control group (p < 0.001). Application was significantly easier in the study group compared with controls (p < 0.001). Average size of initial Hegar dilators used for cervical dilatation was significantly higher in the study group compared with controls (p = 0.017). CONCLUSION: Administration of misoprostol 400 µg orally for cervical ripening before tandem application facilitates the procedure, increases patient tolerability and comfort, and may decrease complication rates.

Surgical transpositioning of ectopic ovarian tissue and pregnancy.

OBJECTIVE: Our objective was to report transpositioning an ectopic ovary, successfully using the assisted reproduction technique (ART), with the outcome of retrieving an oocyte from the transpositioned ovary during ART. CASE REPORT: The couple, presenting with a history of 2 years of secondary infertility, was admitted to our hospital. Two years earlier, the patient had undergone a left salpingo-oophorectomy for a ruptured ectopic pregnancy. The right ovary had not been detected during the previous operation. During surgery, we observed that the right ovary was attached to the posterior abdominal wall near the hepatic flexura. It was repositioned, moved, placed and fixed to the posterior wall of the uterus. One follicle developed and was retrieved from the transpositioned ovary during in vitro fertilization. The patient now has a healthy ongoing singleton pregnancy. CONCLUSION: An ectopic ovary is an extremely rare gynecological entity. Transpositioning an ectopic ovary should be kept in mind as a possible procedure for the management of patients presenting with infertility where the other ovary is absent or does not respond to controlled ovarian hyperstimulation treatment.

The investigation of fetal doses in mantle field irradiation.

To determine clinically the fetal dose from irradiation of Hodgkin's disease during pregnancy and to quantify the components of fetal dose using phantom measurements. The fetal dose was measured with phantom measurements using thermoluminescent dosemeters (TLDs). Phantom measurements were performed by simulating the treatment conditions on an anthropomorphic phantom. TLDs were placed on the phantom 41, 44, 46.5 and 49.5 cm from the centre of the treatment field. Two TLDs were placed on the surface of the phantom. The estimated total dose to all the TLDs ranged from 8.8 to 13.2 cGy for treatment with (60)Co and from 8.2 to 11.8 cGy for 4 MV photons. It was concluded that the doses in different sections were evaluated to investigate dose changes in different points and depths of fetal tissues in phantom. Precise planning and the use of supplemental fetal shielding may help reduce fetal exposure.

Expression and comparison of gap junction protein connexin 37 in granulosa cells aspirates from follicles of poor responder and nonpoor responder patients.

OBJECTIVE: To localize gap junction protein connexin 37 (Cx37) in granulosa cells obtained from aspiration of follicles, and to compare differences between poor responder and nonpoor responder patients in assisted reproductive technology. DESIGN: Prospective clinical study. SETTING: IVF unit of a university hospital. PATIENT(S): Seventy patients with various causes of infertility, undergoing an IVF treatment. INTERVENTION(S): Controlled ovarian hyperstimulation, serum hormone level measurements, ultrasonography scanning of ovarian follicles, oocyte retrieval after hCG administration and embryo transfer. MAIN OUTCOME MEASURE(S): Outcome of the IVF treatment and expression rate of Cx37 in granulosa cells. RESULT(S): Connexin 37 was expressed in the granulosa cells of all the patients. Connexin 37 rate in granulosa cells in the poor responder group was 81.32 +/- 35.86% (distribution: 2.95%-99.9%), while it was 88.98 +/- 23.73% (distribution: 6.30%-100.00%) in the nonpoor responder group. Connexin 37 rates between the two groups were not significantly different. CONCLUSION(S): Connexin 37 is expressed in the granulosa layer of follicles in the human ovary, and expression of Cx37 in granulosa cells was not different between poor responder and nonpoor responder patients.

Transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose for treatment of unruptured tubal heterotopic pregnancy.

OBJECTIVES: To report a case of tubal heterotopic pregnancy (HP) treated conservatively with transvaginal ultrasound-guided aspiration and instillation of hyperosmolar glucose. METHODS: Aspiration of the tubal ectopic pregnancy and hyperosmolar glucose instillation was performed with a 16-gauge needle under transvaginal ultrasound guidance. RESULTS: Unruptured tubal HP with positive cardiac activity was treated successfully without any further interventions, and intrauterine pregnancy has reached full-term without any complications. CONCLUSIONS: Early diagnosis of this life-threatening condition is the key to its successful treatment. Transvaginal ultrasound-guided aspiration and hyperosmolar glucose injection can be safely performed for the treatment of unruptured tubal HP.