TRPV4 is involved in levonorgestrel-induced reduction in oviduct ciliary beating.

Previous studies revealed the increasing risk of tubal pregnancy following failure of levonorgestrel (LNG)-induced emergency contraception, which was attributed to the reduced ciliary motility in response to LNG. However, understanding of the mechanism of LNG-induced reduction in the ciliary beat frequency (CBF) is limited. The transient receptor potential vanilloid (TRPV) 4 channel is located widely in the female reproductive tract and generates an influx of Ca2+ following its activation under normal physiological conditions, which regulates the CBF. The present study aimed to explore whether LNG reduced the CBF in the Fallopian tubes by modulating TRPV4 channels, leading to embryo retention in the Fallopian tubes and subsequent tubal pregnancy. The study provided evidence that the expression of TRPV4 was downregulated in the Fallopian tubes among patients with tubal pregnancy and negatively correlated with the serum level of progesterone. LNG downregulated the expression of TRPV4, limiting the calcium influx to reduce the CBF in mouse oviducts. Furthermore, the distribution of ciliated cells and the morphology of cilia did not change following the administration of LNG. LNG-induced reduction in the CBF and embryo retention in the Fallopian tubes and in mouse oviducts were partially reversed by the progesterone receptor antagonist RU486 or the TRPV4 agonist 4α-phorbol 12,13-didecanoate (4α-PDD). The results indicated that LNG could downregulate the expression of TRPV4 to reduce the CBF in both humans and mice, suggesting the possible mechanism of tubal pregnancy. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

Bilateral ampulary pregnancy after clomifen citrate and intrauterine insemination--a unique case report.

We report a case with bilateral tubal ampullary pregnancy after Clomifen Citrate medication. The first conception in the right tube was after intrauterine insemination or intercourse performed before insemination, while the second one was achieved 10 d after insemination, during the intercourse, in the left tube. This life-threatening and routinely unexpected finding must always have in mind all doctors dealing with patients in emergency care, especially those receiving fertility enhancing drugs. According to the literature data available, this is the first and unique such case in the literature.

Simultaneous presentation of tubal and primary abdominal pregnancies following clomiphene citrate treatment.

Abdominal pregnancy is a rare condition that is potentially life-threatening for the mother. We present a case of simultaneous ectopic pregnancies (EPs) in the right fallopian tube and in the vesicouterine pouch. A 26-year-old woman had undergone prior ovulation induction with clomiphene citrate and human chorionic gonadotropin (hCG) at an outside hospital for unexplained infertility. The patient was referred to our hospital for a suspected ectopic pregnancy at 6 weeks gestation. Transvaginal ultrasonography detected a viable fetus at the anterior left side of the uterus; therefore, we suspected a left tubal pregnancy. However, laparoscopic surgery revealed that EPs were located in both the left vesicouterine pouch and in the right fallopian tube. Resection of the right salpinx and abdominal implant were performed. Histopathological examination confirmed the simultaneous presentation of a primary abdominal pregnancy and a right tubal pregnancy. After surgery, the patient's serum hCG level returned to normal. Concurrent EPs and abdominal pregnancy are very rare. However, it should be noted that reproductive technologies sometimes cause unusual clinical situations. A thorough abdominal inspection is needed.

Bilateral simultaneous isthmic ectopic pregnancy after clomiphene induction.

A rare case of a 32-year-old patient with simultaneous bilateral isthmic tubal pregnancy. A 32-year-old woman with a 3-year history of primary infertility was admitted with light vaginal bleeding and mild abdominal pain. She was 41 days after her last menstruation and 23 day after intrauterine insemination with her husband's sperm. Clomiphene citrate (CC) was used for the induction of ovulation. In cases of ectopic pregnancy with ovulation induced by CC, doctors must be aware of the possibility of bilaterality.

Short-term Reproductive Outcomes of Nulliparous Women with Previous Ectopic Pregnancy.

OBJECTIVE: To determine the characteristics and subsequent pregnancy outcomes in patients with a previous ectopic pregnancy (EP). STUDY DESIGN: Descriptive-cross sectional study. PLACE AND DURATION OF STUDY: Department of Obstetrics-Gynaecology, Etlik Zubeyde Hanim Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey, between January 2014 and December December 2018. METHODOLOGY: The data of nulliparous patients diagnosed with tubal ectopic pregnancy (EP) was analysed retrospectively. Reproductive outcomes within the first two years after ectopic pregnancy diagnosis were used as "short-term" reproductive outcomes. Their EP treatment and pregnancy outcome were determined. RESULTS: Expectant management was chosen in 5.8% of the patients, while the surgical intervention was 32.3%. Medical therapy involving methotrexate (MTX) was given to the remaining patients (61.9%). The tubal rupture was confirmed in 12% of the cases that received MTX. In the 2-year follow-up period after the ectopic event, the most common outcome of the subsequent pregnancies was a live birth (47.7%). Recurrent EP occurred in 4.6%. CONCLUSION: The subsequent short-term pregnancy outcomes in this study were not related to the chosen treatment modality. KEY WORDS: Ectopic pregnancy, Nulliparity, Reproductive outcomes, Treatment modalities, Expectant management.

Combined pregnancy after gonadotropin therapy.

Three cases of combined pregnancy are described after gonadotropin therapy; two cases after human pituitary gonadotropin and one after human menopausal gonadotropin administration. In each case the intrauterine gestation was a multiple pregnancy. After salpingectomy, two of the women have proceeded to the delivery of healthy infants; the third woman aborted. In each case the gonadotropin stimulation regimen was ceased at the appropriate stage when the estriol excretion was between 60 and 125 micrograms/day, but the subsequent rate of rise of estriol was 2.3- to 3.2-fold during the coasting phase before the human chorionic gonadotropin trigger when the estriol excretion rate was 140 to 350 micrograms/day.

