Obstetric outcomes of patients undergoing total laparoscopic radical trachelectomy for early stage cervical cancer.

OBJECTIVE: To assess the obstetric outcomes of our total laparoscopic radical trachelectomy (TLRT) cases for early stage cervical cancer. MATERIALS AND METHODS: A total of 56 patients who underwent TLRT between December 2001 and August 2012 were reviewed retrospectively using clinicopathological, surgical, and follow-up data from patients' medical records. RESULTS: We performed this operation on 56 patients during the study period. The mean age of these 56 patients was 31.9 years (range 22-42 years). Fifty-three patients' fertility was preserved without requiring post-operative adjuvant treatment. Twenty-five women attempted to conceive, of whom 13 succeeded for a total of 21 pregnancies (52% pregnancy rate). Ten of these 21 pregnancies were the result of assisted reproductive technologies. Of those, 5 resulted in first trimester miscarriages, 2 in second trimester miscarriages, and 13 in live births. Ten pregnancies reached the third trimester. Preterm premature rupture of membranes (8/13, 61.5%) was the most common complication during pregnancy. The rate of preterm delivery was 47.6%. Three patients delivered at 22-28 weeks of gestational age. Two of these babies showed permanent damage: one has cerebral palsy; the other has developmental retardation. One pregnancy is ongoing. CONCLUSION: TLRT is a useful technique associated with an excellent pregnancy rate in fertility-preserving surgery to treat early stage cervical cancer.

Successful delivery derived from vitrified-warmed spermatozoa from a patient with nonobstructive azoospermia.

OBJECTIVE: To report the clinical outcomes following intracytoplasmic sperm injection (ICSI) with vitrified sperm from patients with severe male factor infertility. DESIGN: Retrospective case series. SETTING: IVF unit of a medical center. PATIENT(S): Three patients with severe oligozoospermia or nonobstructive azoospermia (NOA). INTERVENTION(S): Cryopreservation of limited numbers of spermatozoa with the use of Cryotop and Cell Sleeper as nonbiologic containers. MAIN OUTCOME MEASURE(S): Four cycles underwent intracytoplasmic sperm injection (ICSI) with vitrified sperm. RESULT(S): A total of 148 spermatozoa in 18 containers (8.2 sperm per container) were vitrified and 36 of them (5 containers) were warmed. Thirty-three sperm (92%) were retrieved successfully and injected individually into 17 mature oocytes. Fertilization was observed in 12 oocytes (71%), and all zygotes (100%) cleaved. A couple with NOA achieved a singleton pregnancy and concluded with full-term delivery of a healthy boy (2,632 g). CONCLUSION(S): A successful delivery was achieved after transfer of a blastocyst derived from vitrified-warmed spermatozoa. A small number of vitrified sperm cells were used for ICSI to fertilize oocytes with predictable timing.

Scar endometriosis after a laparotomy for uterine perforation as a complication of dilatation and curettage.

BACKGROUND: Ectopic endometriosis is an uncommon disease. Abdominal scar endometriosis is especially rare. CASE: A 38-year-old gravid 1, para 1 woman underwent dilatation and curettage due to an intrauterine infection. During the procedure, uterine perforation occurred and an emergency laparotomy was performed to provide hemostasis and suturing. Three years later, she complained of pain and swelling at the lower end of her abdominal scar during menstruation. A biopsy of the abdominal scar demonstrated endometriosis. The patient elected to receive conservative management rather than a surgical procedure. Therefore, hormonal therapy was initiated. The hormonal therapy provided symptomatic relief and reduced the size of the lesion. CONCLUSION: We reported an extremely rare case of scar endometriosis after a laparotomy for a uterine perforation that occurred as a complication of dilatation and curettage. We suggest that hormonal therapy using gonadotropin-releasing hormone agonist might be an alternative to surgical treatment for ectopic endometriosis.

Significant association between Helicobacter pylori infection and serum C-reactive protein.

BACKGROUND: Helicobacter pylori (H. pylori) infection in gastric mucosa may cause systemic inflammatory reaction. This study aimed to examine the association between the infection and serum high sensitivity C-reactive protein (hsCRP). METHODS: Subjects were comprised of three groups; 453 health checkup examinees from Yakumo town inhabitants in Hokkaido, Japan (YTI, 153 males and 300 females), 449 health checkup examinees (ENUH, 273 males and 176 females), and 255 female patients of an infertility clinic (PIC), Nagoya University Hospital. Twenty participants with hsCRP more than 1 mg/dl were excluded from the analysis. Those with hsCRP more than 0.1mg/dl were defined as high hsCRP individuals. H. pylori infection status was examined with a serum IgG antibody test. RESULTS: When the three groups were combined, the geometric mean of hsCRP concentration was significantly higher among the seropositives (0.047 mg/dl) than among the seronegatives (0.035 mg/dl); p<0.0001 by a t-test. The percentage of high hsCRP individuals was also higher in the seropositives than in the seronegatives among any group; 23.3% and 20.1% in YTI, 22.0% and 16.0% in ENUH, and 32.7% and 18.7% in PIC, respectively, although the difference was significant only in ENUH. The summary odds ratio of the high hsCRP for the seropositives relative to the seronegatives was 1.38 (95% confidence interval, 1.01-1.89), when age, sex, body mass index, smoking, and subject group were adjusted by a logistic model. CONCLUSIONS: In three groups, hsCRP was higher among the infected individuals. The summary odd ratio indicated that H. pylori infection could influence the serum hsCRP level.

