Insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is, the normal response to a given amount of insulin is reduced. As a result, higher levels of insulin are needed in order for insulin to exert its effects. Polycystic Ovarian Syndrome (PCOS) is one of the metabolic syndromes that link insulin resistance with diabetes mellitus, hyperandrogenism, and ovulatory dysfunction. PCOS often has a menarcheal age of onset characterized by a failure to establish a regular pattern of menses. In the case presented, the patient has primary amenorrhea assoicated with the development of secondary sexual characteristics, acanthosis nigricans, and acromegaloid attributes. Evaluation of pituitary function revealed that the patient's amenorrhea is secondary to hypergonadotropic hypogonadism, particularly, ovarian insufficiency. This case provides a unique setting to relate the syndrome of insulin-mediated expression of an acromegaloid pnenotype with insulin-mediated pathogenic mecahnisms for ovarian failure to exist concurrently.
Human ; Female ; Adult ; PRIMARY OVARIAN INSUFFICIENCY ; ACANTHOSIS NIGRICANS ; HYPERANDROGENISM ; POLYCYSTIC OVARY SYNDROME

Objective: To determine the pregnancy rate after intrauterine insemination using samples with. processed total motile count of 1.0 x 106 and less and describe the semen quality profile of Filipino males with severe male factor infertility in both the raw and processed semen samples. Design: Retrospective descriptive study. Setting: Andrology Laboratory, St. Luke's Medical Center. Patients: 307 infertile Filipino couples who underwent 426 IUI cycles. Main Outcome Measures: Pregnancy rate (PR) after intrauterine insemination. Results: A total of 10 pregnancies were obtained out of 426 IUI cycles, for a pregnancy rate per cycle of 2.4%. Seven of these eventually delivered to term, for a live birth rate of 1.6%. Among those who did not get pregnant with IUI, 8 had spontaneous pregnancies within 1 to 5 year period of follow-up for a spontaneous pregnancy rate of 1.9%. As expected, all the semen parameters analysed showed improvement after semen processing in all subjects. However, these improvements failed to result in a more acceptable pregnancy rate. Among the parameters, morphology was notably better among those who had pregnancies. Conclusion: The chance of pregnancy with IUI using semen samples with processed total motile count of 1.0 x 106 or less is relatively low. For these couples, it may be more prudent to proceed directly to IVF-ICSI than to try several cycles of IUI in futility.
INTRAUTERINE INSEMINATION ; SEVERE OLIGOSPERMIA

Two women presenting with recurrent pregnancy loss were both diagnosed to have septate uterus. After hysteroscopic resection of the septum under laparoscopic guidance, successful term pregnancy was achieved in one patient, while second patient is currently on her 24th week of gestation. Septate uterus is the most common type of congenital uterine anomaly and has long been known to be associated with recurrent miscarriages, late-term abortion, and preterm labor. The pre-treatment abortion rate is 90%, which is both distressing for the patient and frustrating for the physician. Hysteroscopic septal resection under laparoscopic guidance is considered the standard for treatment, and is shown to improve reproductive outcome.
ANOMALY ; SEPTATE UTERUS ; RECURRENT PREGNANCY LOSS

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Human ; Male ; Female ; Adult ; Reproductive History ; Spouses ; Infertility ; Uterus ; Fallopian Tubes ; Insemination ; Fertility ; Spermatozoa

This is a case of a 37-year-old nulliparous woman, and her 53-year-old husband diagnosed with complete retrograde ejaculation and absolute azoospermia, who conceived after transfer of embryos fertilized using cryopreserved sperm retrieved from postejaculatory urine. Four embryos were thawed, then transferred in the blastocyst stage, resulting in a singleton pregnancy and delivery by cesarean section at term to a healthy baby boy weighing 3100 g. This case study shows that cryopreservation of sperm retrieved from postejaculatory urine is feasible for IVF, despite demonstration of low motility. This is more cost-effective and least invasive as the husband may avoid surgical aspiration or extraction of sperm.
Cryopreservation ; Infertility ; Fertilization in Vitro

Objective: This study aimed to evaluate the effect of oocyte incubation after retrieval in TFF among IVF-ICSI and identify factors affecting total fertilization failure (TFF).

