ObjectiveTo report a rare successful pregnancy after fertility treatment in a patient with Swyer syndrome.DesignCase report.SettingHerts & Essex Fertility Centre, Cheshunt, UK.Patient(s)A 36-year-old patient with 46, XY gonadal dysgenesis. 31 year old husband with normal sperm analysis.Intervention(s)Chromosomal analysis, Saline infusion sonography, Pipelle endometrial scratch, ICSI using donor eggs, Embryo Transfer, and Caesarean delivery.Main Outcome Measure(s)Successful pregnancy and live birth.Result(s)Successful treatment with donor eggs, pregnancy, and delivery.Conclusion(s)A patient with 46, XY gonadal dysgenesis in a specially tailored fertility program, can maintain a normal pregnancy and delivery.
This report presents our experience with gamete intra-Fallopian transfer (GIFT) in cases with non-endometriotic pelvic adhesions. Two-hundred-and-eight GIFT attempts, where pelvic adhesions were identified laparoscopically in patients with no previous history of endometriosis, were subdivided into two groups: (i) post-surgical (n = 134) and (ii) non-surgical (n = 74). The extent of the adhesions was further classified according to the American Fertility Society (AFS) classification system. The overall clinical pregnancy rate was 39.4% (82 out of 208 attempts). There was no significant difference in the clinical pregnancy rate per attempt between the surgical (38.8%) and the non-surgical (40.5%) groups. A gradual, but not significant decline in the pregnancy rate was noticed from adhesion Stages I to III, but Stage IV had a significantly lower pregnancy rate (22.7%) than Stage I (47.4%). The intra-uterine pregnancy rate was observed to be higher, but not significantly, in the non-surgical (37.8%) than in the surgical (29.1%) cases. The overall ectopic pregnancy rate was 7.2% per attempt and 18.3% per clinical pregnancy. In the post-surgical group, the ectopic pregnancy rate per pregnancy was 3.5 times that in the non-surgical (23.2% versus 6.5%, respectively), and it was significantly higher in Stage IV (40%; two out of five pregnancies) than in Stage I adhesions (11.1%; three out of 27 pregnancies). In cases with a history of tubal surgery, the ectopic pregnancy rate was 33.3% (10 out of 30 pregnancies). Our results indicate that GIFT can offer a successful treatment option for selected cases with non-endometriotic pelvic adhesions.
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