Intermittent spontaneous ovulation in patients with premature ovarian failure:Three case reports and review of literature

BACKGROUND Premature ovarian failure(POF)is the end-stage of a decline in ovarian function prior to the age of 40 years that involves symptoms associated with low estradiol(E2)levels and a minimal probability of pregnancy.This increases the physical and psychological burden experienced by young women of reproductive age,particularly with regards to over-diagnosis.CASE SUMMARY Here,we report three cases(29,22,and 33 years-of-age)diagnosed with POF after experiencing secondary amenorrhea for more than one year,serum levels of follicle-stimulating hormone(FSH)>40 IU/L on two occasions with an interval of more than 4 wk,and negative progesterone withdrawal tests.All three patients were intermittently administered with drugs to create an artificial cycle.During the subsequent discontinuation period,the patients experienced intermittent follicular growth and spontaneous ovulation.One patient experienced two natural pregnancies(both with embryo arrest).CONCLUSION Our findings suggest that young patients with POF can experience unpredictable and intermittent spontaneous follicular development,ovulation,and even natural pregnancy.Clinicians should provide appropriate medical guidance and individualized treatments according to fertility requirements,genetic risks and hypoestrogenic symptoms as soon as possible.

Spontaneous ovarian hyperstimulation syndrome: Report of two cases

BACKGROUND Spontaneous ovarian hyperstimulation syndrome(s OHSS) is extremely rare. It can be divided into four types according to its clinical manifestations and follicle stimulating hormone receptor mutations.CASE SUMMARY Here we report two cases of s OHSS in Chinese women, one with a singleton gestation developing s OHSS in the first trimester who conceived naturally and the other with a twin pregnancy developing s OHSS in the second trimester after a thawed embryo transfer cycle. Both patients were admitted to the hospital with abdominal distension, ascites, and enlarged ovaries. Conservative treatment was the primary option of management. The first patient had spontaneous onset labor at 40 wk of gestation and underwent an uncomplicated vaginal delivery of a male newborn. The second patient delivered a female baby and a male baby by caesarean section at 35 wk and 1 d of gestation.CONCLUSION Patients with a history of ovarian hyperstimulation syndrome should be closely monitored. Single embryo transfer might reduce the risk of this rare syndrome.

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia:a tertiary care center experience

Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.