Unusual clinical presentation of rare case of vaginal leiomyoma: a case report

Primary vaginal leiomyoma are rare and usually arise from anterior vaginal wall, approximately 330 cases of vaginal fibroid reported in world literature. Vaginal myoma usually presented as discharge per vaginum, abnormal bleeding, pain lower abdomen, dyspareunia etc. We report a case of primary vaginal leiomyoma arising from lateral vaginal wall which is presented clinically as pain in hip joint and radiating to ipsilateral leg which is unusual clinical presentation creating diagnostic dilemma and because of rarity of the case

Where is the best site for embryo transfer? A study of relation of embryo-fundal distance with pregnancy rate in ICSI-ET cycle

Background: Embryo transfer is the ultimate and most critical step of IVF-ICSI treatment cycle. It has a significant impact on the success rate of IVF cycle. Undoubtedly, it has significant impact of the pregnancy rate and implantation rate. Along with the other factors the impact of the site of embryo transfer has also been studied by several investigators. There is lack of clear consensus about the ideal site of embryo transfer.Methods: This study includes a retrospective analysis of 200 embryo transfers done in 200 infertile couples done at our infertility clinics from January 2016 to March 2016. Transfer cycles of gamete donation, embryo donation and frozen embryos were excluded from the study. The study involved patients undergoing their first IVF- ICSI cycle with fresh embryo transfer at our IVF Unit. All patients were stimulated using Antagonist protocol starting Gonadotropins from day 2/3 of menses.Results: The clinical pregnancy rate was highest (55.2%) in group 2 when the embryo fundal distance was more than 10 mm but less than or equal to 15 mm. In group 3 when embryos were placed beyond 15 mm distance from the fundus, the clinical pregnancy rate was 34.66%. The lowest pregnancy rate - 30% was found in group 1 when embryos were places less than 10 mm from fundus. There was only a single case of ectopic pregnancy in the study group. The ectopic pregnancy was seen in group 1. There two cases of abortion each in group 2. The miscarriage rate was higher in group 3-5. 33% as compared to 1.9% in group 2. The sample size was small to determine if these results were significant enough.Conclusions: The present study demonstrates that higher pregnancy rates are obtained if the embryos are selectively placed at a distance between 10mm to 15 mm from the fundal endometrial surface. It is not possible to determine exact location of embryo placed in utero by any method. The findings of our study can be considered as a guiding force by clinicians

Successful pregnancy outcome in a case of Swyer Syndrome with hypertension and morbid obesity

To report a case of Swyer syndrome with hypertension and morbid obesity with successful pregnancy and live birth after assisted reproductive technology. 27 year old morbidly obese female with essential hypertension who had been on HRT for 10 years with well-developed secondary sexual characters with primary infertility. After adequate development of the uterus and the endometrial preparation, Patients with Swyer syndrome conceive with oocyte donation and ICSI. Caesarean section rate is high due to multiple pregnancies and other obstetric complications. Early detection of these cases would help in timely development of their secondary sexual characters and restoration of menses and gonadectomy for prevention of malignancy as its propensity is high. Multidisciplinary approach is required including counseling and management of long term health problems. Pregnancy is feasible but caesarean rate is high

Knowing a cross-talk between embryo and endometrium can help to achieve successful pregnancy outcome in recurrent implantation failure

Recurrent implantation failure is most distressing condition to both couple as well as doctor in the field of reproductive medicine. Patients have already undergone various ART treatments with no favourable outcome and are drained emotionally as well as economically. To overcome this obstacle a comprehensive approach is needed. In this case report, we are addressing a couple who came to us with primary infertility of 15 yrs, with recurrent IVF failures (four cycles of IUI, seven cycles of ICSI both fresh and frozen and with ovum donation in last two cycle), with poor ovarian reserve and male factor infertility for surrogacy as a last option. After complete evaluation of couple, recurrent Implantation failure is thought to be due to poor endometrium and bad embryo quality, and we counselled couple to go for ovum donation and ICSI before considering surrogacy. To improve endometrial receptivity we performed local endometrial injury, oral estradiol therapy, intrauterine G-CSF instillation and IVIG etc. Simultaneously for better quality of embryo we decided to choose ovum donation due to poor ovarian reserve and advance age of the patient and ICSI was done with husband sperm after treatment of male factor infertility and ET was performed. Patient conceived in first cycle with single live intrauterine pregnancy, her antenatal course was uneventful and delivered a healthy baby at term without any complication