Successful management of a massive hemorrhage due to rupture of cystic cervical endometriosis by a loop electrosurgical excision procedure.

OBJECTIVE: To report a case of cystic cervical endometriosis that caused a massive hemorrhage due to rupture of a cyst and successful management with a loop electrosurgical excision procedure (LEEP). DESIGN: Case report. SETTING: University Hospital. PATIENT: A 37-year-old nulliparous woman. INTERVENTION(S): Medical management including surgical treatment. MAIN OUTCOME MEASURE(S): Clinical follow-up and pathologic diagnosis. RESULT(S): A hemorrhagic cystic cervical mass was excised with emergent LEEP. The mass was found to be cervical endometriosis. There was no evidence of recurrence until 1 year after excision. CONCLUSION(S): Cystic formation of cervical endometriosis--like ovarian endometrioma, which causes a massive hemorrhage due to rupture--is extremely rare, although cervical endometriosis is generally asymptomatic. Hysterectomy is considered in such cases but can be avoided via LEEP that incorporates partial excision of the uterine cervix.

The plausibility of Helicobacter pylori-related infertility in Japan.

The aim of the present study was to confirm the seropositive rate of Helicobacter pylori to which antibodies cross-react with spermatozoon flagella in patients with infertility. Of the 204 patients in whom the anti-H. pylori IgG antibody in serum and follicular fluids were measured, 45 (22.1%) were seropositive for H. pylori and the seropositive percentage of infertile patients without any possible cause was higher than that of patients with one or more known infertility factors [8 of 21 patients (38.3%) vs. 37 of 183 patients (20.2%), respectively], which suggests a new concept: H. pylori-related infertility.

Oral progestogen versus intramuscular progesterone for luteal support after assisted reproductive technology treatment: a prospective randomized study.

OBJECTIVES: To evaluate the efficacy of oral progestogen, chlormadinone acetate, and intramuscular (IM) progesterone for luteal support in patients, undergoing assisted reproductive technology (ART) treatment, who were treated with a gonadotropin-releasing hormone agonist (GnRHa). METHODS: This was a prospective randomized study of 40 patients with normal and high response (serum estradiol > 2,000 pg/ml) in GnRHa down-regulation. Patients were randomized to receive either oral chlormadinone acetate or IM progesterone. The outcomes of ART treatment, including pregnancy and embryo implantation rates, were analyzed. RESULTS: There were no significant differences in the clinical pregnancy rates (25 vs. 20%) and in the implantation rates (12.7 vs. 9.1%) of patients who received IM progesterone and oral chlormadinone acetate. Endometrial thickness was also comparable between oral chlormadinone acetate and IM progesterone. CONCLUSION: Oral progestogen, chlormadinone acetate showed a comparable pregnancy rate and live birth rate with IM progesterone as luteal support for the high responders. The optimal methods for luteal support may be dependent on responses to stimulation with gonadotropin, although it is not concluded that oral chlormadinone acetate is recommended as an option for luteal support in high responders.

PTEN and Akt expression during growth of human ovarian follicles.

PURPOSE: To assess the expression of PTEN and total and phosphorylated Akt in human ovarian follicles during follicular growth. METHODS: Immunohistochemistry of ovarian tissues and Western blotting and immunofluorescence of primary cultured luteinized granulosa cells for PTEN and Akt. RESULTS: Immunoreactivity of Akt was found in the oocytes, granulosa cells and theca cells in primordial follicles, follicles at each growing stage and luteal cells. As the follicles grew, staining for PTEN became intense in the granulosa cells, whereas the intensity of phospho-Akt became weak. Western blotting and immunofluorescence analysis using primary cultured granulosa-lutein cells showed Akt and PTEN expression, and phosphorylation of Akt in vitro. CONCLUSIONS: PTEN and Akt are present in the granulosa cells during folliculogenesis. An increase in PTEN may lead to changes in proliferation and/or differentiation of granulosa cells during follicular growth via regulation of Akt phosphorylation.