Heterotopic Gestation with Twin Intrauterine Implantation Following Transfer of Three Developmentally-delayed Embryos from Cryopreserved Oocytes: A Case Report.

BACKGROUND: In vitro fertilization (IVF) data suggest improved live birth rates for embryos transferred at the blastocyst versus the cleavage stage. Embryos that have not reached the blastocyst stage by day 5 postthaw have diminished potential for implantation and live birth. Few data exist regarding embryogenesis and optimal timing of transfer for embryos derived from previously cryopreserved oocytes, but we report the case of 100% implantation following transfer of 3 developmentally-delayed embryos derived from cryopreserved oocytes. CASE: A 38-year-old woman cryopreserved 20 oocytes for the purpose of future childbearing. At age 42 she returned to thaw and fertilize 8 oocytes using donor sperm. Embryos were cultured to day 5 postthaw, at which time 1 morula and 2 cleavage-stage embryos were available for transfer. Three-embryo transfer resulted in a heterotopic tubal pregnancy and twin intrauterine gestation. Laparoscopic salpingectomy was performed for the ectopic gestation. The twin intrauterine pregnancy spontaneously reduced to singleton, and the patient delivered a live-born infant. CONCLUSION: While heterotopic and multifetal pregnancy are known risks of multiembryo transfer, 3 lesser-quality embryos derived from cryopreserved oocytes would be unlikely to have high implantation potential. Future studies are needed to delineate timing of embryogenesis events in previously cryopreserved oocytes.

Massive ovarian edema associated with a broad ligament leiomyoma: a case report and review.

Massive ovarian edema is a rare disorder in which there is marked accumulation of interstitial fluid in the stroma of the ovary. Grossly, the involved ovary is an enlarged solid mass with a smooth tan-white surface, easily confused with a neoplasm. Microscopically, it features diffuse interstitial edema sparing follicles and outer cortex, dilated lymphatic vessels, thick-walled veins, fibromatosis, and luteinized stromal cells. It is believed that massive ovarian edema arises from interference in lymphatic drainage and venous return of the ovary secondary to partial torsion among other etiologies. Herein we provide the first description of unilateral ovarian edema in association with a large leiomyoma in the ipsilateral broad ligament. It is important to recognize the various presentations of this benign entity and to consider it in the differential diagnosis of an adnexal mass in a reproductive age woman.

Radiolucencies surrounding a smooth-stemmed radial head component may not correlate with forearm pain or poor elbow function.

HYPOTHESIS: Radiolucencies surrounding the stems of smooth-stemmed metal radial head prostheses placed for comminuted radial head fractures are associated with proximal radial forearm pain. MATERIALS AND METHODS: Patients in whom 18 consecutive elbows that underwent metal radial head replacement with smooth stems for comminuted radial head fractures were assessed at least two years after surgery. Proximal radial forearm pain was assessed with a visual analog score (0-10) and elbow function with a Mayo index. "Mean stem radiolucency" was determined by two musculoskeletal radiologists based upon three radiographs of each elbow: a lateral in maximum extension, a lateral in maximum flexion, and an antero-posterior. RESULTS: All elbows were stable and stem radiolucencies were present in 16 of the 17 available for study. "Mean stem radiolucency" did not correlate with proximal radial forearm pain (p = 0.63) or Mayo scores (p = 0.37) using Spearman's correlation coefficients. 6/17 prostheses were in patients that rated their pain level as 0; 11/17 were in patients that rated their pain as at least 1 with 5 being the highest. Using the Signed Rank test, operative elbows had less motion for both flexion/extension (p = 0.0001) and pronation/supination (p = 0.01) compared to non-operative elbows from the same patient. DISCUSSION: "Mean stem radiolucency" did not correlate with proximal radial forearm pain. However, proximal radial forearm pain was present in 11/17 elbows based upon visual analog scores. Proximal radial forearm pain in this population may have several etiologies. CONCLUSION: "Mean stem radiolucencies" surrounding smooth-stemmed metal radial head prostheses for fractures did not correlate with proximal radial forearm pain scores. LEVEL OF EVIDENCE: Level 4; Retrospective case series, no control group.