C.E. Busso

Vaginal management of a “late” ectopic pregnancy after vaginal hysterectomy

OBJECTIVE To describe the first vaginal approach to an ectopic pregnancy after hysterectomy. DESIGN Case report. SETTING Private hospital. PATIENT(S) A 38-year-old woman presenting with an ectopic pregnancy 5 months after having a vaginal hysterectomy due to uterine myomatosis. INTERVENTION(S) Vaginal adnexectomy. MAIN OUTCOME MEASURE(S) Vaginal surgery as a plausible approach for this very particular situation (ectopic pregnancy in hysterectomized patient). RESULT(S) After vaginal surgery with removal of the left tube (containing a gestacional sac) and ovary, the patient fully recovered. CONCLUSION(S) Vaginal surgery can be a safe option for ectopic pregnancy resolution in noncomplicated cases.

Fertilização in vitro com injeção intracitoplasmática de espermatozóide em ciclos naturais

PURPOSE: to evaluate the efficacy of in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in natural cycle (NC). METHODS: retrospective clinical trial that evaluated 70 treatment cycles in 60 couples that were submitted to IVF treatment with ICSI in NC performed in private clinic from 1999 until 2003. It was performed daily ultrasound monitorization or on alternate days, and urinary LH dosage when the follicle reached 16 mm of diameter. It was scheduled egg retrieval when the follicle reached 18 mm of diameter and 36 hours after hCG administration when the LH test was negative. Embryo transfer was performed 48 to 52 hours after ICSI. RESULTS: 70 ICSI cycles in 60 patients were performed and the indications of treatment included: male factor (47.1%), tubal factor (37.1%), associated factors (8.7%), unknown infertility (7.1%). Out of 70 cycles, 18 cycles were cancelled (25.7% of cancellation rate). Out of 52 patients that were submitted to ovarian punction to oocyte retrieval we found mature oocytes in 77% of the cases (40 cycles), in four cases we collected immature oocytes and in eight cases we could not found it. We had 70% of fertilization rate and only one fertilized oocyte did not achieve the cleavage stage. So, the transfers rate per punction and per mature oocyte was 52% and 67.5%, respectively. We had 11.4% of pregnancy rate per cycle, 15.4% per punction and 29.6% per embryo transfer. CONCLUSIONS: FIV/ICSI in NC seem to be a satisfactory option of treatment, with low costs and complications (multiple gestation and Ovarian Hyperstimulation Syndrome), mainly in poor responder patients and in poor populations.