Infertility may be caused by a number of diverse reasons. The diagnostic and therapeutic modalities in the management of this have advanced tremendously in the last three decades with the birth of the first "test tube" baby, Louise Brown in 1978. The underlying problem in infertility may be any of the following: semen quality; ovulation; passage of the sperm to the fallopian tubes; fertilization; or the transport of the embryo to the uterine cavity. All this can now be addressed by doing in-vitro fertilization and embryo transfer (IVF-ET). However, the solution to the problem of implantation remains elusive. The dilemma is even worse, if there is no endometrium to implant on. Presented here is one such case where a disease in childhood was likely to have made a lasting impact on the future of her reproductive potential. The diagnosis, fertility prognostication and reproductive options in these cases are also discussed.
ASHERMAN'S ; SYNDROME ; UTERINE ; SYNECHIAE ; GENITAL ; TUBERCULOSIS ; INTRAUTERINE ; ADHESIONS ; ;

Recurrent ectopic pregnancy after bilateral salpingectomy is a very rare condition, with only one previous case reported. This is a case of a 29 year old G4P0(0030) who presented with abdominal pain at the background of missed menses and positive pregnancy test, two years after bilateral salpingectomy. Intraoperatively, a 5x4cm bleeding mass was visualized at the right distal tubal remnant, containing an embryo and decidualized tissues. Excision of the adnexal mass and bilateral tubal remnants were completed. In such cases, total salpingectomy is the gold standard in preventing recurrence of another extrauterine gestation. In the presence of tubal remnants, a hysterosalpingography is recommended to assess tubal patency. Ultimately, the rarity of this case demands prompt recognition of risk factors, clinical presentation and appropriate management. It underscores the importance of maintaining vigilance, with high index of clinical suspicion in all women in the reproductive age group, especially those with risk factors.
Amenorrhea

Objective: The objective of the study was to determine the effectiveness of myoinositol (MI) supplementation in the prevention of gestational diabetes mellitus (GDM) among high-risk patients. Materials and Methods: Comprehensive and systemic online searches were performed on PubMed, MEDLINE, Ovid, and Cochrane. Cross-referencing from related articles was also done. Only studies published in English were included in the study. We selected all randomized controlled trials on MI and singleton pregnant women with high risk for GDM. Data Collection and Analysis: Five randomized controlled trials were evaluated by two independent reviewers. For each comparison, the quality of evidence was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Cochrane Collaboration tool. Review Manager 5.3 was used to generate the risk of bias evaluation and the analysis of the results. Main Results: The present study identified five randomized controlled trials involving 871 participants. The comparison of the studies showed a statistically significant reduction in the incidence of GDM in MI supplementation versus the control group (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.19–0.53, P = 0.0001, Z = 4.36) by 68%. Similarly, there is a greater reduction in the incidence of fetal macrosomia among patients in the MI group than the controlled group (OR = 0.24, 95% CI = 0.07–0.78; P = 0.02, Z = 2.36) by 78%. However, there was no difference in terms of incidence of gestational hypertension (OR = 0.61, 95% CI = 0.19–2.01; P = 0.42, Z = −0.81), cesarean section (OR = 0.89, 95% CI = 0.65–1.22; P = 0.47, Z = 0.72), and neonatal hypoglycemia (OR = 0.35, 95% CI = 0.01–8.80; P = 0.53, Z = 0.63) outcomes. Conclusion MI supplementation taken at 4 g daily would decrease the incidence of GDM and fetal macrosomia. There was no statistically significant reduction in the risk of gestational hypertension, cesarean section, and neonatal hypoglycemia in the supplementation of MI.
Cesarean section ; fetal macrosomia ; gestational diabetes mellitus ; gestational hypertension ; myoinositol ; neonatal hypoglycemia

Mayer-Rokitansky-Kuster-Hauser syndrome, the second most common cause of primary amenorrhea, is a congenital anomaly caused by defective Mullerian duct development. It is the absence of uterus, cervix and upper two thirds of the vagina that results in primary amenorrhea. This is a case of a 42-year-old, nulligravid with primary amenorrhea complaining of acute abdominal pain. She has no co-morbidities or previous surgeries. Examination revealed an absent cervix and a left adnexal mass. Ultrasonography revealed an atrophic uterus with no endometrial stripe and cervix, with possible ovarian tumor versus myoma. Impression was mullerian agenesis with pelvoabdominal mass in torsion. She then underwent total abdominal hysterectomy with bilateral salpingectomy and adhesiolysis. Intraoperatively, there were two hemiuteri connected by a fibromuscular stalk. Left hemiuterus was dextrorotated, adherent to the sigmoid mesentery and peritoneum. Histopathology confirmed absence of endometrial cavity but with adenomyosis in bilateral uterine buds. Chromosomal analysis confirmed 46, XX karyotype.
Adenomyosis