In the past, most cases of osseous metaplasia of the endometrium were diagnosed following removal of bone from the endometrium by dilatation and curettage and frequently subsequently treated by hysterectomy. Nowadays, management involves a suggested diagnosis by transvaginal ultrasound examination, confirmation by hysteroscopy and hysteroscopic removal of ectopic intrauterine bone. This is usually carried out under laparoscopic guidance. However, the degree of visual control provided by combined transabdominal and transrectal ultrasonography may prove sufficiently accurate for hysteroscopic guidance. In this report we describe a case of endometrial osseous metaplasia successfully managed by ultrasound-guided hysteroscopy. The advantages of our approach include reduced invasiveness, reduced costs and simultaneous visualization of the abdominal and intrauterine cavities. One limitation, however, is represented by the greater operator dependence of ultrasound guidance as compared to laparoscopy, the former requiring extensive training and state-of-the-art equipment. We suggest that ultrasound guidance for hysteroscopic removal of extensive osseous metaplasia may represent a potentially safer and more effective alternative to laparoscopy and would therefore encourage further clinical evaluation of this technique.
We report a case of acute abdomen due to puncture of a dermoid cyst during oocyte aspiration, which required laparotomy. A woman who had undergone an in-vitro fertilization and embryo transfer required hospitalization due to onset of an acute abdomen. An ultrasonographic scan showed a pelvic mass with the features of dermoid cyst. The patient required diagnostic laparotomy which confirmed the presence of a ruptured dermoid cyst with subsequent peritonitis.
Several tests based on semen variables have been proposed to predict the fertilization rate in the presence of male factor infertility, but their significance remains unclear. We investigated the utility of a screening test based on sperm survival (SST) to predict the outcome of in-vitro fertilization (IVF) cycles in the presence of male factor infertility. The SST was considered normal when the percentage of motile spermatozoa 24 h after oocyte insemination was > or =50%. The sperm survival test yielded abnormal results in <90% of cycles which were unsuccessful. The sensitivity of the SST was 87% and specificity 65% with a positive predictive value of 90% in the male factor group. We believe that the SST may be a useful predictor of the IVF cycle outcome and we propose its introduction into the routine preliminary evaluation of semen samples in cases of male factor infertility.
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