Eliran Mor

Spontaneous twin gestation after vaginal dilation in a woman with uterus didelphys and bladder exstrophy.

BACKGROUND Bladder exstrophy is an uncommon anomaly rarely associated with uterus didelphys. Fertility is limited by associated vaginal malformations, which have traditionally required surgical reconstruction. CASE A woman with a history of bladder exstrophy and hypoplastic vagina presented complaining of painful intercourse. The patient underwent vaginal dilator treatment after corrective surgery for the bladder defect. Without any further fertility therapy she subsequently conceived twins, with one implantation in each horn of a didelphic uterus. CONCLUSION Bladder exstrophy, uterus didelphys, and vaginal hypoplasia share a common embryological development, and the finding of one anomaly can alert to the presence of another. Vaginal dilators may be used in place of surgical reconstruction to allow conception.

Alterations in gonadotropin levels following oral and vaginal administration of the Yuzpe regimen and plan B for emergency contraception

There is increasing use of the Yuzpe regimen [500g levonorgestrel (LNG)/100g ethinyl estradiol] and Plan B (750g LNG) for emergency contraception. These regimens are believed to act by delay of ovulation in conjunction with a local effect on the endometrium; however the exact mechanism of action is unknown. Furthermore data regarding vaginal administration of both regimens are lacking. The objective of this study was to determine the effects of Plan B and Yuzpe regimens administered orally or vaginally on serum gonadotropin levels at peak and nadir LNG levels. There was no significant difference in LH and FSH suppression between Plan B and the Yuzpe regimens suggesting that when high doses of LNG are used (Plan B) the addition of EE as in the Yuzpe regimen contributes little to further gonadotropin suppression. Vaginally administered Plan B and Yuzpe regimens did not differ significantly from the same regimens administered orally in suppression of LH and FSH suggesting that vaginal administration of such regimens may be as efficacious as oral ones in delaying ovulation. (excerpt)