Uterine leiomyoma in an adolescent female.

BACKGROUND: Uterine myomas are the most frequently occurring neoplasms in the female pelvis, presenting in approximately one-third of women. Fewer than half develop menstrual abnormalities, pelvic pain, and discomfort. Large myomas may compromise fertility. These tumors very rarely occur in the pediatric and adolescent population. When suspected on examination, careful evaluation is necessary to distinguish the tumor from an adnexal lesion. CASE: A 17-year-old girl presented with a large asymptomatic pelvic mass, which was clinically suspected to be a leiomyoma. An initial sonographic study was questionable for a myoma but was confirmed on subsequent magnetic resonance imaging (MRI). A large myoma was noted and removed at surgery. The patient subsequently became pregnant and delivered at term by caesarean section. SUMMARY AND CONCLUSION: Leiomyomas of the uterus in women under 20 years of age are rare and occur much less often than adnexal lesions. Although ultrasound studies are usually sufficient to make the distinction between the 2, MRI generally is superior to sonography in this regard. In this young population, myomectomy is the surgical procedure of choice to preserve fertility.

Pregnancy after microinsert sterilization with tubal occlusion confirmed by hysterosalpingogram.

BACKGROUND: Introduced to the U.S. market in late 2002 as a permanent method of contraception, a microinsert device is placed hysteroscopically into the fallopian tubes, not requiring incisions or general anesthesia. This report describes a case of pregnancy more than 6 months after a hysterosalpingogram (HSG) confirming bilateral occlusion after microinsert sterilization. CASE: A 30-year-old gravida 1 para 1 woman desired permanent sterilization. The patient underwent microinsert device placement and 6 months later had an HSG that confirmed bilateral tubal occlusion. More than 6 months after the confirmatory HSG, the patient became pregnant and delivered a term infant by cesarean birth. Cornual perforation was noted at surgery. CONCLUSION: This case illustrates pregnancy after microinsertion sterilization and an HSG confirming bilateral tubal occlusion, despite perforation. A microinsert device continues to be a viable option for sterilization.

How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening?

OBJECTIVE: Identify the determinants that influence the patient's decision-making process when deciding to accept or decline preimplantation genetic screening (PGS) in a given IVF cycle. DESIGN: Pilot, retrospective, cross-sectional study that used a questionnaire containing a combination of quantitative and qualitative items. SETTING: Private practice IVF clinic. PATIENT(S): Patients and partners initiating an IVF treatment cycle, both autologous and donor, between October 2012 and January 2015. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Identification of patient perceived determinants and the importance of each on the decision to accept or decline PGS. RESULT(S): Responses from the questionnaire (N = 117) were returned, and of these, 60% accepted PGS. The female response rate was 75% (N = 88) and the male response rate was 25% (N = 29). Ninety-eight percent were Christian (N = 112) and 88% college educated (N = 102) with 39% (N = 40) having some postgraduate education. Sixty-eight percent (N = 79) had no knowledge of PGS before the IVF cycle; however, after provider education, 92% (N = 108) correctly identified that PGS was elective and 93% (N = 109) reported sufficient knowledge to make an informed decision to accept or decline PGS. The additional cost of screening, the provider information and influence, and social support or acceptance from partner, family, and/or friends, were the three statistically significant variables affecting the decision. CONCLUSION(S): This is the first study, to the authors' knowledge, to identify and assess the determinants of the patient decision-making process when presented with the choice of PGS. Several factors contribute to the patient-perceived determinants when choosing to accept or decline PGS, including cost, religious and ethical beliefs and values, social and family support, provider influences, and the past reproductive experience of the patient.

FEM1A is a candidate gene for polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, and is characterized by infertility, hyperandrogenism and insulin resistance in skeletal muscle. There is evidence for a PCOS gene localized to chromosome 19p13.3. The FEMIA gene maps to chromosome 19p13.3 and is highly expressed in skeletal muscle. FEMIA is a homolog of fem-1, a sex-determination gene of Caenorhabditis elegans that controls masculinization. In a pilot study of Caucasian PCOS patients from our local clinic, we found that one of these five patients exhibited a heterozygous germline missense mutation in FEM1A, designated FEM1A*H500Y. This mutation alters an amino acid conserved from human to C. elegans, and was not found in any of 198 control chromosomes. This missense allele was not found in any of a separate group of 30 PCOS patients from a different regional/ethnic background. Immunostaining of mouse ovary demonstrated that the mouse homolog of FEM1A is expressed in androgen-producing secondary interstitial cells, with a marked increase in expression after puberty, consistent with a key feature of PCOS -- ovarian hyperandrogenism. In conclusion, FEM1A should be considered a candidate gene for PCOS, and more extensive analysis of FEM1A, both coding and regulatory sequences, is warranted in patients and families with PCOS.

Leukemia inhibitory factor and homeobox a10 gene expression in an ectopic pregnancy model for implantation.

OBJECTIVE: We investigated the expression of leukemia inhibitory factor and homeobox a10 in endometrium that was derived from patients with concurrent ectopic pregnancies compared with nonpregnant luteal phase endometrium from the same patients. STUDY DESIGN: Endometrial biopsy specimens that were obtained from women (n=3) who underwent surgery for ectopic pregnancy were matched with biopsy specimens in a nonpregnant luteal phase from the same patients. Quantitative reverse transcription polymerase chain reaction for leukemia inhibitory factor and homeobox a10 was performed. Polymerase chain reaction products were assayed with laser detection of nanogram quantities of complementary deoxyribonucleic acid. Ratios of each implantation marker to glyceraldehyde-3-phosphate dehydrogenase as an internal standard were compared for quantification. RESULTS: Leukemia inhibitory factor expression is increased in endometrium from ectopic pregnancy; homeobox a10 is increased in luteal phase endometrium. CONCLUSION: Leukemia inhibitory factor appears to be regulated by human chorionic gonadotropin or other factors of pregnancy; homeobox a10 is regulated by ovarian steroids of the luteal phase.