Ovarian torsion: Sonographic evaluation

The sonographic and clinical findings of 13 patients with surgically proven ovarian torsion are reported. Sonography demonstrated an abnormal pelvic mass in all patients. The appearance was nonspecific, ranging from solid to cystic, but frequently reflected the commonly associated ovarian pathology present in 69% of patients. The mass was large (mean diameter: 8 cm) and frequently midline (8/13). The clinical findings were variable and nonspecific, leading to a correct preoperative differential diagnosis in only 35% of patients. Preoperative sonography reduced the likelihood of unnecessary appendectomy in patients with ovarian torsion.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38192/1/1870170504_ftp.pd

Intrauterine pregnancy following low-dose gonadotropin ovulation induction and direct intraperitoneal insemination for severe cervical stenosis

BACKGROUND: We present a case of primary infertility related to extreme cervical stenosis, a subset of cervical factor infertility which accounts for approximately 5% of all clinical infertility referrals. CASE PRESENTATION: A 37 year-old nulligravida was successfully treated with ovulation induction via recombinant follicle stimulating hormone (FSH) and direct intraperitoneal insemination (IPI). Anticipating controlled ovarian hyperstimulation with in vitro fertilization/embryo transfer (IVF), the patient underwent hysteroscopy and cervical recanalization, but safe intrauterine access was not possible due to severe proximal cervical stricture. Hysterosalpingogram established bilateral tubal patency and confirmed an irregular cervical contour. Since the cervical canal could not be traversed, neither standard intrauterine insemination nor transcervical embryo transfer could be offered. Prepared spermatozoa were therefore placed intraperitoneally at both tubal fimbria under real-time transvaginal sonographic guidance using a 17 gage single-lumen IVF needle. Supplementary progesterone was administered as 200 mg/d lozenge (troche) plus 200 mg/d rectal suppository, maintained from the day following IPI to the 8(th )gestational week. A singleton intrauterine pregnancy was achieved after the second ovulation induction attempt. CONCLUSIONS: In this report, we outline the relevance of cervical factor infertility to reproductive medicine practice. Additionally, our andrology evaluation, ovulation induction approach, spermatozoa preparation, and insemination technique in such cases are described

Beginning with poems : an anthology

xxx, 379 p. ; 22 cm