Background: Heterotopic pregnancy is an exceedingly rare condition in which an intrauterine and extrauterine pregnancy coexist. Superfetation refers to the coexistence of 2 or more fetuses of different gestational ages as a result of ovulation, fertilization, and implantation during an ongoing pregnancy. We present a case of heterotopic triplet pregnancy with a difference in gestational age by crown rump length of more than 1 week between the twin intrauterine pregnancy and the singleton tubal ectopic. Case Report: A 31-year-old gravida 3, para 2002 presented to the emergency department with abdominal pain at 9 weeks 2 days’ gestation dated by last menstrual period, consistent with ultrasound. She was discharged home with a diagnosis of ruptured hemorrhagic cyst but returned 4 days later with ruptured tubal ectopic pregnancy measuring 9 weeks’ gestation and ongoing twin gestation measuring 10 weeks 1 day. She was taken to the operating room for laparoscopic salpingectomy, and ectopic pregnancy was confirmed on tissue diagnosis. Conclusion: Heterotopic pregnancy presents a diagnostic challenge for obstetricians/gynecologists. Superfetation has never been demonstrably proven in humans but has been suggested in the literature. This report adds to the literature that perhaps superfetation can be artificially induced in humans in the presence of assisted reproductive technologies.
Many health conditions may impact an individual's future fertility.For example, longitudinal studies of childhood cancer survivors showed that patients were distressed about potential infertility after cancer treatment and regretted missing opportunities for fertility preservation (FP). 1 Studies have extrapolated this to non-oncologic populations and recommend that youth with gender dysphoriadistress due to discrepancy between one's gender identity and assigned sex-discuss the fertility risks of surgery or hormone therapy, and availability of FP, prior to undergoing gender-affirming treatments. 1,2 Transgender refers to someone whose gender identity is opposite from their sex assigned at birth. 2 Transitions of gender
The factors most predictive of mortality were late entry to prenatal care, critical status requiring transfer from an outside facility, and non-private insurance status.
Objectives To compare the use of the luteinizing hormone (LH) surge versus the last menstrual period (LMP) for the accuracy of pregnancy dating in fertile women with a diagnosis of recurrent early pregnancy loss (REPL). Methods This was an observational cohort study using prospectively collected data at 2 academic REPL programs between 2005 and 2018. Women with a history of REPL and at least 1 subsequent live birth after the evaluation were included. All patients conceived by intercourse timed to the LH surge. Transvaginal ultrasound was examinations were performed 2 weeks after missed menses. The gestational age (GA) was calculated by the LH surge (GALH), LMP (GALMP), and first crown‐rump length (CRL) that measured 5 mm or greater (GACRL). A secondary analysis compared GA based on the first measurable CRL of less than 5 mm versus GA based on the first CRL of 5 mm or greater. The GALH and GALMP were compared to determine which measure showed greater concordance with the CRL. The mean absolute difference in days between the GACRL versus GALH and GACRL versus GALMP was determined. Results A total of 115 women with 118 subsequent pregnancies resulting in live birth were included, with a mean age at delivery of 35.5 years and a mean of 3.6 prior pregnancy losses. The GALH showed a stronger correlation with the CRL (0.77) than the GALMP (0.63; P = .002). The GALH was more similar to the GACRL than the GALMP, with a mean absolute difference of 2.0 versus 3.1 days (P < .0001). Conclusions When known, the LH surge appears to be more accurate than the LMP and should be used preferentially for dating of early pregnancy.
INTRODUCTION: Obstetricians and gynecologists play an important role in providing care to all persons who desire parenthood. However, there are limited studies assessing the preferences of transgender adults in achieving parenthood. We aimed to examine the importance of parenthood and preferred means to achieve it in a transgender adult population. METHODS: A cross-sectional survey of patients aged ≥ 18 years and who self-identified as a gender minority at an urban academic medical center and outpatient primary care center specializing in LGBTQ health. RESULTS: Sixty-two people completed the survey, of which 7 (11.3%) were born male and 55 (88.7%) were born female. The average age of participants was 28.2. Only 2 (3.2%) participants had children, although 52 (88%) reported desiring parenthood. Of those who desired parenthood, 14 (29%) preferred to achieve this using their own gametes, 12 (24%) preferred adoption and 14 (29%) preferred to use a gestational carrier without using their gametes. Only 34 (56%) reported that a healthcare provider discussed oocyte cryopreservation prior to transition. The largest barriers identified to oocyte cryopreservation were desire (33%), cost (58%), and stopping cross-sex hormones (25%). 10 (16.4%) believed their ability to have children was decided without their consent. CONCLUSION: In this survey of adult transgender patients, the majority are desiring parenthood. Barriers previously identified in the literature such as physical examination and provocation of periods/penile tumescence were not viewed to be as significant as cost and stopping cross-sex hormones. This knowledge can improve clinical discussions and identify the barriers that transgender patients experience in achieving parenthood.
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