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Objective: To determine if the prolonged time for achieving ovarian suppression before starting stimulation affected the pregnancy rates. Patients and Methods: Retrospective cohort analysis was performed on 565 women undergoing first assisted reproductive technologies (ART) treatment in a University-affiliated Hospital. The women were grouped according to the duration of downregulation by gonadotropin-releasing hormone (GnRH) analogue. Group A consisted of women in the lower 25th percentile, group B consisted of women in the upper 25th percentile, according to the duration of GnRH analogue use. The implantation and clinical pregnancy rates were compared. Results: Mean number of aspirated and inseminated oocytes were more in group A than in group B. Implantation rates were similar. Clinical pregnancy rates were alike. Conclusion: Prolonged time for achieving ovarian supression does not compromise clinical pregnancy rates in ART cycles.

A 29-year-old woman at 19 weeks and 1 day in gestation gravida 2 para 1 was admitted with the complaints of sudden onset of lower abdominal pain and syncope. During her abdominal ultrasonographic examination the fetus was floating in the abdomen. No amniotic sac was seen surrounding the fetus nor any myometrial image around it. The fetal cardiac activity was not detected. An emergency exploratory laparotomy was performed via a low midline incision. The fetus was lying free in the abdomen. 2000 ml of free and fibrinated blood was drained from the peritoneal cavity. There was a rupture in the right part of the uterus considered to be a rudimentary horn exposing the placenta and part of the umbilical cord. The rudimentary horn and the right tube were excised. The patient discharged on the third postoperative day.

A 29-year-old woman with tenderness in the left lower quadrant of the abdomen with no guarding or rebound tenderness was admitted to the hospital. Her pelvic examination revealed a tender, semi-mobile and semi-solid mass, 6 cm in diameter, just palpable adjacent to the left fornix. Her medical history was otherwise normal except that she had had laparoscopic tubal ligation by bipolar cauterization two months earlier. After 48 hours of medical treatment, laparoscopy was performed. The uterus and both ovaries appeared normal. The distal portion of the left tube remnant was twisted three times on its mesosalpinx and appeared gangrenous and necrotic. A left partial salpingectomy was done laparoscopically. The woman was discharged after 8 hours from the hospital. The pathology confirmed the diagnosis of torsion of a previously dilated tube.