title: Successful pregnancy outcome following gamete intra-Fallopian transfer in a patient with Müllerian dysgenesis.
abstract: A 29-year-old lady with Müllerian dysgenesis was keen to have a baby. Clinically, she was medium built with well-developed secondary female sexual characteristics. There was a short and blind vagina. She had undergone surgery for an imperforated hymen. Her FSH and LH concentrations were normal. Laparoscopy revealed a patent right Fallopian tube, a rudimentary right uterus and extensive pelvic endometriosis. She subsequently underwent gamete intra-Fallopian transfer (GIFT). Oocyte retrieval was carried out laparoscopically and a total of nine oocytes were retrieved. Four of the oocytes were transferred together with motile spermatozoa into the right Fallopian tube and the remaining five oocytes were inseminated with spermatozoa for IVF. Three embryos resulted and were frozen. She subsequently developed moderate ovarian hyperstimulation syndrome. Serum β-human chorionic gonadotrophin concentration 14 days after GIFT was 1612 IU/l. Her antenatal care was relatively uneventful until 31 weeks of gestation when she was diagnosed to have intrauterine growth retardation and oligohydramnios. She then underwent an emergency Caesarean section at 32 weeks of pregnancy delivering a normal baby. This case study describes a successful pregnancy outcome following gamete intra-Fallopian transfer (GIFT) in a woman with malformation of the vagina (Müllerian dysgenesis). A 29-year-old lady with Müllerian dysgenesis diagnosed at 16 years of age was keen to become pregnant. Upon examination, a decision was made for a William's vulvovaginoplasty but as the patient was indecisive the surgery was deferred. Clinically, she is a medium-built lady with well-developed secondary female sexual characteristics. There was a short and blind vagina. Her serum FSH and LH concentrations were normal. Laparoscopy revealed a patent right Fallopian tube, a rudimentary right uterus and extensive pelvic endometriosis. She subsequently underwent GIFT. Nine oocytes were retrieved through laparoscopy. Four of the oocytes were transferred together with motile sperm into the right Fallopian tube and the remaining five oocytes were inseminated with sperm for IVF. Three embryos resulted and were frozen. Serum β human chorionic gonadotrophin concentration measured 14 days after GIFT was 1612 IU/l. An abdominal ultrasonography performed at 5 weeks showed one intrauterine gestational sac. Her antenatal care was uneventful until 31 weeks of gestation when she developed a deficiency of amniotic fluid in the amniotic sac. She then underwent an emergency Caesarean section at 32 weeks of pregnancy. She delivered a healthy, normal 1.24 kg baby boy. Her post-natal care was uneventful.
authors.affiliation: Alpha International Fertility Centre, 31, Level 2, Jalan PJU 5/6, Dataran Sunway, Kota Damansara 47810, Petaling Jaya, Selangor, Malaysia. colinleess@yahoo.com
authors.forename: Colin S S
authors.initials: CS
authors.lastname: Lee
authors.forename: Aldrin T M
authors.initials: AT
authors.lastname: Lie
mesh_terms: D000328:Adult; D002585:Cesarean Section; D005260:Female; D015181:Gamete Intrafallopian Transfer / Q000379:methods*; D023961:Gonadal Dysgenesis, 46,XX / Q000150:complications*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy*; D007315:Insemination, Artificial; D009095:Mullerian Ducts / Q000002:abnormalities*; D054315:Oocyte Retrieval; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D014599:Uterus / Q000002:abnormalities; D014621:Vagina / Q000002:abnormalities