A Rare Case of Swyer Syndrome in Two Sisters with Successful Pregnancy Outcome in Both.

Swyer syndrome is a disorder of sex development characterized by gonadal dysgenesis in a phenotypic female with normally developed Mullerian structures but a 46XY karyotype resulting from failure of testicular development in the early embryogenesis. It can have X-linked, Y-linked, or autosomal inheritance. We had a case of two sisters who presented with primary amenorrhea and primary infertility. On investigation, both had hypergonadotropic hypogonadism, 46XY karyotype, and streak gonads. They conceived following in vitro fertilization (IVF) with ovum donation. Prophylactic gonadectomy has been done in one and advised in other due to the increased risk of gonadoblastoma which is as high as 15%-35%. Such patients should be counseled that despite hypoplastic uterus, successful pregnancy can be achieved through IVF and ovum donation.

Mid-life fertility: Challenges & policy planning.

This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients' personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.

Spontaneous conception in 40-year-old infertile woman with polycystic ovaries after complete reversal of endometrial intraepithelial neoplasia: A case report with review of literature.

We report a case of polycystic ovary syndrome and prolonged infertility in which endometrial intraepithelial neoplasia was reversed with high dose progesterone therapy. Spontaneous conception after failure of assisted reproductive techniques highlights the role of endometrial receptivity.

Use by gynecologists of a modified sensate focus technique to treat vaginismus causing infertility.

Of 5,341 infertile couples seen over an 8-year period, 76 (1.4%) had primary vaginismus, of whom 63 were treated with the use of a simplified sensate focus technique. There was complete symptomatic resolution of vaginismus in 60 women, and pregnancy was achieved in 33.

Changes in affect and state anxiety across an in vitro fertilization/intracytoplasmic sperm injection cycle.

OBJECTIVE: To identify pattern of change in average positive affect (PA), negative affect (NA), and state anxiety (St ANX) across three biological end points of an IVF/intracytoplasmic sperm injection (ICSI) procedure and to examine whether the pattern varied across sociodemographic and biomedical subgroups. DESIGN: Longitudinal follow-up study of PA, NA, and St ANX at three different time points: before start of study, before ovum pick-up (OPU), and before embryo transfer. SETTING: Three infertility centers in northern India. PATIENT(S): Baseline data were obtained from a consecutive sample of 85 women. However, final analysis was done on data obtained from 74 women who reached the embryo transfer stage and completed the questionnaires at both OPU and embryo transfer. INTERVENTION(S): The PA, NA, and St ANX scores. MAIN OUTCOME MEASURE(S): Change in PA, NA, and St ANX scores at three stages of the treatment: baseline (T(0)), before OPU (T(1)), before embryo transfer (T(2)). RESULT(S): The PA scores before OPU and embryo transfer were significantly lower than those at baseline. The mean NA and St ANX scores before OPU and embryo transfer were significantly higher than baseline scores. Furthermore, mean NA before embryo transfer was significantly higher than mean NA before OPU. The PA and St ANX scores showed statistically insignificance within cycle variations. Furthermore, the mean PA and St ANX for a subgroup of women who reported more than moderate level of burden were less variable. CONCLUSION(S): The OPU and embryo transfer stages are more stressful than the baseline stage for most women across various sociodemographic and biomedical subgroups. Women with more than a moderate level of financial burden were relatively more stable.

GnRH antagonists in controlled ovarian hyperstimulation protocols in assisted reproductive technique programmes--current concepts.

Gonadotrophin (Gn) preparations eg, human menopausal gonadotrophins, follicle stimulating hormone both urinary and recombinant have been highly successful in achieving controlled ovarian hyperstimulation which has become the standard practice in assisted reproductive technique cycles. The fine programming of cycles requires blocking of endogenous luteinising hormone surge, the final ovulation trigger. GnRH analogues, both agonists and antagonists which were developed by substituting amino acids are highly effective in preventing LH surge. Both agonists and antagonists have been developed generating a fierce debate regarding the superiority of one above another. This article is a brief review of literature and attempts to clarify following issues: (a) Major differences between agonists and antagonists. (b) Brief outline of antagonist protocol. (c) Comparative advantages and disadvantages. (d) Use of antagonists in various categories of patients. (e) Future! Can antagonists replace agonists?