Third Party Reproduction in Recurrent Pregnancy Loss
Howard J.A. Carp in Recurrent Pregnancy Loss, 2020
In 8 years’ experience of an IVF surrogate gestational program, Raziel et al. [36] reported 33% and 12% pregnancy rates per patient and per transfer, respectively, in patients with IVF implantation failure, recurrent miscarriages, and deteriorating maternal diseases, compared to 70% and 20%, respectively, in patients with Rokitansky syndrome and post-hysterectomy. The authors concluded that the existence or absence of the uterus in the commissioning mothers is irrelevant for their IVF performance and conception rates. In patients who conceived after more than three IVF cycles, an additional “oocyte factor” might be present [36]. Raziel et al. [37] reported a normal live birth in a patient with 24 prior pregnancy losses. The editor has advised surrogacy (unpublished) in a secondary aborter with 12 miscarriages, one primary aborter with 6 miscarriages and triplets of 25 weeks who died from prematurity, and a primary aborter with 8 missed abortions including 2 euploid miscarriages, who continued miscarrying despite immunoglobulin therapy. In all three cases, the surrogate carrier delivered normal twins. The logic of surrogacy in patients with large numbers of miscarriages is due to the poor prognosis and low incidence of chromosomal aberrations.
The development and anatomy of the female sexual organs and pelvis
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
In approximately 1 in 5,000 to 1 in 40,000 girls, the Müllerian system does not develop, resulting in an absent or rudimentary uterus and upper vagina. This condition is known as Rokitansky syndrome or Mayer–Rokitansky–Kuster–Hauser syndrome (MRKH). The ovaries function normally and so the most common presentation is with primary amenorrhoea in the presence of otherwise normal pubertal development. The aetiology of this condition is not known, although possible factors include environmental, genetic, hormonal or receptor factors. On examination, the vagina will be blind ending and is likely to be shortened in length. An ultrasound scan will confirm the presence of ovaries, but no functioning uterus will be present.
Normal and abnormal development of the genitalia
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Rokitansky syndrome (agenesis of the uterus and vagina) is considered separately later in this section. More recently a new classification system has been developed by ESHRE/ESGE28 which classifies abnormalities of uterus (U0–6), with two subclasses incorporated, the cervix (C0–4) and vagina (V0–4). This system is complex and as yet is not in widespread clinical use.
Uterine transplantation
Published in Climacteric, 2019
The second attempt was in Turkey in 2011. The recipient was a 23-year-old woman, with complete Müllerian agenesis for which a prior vaginal reconstruction had been performed. The donor was 22 years old, a deceased multiorgan donor. Eighteen months after the transplantation, embryo transfer was attempted in two separate cycles; a single day-3 thawed embryo was transferred under real-time ultrasound guidance 3 days after the initial progesterone application. Eleven days after the first transfer, serum human chorionic gonadotropin (hCG) levels were consistent with a biochemical pregnancy (hCG, 35.7 IU/l) but dropped 4 days later. Following the embryo transfer in the second cycle, transvaginal ultrasound confirmed an intrauterine pregnancy of 5 gestational weeks, but the gestation failed to develop further15,16.
Vaginal reconstruction with the modified rectosigmoid colon: surgical technique, long-term results and sexual outcomes
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Ömer Özkan, Özlenen Özkan, Anı Çinpolat, Nasuh Utku Doğan, Gamze Bektaş, Kemal Dolay, Alihan Gürkan, Cumhur Arıcı, Selen Doğan
Vaginal reconstructions with pedicled rectosigmoid colon transfer were performed in 43 patients. The mean age was 29.6 with a range of 17 and 48 years. The etiology was MRKH syndrome in 34 patients, while nine patients had undergone male to female sex reassignment surgery in other institutions, but adequate vaginal depth had not been achieved. The mean ages (and range) of the transgender and MRKH patients were 40 (24–48) and 26.9 (17–43) years, respectively (Table 1). Development of the ovaries and secondary sex characteristics was normal in all cases of Müllerian agenesis.
An alternative approach to vaginal dilation in patients with Meyer-Rokitanski-Küster-Hauser syndrome: two case reports
Published in Gynecological Endocrinology, 2020
Kátia Crys Moura Ogliari, Salete da Silva Rios, Ana Carolina Rios Chen, Juliana Rios Chen, Ceres Nunes Resende, Edward Araujo Júnior
The MRKH is commonly diagnosed in adolescence or early adulthood; primary amenorrhea is often the first sign of MRKH in women with normal secondary sexual characteristics and karyotype 46, XX [2]. Another important manifestation of Müllerian agenesis is difficulty with sexual intercourse because of impossibility of vaginal penetration, although sexual desire and pleasure remain intact [5].
Related Knowledge Centers
- Amenorrhea
- Birth Defect
- Bladder
- Paramesonephric Duct
- Urogenital Sinus
- Cervix
- Urethra
- Vagina
- Uterus
- Vaginal Hypoplasia