The possible etiologies for primary amenorrhea are classified into four groups based on the presence or absence of the uterus and the development of the breasts. Based on this, gonadalc dysgenesis and mullerian agenesis in a patient with no Y chromosome are two separate causes of primary amenorrhea. These two conditons seen together is a very uncommon occurence. Presented here is such a case where the diagnosis Turner Syndrome and the Mayer-Rokitansky-Kuster-Hauser Syndrome coexist in apatient with a 45, X [6]/46, X, i(X) (q10)[9] karyotype.
TURNER SYNDROME ; ROKITANSKY KUSTER HAUSER SYNDROME ; AMENORRHEA ; ;

Wunderlich-Herlyn-Werner syndrome is an uncommon but already well-established mullerian anomaly consisting of uterine didelphys, hemivaginal septum and ipsilateral renal agenesis. The discussion here would concentrate on the occurrence of foul-smelling vaginal discharge in some of these cases, its pathogenesis and its impact on generally-accepted assumptions on the embryogenesis of the mullerian system. Reported here are three such cases with discussions on the goals of therapy being relief of the obstructive symptoms, restoration of normal menstrual egress and sexual function, with preservation of reproductive potential.
UTERINE DIDELPHYS ; VAGINAL SEPTUM ; MULLERIAN ANOMALY

A 22 year old nulligravid presented with progressively increasing dysmenorrhea. Transvaginal ultrasound showed a unicornuate uterus with a functioning left rudimentary horn which was confirmed on exploratory laparotomy. The patient was also found to have a missing right fallopian tube and ovary. Excision of the left rudimentary horn was done. The surgery resulted in the patient with a remaining hemiuterus on one side and a separate fallopian tube with the ovary on the other. A very limited number of case reports are available in the literature to describe concomitant occurrence of gonadal and uterine developmental abnormalities. Rarer still is the occurrence of a unilateral fallopian tube and ovary contralateral to a unicornuate uterus. Its possible pathogenesis and implications on the patient's reproductive outlook are discussed.
Human ; Female ; Young Adult ; ABNORMALITIES ; UTERUS

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 ; ;

Swyer syndrome is a medical condition that begins with a mutation in the SRY gene that favors the development of female reproductive organs despite the presence of Y chromosome. The aberrancy in testicular differentiation will lead to abnormal testosterone production and impaired Mullerian Inhibiting Substance secretion resulting in the formation of Mullerian derived structures and regression of Wolffian ducts. Since an XY karyotype is incompatible with follicle formation, the gonads will degenerate and become streak fibrous tissue. Patients are phenotypically female at birth with a uterus, fallopian tubes and bilateral steak gonads. Management involves puberty induction and bone loss prevention through combined hormonal replacement therapy. Bilateral gonadectomy should be performed soon after the diagnosis because of the risk of malignancy. Infertile, childbearing is only through assisted reproductive technology and oocyte donation.
Human ; Adult ; GONADAL DYSGENESIS, 46,XY ; AMENORRHEA

Objective: To validate the Filipino Translation of the Fertility Problem Inventory as a measure of infertility-related stress among female infertile patients. Design: Cross-sectional study Setting: Tertiary referral center Study Population: Female infertility patients aged 21-40 years, with at least one year of attempting to achieve pregnancy. Outcome Measures: Patients' infertility-related stress was assessed by written questionnaire using the Filipino translation of the Fertility Problem Inventory. Results: Global stress scores were identical across all ages and educational level attained. increasing number of years trying to conceive has no impact on the global stress scores. Conclusion: The Filipino translation of the Fertility Problem Inventory provides a valid measure of infertility-related stress.
Human ; Female ; Adult ; INFERTILITY ; INFERTILITY, FEMALE

A premenopausal woman witj multiple risk factors for endometrial cancer, diagnosed with giant endometrial polyp with benign features on preoperative biopsy is presented. On hysteroscopy, intraoperative frozen section revealed a benign polyp, but was malignant on final histopathology. Definitive surgery yielded simple hyperplasia and endometrial polyp. Giant endometrial polyp grows to 9-12cm diameter. Complications in hysterosocopic removal of giant polyps are higher risk of perforation, more blood loss, hyponatremia, pulmonary edema, and hyperglycemia. All associated with dificult visualization and prolonged surgery. Frozen section of endometrial mass may help in instituting appropriate treatment. Local studies show high accuracy, although some reports were conflicting. In case of malignancy, maintenace of intrauterine pressure distention to less than 70mm Hg prevents dissemination of cancer cells. The hyperestogenic state seen in obesity with uncontrolled hypertension, diabetes, nulliparity and vaginal bleeding were associated in developing endometrial cancer arising from endometrial polyp resected by hysteroscopy.
Human ; Female ; Middle Aged ; CARCINOMA, ENDOMETRIOID ; HYSTEROSCOPY ; ENDOMETRIAL NEOPLASMS

Some women may not be able to carry their own children even when capable of conceiving biological offspring. In-vitro fertilization and embryo-transfer (IVF-ET) through surrogacy can now make this possible for these women. Surrogacy however, is still considered unacceptable in the Philippines due to moral and legal issues. This article will explore the need and acceptability of surrogacy in this age of IVF-ET in a country where the prevailing social norms and religious values still disapprove of third-party assisted reproductive technology (ART). Medical indications that would benefit from gestational surrogacy were enumerated and briefly discussed. The differentiation between traditional and gestation surrogacy, as well as commercial and altruistic surrogacy were defined. IVF with gestational surrogacy is a feasible solution to a number of medical difficulties in the carrying of a gestation. Strictly regulating the practice and restricting its use only to cases with legitimate medical indications will prevent its misuse and exploitation. Moral issues, admittedly will still remain an issue particularly for commercial surrogacy. However, limiting these only to altruistic and gestational surrogacy in some cases may be an acceptable compromise.
Child ; Fertilization in Vitro ; Reproductive Techniques, Assisted

The true incidence and prevalence of congenital Mullerian duct anomalies are difficult to determine. Some patients may present as adolescents with apparent primary amenorrhea, cyclical abdominal pain and sexual difficulties. It is important to ascertain a correct diagnosis for timely and appropriate interventions necessary to prevent sequelae that often affect the future fertility of these patients. This is a case of a fifteen year old with severe cyclical pelvic pain and hematuria with amenorrhea. Work up included a transrectal ultrasound and a magnetic resonance imaging of the pelvis revealing presence of a uterine corpus and cervix but absence of uterine isthmus. A conservative surgical approach was planned. The patient underwent end-to-end anastomosis of the cervix and uterine corpus. At present, the patient is regularly menstruating with no pelvic pain.
Amenorrhea