Fresh versus frozen embryo transfer: a retrospective cohort study

Background: Elective frozen embryo transfer (FET), has recently increased significantly with improvements in cryopreservation techniques. Observational studies and randomized controlled trials suggested that the endometrium in stimulated cycles is not optimally prepared for implantation; risk of ovarian hyperstimulation syndrome reduced and pregnancy rates increased following FET and perinatal outcomes are less affected after FET. However, the evidence is not unequivocal and recent randomised control trials challenge the use of elective FET for the general IVF population. Pregnancy rates were analysed in a cohort of patients undergoing embryo transfers.Methods: This was a retrospective cohort study of patients who underwent embryo transfers from April 2018 to March 2019 at study centre in Surat.175 cycles of embryo transfers (119 fresh and 56 frozen) were included in the study. Outcomes measured were positive pregnancy, clinical pregnancy and ongoing clinical pregnancy rates achieved in the IVF-ET cycles.Results: There were no statistically significant differences between positive pregnancy rate (54.6% versus 60.7%, Odds ratio (OR) 0.78; 95% Confidence Interval (CI) 0.41-1.49), clinical pregnancy rate (48.73% versus 57.14%, OR 0.52; 95% CI 0.1- 2.64) and ongoing clinical pregnancy rate  (45.38% versus 51.78% OR 1.4; 95% CI 0.29 - 6.67) in fresh ET and FET cycles, respectively, p < 0.05 was considered statistically significant for all measures.Conclusions: Despite the observed higher rates of positive biochemical, clinical and ongoing clinical pregnancy per transfer in the FET cohort, these did not reach statistical significance. Thus, both transfer strategies are reasonable options, although there is a trend favouring the freeze-all strategy

Unusual clinical presentation of rare case of vaginal leiomyoma: a case report

Primary vaginal leiomyoma are rare and usually arise from anterior vaginal wall, approximately 330 cases of vaginal fibroid reported in world literature. Vaginal myoma usually presented as discharge per vaginum, abnormal bleeding, pain lower abdomen, dyspareunia etc. We report a case of primary vaginal leiomyoma arising from lateral vaginal wall which is presented clinically as pain in hip joint and radiating to ipsilateral leg which is unusual clinical presentation creating diagnostic dilemma and because of rarity of the case

The Nonbulky DNA Lesions Spiroiminodihydantoin and 5‑Guanidinohydantoin Significantly Block Human RNA Polymerase II Elongation <i>in Vitro</i>

The most common, oxidatively generated lesion in cellular DNA is 8-oxo-7,8-dihydroguanine, which can be oxidized further to yield highly mutagenic spiroiminodihydantoin (Sp) and 5-guanidinohydantoin (Gh) in DNA. In human cell-free extracts, both lesions can be excised by base excision repair and global genomic nucleotide excision repair. However, it is not known if these lesions can be removed by transcription-coupled DNA repair (TCR), a pathway that clears lesions from DNA that impede RNA synthesis. To determine if Sp or Gh impedes transcription, which could make each a viable substrate for TCR, either an Sp or a Gh lesion was positioned on the transcribed strand of DNA under the control of a promoter that supports transcription by human RNA polymerase II. These constructs were incubated in HeLa nuclear extracts that contained active RNA polymerase II, and the resulting transcripts were resolved by denaturing polyacrylamide gel electrophoresis. The structurally rigid Sp strongly blocks transcription elongation, permitting 1.6 ± 0.5% nominal lesion bypass. In contrast, the conformationally flexible Gh poses less of a block to human RNAPII, allowing 9 ± 2% bypass. Furthermore, fractional lesion bypass for Sp and Gh is minimally affected by glycosylase activity found in the HeLa nuclear extract. These data specifically suggest that both Sp and Gh may well be susceptible to TCR because each poses a significant block to human RNA polymerase II progression. A more general principle is also proposed: Conformational flexibility may be an important structural feature of DNA lesions that enhances their transcriptional bypass