Tzay-Shing Yang

Laparoscopic surgery for heterotopic pregnancies: a case report and a brief review

A heterotopic pregnancy is in effect a multiple pregnancy with one or more intrauterine pregnancies coexisting with an ectopic pregnancy and is rarely spontaneous. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, it will not be surprising to observe that this phenomenon has increased significantly. However, diagnosis is often delayed because of its rarity and difficulty. We report a case of a woman with a viable intrauterine pregnancy who had a complication of ovarian hyper-stimulation syndrome secondary to ovulation induction following in vitro fertilization and embryo transfer, but who, during hospitalization, presented with clinically progressive abdominal pain. An unruptured ectopic pregnancy of the right fallopian tube was diagnosed accidentally by laparoscopy and laparoscopic salpingectomy was immediately performed. Post-operative follow-up revealed that the intrauterine pregnancy continued normally. She delivered a normal female baby at 38 weeks of gestation. The promising neonatal outcome might suggest that laparoscopy might be safely performed to aid differential diagnosis in an uncertain condition during pregnancy: therefore, laparoscopic surgery might be an appropriate method to manage some carefully selected patients with HP. A brief review of the published literature on the role of laparoscopy in the diagnosis and management of heterotopic pregnancy is given.

The Evaluation of a New 7-Day Gonadotropin-Releasing Hormone Agonist Protocol in the Controlled Ovarian Hyperstimulation for in vitro Fertilization

Objective: Gonadotropin‐releasing hormone agonist (GnRHa) was used in the controlled ovarian hyperstimulation (COH) for the in vitro fertilization program. However, the traditional long protocol demanded more human menopause gonadotropin (hMG) and sometimes causes unnecessary delay in the procedure. A new 7‐ day GnRHa/hMG protocol required to conserve cost and time is thus evaluated for better outcome.

The Effects of Sequentially Combined Hormone Replacement Therapy on Climacteric Symptoms and Lipid Profiles

Objectives: To compare the climacteric symptoms, bleeding patterns, and lipid metabolism in Taiwanese postmenopausal women using 2 different cyclic sequential hormone replacement regimens, containing either 1 to 2 mg 17βestradiol plus 1 mg norethisterone acetate (Sevina®) or 0.625 mg conjugated estrogen plus 5 mg medroxyprogesterone acetate (Premarin®/Provera®; PP). Material(s) and Method(s): Fifty-seven generally healthy, female, postmenopausal patients from 45 to 60 years of age were randomized into groups receiving either 1 tablet Sevina® daily or I tablet of 0.625 mg Premarin® daily with 1 tablet of 5 mg Provera® daily for the first 12 days (days 1 to 12) (PP group) for 6 months. Climacteric symptoms and bleeding patterns were assessed at the baseline and at 1, 3, and 6 months. The effects on lipid variables, hormone profiles, and liver function tests were measured at the baseline and at 6 months. Result(s): Both drugs produced a statistically significant reduction in most climacteric symptoms during the 6 months of treatment (p ＜ 0.05). After 6 months of treatment, total cholesterol showed no significant change in the PP group, whereas there was a significant decrease in the Sevina® group. Meanwhile, low-density lipoprotein cholesterol also revealed a significant reduction in both treatment groups, while high-density lipoprotein cholesterol remained unchanged in both groups. The triglyceride level decreased in the Sevina® group, but showed a significant increase in the PP group (p ＜ 0.05). There was also a significant difference between the 2 groups in changes in triglycerides. Conclusions: This study demonstrates that Sevina® is effective in decreasing low-density lipoprotein cholesterol and the total cholesterol level, without increasing the level of triglycerides, and can effectively alleviate climacteric symptoms during treatment. Sevina® is a highly effective and acceptable sequential hormone replacement regimen for the treatment of climacteric symptoms and lipid effects in postmenopausal women.

Buserelin treatment of endometriosis in Chinese women

Twenty five patients with endometriosis of varying degree had been treated with Buserelin (GnRH analogue) for 6 months. Among them, 83.4% reached castrated level by measuring the serum estradiol (E2) 2 months after therapy. Dysmenorrhea was alleviated or completely disappeared during therapy. Hot flush was the one mostly complained. Vaginal dryness was the second and decreased libido the third. Persisted periodic bleeding was noted in 3 patients. Ovulation was suppressed as evidenced by low serum progesterone throughout the whole course of treatment. Second-look laparoscopy was done at the end of 6-month therapy. Scoring assigned by the American Fertility Society (AFS) was reduced by 27.5%. The adrenal gland, liver and renal functions as well serum calcium and phosphate were retained at the end of treatment. Ovulation and menstruation also returned to normal within 2 months after cessation of therapy. There were 4 pregnancies during the 6-month follow period (4/15 = 26.6% pregnancy rate). 7 patients had improved symptoms whereas 7 patients sustained recurrent dysmenorrhea. The hormonal profile showed that dysmenorrhea improved group had better ovarian suppression than the dysmenorrhea recurrent group.

Transient hyperprolactinemia in gonadotropin-stimulated cycles for in vitro fertilization and its effect on conception

The significance of transiently increased serum prolactin (PRL) levels on pregnancy rates in vitro fertilization (IVF) is unknown. The aim of this study was to evaluate PRL levels in IVF patients who conceived and in matched controls who did not. Ten IVF cycles resulting in pregnancy and forty nonpregnant cycles were compared. Prolactin was measured before ovarian stimulation with gonadotropins and estradiol (E2), progesterone (P) and PRL were measured 36 hours, 12 hours, 10 minutes before and 12 hours after human chorionic gonadotropin (hCG) administration at mid-cycle. Serum PRL levels at various time were not significantly higher in the nonpregnant women than in the pregnant women. Twelve hours before hCG, P levels were significantly higher in the nonpregnant women than in the pregnant women (1.5 +/- 0.2 ng/ml [mean +/- standard error] and 0.9 +/- 0.3 ng/ml, respectively; P < 0.05). All women had transient hyperprolactinemia for one to three times during ovarian hyperstimulation. There was no correlation between PRL and E2 in either group. These results do not support the treatment of transient hyperprolactinemia with dopamine agonists in IVF patients.