JBRA Assisted Reproduction

Pregnancy in patients submitted to arterial embolization for uterine leiomyomas

To determine the frequency of pregnancy in patients submitted to uterine artery embolization (UAE) for the treatment of uterine leiomyomas who undergo medical follow-up at a clinic in Belo Horizonte. This study consists of a retrospective cohort study. It is based on data analysis of electronic medical records of patients who underwent the embolization procedure for uterine leiomyomas between March 2003 and March 2018. Out of a total of 587 patients who underwent the UAE procedure to treat leiomyomas, 150 expressed an interested in becoming pregnant. Among these patients, 88 successfully achieved pregnancy, representing a frequency of 58.7%. Among the symptoms and signs analyzed prior to the procedure, menorrhagia (97%) and dyspareunia (71%) were the most commonly observed in the analyzed patients. According to race/ethnicity, the majority (n=39) of the patients identified themselves as brown, and the intramural location (96%) was the most frequent. The study showed that 58.7% of the women who underwent UAE and expressed an interest in becoming pregnant were able to achieve pregnancy, with a 13.6% loss rate. However, further studies are needed to elucidate the key variables that contribute to the increased likelihood of pregnancy after leiomyoma embolization procedure, as well as the effectiveness of symptoms reduction and the actual improvement in pregnancy rates.

Voluminous bilateral adnexal cysts in a young female: the challenge of fertility preservation

An ovarian benign cyst is a common finding in women of reproductive age. However both the disease and its treatment may have an impact on ovarian reserve, resulting in a significant risk of premature ovarian insufficiency. The counselling on fertility preservation is of paramount importance in such cases. We report the management of a young woman with giant bilateral benign adnexal cysts, highlighting the complexity of fertility preservation in such scenario.

Hydatidiform Mole and coexisting fetus following intrauterine insemination: a case report

Gestational trophoblastic diseases (GTD) comprise a heterogeneous group of disorders arising from genetic anomalies occurring during fertilization in twin pregnancies and often may be associated with assisted reproductive techniques. An exceedingly rare presentation of GTD is a twin pregnancy hydatidiform mole with a co-existing fetus, condition which may be an important cause of complications for the mother and the fetus. A 36-year-old woman (G2, P0, A1) underwent a friendly controlled ovarian stimulation (COS) followed by intrauterine insemination (IUI) for assisted reproductive purposes, resulting in a twin pregnancy initially characterized by two gestational sacs. However, one sac failed to progress and instead degenerated into molar trophoblastic disease, while the other sustained a normal fetus with regular growth. At 33 weeks gestation, the patient developed preeclampsia, necessitating delivery via cesarean section at a tertiary care facility. Reproductive-assisted procedures may be linked to cases of trophoblastic disease. Additionally, the presence of cystic lesions warrants a wide differential diagnosis, with magnetic resonance imaging serving as a valuable tool for accurate assessment and differentiation of structures.

Partial hydatidiform mole and coexisting fetus after frozen embryo transplantation: a case report

Hydatidiform mole and coexisting fetus is a very rare condition of which etiology is still inconclusive. It may occur after assisted reproduction, often leading to the death of normal embryos and other serious complications. We report a case of partial hydatidiform mole and coexisting fetus after frozen embryo transplantation. More than two months after the patient underwent transplantation with two blastocysts (scored 4AB and 4BC), B-ultrasound showed a single live fetus with a large dense dotted strong echo area. The patient was treated with chemotherapy after the termination of pregnancy due to persistently increased human chorionic gonadotropin levels. Many studies have described trophoblast quality as a strong predictor of pregnancy. In the case in question, in addition to partial hydatidiform mole caused by multiple sperm entering the egg, we also speculate that the condition may be related to the poor quality of the trophoblastic ectoderm of the transferred embryo. In the process of assisted reproduction, the transfer of embryos with poor trophoblastic ectoderm in multiple embryo transfers may adversely affect pregnancy outcomes.

Fertility-Sparing Treatment in Young Women with Atypical Endometrial Hyperplasia and Low-Grade Endometrial Cancer: A Tertiary Center Experience

To evaluate the oncologic and reproductive outcomes of patients with atypical endometrial hyperplasia and low grade stage 1 endometrial cancer who received medical treatment. We carried out a retrospective study on all patients aged 20-42 years with complex, atypical endometrial hyperplasia, and low-grade stage 1 endometrial cancer, who wished to preserve fertility and were treated at the Royal Hospital. We held this study between January 2006 and December 2016. The patients received oral megestrol acetate with or without a levonorgestrel intrauterine system. We assessed their response to progestin treatment in terms of treatment duration, time to response, pregnancy, time of surgery, and oncological outcome. We performed the statistical analysis using the SPSS 20.0 software. Twenty patients met the inclusion criteria, and among them 90% had complete remission. Among these 90%, 55% had complete remission within six months of treatment. The recurrence rate was recorded in 11 patients (55%) and it was more frequent in obese patients with body mass index (BMI) ≥30 (p=0.001), who had complete response in > 6 months of hormonal treatment. About 15% of the patients required hysterectomy, and 12 (60%) patients conceived after full treatment. Fertility-sparing treatment of atypical endometrial hyperplasia and grade 1 stage 1 endometrial cancer in reproductive-age women is feasible. However, obese patients (BMI ≥ 30) had a higher recurrence rate.

Metabolic risk factors of ovarian cancer: a review

Ovarian cancer continues to be the leading cause of death from gynecological cancers. Despite inconsistent results, patients with metabolic abnormalities, including obesity and diabetes mellitus (DM), have poorer outcomes, showing a correlation with ovarian cancer incidence and ovarian cancer survival. Since ovarian cancer is the most common cancer in women, and considering the increasing prevalence of obesity and DM, this paper reviews the literature regarding the relationship between the aforementioned metabolic derangements and ovarian cancer, with a focus on ovarian cancer incidence, mortality, and likely mechanisms behind them. Several systematic reviews and meta-analyses have shown that obesity is associated with a higher incidence and poorer survival in ovarian cancer. Although more studies are required to investigate the etiological relation of DM and ovarian cancer, sufficient biological evidence indicates poorer outcomes and shorter survival in DM women with ovarian cancer. A variety of pathologic factors may contribute to ovarian cancer risk, development, and survival, including altered adipokine expression, increased levels of circulating growth factors, altered levels of sex hormones, insulin resistance, hyperinsulinemia, and chronic inflammation. Thus, obesity and DM, as changeable risk factors, can be targeted for intervention to prevent ovarian cancer and improve its outcomes.