Methods: This is a retrospective cohort study, involving 995 IVF cycles using the antagonist protocol that were clustered into three timings of oocyte denudation from retrieval : Group 1: <1 hour, Group 2: ?1 hour to <2hours and Group 3: ?2hours. Other variables considered were etiology of infertility, female age, days of stimulation and total number of oocytes retrieved.

Results: Overall TFF was 4.5%. TFF among groups were 4.8%, 5.8% and 3.2%, respectively. Multiple logistic regression analysis showed that oocyte incubation prior to denudation for ? 2 hours tend to decrease TFF incidence. Among factors studied, male factor infertility and a low number of oocytes adversely affect TFF.

Conclusion: Timing of incubation of oocyte did not significantly affect the occurrence of TFF. Among factors studied, male factor infertility and a low number of oocytes adversely affect TFF.

Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality worldwide, as seen in 9 to 13% and up to 30% of maternal deaths in developed and developing countries, respectively. Bilateral tubal pregnancy is an exceedingly rare condition with an even greater risk of rupture and hemorrhage than that of the unilateral type. This is a case of a 32 yearold G4P3 (4004) who presented with amenorrhea of 5 weeks, vaginal bleeding, and abdominal pain. The triad of symptoms, elevated serum β-HCG levels, along with a transvaginal ultrasound finding of a right adnexal mass led to the impression of a ruptured ectopic pregnancy, probably tubal. Patient underwent laparoscopy and intraoperative findings revealed bilateral tubal pregnancy for which bilateral salpingectomy was done. Oftentimes, as in this case, bilateral tubal pregnancy is diagnosed intraoperatively. However, it is possible, as seen in a review of cases, that a combination of history, symptoms, and clinical findings may point to a probable diagnosis which is imperative in treatment planning. Bilateral tubal pregnancy is rare, but due to a rise in pelvic inflammatory disease, its consequences, and the advent of assisted reproductive techniques, the risk for this condition increases with important clinical implications.
Pregnancy, Ectopic

Objective: This study aims to establish baseline information on the practice of minimally invasive gynecologic surgery (MIGS) among Filipino gynecologic endoscopists amid the COVID-19 pandemic. Materials and Methods: MATERIALS AND METHODS: An online survey was conducted among Fellows of the Philippine Society for Gynecologic Endoscopy (PSGE) practicing in private and government hospitals in the Philippines after informed consent. The survey had five subsections: (1) demographic data, (2) impact of COVID-19 pandemic on MIGS practice, (3) changes of practice during the COVID-19 pandemic, and (4) changes in the conduct of surgery and postoperative care. Results: A total of 119 out of 144 PSGE Fellows based in the Philippines participated in the survey, 83% were Fellows in both laparoscopy and hysteroscopy. The majority had more than 15 years of practice and were practicing in the National Capital Region. Surgeries were canceled initially but have since resumed. The majority were hysteroscopy cases, the most common being polypectomy. Majority of the respondents reduced their clinic hours and appointments. Most have used telemedicine for consultations. Use of face masks, face shields, and personal protective equipment (PPE) were the top precautions taken in the clinics. Screening and precautions per guidelines inside the operating room setting were observed. Modifications during surgery include the use of smoke evacuators, minimizing energy device use, and wearing enhanced PPE. Conclusion The volume of laparoscopy and hysteroscopy cases was greatly reduced during the pandemic. The pandemic has disrupted the practice of MIGS both in the outpatient clinics and the operating rooms. Most of the changes made are congruent to local and international automotive task force guidelines. Precautionary measures and screening procedures must remain in place to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to patients and health-care workers.
COVID-19 ; Personal Protective Equipment ; Telemedicine