No abstract

In countries where the ROPA technique is legal, it offers lesbian couples a more favourable route, involving both partners, to start a family, and doctors who treat lesbian couples must be sensitive to this new family model.

No abstract

The first pregnancy achieved in a seronegative woman following in-vitro fecundation through intracytoplasmic sperm (ICSI) injection from a man with autoimmune deficiency syndrome (AIDS; HIV-1 carrier) is reported. The semen was prepared by PureSperm and swim-up techniques. Some of the motile spermatozoa obtained were used to detect the presence of HIV-1 using the polymerase chain reaction technique. HIV-1 in DNA or RNA form was not detected using this technique. The remaining spermatozoa were frozen. Ovarian stimulation in the woman was performed with long-protocol analogues and gonadotrophins. Thirteen mature oocytes were recovered, into which the thawed spermatozoa were microinjected. Nine embryos were obtained. Four were frozen, four transferred and one discarded. The woman became pregnant. Analyses for HIV-1 in the woman, performed in the first and third months of pregnancy, gave negative results. This case provides further experience with washed semen of sufficient quality for performing artificial insemination in HIV-1-serodiscordant couples (101 inseminations, 31 pregnancies, 28 deliveries, 37 babies, all healthy). In women with obstructed Fallopian tubes, or when the semen is not of sufficient quality for artificial insemination techniques to be performed, ICSI can be carried out using frozen, HIV-1-free semen.

This randomized, prospective study was performed to compare 2 techniques used to reduce the size of an enlarged uterus before vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH). Thirty patients scheduled to undergo vaginal hysterectomy or LAVH were randomized to have uterine reduction performed using either bisection/morcellation (group I, n ϭ 14) or myometrial coring (group II, n ϭ 16). The 2 groups were comparable in clinical and demographic characteristics, including preoperative uterine size, operating times, surgical outcomes, and use of laparoscopic assistance. There were no conversions to laparotomy and no major perioperative complications. The uterus was successfully removed in all cases. The uterus weighed more than 280 g in 81% of the patients in group I (bisection/morcellation) and in 73% of the patients in group II (myometrial coring). There were no significant differences between the 2 groups in operative details except for the rate of extraction failure. In 4 patients (25%) in group II, myometrial coring failed to reduce the size of the uterus, necessitating the use of the bisection/morcellation technique to complete the operation. All reduction attempts were successful in group I (P ϭ 0.06 for difference). Blood loss and transfusion rate were similar in both groups (3 transfusions required in group I and 2 in group II). Postoperative data were similar in both groups with the exception of a greater number of patients with postoperative fever (28%) among those who had myometrial coring compared with bisection/morcellation (P ϭ 0.03). Most uterine characteristics were similar in women in whom uterine reduction with myometrial coring was or was not successful. However, myometrial coring failure occurred more often when the uterus was narrow (68.3 Ϯ 2.3 mm) compared with wide (83.9 Ϯ 9.6 mm; P ϭ 0.01) and less often in uteri heavier than 280 g. EDITORIAL COMMENT(There are many advantages to vaginal hysterectomy, and the skilled gynecologic surgeon will find the vaginal approach in the patient with an enlarged uterus both challenging and, hopefully, satisfying. However, there are several ad-vanced surgical techniques that are required to facilitate the removal of an enlarged uterus. In this article, Nazah and his colleagues from Paris compared bisection and morcellation with myometrial coring in a prospective, randomized, GYNECOLOGY Volume 59, Number 2 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT At the Mayo Clinic, vulvar vestibulitis is treated with vestibulectomy consisting of simple excision of the vulvar vestibule as described by Bornstein and Kaufman. The authors conducted a review of the medical records of their patients who underwent vestibulectomy between 1986 and 2002, and identified 45 who met the definition of vestibulitis described by Friedrich: 1) focal, reproducible points in the vestibule exquisitely tender to light touch; 2) coincident focal area of erythema; and 3) a history of superficial dyspareunia or severe pain on attempted vaginal entry. In addition, a ...