Chi Huang Chen

Relationship between peak serum estradiol levels and treatment outcome in in vitro fertilization cycles after embryo transfer on day 3 or day 5

OBJECTIVE To examine the relationships between peak serum estradiol (E(2)) levels and treatment outcome in in vitro fertilization (IVF) cycles after embryo transfer (ET) on day 3 or day 5. DESIGN Retrospective analysis of 697 IVF-ET cycles between January 1999 and December 2001. SETTING A university-affiliated assisted reproduction program. PATIENT(S) Infertile patients undergoing IVF-ET cycles. INTERVENTION(S) Peak E(2) concentration in serum was determined on the day of human chorionic gonadotropin (hCG) administration. The IVF-generated embryos were cultured for 2 days until transfer on day 3. If more than four 8-cell embryos were present on day 3, embryo culture was continued until day 5 for blastocyst transfer. MAIN OUTCOME MEASURE(S) Clinical pregnancy rates. RESULT(S) High peak E(2) levels did not adversely affect treatment outcome. After the cycles were divided according to the day of ET, high peak E(2) levels were associated with improved pregnancy rates after ET on day 5 but not on day 3. CONCLUSION(S) Increasing peak E(2) levels in IVF cycles are associated with improved pregnancy rates after ET on day 5.

Protective effect of a gonadotropin-releasing hormone analogue on chemotherapeutic agent-induced ovarian gonadotoxicity: A mouse model

OBJECTIVE To demonstrate the protective effect of triptorelin, a GnRH analogue, on chemotherapy-induced ovarian gonadotoxicity. STUDY DESIGN Twenty-four sexually mature, virgin, female FVB/NJNarl mice were divided into four groups: busulfan (B); low-dose triptorelin plus busulfan (T(L)+B); high-dose triptorelin plus busulfan (T(H)+B); and control. Mice in the T(L)+B and T(H)+B groups were injected with 3.8 and 38 mg/kg of triptorelin subcutaneously, respectively. Four weeks later, mice in the B, T(L)+B, and T(H)+B groups were injected with busulfan intraperitoneally at a dose of 36 mg/kg. Histologic examinations were performed 4 weeks later. RESULTS Obvious destruction of ovarian structure and significant depletion of primordial, primary, and secondary follicles were demonstrated in the B group compared with the control group, affirming the gonadotoxicity of busulfan. In the T(L)+B group, a greater number of larger primordial and primary follicles were enumerated compared with the B group; however, statistical significance was not achieved. In the T(H)+B group, the number of primordial and primary follicles was significantly greater than in the B group, and the ovarian tissue in the T(H)+B group was spared, demonstrating the effect of triptorelin pre-treatment on ovarian protection. CONCLUSION Our results have demonstrated a dose-dependent protective effect against gonadotoxic chemotherapy of a GnRH analogue on ovarian reserve, thus suggesting a novel application of GnRH analogues in fertility preservation.

General gynaecology: Effect of uterotonics on intra‐operative blood loss during laparoscopy‐assisted vaginal hysterectomy: a randomised controlled trial

Objective  To investigate the effectiveness of uterotonics misoprostol and oxytocin on reducing blood loss during laparoscopy‐assisted vaginal hysterectomy (LAVH).

Huge pedunculated fibroma of the vulva

A wide variety of masses occur in the vulva and most are malignant. Fibroma is a relatively rare but usually benign tumor of the vulva found in only 0.03% of all patients with gynecologic neoplasms. Fibromas originate from deep connective tissue structures particularly those surrounding the introitus the perineal body or the round ligament. They usually occur on the labium majus tend to become pedunculated especially if large and lymphadenematous and the pedicle may become so long that the growth dangles between the limbs. In the literature only a few similar cases have been reported. We present a rare pedunculated vulvar fibroma with a 7-year progression. (excerpt)

Prenatal diagnosis of mosaic ring chromosome 15 with abnormal maternal serum Down syndrome screening and Dandy-Walker malformation.

Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan Department of Biotechnology, Asia University, Taichung, Taiwan Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan

Serum vascular endothelial growth factor165 levels and uterine fibroid volume

Background.  Vascular endothelial growth factor165 (VEGF165) demonstrates increased expression in uterine fibroids. This study aimed to investigate the relationship between serum VEGF165 levels and uterine fibroid volume.

Perimenopausal Amenorrhea with Cervical Atresia and Hematotrachelos

Obstruction of the lower female genital tract leading to proximal dilatation and development of hematotrachelos is most commonly a result of congenital abnormalities such as an imperforate hymen, a complete transverse vaginal septum, or rarely, cervical atresia. Acquired hematotrachelos is rare, and the possible etiology includes iatrogenic trauma to the uterocervix such as cervical surgery, dilation and curettage, obstetric laceration, cervical or endometrial carcinoma, and radiation therapy. We report an unusual case of a patient in who spontaneously acquired hematotrachelos developed in the perimenopausal period. Combined speculum inspection of the cervix and recognition of transvaginal echographic features assisted the diagnosis. In addition, we tried a new treatment method, using the firm plastic end of an Ipas Karman cannula (6 mm diameter and 6 cm length) with nylon fixation retained for I month that resulted in a patent cervical canal.

Successful Management Ofgravid Uterine Rupture

Spontaneous rupture of the gravid uterus is very rare, with a reported rupture rate of 0.09% [1]. Previous uterine surgery, macrosomia, high parity, advanced maternal age, fundal pressure, oxytocin, and prostaglandin augmentation are risk factors. Uterine rupture is a catastrophic obstetric event, associated with high rates of perinatal morbidity and mortality. Early diagnosis and adequate hemostasis are extremely important for good outcomes. A 37-year-old Taiwanese woman, para 0, with a history of myomectomy 5 years previously, became pregnant naturally, and antenatal examinations were uneventful. She presented with regular labor pain at 36 weeks 6 days of gestation. Her labor pain was characterized by a gradual increase in intensity until it became intolerable 20 minutes before arrival at the delivery room. Her vital signs revealed a body temperature of 36.5°C, heart rate of 120 beats per minute, and respiratory rate of 20 breaths per minute. No ripening of the cervix or rupture of the amniotic membranes was evident. Abdominal muscle guarding, sweating, hyperstimulation of uterine contractions, along with variable decelerations occurred 20 minutes after arrival. No pelvic fluid was identified on sonography. Immediate pelvic examination showed that the cervix was not dilated. Intrauterine resuscitation with intravenous fluid, maternal positional changes, and oxygen administration did not resolve the prolonged decelerations. The “staircase” sign (Figure 1) appeared after 10 minutes, and the possibility of uterine rupture was suspected, based on her previous surgical history, physical examination, and the presence of the staircase sign. Immediate cesarean delivery was performed under spinal anesthesia. Upon cesarean delivery, a fresh uterine laceration with blood clots was found. The laceration measured 10 cm, with complete disruption along the left posterior uterine wall and active bleeding (Figure 2). A male fetus, weighing 2,515 g, was delivered with Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. SUCCESSFUL MANAGEMENT OF GRAVID UTERINE RUPTURE

Influence of late follicular luteinizing hormone concentrations on ovarian response and fertilization outcome in patients undergoing in vitro fertilization with a short protocol

The objective of this study was to investigate the effect of luteinizing hormone levels on the day of human chorionic gonadotropin administration (late follicular phase) on ovarian response and pregnancy outcome in women receiving pituitary down-regulation with gonadotropin releasing hormone-agonist administration in a short protocol. Blood samples were collected from 74 women undergoing assisted reproduction and analyzed retrospectively. Based on luteinizing hormone levels on the day of human chorionic gonadotropin administration, patients were divided into two groups (＜5 and ≧5 IU/L). The number of follicles ≧15 mm in size and fertilized oocytes showed a highly significant correlation with luteinizing hormone concentration on the day of human chorionic gonadotropin administration. The levels of luteinizing hormone in the late follicular phase had a significant impact on the ovarian response and the quality of retrieved oocytes.