Impaired reproductive performance in DES-exposed women.

The reproductive history of 69 women with demonstrated diethylstilbestrol (DES)-related cervical-vaginal abnormalities is reviewed. All of the patients were sexually active non-contraceptive users who were studied over an 8-year period. Forty-six patients conceived, for an uncorrected fertility rate of 66.7%. Fourteen patients elected therapeutic abortion. The 32 remaining patients had 62 pregnancies which resulted in 26 living children, for a success rate of 41.9%. However, cervical cerclage was required for continuation of 8 of these successful pregnancies. The 36 pregnancy failures consisted of 19 first- and 11 second-trimester spontaneous abortions, 3 third-trimester losses due to permaturity, and 3 tubal pregnancies. Uterine abnormalities were found in all of the 25 patients who underwent hysterosalpingograms. Although other reproductive diseases unrelated to DES exposure in utero were also present in this select group of patients, it is probable that the high rate of infertility and pregnancy wastage is related to the uterine structural abnormalities encountered.

Combined subsequent development of intrauterine and extrauterine gestations.

A case of combined subsequent development of intrauterine and extrauterine pregnancy is reported. Signs of normal pregnancy associated with abdominal pains and an adnexal mass were the most significant symptoms and the final diagnosis was verified by laparoscopy in both cases. We consider that drugs for induction of ovulation (chlomiphene citrate and menopausal gonadotropins) were the causative factors of this rare obstetric complication.

Heterotopic pregnancy following clomid treatment.

A case of concomitant intra- and extrauterine pregnancy after clomiphene treatment is reported. The incidence of multiple ovulations and multiple pregnancies is higher after induced ovulation. The increased likelihood of combined intra- and extrauterine pregnancy in patients with a higher rate of fraternal twinning is discussed.

[2 clinical cases of tubal pregnancy after incorrect use of the combined pill]. / Su due casi clinici di gravidanza tubarica dopo assunzione scorretta di pillola combinata.

PIP: 2 cases of tubal pregnancy in patients on combined oral contraceptives are examined. Both patients had not only failed to take the pill correctly, but had stopped taking it in midcycle. This led to nidation of the fertilized ovun in the left tube, with consequent rupture of the same. Implantation in the tube may be due to slower physiological recovery of tubal motility, as opposed to that of the ovulatory and cervical mechanisms. The article also contains a discussion of the contraceptive mechanism of combined pills.^ieng

[Heterotopic pregnancy following ovulation induction by clomiphene citrate and prednisone. Report of a case]. / Embarazo heterotópico, después de inducción de ovulación con citrato de clomifeno y prednisona. Informe de un caso.

Heterotopic pregnancy (HP) is a very rare pathologic event. The incidence of ectopic pregnancy has increased as the consequence of assisted reproduction and the wider use of ovulation induction agents. The diagnosis of HP is frequently done not as earlier as it should be, and it has serious repercussions. The concept of screening, to find relevant rise factors and the correct diagnosis of HP should be pursued as early as possible. In this report we describe an unusual case of a female patient with therapeutic failure to clomiphene citrate. She was treated with two cycles of combined clomiphene citrate and prednisone, and ovulation induction assent. The after she developed HP. Overall, we conclude that the possible association observed could be an accident. The land of investigation is open, to fill cover. The holes on understanding that we still have.

Gestación heterotópica tras estimulación ovárica con clomifeno / Heterotopic pregnancy following induction of ovulation with clomiphene citrate

Introducción: la gestación heterotópica consiste en la coexistencia de una gestación intraútero y otra ectópica. La incidencia se ha multiplicado, debido especialmente a las técnicas de reproducción asistida. Es un cuadro infradiagnosticado. El diagnóstico será ecográfico o laparoscópico. Caso clínico: mujer de 27 años gestante en la semana 5 tras tratamiento con clomifeno que acude a urgencias por abdominalgia. En ecografía, saco gestacional intraútero y en anejo izquierdo saco de 5,73 mm con vesícula vitelina y líquido libre en Douglas. Ante la sospecha de gestación heterotópica se indica laparoscopia diagnóstico- terapéutica: trompa izquierda dilatada con embarazo tubárico. Se realiza salpinguectomía (AU)

Blackground: A heterotopic pregnancy is defined by the coexistence of an intrauterine pregnancy and ectopic pregnancy. The incidence of heterotopic pregnancy has increased due to Assisted Reproduction Therapy and it tends to be underdiagnosed. The diagnosis is made by Ultrasound and Laparoscopy. Case report: A 27-year-old woman in her fifth week of pregnancy, after treatment with Clomiphene comes to the emergency room for abdominal pain. A routine ultrasound finds an intrauterine gestational sac, along with a left adnexal mass resembling a gestational sac with vitelline vesicle and a collection in Douglas. A diagnostictherapeutic laparoscopy was performed, finding a left tubaric pregnancy which was removed by salpinguectomy (AU)

Ectopic pregnancy following levonorgestrel emergency contraception: a case report.

Use of levonorgestrel as emergency contraception is a safe and effective measure to prevent unwanted pregnancy. However, ectopic gestation in case of failure is a known risk. Access to levonorgestrel without a prescription in many countries has made it impossible to estimate the exact incidence of this potential adverse event. Thus, spontaneous reporting of cases serves to alert physicians to this possibility. We present a case of ectopic pregnancy following use of levonorgestrel emergency contraception. To our knowledge, this is the first case report from India following introduction of levonorgestrel emergency contraception in 2001.