Levonorgestrel intrauterine system: A first line medical therapy for idiopathic heavy menstrual bleeding

Heavy menstrual bleeding or menorrhagia is a common menstrual disorder. Currently, both medical and surgical treatment options are available for the management of heavy menstrual bleeding. Hysterectomy, one of the surgical treatment options is associated with risks and is a costly procedure. Medical treatment may be preferred for the management of heavy menstrual bleeding. Oral medical treatments have various limitations for their use. For instance, cost is a limiting factor for tranexamic acid. Limited data is available to support the effectiveness of oral contraceptives. Poor patient compliance and intolerable adverse events are some other limitations especially in long term use. Levonorgestrel intrauterine system (LNG-IUS) is one of the common medical modalities in the management of heavy menstrual bleeding. LNG-IUS has been compared with other medical options like tranexamic acid, mefenamic acid, combined estrogen-progestogen, or progesterone alone, cyclic oral medroxyprogesterone acetate (MPA) oral norethisterone and low-dose combined oral contraceptive. LNG-IUS is more effective than usual medical treatment and also reduces the effect of heavy menstrual bleeding on quality of life. Similarly, it has shown similar therapeutic effects compared to endometrial ablation. Based on its efficacy, convenience and cost of therapy, it can be considered as the first line medical therapy for the management of heavy menstrual bleeding

Successful expectant management of tubal heterotopic pregnancy

Expectant management for tubal heterotopic pregnancy could be considered as a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. We report the obstetric outcome after expectant management for a right tubal heterotopic pregnancy. Heterotopic pregnancy was first recognized at 6 weeks gestation in a 32-year-old salpingectomized woman with an 8-year history of subfertility who conceived after in utero transfer of three embryos obtained by in vitro fertilization. Expectant management and close ultrasonographic and clinical monitoring were done. The intrauterine pregnancy proceeded unremarkably. A cesarean section was performed for breech presentation, and it allowed the delivery of a healthy 2260-g male infant. The examination of the adnexa showed a pre-rupture of the right fallopian tube

Successful birth of an IVF baby in a patient with Parkinson's disease

Parkinson's disease, although rare in young patients, may be encountered in the reproductive age group. We report a rare combination of this disease with infertility, which has not been previously reported. The case record of a 29-year-old woman with infertility and Parkinson's disease are retrospectively reviewed. An IVF indicated for tubal factor infertility resulted in a successful singleton pregnancy. She delivered a healthy male baby without experiencing any worsening of her Parkinsonism. The course of pregnancy remained unaffected by the Parkinson's disease and anti-Parkinsonian drugs. The details of the infertility management, antenatal and postnatal course, and medications are described. With careful evaluation, counseling, and monitoring, IVF may be safely used in women with Parkinson's disease